The Veterinary Dental Patient - A Multidisciplinary Approach

In order for our profession to continue to improve in protecting and improving the oral and general health of our patients, I believe two things are required. First, clinicians in general practice need to ensure that they have adequate training and are suitably equipped with dental diagnostic tools, from periodontal probes to X‐ray machines. Second, and perhaps more importantly, the curriculum in our veterinary undergraduate programs needs to include practical training in dental and oral diagnostics.

My professional experiences are different from those of most specialists. Over 60% of the dental patients I see come from education, promotion, and prophylaxis. The remainder come through referral. My perspective is thus non‐academic; I deal with patients at all different levels every day. I hope I may be of help to those in developing countries as well as to graduates and professionals in the developed world.

Jerzy Gawor

The two things in life which give me the greatest pleasure are my family and my profession. Without the support and encouragement of the former, I would never have been able to achieve so much or have the motivation to go still further in the latter. Furthermore, the daily interaction I have with my clients and patients has given me tremendous job satisfaction and allowed me to become the man I am.

I owe my patients a debt of gratitude which surpasses that due to my professional discipline of veterinary dentistry. I always strive to be a better veterinarian and dentist by putting my patients’ welfare first, and to this day, difficult cases teach me humility and challenge my skills. Throughout my career, I have become increasingly aware of the need for the entire practice team to focus on the requirements of the dental patient.

Teaching is an important part of being a specialist, and writing this book as an educational tool has presented a unique set of challenges to myself and my associates. Special thanks go to Emilia Klim, my mentee who contributed to the selection and production of pictures; my friend Brook, who is always ready to share projects, challenges, and commitments; my wife Grażyna and our kids Jerzy, Antoni, and Mela; and my parents and brothers.

Finally, to all my veterinary dental patients of all species, small and large, old and young: my heartfelt thanks.

Jerzy Gawor

This book is accompanied by a companion website:

www.wiley.com/go/gawor/veterinary‐dental‐patient

The website includes:

Further content on ‘Assisted feeding in dental patients’

Scan this QR code to visit the companion website.

Jerzy Gawor

Veterinary Clinic Arka, Kraków, Poland

This chapter will cover the creation of a dental presence within a general practice. In addition, it will discuss how to create a business plan and how to design a consulting room and dental operatory. It will describe all the necessary equipment, instrumentation, and materials. Finally, it will cover the practical use of instruments.

There are many reasons why creating a dental presence within a general practice is a natural, necessary, and reasonable move in the development of a small‐animal veterinary business. Some are listed in this chapter, and they should provide more than enough motivation for the practice manager or owner to provide dental services. However, this book focuses on the dental patient, and the proposed solutions will thus emphasize the benefits to the patient, not the business. The author believes that it is very important to combine a focus on the patient with the commercial side of dentistry.

Studies have shown that most of our patients require immediate dental care. By the age of just two years, 80% of dogs and 70% of cats have some level of periodontal disease (Lund et al. 1999); more recent studies have reported the incidence at closer to 90% of all patients: (Fernandes et al. 2012; Stella et al. 2018). Some 10% of dogs presented to veterinary clinics have pulp exposure, while the prevalence of teeth resorption in cats is estimated at 28–62% (Reiter and Mendoza 2002). The oral cavity is the fourth most common place to find oral cancer. There are proven links between periodontal disease and pathologic findings in the liver, kidney, and myocardium (DeBowes 1998). Thus, with this obvious systemic impact of dental problems, we must not neglect dentistry in our general preventative care program for dogs and cats under our care.

Three major areas cover approximately 75% of dental procedures offered in small‐animal dentistry: diagnostics, prophylactic procedures, and extractions. These also make up a significant part of the day‐to‐day work of specialty clinics.

Having a dental presence within a general practice means having the ability and equipment to properly perform these three groups of procedures. Each area present challenging cases, and therefore it is necessary to have a good relationship with the relevant specialists. Currently, the internet provides a very fast and easy means of communication, in addition to professional portals offering specialty consultations based on submitted radiographs, videos, photographs, and other resources.

The vast majority of small‐animal patients require what is known by the general public as “dental” or “prophy.” The Veterinary Internet Network (VIN) refers to this instead as “comprehensive oral health assessment and treatment” (COHAT), which much better describes the essence of prophylactic procedure. According to American Veterinary Dental College (AVDC) nomenclature, the current preferred term is “professional dental cleaning”. This procedure will be detailed in Chapter 20.

It is possible to perform professional dental cleanings within a general practice with a dedicated and well‐equipped dental room along with a skilled veterinarian and personnel. Considering the number of dental cases which may or should be performed daily in our practices, a dental X‐ray, high‐speed dental unit, sonic or ultrasonic scaler, and polisher are at the top of the list of profitable equipment to obtain for a surgery, and the fastest to pay for themselves.

A clinic's investment plan and equipment selection should be the result of a thorough deliberation on what kind and range of dentistry it wants to offer. Most procedures belong to one of the three aforementioned groups, but the fundamental one is diagnostics. Without appropriate diagnostics, the number and degree of mistakes and the likelihood of malpractice become unacceptably large. Therefore, sufficient investment in diagnostic tools is very important. With improvement in skills and equipment, additional procedures can be performed; however, the majority of cases will still be part of the main three core ones.

The most critical diagnostic element of veterinary dentistry is radiography. One can obtain sufficiently good radiographs with conventional full‐body X‐Ray when exposing intraoral films or plates. For many indications in dental and maxillofacial conditions, such a device is likewise useful. For intraoral exposures, dental radiology is more convenient and appropriate. Ideally, practices should have both modalities: dental and conventional full‐body X‐ray machines. The next thing to consider in diagnostic radiography is the selection of a system that will both provide the radiation (generator) and create the image. Analog dental films, which require a darkroom and chemicals, are slowly leaving the market, and being replaced by digital systems. There are numerous products available, and it is not easy to decide between them based exclusively on manufacturer information and advertising.