The ORAL ATP™ Visit

The Oral Assessment, Treatment and Prevention (ORAL ATP™) visit involves much more than just cleaning the plaque and calculus from a patient's teeth. The following is a typical example of the process.

9:00 am — Patient Intake Exam
Ask important general health and specific oral health questions related to the procedure to be performed and inquire as to the willingness and ability of the pet owner to perform home dental care.

Conduct a general physical and a brief oral examination that will allow you to design a preliminary treatment plan. Consider taking digital photos at this time to capture areas of pathology to discuss further. NOTE: Only when the patient has been anesthetized can a complete oral examination be performed and a precise treatment plan be formulated.

Watch for the following age-related dental conditions and common abnormalities:

Birth to nine months — Persistent deciduous teeth, missing or extra (supernumerary) teeth, individual tooth malposition and jaw length abnormalities.
Nine months to two years — Permanent dentition anomalies and accumulation of plaque and calculus.

Periodontal disease often occurs during this period, especially in small-breed dogs and cats. The onset and severity of periodontal disease varies widely with breed, diet and home care. In small-breed dogs without home care, periodontal disease can start as early as nine months of age. In large-breed dogs, it usually starts at two to three years. Most small dogs experience signs of periodontal disease by age three. For this reason, attention to dental care needs to be started early in life.
Two to six years — Periodontal disease, oral trauma from chewing on inappropriate objects and adequacy of home dental care.
Six years + — Progression of periodontal disease and oral cancer.

9:30 am–10:30 am
Conduct and review preoperative blood and urine tests, electrocardiographs, blood pressure tests and chest and abdomen x-rays as needed.

Blood Sample

11:00 am–11:30 am
Administer pre-anesthetic medication, induction, intubation and anesthesia.

11:30 am–12:30 am
Perform teeth cleaning, polishing, intraoral radiographs and a tooth-by-tooth evaluation. Then create an appropriate treatment plan.

X-rays of the mouth should be a part of each ORAL ATP™ visit. In one published report, intraoral radiographs revealed important pathology in 27.8% of dogs and 41.7% of cats when no abnormal findings were noted on the initial examination. In patients with abnormal findings present, additional pathology was revealed with x-rays in 50% of dogs and 53.9% of cats.

Periodontal support loss first molar in a dog

Clean teeth using an ultrasonic scaler and a curette.
After teeth are clean, polish them using a low-speed handpiece with prophy paste loaded on a prophy cup.
Irrigate the teeth and gingiva to remove remaining debris. Then conduct a tooth-by-tooth examination and develop a treatment plan to address pathology found.
Diagnose abnormal periodontal pocket depths using a periodontal probe. Normal probing depths vary with the size of the patient and specific area being examined. The typical probing depth in a dog is 1–2 mm. In a cat it is 0.5–1.0 mm.

Periodontal probe before subgingival placement

Abnormal 7 mm periodontal pocket confirming periodontal disease
Apply fluoride next to dried teeth. Fluoride helps to control plaque and dentin pain.

Application of FluraFom^® (Virbac) on gauze

Application of fluoride on cheek teeth

Removal of excess fluoride foam with dry gauze
Apply a plaque barrier.

Teeth thoroughly dried

Barrier sealant applied with applicator gun

Sealant pressed under the gum line with gloved finger onto the teeth and into the sulcus and interdental spaces

Technician obtaining digital images of anesthetized patient for client report

Doctor reporting oral exam findings and gaining permission for therapy

12:30 pm — End of Procedure
Perform treatment for pathology found during the tooth-by-tooth examination, upon client approval.

Dental therapy

3:00 pm
Have a technician prepare an exit case report with images documenting before and after therapy appearances.

Clinical image of dog presented with halitosis

Radiograph showing attachment loss

Postoperative appearance

Postoperative radiograph of extraction sites

Once the procedure is complete, give intravenous fluids, control body temperature and monitor the patient until he/she can sit up voluntarily.

Recovery

5:00 pm — Exit Interview

Post-operative client communication — Discussing operative procedures and existing or potential complications (e.g., bleeding, coughing, vomiting, diarrhea and inappetence) at the time of discharge is fundamental to ongoing dental care. Be sure to explain immediate postoperative home care, including medications and their side effects.
Home oral care — Your patients' individually tailored home care plans should include the frequency, duration and method of rinsing and brushing, as well as information about applying plaque barrier gel and the use of special dental diets or digestible dental treats.
Follow-up evaluations — At a minimum, a patient with a healthy mouth should be evaluated annually. Examinations every six months can help ensure optimal home care. Patients showing signs of gingivitis need a checkup at least every six months and those with moderate periodontitis at least every three months. Advanced periodontal disease requires monthly examinations until the disease is controlled.

Teeth wiped dry with gauze

Applicator used to remove OraVet Plaque Prevention Gel (Merial) from the container

Application of OraVet Plaque Prevention Gel