The Veterinary Dental Patient - A Multidisciplinary Approach

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Zlatko Pavlica1, Jerzy Gawor2, and Lisa Mestrinho3

1 University of Ljubljana, Ljubljana, Slovenia

2 Veterinary Clinic Arka, Kraków, Poland

3 Faculty of Veterinary Medicine, University of Lisbon, Portugal

This chapter was written for several reasons. First, to highlight the importance of education to the proper development of veterinary dentistry. Second, to present the current situation, which is plagued by a lack of systemic solutions, leading to low competence among veterinary graduates in the field of dentistry. And third, to discuss the requirement to provide efficient veterinary dental education.

Dentistry is part of the clinical sciences: a vast field of veterinary science based on practical learning and training.

In clinical disciplines, students should acquire skills based on the model of Miller’s pyramid of clinical competence (Miller 1990), from the knows , to the knows how , to the shows how , to the does . At the base of this pyramid is fact gathering, progressing to an upper level of interpretation and application, followed by demonstration of learning, and finally performance integrated into practice ( Figure 3.1).

There are several aspects and fields of veterinary dental education in which Miller’s principles are applied. Teaching at university or college (addressed to future veterinarians or nurses) is key to achieving graduate competence. Continuous professional development (CPD) helps in the development and extension of skills. Finally, public education improves awareness of the importance of oral health among pet owners.

Several current documents list the minimum requirements for veterinary education among establishments of higher education (Directive 78/1027) and regulate professional qualification (Directive 2005/36), but without defining or describing veterinary specialization as they would for human doctors. At all European universities, veterinarians must qualify after a five‐ or six‐year curriculum, comprising a bachelor degree (three years) plus a master's degree (two years), as set out in the Bologna Process (2005).

The first Global Conference in Paris (2009) identified the need to define minimum competences that newly graduated veterinarians must have in order to provide veterinary services. The recommendations on veterinary day‐one competencies were first produced by the World Organization of Animal Health (OIE 2012). Although such recommendations do not have a legal power, nowadays, with the work of the European Association of Establishments of Veterinary Education (EAEVE), through the certification of European universities, they have improved the institutional education throughout Europe.

The Joint European Veterinary Dental Society (EVDS)/ European Veterinary Dental College (EVDC) Statement on Clinical Competencies in Small Companion Animal Dentistry and Oral Surgery states the following:

Veterinarians must possess scientific knowledge and be able to demonstrate practical skills in order to perform basic diagnostic and treatment procedures in veterinary dentistry and oral surgery, independently, at the time of graduation. At a minimum, veterinary graduates must be competent in providing entry‐level dental and oral health care for small companion animals. The veterinary university/school/college must provide training for students to meet day‐1 and for veterinarians to meet year‐1 and year‐3 competencies in small companion animal dentistry and oral surgery. Academic institutions that provide evidence for offering appropriate learning and continuing education opportunities in that regard may – upon thorough review of these opportunities – be awarded an endorsement by EVDS/EVDC.

(EVDS and EVDC 2014)

Figure 3.1 Framework for clinical assessment.

Source: Based on Miller (1990).

Day‐one skills include the following veterinary dental procedures ( www.evds.org):

Obtain a history for a dentistry and oral surgery patient

Perform an oral examination in a conscious and anesthetized patient

Distinguish between normal and abnormal oral and maxillofacial anatomy

Utilize nomenclature accepted in dentistry and oral surgery

Use the modified Triadan system for numbering teeth

Identify and name normal anatomical structures on a dental radiograph

Interpret and fill out an oral examination assessment form

Demonstrate the use of a dental explorer, periodontal probe, and dental mirror

Perform a professional dental cleaning with scaling and polishing

Explain and demonstrate home oral care/hygiene measures

Recognize and relieve pain in dentistry and oral surgery patients

Understand the rational use of antibiotics in dentistry and oral surgery

Know when and how to refer a dentistry and oral surgery patient to a specialistIt is remarkable that there are no surgical skills on this list, despite extraction being a very frequent surgical oral procedure. These skills are intentionally included in year‐1 and year‐3 competencies for the veterinarian as a part of their CPD.

Since oral health must be incorporated into primary care, dentistry should be an obligatory subject (as opposed to an elective) for all small‐animal‐oriented students. However, there seems to be a disconnection between the required classes in the standard veterinary curriculum and the skills required in everyday practice.