Читать книгу The Veterinary Dental Patient: A Multidisciplinary Approach - Группа авторов - Страница 85

Note that the ideal technique may only be possible in the most tractable patients. Clients should be encouraged to work toward this level of care, but to accept any degree of brushing as successful (Figure 5.6). Forcing home care on a patient is counterproductive and may decrease the client–animal bond (Holmstrom et al. 1998). Furthermore, coercing clients may drive them away from your practice (Holmstrom et al. 1998). Therefore, it is important to understand your clients and patients and tailor your recommendation based on the situation.

The keys to achieving success with home tooth brushing are as follows (Niemiec 2013):

 Start Early: Young patients are more amenable to training (Holmstrom et al. 1998).

 Go Slow: Start with just holding the mouth, then progress to a finger, and finally start brushing slowly.

 Be Consistent: Make tooth brushing a routine.

 Make it a Positive Experience: Using food, treats, hair brushing, or playtime as a reward will greatly increase the likelihood of acceptance.

Figure 5.5 Selection of toothpastes.

Figure 5.6 Teaching tooth brushing should be gradual and gentle.

Source: Emilia Klim.

However, it is important to ensure that the patient's temperament is amenable for this process. Advise your clients that getting bitten is not worth it (Holmstrom et al. 1998).

The ideal tooth brushing technique begins with the brush at a 45° angle to the long axis of the tooth. The brush should be placed at the gingival margin and moved along the arches utilizing a rotary motion. The buccal/labial surfaces of the teeth are the most accessible, and fortunately are the most important, as they generally have more calculus accumulation and gingival inflammation (Niemiec 2013). Pet owners should not attempt to open their pet's mouth, especially early on (Figure 5.7). Most animals greatly dislike their mouth being opened, and it will likely decrease the chances of their accepting the procedure. Clients should be instructed to begin by working toward effectively brushing the buccal surfaces of the teeth with the mouth closed. The distal teeth may be cleaned by gently inserting the brush inside the cheek, relying on tactile feel to achieve proper positioning.

If the patient is amenable, the client may progress to caring for the palatal/lingual surfaces of the teeth. This is critical if periodontal therapy/surgery has been performed on them, which is most common in cases of deep pockets on the palatal surfaces of the maxillary canine teeth. The best and safest way to open the mouth is to place the thumb of the nondominant hand just behind the mandibular canines. This allows for some leverage, and is also the safest place in the mouth for the finger to rest.

Frequency of brushing is a controversial subject. Once a day is the gold standard, as this level of care is required to stay ahead of plaque formation (Wiggs and Lobprise 1997; Niemiec 2008; Harvey et al. 2015). Furthermore, every‐other‐day brushing has been shown to be ineffective at gingivitis control (Gorrel and Rawlings 1996; Harvey et al. 2015). Three days a week is considered the minimum frequency for patients in good oral health (Tromp et al. 1986a,b). Brushing once a week is not considered sufficient to maintain good oral health (Niemiec 2013; Harvey et al. 2015). For patients with established periodontal disease (even gingivitis), daily brushing is required to maintain oral health, and twice daily may be recommended (Corba et al. 1986a,b; Tromp et al. 1986a,b; Gorrel and Rawlings 1996; Wiggs and Lobprise 1997; Niemiec 2008; Harvey et al. 2015). Finally, consistency with home care is critical. If brushing is suspended for as little as 30 days, gingival inflammation will return to the same level as in patients who have never had home care (Ingham and Gorrel 2001).

Figure 5.7 Avoid wide opening of the mouth when teaching tooth brushing.