Dentistry in Private Practice--When to Call the Specialist
World Small Animal Veterinary Association World Congress Proceedings, 2008
Jerzy Gawor, DVM
Veterinary Clinic ARKA,
Kraków, Poland

General Services

Every general practitioner is expected to provide the following dental services:

 Oral examination on regular basis (part of clinical examination) during all office calls including vaccination

 Oral check-ups (e.g., Pet Smile Campaign)

 First aid in oral emergencies

 Preoperative blood profiles prior to all planned and emergency dental procedures which require sedation and/or anesthesia

 Regular dental prophylaxis including: thorough examination in conscious and sedated patients, dental charting, supra- and subgingival scaling, polishing, gingival sulcus lavage

 Oral radiography at basic level but with quality allowing for further consultation

 Simple extraction of periodontally compromised teeth

 Prophylactic dental care promotion and establishment of a home care program that includes: teeth brushing, dietary support, dental chews and toys and schedule of rechecks and follow-up

 Making impressions and stone-models to refer orthodontic cases (for more advanced veterinarians)

General Knowledge Requirements

 Identify normal oral structures

 Diagnose basic dental and oral/maxillofacial pathologies

 Occlusal evaluation

 Perform TNM (tumor, node, metastasis) evaluation of oral tumors

 Provide first aid

Some Recommendations for General Practitioner Who Wishes to Improve His/Her Dental Skills

 Never perform the method of treatment 'Wait and see what will happen'.

 Develop your skills, be up-to date with publications, books, take part in dental promotions, discussions and wetlabs.

 Training on cadavers will define your limitations. Ask an expert to evaluate your work to ensure proper performance. Follow gold standards of procedures even in cadaver work.

 The teeth are not bone and the oral tissues are not skin. Oral surgery has numerous differences compared to orthopaedic or soft tissue surgery.

 The following equipment is necessary to establish quality dental services: dental X-ray, dental unit with air-water syringe, high-speed air-driven hand piece, and a mechanical scaler/polisher unit. In addition, a full range of instrumentation and materials is required to start the process of becoming a specialist. In addition, further skills and experience, educational training, and hands-on wet labs are required.

 Human dentists without experience in veterinary field should not be regarded as a referral source.

More Advanced Dental Services Include

1.  Oral fracture repair

2.  Endodontic therapy

3.  Oral surgery (e.g., oncologic, fistula repair)

4.  Orthodontics

5.  Restorations

6.  Periodontal surgery

7.  Difficult extractions

a.  Surgical extractions

b.  Risk of oro-nasal fistulation

c.  Full mouth extractions

Specialist Cases

The following cases (as well as many others) require specialist input which will provide a wider spectrum of treatment options and a diminished risk of failure. All cases will be illustrated during the presentation.

Case# 1

Dog: complicated crown fracture (slab) of the mandibular first right molar (409) with pulp exposure. In addition, the fracture line extends below the gingival margin. Radiologic evaluation is mandatory. Therapeutic options include: endodontic therapy followed by restoration or extraction. Both are advanced procedures.

Case# 2

Cat: tooth resorptive lesions (TRs) of the mandibular left fourth premolar and first molar 308 309. At this stage, surgical extraction is the only option. The dental radiograph reveals the necessity of complete removal of the roots. A post-operative radiograph is indicated to ensure complete removal of the roots.

Case# 3

Dog: squamous cell carcinoma. T3b, N1a, M0; III stage of growth. Wide resection of the tumor (e.g., rostral mandibulectomy) is the treatment of choice. Tumor resection, maintenance of vital oral structures, proper closure and functionality of remaining jaw are necessary for a successful outcome.

Case# 4

Cat: class 1 malocclusion. Possible therapeutic options: orthodontic treatment, crown shortening followed by vital pulp therapy (or root canal therapy), extraction of affected tooth with odontoplasty of lower canine to protect upper lip. All of these options are best performed by a specialist.

Case# 5

Dog: unfavorable fracture with root tip in the fracture line. The treatment for affected molar tooth is required before stabilization of the fracture. Endodontic therapy with or without mesial root resection must be performed prior to fracture reduction and rigid fixation (e.g., an acrylic splint).

Case# 6

Dog: periodontal disease with pathologic pockets and gingival recession. The alveolar bone destruction may be arrested and controlled after numerous advanced procedures such as: subgingival debridement, periodontal flaps, open curettage, root planing, guided tissue regeneration, teeth splinting and last but not least: daily home care provided by the owner.

References

1.  Bellows J. Small Animal Dental Equipment, Materials and Techniques Blackwell, 2004

2.  Crossley DA, Penmam S. Manual of Small Animal Dentistry BSAVA 1995

3.  Harvey CE, Emily PP. Small Animal Dentistry. St. Louis: Mosby -Year Book, 1993.

4.  Holmstrom SE, Frost P, Eisner ER. Veterinary Dental Techniques for the Small Animal Practitioner,3rd ed. Philadelphia: WB Saunders, 2004.

5.  Mulligan TW, Aller MS, Williams CA. Atlas of Canine and Feline Dental Radiography, Trenton. Veterinary Learning Systems, 1998.

6.  Tutt C. Small Animal Dentistry A manual of techniques Blackwell Publishing 2006

7.  Wiggs RB, Lobprise HB. Veterinary Dentistry: Principles and Practice, Philadelphia: Lippincott-Raven, 1997.

Speaker Information
(click the speaker's name to view other papers and abstracts submitted by this speaker)

Jerzy Gawor, DVM
Veterinary Clinic ARKA
Kraków, Poland


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