The Veterinary Dental Patient - A Multidisciplinary Approach

This is where the examination is performed in the conscious patient, which is a very important part of the dental consultation. In clinics that respect the International Society of Feline Medicine (ISFM) recommendations and standards, it is necessary to have separate rooms for cats where dogs are not allowed to enter ( Figure 1.2). This really makes a huge difference in examination comfort, particularly in sensitive cats with a fragile mentality. A list of cat‐friendly clinics is available online.

The dental consulting room does not have to be large, but the ability to examine the patient in good light is required. For the presentation of radiographs, it is convenient to reduce daylight by closing window blinds.

Space should be available in which to watch the patient's behavior. The examination table should have access to daylight or to a diagnostic lamp that provides near‐natural light. Plaque‐disclosing solution, a toothbrush, and examples of hygienic solutions are very helpful for establishing oral hygiene strategies. Instrumentation should be available to demonstrate additional diagnostic modalities. However, very few patients allow for conscious examination with a periodontal probe or mirror. Having dental models or educational posters and presentations available will be of excellent benefit when explaining what treatments will be performed to the pet owner ( Figure 1.3).

It is confusing when the veterinarian must leave the room repeatedly to fetch equipment, so it is wise to store all of the equipment in one place. It is also important to keep the equipment and models clean and sterile (e.g. for toothbrushes or probes).

Figure 1.1 Waiting room TV screen with informational dental presentation.

Figure 1.2 Feline cabinet, following the standards of a cat‐friendly clinic.

Figure 1.3 Dental models and instruments as well as a small whiteboard can be helpful in explaining dental problems to owners.

Even novices should be able to describe the outline of a problem in an understandable way (e.g. brief pathogenesis, diagnostics and the goal of treatment). Education of the pet owner is very helpful when done in an inoffensive way and adapted to the individual. White boards and a set of colors markers will improve the explanation ( Figure 1.4). Posters presenting occlusal problems, the importance of radiography, and the most commonly diagnosed problems are available ( Figure 1.5). So too are iPad applications containing easy‐to‐follow and customer‐friendly movies on the most common dental problems ( Figure 1.6).

Good‐quality flat‐screen computer monitors are important for the presentation of radiographs and other illustrations during discussion with the client, especially for those who prefer visual communication. Others may prefer logic and quiet verbal communication. Additionally to make important notes withdrawn from the clinical interview a paper and a pen is needed.

As a safety consideration, animals' teeth are a part of their defensive apparatus. A patient may bite as a result of aggression, fear, stress, or frustration, and in most of the cases we cannot blame them for doing so. Before an oral examination in a conscious animal, it is reasonable to ask the owner about its attitude toward strangers. There is a device available that protects the fingers, but in the author's experience it is better to stop an examination rather than force it until the patient begins to fight ( Figure 1.7). Depending on local regulations, the veterinarian may be responsible for any injuries that happen to the pet owner within the consulting room, including being bitten by their own pet. Therefore, anesthesia should be performed in any circumstances where the owner cannot assure assistance or where such assistance may create a hazardous situation.

Figure 1.4 White board drawings explaining a crown height‐reduction procedure.

Finally, here is a list of useful equipment to install in the consulting room:

1 Dental models of a dog and a cat

2 Educational posters

3 Diagnostic flashlight

4 High‐quality screen or tablet

5 Paper and pen

6 Whiteboard and markers (or tablet)

The first step in organizing a dental presence at a practice might be to install a dental corner/table in the preparation room. However, it is much better to have a separate dental operatory ( Figure 1.8). During dental procedures, significant contamination will be produced, including of an infectious aerosol. This is a specific situation in dentistry and thus it is important to separate the dental department from the rest of the surgical operatory. At the same time, all procedures will be performed under general anesthesia, so it is mandatory to provide the infrastructure for safe anesthesia ( Figure 1.9).

Water plays a very important role in dental procedures, not only as a coolant, but also as a cleaning and flushing (lavage) medium. A source of demineralized water is necessary for the dental unit when using air‐driven handpieces, as the minerals in water can cause damage to them. Demineralized water provided by three‐way syringe or mechanical scalers can be supplied via containers attached to these devices. The water used for postoperative washing of the patient may be tap water, and it is convenient to have separate preparation and postoperative care tables with hot and cool water, a shower, and a bath ( Figure 1.10a). Water used during dental procedures causes rapid loss of body temperature of the anesthetized patient, so the dental room must be equipped with all devices necessary for body temperature maintenance.

Central distribution of compressed air or nitrogen and of oxygen, as well as a central vacuum cleaner with convenient distribution of ports, will improve comfort and reduce noise and dirt ( Figure 1.10b).

The small operating field must be well illuminated, using a light source as close as possible to natural.

Dental X‐ray is necessary for almost every dental procedure, so the X‐ray equipment must be close to the operating table and preferably wall‐mounted. Dental X‐ray generators do not require frequent changes of patient recumbency or position. Having a computer with radiography software in the operatory provides an easy way to evaluate digital scans immediately after exposure. Handheld devices may be very practical for a limited number of exposures or when the dentist must operate in a variety of places or in exotic locations without electricity supply, but this solution may be a safety concern in some countries ( Figure 1.11).