HALE VETERINARY CLINIC Fraser Hale DVM, FAVD, DipAVDC

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1 HALE VETERINARY CLINIC Fraser Hale DVM, FAVD, DipAVDC BOARD-CERTIFIED VETERINARY DENTAL SPECIALIST DENTAL AND ORAL SURGERY FOR PETS SINCE 1991 PHONE TOLL-FREE 866-toothvet ( ) FAX WEB SITE ADDRESS 159 Fife Road, Guelph, ON N1H-7N8 OFFERING ROUTINE AND ADVANCED VETERINARY DENTAL SERVICES IN THE FOLLOWING AREAS ENDODONTICS ORAL MEDICINE ORAL SURGERY ORAL & DENTAL RADIOLOGY ORTHODONTICS PERIODONTICS PROSTHODONTICS RESTORATIONS February 6, 2014 Dear I had the pleasure of seeing statement and some images from the visit. today. I have attached her dental chart, discharge The primary problem was a very large and advanced caries lesion affecting tooth 109. More on this condition here - Most of the crown was gone, there was pulp exposure and necrosis and infection in the space around the root tips. There was also end-stage periodontal disease affecting tooth 110 behind. I elevated a flap, removed teeth , curetted inflamed soft tissue from the wound, smoothed the bone and sutured with 4-0 Monocryl. On the left side, most of tooth 209 was completely gone, presumably consumed by caries. There was a remnant of the mesial root in place and I removed this and sutured. There was a small caries lesion affecting the crown of tooth 210 which I drilled and filled. has some crowding issues with incomplete gingiva between teeth and , which poses an increased risk for periodontal disease in these locations, but fortunately, this has not developed as yet. has been in the habit of hand scaling teeth periodically. I have asked her to not do this but to brush teeth daily instead. She was also interested in using healthymouth water additive, so I sent some of that along with her as well. If you have any questions, please call. Thank you very much for your continued support. Sincerely, Fraser A. Hale, DVM, FAVD, Dip AVDC Ontario distributor of healthymouth(tm) Hale Veterinary Professional Corporation

2 HALE VETERINARY CLINIC DENTAL AND ORAL SURGERY FOR PETS PHONE TOLL FREE 866-toothvet ( ) FAX WEBSITE MAIL 159 Fife Road, Guelph, ON, N1H-7N8 Chief Complaint: Other Findings: Previous Treatment and History: Owner: Patient: Clinic: Weight: Age: Adapted from DentaLabels 1991 and Pacific Dental Service Mentorship Group 1994 Home Care: Condition: Diet: Reccesion (mm) Calculus Index (0-3) Gingivitis Index (0-3) Periodontal Index (0-4) Furcation (0-4) Mobility (0-3) Tooth Name Buccal Occlusal Palatal Buccal Occlusal Lingual Tooth Name Recession (mm) Calculus Index (0-3) Gingivitis Index (0-3) Periodontal Index (0-4) Furcation (0-4) Mobility (0-3) Right C A N I N E D E N T A L R E C O R D Left Date:

3 Patient: Diagnosis & Radiographic Evaluation: Missing teeth 105, 205, 308,408 confirmed radiographically -Very large/advanced caries lesion tooth 109 with pulp exposure and necrosis and apical periodontitis -End-stage periodontal disease of tooth 110 -most of tooth 209 missing but retained remnant of mesial root suspect this tooth also had caries and most the rest of it rotted and/or fell out -small caries in central occlusal pit of tooth 210 -small chip fracture tip of tooth 403 no clinical or radiographic evidence of endodontic disease at this time -anterior cross bite with upper incisors occluding on lingual aspect of lower incisors -crowding between teeth , increasing risk for development of periodontal disease in those spaces but tolerated well so far. -minor coronal plaque and calclulus and reversible gingivitis overall excellent periodontal health. Post-Operative Assessment: Extracted teeth , curetted inflamed tissue from wound, smoothed the bone, elevate a flap and sutured with absorbable material (4-0 Monocryl ) -Removed remnant of mesial root of 209 and sutured -drilled and filled caries on 210 (etch, MPa, Artiste, MPa) -scaled and polished all above and below the gum line Prognosis: Good. Analgesics: Preoperative local nerve blocks: Vivacaine [x] Post-op injection of Metacam (lasts 24 hours) dose: 1.1mg route: injection Dispensed oral Metacam. Amount: 3.0mL dose: Give 0.37mL dose orally once daily starting January 30 th for 4 days. Best given with food. Tramadol capsules 15mg. Give one capsule every 12 hours for 5 days. Can start as soon as you get home and then morning and evening thereafter. Hide in food/treats. May cause some sedation. Oral Antibacterials: Pre-op Rinse [ ] Post-op Rinse [x] Agent: CHX Feeding Instructions: Soft food only for 14 days. Can give a small meal (1/4 normal meal) as soon as you get home. If this goes down and stays down, another meal can be given and hour later. No hard toys, treats or biscuits for 14 days Rechecks: See Regular veterinarian in 14 days to assess healing. General Comments: This comment applies to all dogs and is a life-long instruction. Always avoid really hard toys such as natural and nylon bones, antlers, large raw hide bones, dried cow hooves and ice cubes as hard toys are a very common cause of tooth fracture. Rubber toys such as kongs and treats such as Greenies are much safer if used appropriately. Remember the Knee-cap Rule. Visit for a list of dental products with valid claims Keep your pet quiet for a few [4] days to avoid an increase in heart rate & blood pressure that would lead to increased swelling & pain at the oral surgery site. Leash exercise at a walking pace is fine. DO NOT handle mouth at all for 14 days, any attempt to do so could cause pain and disrupt healing. Start the homecare program as outlined on a separate sheet AFTER your animal has had the twoweek recheck appointment and the mouth has been deemed healthy. Starting to brush too soon after surgery can cause trauma and pain. Following oral surgery, there may be some bloody oral discharge for 24 hours or so. Being anesthetized is tiring, so will likely be very quiet for the rest of the day and overnight. DISCHARGE STATEMENT Date: 6 February 2014 Hale Veterinary Clinic 159 Fife Road Dental and Oral Surgery for Pets Guelph, Ontario, N1H-7N8

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