The role of a good assistant in veterinary dentistry is incalculable. The hygienist/nurse is responsible for many pre, intra and post operative aspects of dental procedure, playing an important role in the treatment and influencing the quality of the service. One has to remember that all responsibility for the clinical result of the treatment belongs to the operator, therefore all surgical procedures such as: extractions, surgical flaps, suturing in the oral cavity as well as nerve blocks must be performed by a skilled veterinarian. A modern, efficient dental service which would satisfy all participants of the dental procedure--patient, owner and veterinarian--requires skilled assistants. There are numerous options, however the best option is if one or two nurses are specifically trained and dedicated to dental matters, however every nurse in the clinic should have the ability to fill in if necessary.
Below are examples of tasks that can be dedicated to a dental assistant during the pre-, intra- and post-operative parts of service.
Pre-operative
1. Blood work, pre-op radiography (chest, abdomen, if required), pharmaceutical support
2. Preparation of patient and anesthetic drugs; anesthetic monitoring
3. Dental armamentarium arranged according to specific procedure:
a. Always: dental chart, examination kit (mirror, probe, explorer, forceps, swabs)
b. Often: nerve block syringe with appropriate needle
c. Prophylaxis set
d. Extraction kit: dogs, cats
e. Periodontal surgery kit
f. Specific conditions: endodontic materials, impression and stone-model, oncologic surgery kits
4. Intravenous fluid set adequate to patient individual requirements
5. Preoxygenation
Intra-operative
1. Rinsing mouth with 0.12% chlorhexidine
2. Permanent focus on anesthetized patient: temperature maintenance, PCO2, blood pressure, anesthetic records
3. Good light and visualization of operating field
4. Assist in charting (abbreviations and handwriting)
5. Instruments and material on request
6. Radiography: exposure and development of dental films (chairside darkroom, self developing films or developing in darkroom)
7. Dental prophylaxis: supra and subgingival scaling, polishing, sulcal lavage, final oral rinse.
Postoperative
1. Clearing mouth, extubation, monitoring
2. Instruments to be counted, checked, cleaned, sharpened and sterilized
3. Preparing the dog for discharge: medicants, client instructions
4. Toothbrushing presentation in model and in patient in close follow-up
5. Assist in discharge--all those important details that reduce stress and provide comfort for the owner and patient.
Other
1. Checklist of materials and instruments--their quality, condition and amount, resupply if necessary
2. Instrument sterilization: organizing and control
3. Emergency support
4. Dietary advice and recommendation, home-care establishment and control
5. Oral health promotion: education how to properly brush the teeth with the use of models and in patient's mouth. Rechecks to ensure that the client is complying with the home care instructions.
6. Clinical records and storage--radiographs mounting and description
References
1. Bellows J. Small Animal Dental Equipment, Materials and Techniques: A Primer, Blackwell 2004
2. Bellows J. The Practice of Veterinary Dentistry: A Team Effort, Blackwell 1999
3. Gorrel C. Derbyshire S. Veterinary Dentistry for the Nurse and Technician WB Saunders 2005
4. Holmstrom S. Veterinary Dentistry for the Technician and Office Staff WB Saunders 1999
5. Kesel ML. Veterinary Dentistry: Small Animal Technician Wiley-Blackwell 2000