From the Exam Room to the Dental Table Denise S. Rollings, CVT, VTS (Dentistry) Veterinary dentistry isn’t just about cleaning teeth or getting rid of bad breath. A dental procedure is an anesthetized procedure that requires trained and educated veterinarians and veterinary technicians. Dentistry should be treated like every other anesthetized procedure that takes place in the veterinary hospital. Only veterinarians can diagnose disease, but the veterinary technician plays a major role in assisting the veterinarian. The veterinary technician assists by obtaining an accurate history, recognizing pathology and bringing it to the veterinarian’s attention. The veterinary technician can be trained to perform a proper and thorough dental cleaning and to obtain diagnostic dental radiographs. Periodontal disease is the top disease diagnosed in dogs and cats, where 80% of all dogs and cats over the age of 3 have some stage of periodontal disease. Every patient should be receiving routine dental care. The following procedures outline the steps of the dental procedure day.
The Pre-anesthetic Exam
Oral History and Oral Exam: Look for and ask the owner about things, including bad breath; swollen, red or bleeding gums; excessive drooling; and changes in eating or chewing habits including dropping food, going to the food but not eating, vocalizing while eating, teeth loss and the disinterest in toys. Often, pets show no signs of pain. Find out what the pet chews on and how the family takes care of the pet’s dental needs at home. A patient may avoid a toy or a particular food due to pain, and the owner may perceive it as the pet not liking that item anymore.
The Day of the Procedure Perform another physical exam upon admission including a temperature, pulse rate and respiration rate check (TPR) and hydration status check. Make sure you get all phone numbers and emergency contacts. Tell the owners they must be able to be reached and have someone else as back up to make decisions on their behalf. Know the owners’ wishes and have it in writing, in case of an emergency. The technician should review the treatment plan, estimate and review consent forms, again, with the client. The treatment plan should be as accurate as possible, and the technician should go through it with the client line by line. One can use pictures, models, skulls, videos and charts to explain the procedure, pathology and importance of the treatment. There should be a low and high range on the estimate in case of a worst-case scenario. This will help prevent stress to the client and staff over unexpected expenses. Take a deposit for the low end of the estimate in the morning and take care of the difference at discharge.
Blood Work: A lot of our patients are geriatric, and we need to make sure there isn’t underlying disease. Age is not a disease. Age can predispose our patients to having coexisting disease. Ideally, lab work should be done before the day of the procedure in case there are abnormalities found. Having the lab work completed ahead of time will prevent a procedure from being cancelled the day of due to abnormalities. It will also allow the patient to be treated for the abnormalities ahead of time and allows that patient’s protocol to be tailored to his or her needs. A chemistry panel, complete blood count, +/- coagulation panel, urinalysis, chest radiographs, echocardiogram, ECG and blood pressure should be considered for evaluation. Client Communication: It takes a person three times to hear something before it sinks in. The doctor discusses it, the technician goes over it with paperwork, and the client service representative mentions it again and offers to schedule the appointment. Hand out a dental report card, pamphlet and/or treatment plan. Greenies™ and Virbac have premade report cards so you don’t have to make your own. If you aren't ready to take on making your own, use what’s available. Don’t reinvent the wheel. 10 | FVMA ADVOCATE
An anesthetist and technician performing four-handed dentistry. Photo courtesy of Denise S. Rollings
