Page 2187 - Cote clinical veterinary advisor dogs and cats 4th

Dermatologic Diagnostic Procedures 1091

clavulanic acid–amoxicillin 13.5 mg/kg, PO side and the lingual/palatal side of the teeth Postprocedure
12 hours before the procedure. on the recumbent side. Then the animal • Discuss home oral care with owners, and
VetBooks.ir pieces of calculus that could otherwise enter repeated (avoids turning the animal multiple • Provide the owner with information about
is turned over, and the procedure can be
find appropriate regimen.
• Place cotton gauze in the oropharynx to catch
the postoperative treatment plan, including
the trachea after extubation.
times).
Possible Complications and • Remove very heavy calculus deposits with a the date of the next dental appointment.
dental scaler, hoe, or calculus forceps.
Common Errors to Avoid • Remove gross and moderate supragingival Alternatives and Their
• Forgetting to remove the cotton gauze in calculus using hand instrumentation (dental Relative Merits
the oropharynx before extubation curette, scaler) or power instrumentation • The wrong alternative to preventing peri-
• Causing thermal damage to the dental pulp (sonic or ultrasonic with a heavier tip at odontal disease with dental prophylactic
by staying too long over a tooth during power moderate- to high-intensity setting). treatment and home dental care is to wait
scaling or polishing or inadequate water spray • The working surface of the power scaler until periodontal disease has progressed and
during power scaling should be held parallel, not perpendicular, periodontal treatment is necessary to help
• Damaging the tooth surface by being heavy to the tooth surface. control disease progression. This is obviously
handed during scaling and polishing or by • Remove light supragingival and subgingival not an option that benefits the animal or Procedures and Techniques
using burs (Rotosonics) to remove calculus calculus with hand instrumentation (dental owner.
• Dental cusp (tip) fracture caused when using curette) or power instrumentation (sonic or • Brushing the teeth will not remove existing
extraction forceps to chip away the calculus ultrasonic with slim perio or universal tip at calculus.
(not recommended) low- to moderate-intensity setting). • Dental prophylactic treatment performed
• Power instrumentation: use the lowest • Check for residual dental calculus using a without general anesthesia provides some
effective intensity (power) setting; use a light disclosing solution, air spray from an air/ cosmetic improvement but no long-term
touch; work with the last 3 mm at the end of water syringe, or a dental curette. benefit.
the tip; keep the tip moving, with adequate • The teeth are polished with prophy paste or
water spray. Use the side of the tip. Use a flour pumice. RELATED CLIENT EDUCATION
gauge to check tip wear, and replace when • Dental examination with dental explorer; SHEETS
2 mm has been lost (50% loss of efficacy). periodontal examination with periodontal
probe. Chart all findings. Consent to Perform Dental Cleaning
Procedure • Flush the gingival sulcus with an atraumatic Consent to Perform General Anesthesia
• The anesthetized, intubated animal is placed needle and saline to remove the prophy
in lateral recumbency. All stages of the pro- paste or flour pumice, calculus debris, and AUTHOR: Yvan Dumais, DVM, DAVDC, FAVD
cedure described here are performed on the bacteria. EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
labial side of the teeth on the nonrecumbent • Perform final rinse with 0.12% chlorhexidine. Thompson, DVM, DABVP

Dermatologic Diagnostic Procedures

Difficulty level: ♦ • Dermatophyte culture: indicated when • One or two dull #10 or #21 scalpel blades
dermatophytosis is suspected and in virtually • Glass microscope slides and coverslips (22
Overview and Goal any cat with undiagnosed skin disease × 40 or 22 × 50 mm)
• Tests that are performed to confirm a • Trichoscopy (trichography, trichogram) is • Mineral oil
diagnosis and/or to rule out differential the microscopic examination of forcefully • Cotton-tipped applicators
diagnoses for skin lesions plucked hairs. Most useful for finding ecto- • Acetate tape (clear adhesive tape)
• The most common diagnostic procedures in parasites (particularly louse or Cheyletiella ova • Microscope
dermatology are examination of the haircoat and Demodex), identifying hair shaft fracture • Hemostat
and skin with good lighting and magnification, (e.g., pruritic cats), and finding large melanin • Handheld magnifying lens
flea combing, acetate tape preparation, skin clumps suggesting color dilution alopecia and • Flea combs
scrapings, trichoscopy, skin cytologic examina- black hair follicular dysplasia. It is generally • Otoscope and several otoscopic cones
tion, Wood’s lamp examination, fungal culture not useful for hair cycle arrest in dogs (except • Cytologic examination stain (e.g., Diff-Quick)
for dermatophytes, and skin biopsies. poodles, where most hairs are normally in • Microbiological specimen collection and
anagen) because normal anagen/telogen transport systems (e.g., culture swabs)
Indications ratios have not been established for most • Wood’s lamp
• Skin scrapings: used primarily to find mites breeds. • Dermatophyte test media
and occasionally nematode infestation • Skin biopsies: to confirm a diagnosis or • Sterile toothbrushes
• Skin cytologic examination: extremely provide direction (without always receiving a • Syringes
useful diagnostic procedure indicated in definitive diagnosis). Recommended for any • A few 22-, 23-, and 25-gauge needles
almost every dermatology case. It can neoplastic or suspected neoplastic lesion, any • Biopsy kit, including 4- and 6-mm biopsy
rapidly and inexpensively detect the pres- persistent or unusual lesion, any vesicular punches
ence of inflammation, infection (bacteria, dermatosis, and any undiagnosed alopecia. • Local anesthetic (e.g., lidocaine 2%)
fungi), autoimmune disease (acantholytic • Biopsy jars containing 10% neutral buffered
keratinocytes in pemphigus), or neoplasia. Equipment, Anesthesia formalin
• Wood’s lamp examination: useful screening Simple equipment is required to perform vet-
tool for dermatophytosis caused by Micros- erinary dermatologic tests. Standard equipment Anticipated Time
porum canis and materials: The procedures take a few minutes.

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