The Veterinary Dental Patient: A Multidisciplinary Approach E-Book
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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Provides an interdisciplinary approach to the veterinary dental patient and offers guidance on all aspects of integrating dentistry into veterinary general practice
The Veterinary Dental Patient: A Multidisciplinary Approach helps veterinarians understand the dental aspects of every canine and feline patient and shows them how to effectively manage their oral health. It also provides guidance to the rest of the veterinary team so they can offer a coordinated approach when recommending and performing veterinary dentistry as a regular part of general practice.
Edited by two prominent veterinary dentists who are Board Certified in both Europe and the United States, the text includes the latest information on safe anesthetic and monitoring protocols, accurate diagnosis and management, and referring patients to specialists. Chapters cover: establishing a dental presence in general veterinary practice; nutrition, oral health, and feeding dental patients; local, regional, and systemic complications of dental diseases; pain management; ophthalmic considerations; common situations for malpractice and mistakes; oral and maxillofacial surgery; extraction techniques and equipment; drug dosages and more. The book also offers several helpful appendixes.
The Veterinary Dental Patient: A Multidisciplinary Approach is an essential book for all vets in general small animal practice as well as the wider veterinary team, including managers, veterinary nurses and technicians, and administrative staff.
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Seitenzahl: 965
Veröffentlichungsjahr: 2021
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Table of Contents
Cover
Title Page
Copyright Page
List of Contributors
Preface
Acknowledgments
About the Companion Website
Part I: General Considerations
1 Establishing a Dental Presence within a General Veterinary Practice
1.1 Introduction
1.2 General Considerations: How to Begin Offering Dentistry
1.3 Education
1.4 Promotion
1.5 Equipment Considerations
1.6 Dental Operatory
1.7 Ergonomy, Organization, and Functionality
1.8 How to Choose the Proper Equipment
1.9 Power Dental Equipment
1.10 Dental Instrumentation
References and Further Reading
2 Marketing and Communication in Veterinary Dentistry
2.1 Introduction
2.2 Compliance
2.3 To Sell Is Human
2.4 Making Persuasive Recommendations
2.5 Communication Skills
2.6 Marketing Dental Services
2.7 Conclusion
References
3 Teaching Veterinary Dentistry
3.1 Introduction
3.2 Veterinary Dentistry in Europe's University Curricula
3.3 How Is Veterinary Dentistry Taught in Universities? What Is Missing?
3.4 Veterinary Dental Education Today
3.5 Examples of Teaching
3.6 Student Chapters
3.7 Postgraduate Education and Specialization
3.8 Veterinary Dental Specialists
3.9 Veterinary Dental Education in the Future
References
4 Distribution of Tasks Around the Dental Patient in General Practice
4.1 Introduction
4.2 Receptionists
4.3 Kennel Assistants
4.4 Veterinary Care Assistants
4.5 Credentialed Veterinary Technicians/Nurses
4.6 Veterinarians
4.7 Pet Owners
4.8 Conclusion
References
5 Prophylactic Program for Oral Health
5.1 Introduction
5.2 Regular Dental Examinations (and cleanings)
5.3 Established Regular Oral Home Care
5.4 Conclusion
References
6 Nutrition, Oral Health, and Feeding Dental Patients
6.1 Introduction
6.2 Modifications of the Oral Cavity Microbiome
6.3 Current Nutritional Strategies for Oral Microflora Modification
6.4 Elimination of Dental Plaque by Nutritional Products
6.5 Inhibition of Calculus Formation
6.6 Veterinary Oral Heath Council Seal of Acceptance
6.7 Role of Chewing in Passive Hygiene
6.8 Conclusion
References
7 Antimicrobials in Veterinary Dentistry
7.1 Introduction
7.2 Oral Microbiota of Dogs and Cats
7.3 Antimicrobial Use in Human Dentistry
7.4 Antimicrobials in Veterinary Dentistry
7.5 Prophylaxis for Patients with Orthopedic Implants
7.6 Periodontal Disease Control
7.7 Plaque Control
7.8 Infection Control
References
8 Dental Patient Welfare
8.1 Introduction
8.2 What Is Animal Welfare?
8.3 Modern Animal Welfare Needs Assessment
8.4 Five Freedoms and Five Animal Welfare Needs
8.5 Measuring Quality of Life
8.6 Prevalence of Dental Disease
8.7 Dental Disease Associations with Compromised Animal Welfare Needs
8.8 Physiological Signs of Stress
8.9 Behavior Changes
8.10 Client Education Matters
8.11 Welfare Issues Surrounding the Veterinary Visit, Handling Techniques, and Procedural Design
8.12 Welfare Implications ofAnesthesia‐Free Dentistry
8.13 Economic Consequences of Improved Welfare Outcomes
8.14 Conclusion
References
Part II: The Dental Patient
9 Local, Regional, and Systemic Complications of Dental Diseases
9.1 Introduction
9.2 Oral Health Impacts General Health
9.3 Oronasal Communication/Fistulas
9.4 Periapical Lesions
9.5 Pathologic Fracture
9.6 Ocular Damage
9.7 Oral Cancer
9.8 Osteomyelitis
9.9 Systemic Complications of Oral Diseases
9.10 Conclusion
References
10 Hereditary Oral Disorders in Purebred Dogs and Cats
References
11 Pain Management in the Dental Patient
11.1 Introduction
11.2 Impact of Oral Disease and Pain on Nutrition/Food Intake and Quality of Life
11.3 Present and Future Challenges in Pain Management for the Veterinary Dental Patient
11.4 Physiology of Pain
11.5 Dental Nociception, Inflammation, and Hypersensitivity
11.6 Causes of Dental and Orofacial Pain
11.7 Assessment and Recognition
11.8 Treatment
References
12 Anesthesia of the Dental Patient
12.1 Introduction
12.2 Anesthesia Record Keeping
12.3 Patient History and Physical Examination
12.4 Basic Laboratory Testing
12.5 Anesthetic Management
12.6 Special Patient Presentations
References
13 The Dental Patient and Its General Conditions
13.1 Patients with Cardiac Disease
13.2 Dilated Cardiomyopathy in Dogs
13.3 Mitral Valve Insufficiency in Dogs
13.4 Hypertrophic Cardiomyopathy in Cats
13.5 Patients with Diabetes Mellitus
13.6 Pregnant Patients
13.7 Patients with a History of Seizures
13.8 Brachycephalic Patients
References
14 Ophthalmic Considerations in the Veterinary Dental Patient
14.1 Introduction
14.2 Ophthalmic Manifestations of Dental Disease
14.3 Maxillofacial Trauma
14.4 Ophthalmic Care During Dental Surgery
14.5 Combined Oral and Ocular Surgery Considerations
14.6 Conclusion
References
15 Oral Health in the Context of Other Planned Surgeries
15.1 Introduction
15.2 Pathways Linking Oral Disease to Remote Locations
15.3 Guidelines for the Veterinarian
References
16 Systemic Diseases Influencing Oral Health and Conditions
16.1 Introduction
16.2 Genetic and Developmental Disorders
16.3 Systemic Diseases
References
17 Common Situations of Malpractice and Mistakes, and How Best to Avoid Them
17.1 Introduction
17.2 Anesthesia
17.3 Oral Exam and Diagnostics
17.4 Improper Therapy and Iatrogenic Damage
17.5 Client Communication
References and Further Reading
18 Dentistry Through Life
18.1 Pediatric Dentistry
18.2 Geriatric Dentistry
References
Part III: Dentistry in Daily Practice
19 Management of the Dental Patient
19.1 Identifying Problems
19.2 First Consultation or Discussion with the pet owner
19.3 Additional Consultations: Internal Medicine, Cardiologist, Neurologist, Anesthesiologist
19.4 Day of Surgery
19.5 Follow‐Up
19.6 What Every Vet Should Know About Dental Problems
References and Further Reading
20 Professional Dental Cleaning
20.1 Introduction
20.2 Procedure
20.3 Key Points
References
21 Oral and Maxillofacial Surgery
21.1 Introduction
21.2 Pain Management
21.3 Infection Control
21.4 Treatment Planning
21.5 Four‐Handed Surgery
21.6 Structures and Anatomy
21.7 Techniques, Instruments, and Materials
21.8 Wound Closure
21.9 Biopsy
21.10 Conclusion
References
22 Extraction Techniques and Equipment
22.1 Introduction
22.2 Nonsurgical (Closed) Extractions
22.3 Extraction of Multirooted Teeth
22.4 Surgical (Open) Extractions
References
23 Oral Emergencies
23.1 Introduction
23.2 Selected Topics Related to Oral Emergencies and Maxillofacial Surgery
23.3 Most Common Emergency Procedures
References
24 Feline Dentistry
24.1 Introduction
24.2 Preoperative Actions
24.3 Perianesthetic Hazards
24.4 Surgery
24.5 Postoperative Challenges
24.6 Imaging and Radiography
24.7 Brachycephalic Breeds
24.8 Oral Neoplasms
24.9 High‐Rise Syndrome
24.10 The Cat‐Friendly Clinic
24.11 Caudal Stomatitis
24.12 Tooth Resorption
24.13 Feline Orofacial Pain Syndrome (FOPS)
24.14 Juvenile Periodontal Diseases
24.15 Eosinophilic Granuloma Complex
24.16 Pyogranuloma Secondary to Traumatic Dental Occlusion
24.17 Common Procedures
References
Part IV: When to Call the Specialist
25 A Brief Introduction to Specific Oral and Dental Problems that Require Specialist Care
25.1 Introduction
25.2 Skills and Services
25.3 Cases
Further Reading
26 How to Cooperate with a Specialist
26.1 Introduction
26.2 What You Should Do
26.3 What to Expect from the Specialist
26.4 Conclusion
Useful Algorithms for the Management of Oral Problems
Appendix A: Drugs and Doses
Anti‐inflammatory Drugs
Analgesics
Anesthetics/Sedatives
Appendix B: Instruments Handling and Sharpening
B.1 Introduction
B.2 Sterilization
B.3 Sharpening
B.4 Maintenance of Power Equipment
References
Appendix C: Abbreviations and Dental Charts
Appendix D: List of Hereditary Problems and Breed Predispositions in Dogs and Cats
Appendix E: Tolerance of Malocclusion and Dental Abnormalities in Dogs
Appendix F: Assisted Feeding in Dental Patients
F.1 Change in Food Texture
F.2 Tube Feeding
F.3 Evaluation of Nutritional Needs of Animal
F.4 Nutritional Challenges in Veterinary Dental Patients
References
Index
End User License Agreement
List of Tables
Chapter 1
Table 1.1 Suggested business plan for the equipment of the dental part of a p...
Chapter 2
Table 2.1 Verbal behaviors significantly associated with positive or negative...
Table 2.2 Nonverbal behaviors significantly associated with positive or negat...
Chapter 5
Table 5.1 Oral health parameters assessed during patient examination and inte...
Chapter 7
Table 7.1 American Heart Association recommendations for antimicrobial prophy...
Table 7.2 Common dental antimicrobials.
Table 7.3 Potential criteria for identification of veterinary patients that r...
Table 7.4 Basic measures to reduce the incidence of needlestick injuries.
Table 7.5 Basic goals of cleaning, disinfection, and sterilization.
Table 7.6 Required cleaning and disinfection practices for different types of...
Chapter 8
Table 8.1 Comparison of selected parameters characterizing pet oral care in P...
Chapter 10
Table 10.1 Description of the tests required to diagnose hereditary diseases ...
Table 10.2 Scale for the negative influence of hereditary disease on patient ...
Chapter 11
Table 11.1 Nonsteroidal anti‐inflammatory drugs (NSAIDs): canine and feline d...
Table 11.2 Common local anesthetics used in veterinary anesthesia and pain ma...
Chapter 12
Table 12.1 Drugs used in pre‐anesthetic combinations.
a
Table 12.2 AAHA recommended intravenous fluid rates during general anesthesia...
Table 12.3 Anesthesia induction protocols for dogs and cats.
Table 12.4 Single injections of sedative or analgesic drugs used to decrease ...
Table 12.5 Drugs used as CRIs during anesthesia to reduce MAC.
Table 12.6 Anesthetic management for obese patients.
Chapter 13
Table 13.1 Cardiovascular effects of important anesthetic drugs in physiologi...
Chapter 15
Table 15.1 Bacterial genera cultured from both blood and plaque in different ...
Table 15.2 Incidence of bacteria by procedure group in human dentistry.
Table 15.3 Expected healing times for different tissues.
Table 15.4 Recommendations when dental (class A or B) and other surgeries (clas...
Chapter 18
Table 18.1 Dental formulae for cats and dogs. I (incisors); C (canines); P (p...
Table 18.2 Estimated timing of eruption of different teeth in different speci...
Chapter 22
Table 22.1 Amount of alveolar bone to be removed in different clinical situat...
List of Illustrations
Chapter 1
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 b...
Figure 1.4 White board drawings explaining a crown height‐reduction procedur...
Figure 1.5 Educational posters avaliable at www.vetdentalrad.com.
Figure 1.6 Educational video shown on a tablet in a waiting room.
Figure 1.7 Finger protection during feline oral cavity assessment.
Figure 1.8 Dental operatory.
Figure 1.9 Protection of the patient during sedation.
Figure 1.10 Central distribution of (a) water in preparation and postoperati...
Figure 1.11 Handheld X‐ray generator.
Figure 1.12 Wall‐mounted anesthesia machine.
Figure 1.13 Hazardous materials have to be stored in dedicated containers an...
Figure 1.14 An adjustable table is helpful when working on with larger patie...
Figure 1.15 Veterinary dentist demonstrating the pathology to the pet owner....
Figure 1.16 Discussion in the consulting room is easier when a high‐quality ...
Figure 1.17 Presentation displayed in the waiting room explaining the safety...
Figure 1.18 An object (e.g., a treated tooth) can be radiographically assess...
Figure 1.19 Advantages of 3D versus 2D imaging. (a) The sequestrum revealed ...
Figure 1.20 Device combining a scaler and a polisher.
Figure 1.21 Dental unit main board, including (from left) suction, three‐way...
Figure 1.22 (a) Combination of a UNC probe and explorer in a single instrume...
Figure 1.23 Series of combined probes and explorers. (a) Probes. From left: ...
Figure 1.24 (a) Mouth props extending a dog's jaws. (b) Selection of props i...
Figure 1.25 Mirror (a) reflecting light into the caudal part of the oral cav...
Figure 1.26 Magnification helps greatly with dental procedures.
Figure 1.27 Charting: filling in (a) a paper dental chart and (b) an electro...
Figure 1.28 The oral surgical general kit includes, from left: periosteal el...
Figure 1.29 Extraction kit: luxators (left) and elevators (right), as well a...
Figure 1.30 Rescue kit ‐ From left: four superslim luxators and elevators, m...
Figure 1.31 Selection of burs for extraction.
Figure 1.32 Periodontal kit. From bottom: mirror, three curettes, periodonta...
Figure 1.33 Area‐specific curettes.
Figure 1.34 Use of CHX solution during extraction of a badly infected mouth....
Figure 1.35 Plaque‐disclosing solution.
Figure 1.36 Disposable custom‐made pharyngeal packs made of gauze or sponge....
Chapter 2
Figure 2.1 Scheme illustrating problems associated with selling veterinary d...
Figure 2.2 Client–pet and client–veterinarian bonds.
Figure 2.3 Example of a human–dog bond, with humanization efforts.
Figure 2.4 Diplomas in the waiting room.
Figure 2.5 Array of thank‐you pictures.
Figure 2.6 Nonverbal communication: (a) smile versus (b) non‐smile.
Figure 2.7 A centralized position of the patient is necessary to display emp...
Chapter 3
Figure 3.1 Framework for clinical assessment.
Figure 3.2 Webinar in dentistry.
Figure 3.3 Face‐to‐face learning.
Figure 3.4 Interactive session.
Figure 3.5 WSAVA Dental guidelines team From left: Paulo Stegall DACVAA (Can...
Chapter 4
Figure 4.1 The first impression when a client enters the clinic: North Downs...
Figure 4.2 The kennel assistant, a first‐line dental team member.
Figure 4.3 (a) This patient came to boarding with a fractured 304. (b) An un...
Figure 4.4 Veterinary care assistant packing a dental kit.
Figure 4.5 Four‐handed dentistry: examination and charting.
Figure 4.6 Preparation of the operatory.
Figure 4.7 (a, b) Seven‐year‐old Yorkshire terrier that has received annual
Figure 4.8 Concious animal assessment.
Figure 4.9 Client estimate, prepared based on a filled‐in dental chart.
Figure 4.10 Anaesthetised animal assessment.
Figure 4.11 Modified pen grasp of a scaling handpiece.
Figure 4.12 Color coding of patients for follow‐up visits.
Figure 4.13 Informational brochures in a waiting room.
Figure 4.14 Before and after smile book examples.
Chapter 5
Figure 5.1 Dental Index app.
Figure 5.2 Dental plaque identification is part of pet owner education, and ...
Figure 5.3 Double‐headed toothbrushes have certain benefits in plaque contro...
Figure 5.4 Mechanized toothbrush used in dogs.
Figure 5.5 Selection of toothpastes.
Figure 5.6 Teaching tooth brushing should be gradual and gentle.
Figure 5.7 Avoid wide opening of the mouth when teaching tooth brushing.
Figure 5.8 Indirect (with the use of fingerbrush) application of Maxiguard i...
Figure 5.9 Application of the waxy barrier sealant.
Figure 5.10 Kibbles intended for oral hygiene (right) are larger than normal...
Figure 5.11 Hill’s Dental Care T/D diet for dogs and cats.
Figure 5.12 Dental treats/chews must be attractive for pets.
Figure 5.13 With bones or very hard chews, there is danger of (a) breaking t...
Figure 5.14 The new version of Vet Aquadent without xylitol.
Figure 5.15 Water additives will not work when the animal prefers tap water....
Figure 5.16 Plaque Off series.
Chapter 6
Figure 6.1 Comparison of the dentition of a dog that regularly received a de...
Figure 6.2 Entrapment of a large piece of bone in a dog's mandible.
Figure 6.3 VOHC website.
Figure 6.4 CBCT image showing the relations of occlusion of teeth in differe...
Chapter 7
Figure 7.1 Anaerobic transport medium for sample collection (top). Sterile g...
Figure 7.2 (a) Deep periodontal pocket in the left mandibular molar area of ...
Figure 7.3 Odontogenic abscess in a cat: (a) deep periodontal pocket (circle...
Figure 7.4 Antimicrobial prophylaxis for routine descaling is the most commo...
Figure 7.5 Cultured bacteria from a periodontal abscess with antibiotic susc...
Figure 7.6 Presence of dental plaque demonstrated with the use of (a) ultrav...
Figure 7.7 Antiseptics used in veterinary dentistry: (a) Vet aquadent, conta...
Figure 7.8 Personal protective equipment: gown, gloves, mask, and eye protec...
Figure 7.9 Conjunctivitis as a result of wearing contact lenses during a den...
Figure 7.10 Skin wound caused by lack of protection of sharp working tips.
Figure 7.11 Autoclaved instruments are a necessary condition for performing ...
Chapter 8
Figure 8.1 (a, b) One week before these images were taken, this seven‐year‐o...
Chapter 9
Figure 9.1 Oronasal fistula (ONF) signalments: nasal discharge.
Figure 9.2 ONF presence: visible nasal structures.
Figure 9.3 ONF diagnosis with the use of a periodontal probe.
Figure 9.4 Picture during ONF repair: nasal cavity filled with debris.
Figure 9.5 Perio‐endo lesions in 109. Note the furcation involvement in 109 ...
Figure 9.6 Deep vertical bone loss in the distal root of 409: (a) clinical a...
Figure 9.7 Distal root of mandibular firts molar is very common site for cla...
Figure 9.8 (a) Clinical appearance of the Carnassial abscess. (b) Periapical...
Figure 9.9 (a) Intraoral dental sinus drainage (parulis). (b) Infection of 2...
Figure 9.10 Incidentally revealed pathology: Right mandibular teeth : 407, 4...
Figure 9.11 Pathologic mandibular fracture as a sequela of 304 pulp necrosis...
Figure 9.12 Relation of bone/tooth in (a) small‐ and (b) large‐breed dogs.
Figure 9.13 Infection at the area of fracture requires extraction of the dis...
Figure 9.14 Damaged area of bone surrounding a fracture due to an unsuccessf...
Figure 9.15 Proximity of maxillary teeth roots and their apices (arrows) and...
Figure 9.16 In brachycephalic cats, the apex of the canine tooth is very clo...
Figure 9.17 Chronic irritation of the oral mucosa in plaque‐associated conta...
Figure 9.18 Radiographic appearance of osteomyelitis in the rostal mandible ...
Figure 9.19 Debridement of the necrotic part of a bone affected by osteomyel...
Figure 9.20 CBCT appearance of osteomyelitis resembling cancer.
Figure 9.21 Tooth resorption of a canine tooth as a possible origin of osteo...
Figure 9.22 Periodontal disease revealed (a) clinically and (b) radiographic...
Chapter 10
Figure 10.1 Gingival hyperplasia in a Dogue de Bordeaux.
Figure 10.2 Supernumerary teeth in a Russian blue cat.
Figure 10.3 Persistent deciduous left maxillary canine tooth (604) in a York...
Figure 10.4 Dentigerous cyst (DTC) in the area of (a) 405/406, and (b) 305/3...
Figure 10.5 Results of genetic test for craniomandibular osteopathy (CMO). (...
Chapter 11
Figure 11.1 A maladaptive process is established in chronic conditions such ...
Figure 11.2 Periodontal disease is common in small‐animal practice. It cause...
Figure 11.3 A cat with suspected feline orofacial pain syndrome. Clinical si...
Figure 11.4 Oral cancer can be a significant source of severe pain. It may p...
Figure 11.5 Application of an algometer to the lateral aspect of the maxilla...
Figure 11.6 Changes in facial expressions can be great indicators of pain in...
Figure 11.7 (a) Cat following recovery from anesthesia. It is located in an ...
Figure 11.8 Cat salivating profusely after the oral administration of tramad...
Figure 11.9 Several oral treatments (e.g., tramadol, gabapentin, amitriptyli...
Figure 11.10 Oral transmucosal administration of buprenorphine in cat provid...
Figure 11.11 In this example, blood was aspirated and the injection of the l...
Figure 11.12 Inferior alveolar nerve block in a dog.
Figure 11.13 Infraorbital nerve block in a dog.
Figure 11.14 Infraorbital nerve block in a cat.
Figure 11.15 Bleeding observed after positioning the needle to perform an in...
Figure 11.16 An intraoral approach for the maxillary nerve block in a cat. T...
Chapter 12
Figure 12.1 Patients prepared for dental procedures should be comfortable an...
Figure 12.2 Patients should be calmed in a quiet environment, if possible wh...
Figure 12.3 Preoxygenation of the patient.
Figure 12.4 Straight silicone endotracheal tubes during intubation procedure...
Figure 12.5 Lubrication of an endotracheal tube.
Figure 12.6 Noninvasive blood pressure measurement.
Figure 12.7 (a) ECG waveform on an anesthetic monitor displaying second‐degr...
Figure 12.8 (a) Mainstream Capnography sensor. (b) Normal capnograph wavefor...
Figure 12.9 Pulsoximetry sensors on (a) tongue and (b) paws
Figure 12.10 Temperature maintenance: forced hot‐air blanket on top of a hot...
Figure 12.11 Recovery environment.
Chapter 13
Figure 13.1 Aggressive cats should be sedated by intramuscular injection.
Figure 13.2 Patients with BOAS need special treatment and care.
Figure 13.3 The trachea of brachycepalic dogs is smaller in diameter than th...
Figure 13.4 Brachycephalic patients must always be very carefully supervised...
Chapter 14
Figure 14.1 CT picture of the orbital area in a cat. Root apices are divided...
Figure 14.2 Nine‐year‐old dog with (a) chronic epiphora and conjunctivitis a...
Figure 14.3 Exophthalmos can be associated with multiple oral pathologies: (...
Figure 14.4 Two‐year‐old female spayed Weimaraner with acute left orbital ce...
Figure 14.5 Young pug with severe left orbital cellulitis, exophthalmos, exp...
Figure 14.6 Aged terrier mix with (a) acute‐onset painful fluctuant swelling...
Figure 14.7 Three‐year‐old basset hound with marked ventral chemosis and nic...
Figure 14.8 The nasolacrimal duct passes next to the apex of the left maxill...
Figure 14.9 Two‐year‐old Chihuahua with a non‐painful fluctuant swelling ven...
Figure 14.10 Twelve‐year‐old cat with (a) right side exophthalmos and perioc...
Figure 14.11 (a) High‐rise syndrome in a cat, with hyphema OD, periocular he...
Figure 14.12 (a) Maxillofacial fractures due to vehicular trauma. (b) Severe...
Figure 14.13 Cat with (a) Horner's syndrome secondary to (b) traumatic palat...
Figure 14.14 Eight‐year‐old female spayed shih‐tzu with deep stromal corneal...
Figure 14.15 During dental procedures, it is necessary to repeat ocular lubr...
Figure 14.16 Panophthalmitis OD (right eye) in a cat after inadvertent globe...
Chapter 15
Figure 15.1 Spaying at age six to eight months can be a convenient opportuni...
Figure 15.2 Teeth descaling (a) and dental extractions (b) are both associat...
Figure 15.3 This patient, a 9‐year‐old Yorkshire terrier underwent castracti...
Chapter 16
Figure 16.1 Oral and maxillofacial assessment in young individuals should be...
Figure 16.2 Cleft palate in (a) kitten and (b) puppy.
Figure 16.3 Hydrocephalus associated with malocclusion: (a) clinical picture...
Figure 16.4 Aglossia in a kitten. This problem is lethal.
Figure 16.5 Radiographic appearance of CMO in a dog on extraoral dorsoventra...
Figure 16.6 Treatment of CMO can be successful and the condition of the bone...
Figure 16.7 Ankyloglossia affects drinking and panting, limiting life comfor...
Figure 16.8 Clinical signalments of TMJ dysplasia can be diagnosed during oc...
Figure 16.9 Ulceration of the lingual mucosa, frequently associated with FCV...
Figure 16.10 Oral lesions in a cat suffering from a mixed infection of FIV a...
Figure 16.11 Oral papillomatosis in a puppy.
Figure 16.12 Generalized amelogenesis imperfecta in Akita Inu.
Figure 16.13 Chlamydia infection in cats causes (a) drooling nasal discharge...
Figure 16.14
Cryptococcus
infection: (a) oral lesion; (b) microscopic slide ...
Figure 16.15 Biopsy of a lower‐lip lesion, revealed the typical histopatholo...
Figure 16.16 Seizures and muscle tension are part of the clinical picture of...
Figure 16.17 Oral lesions caused by
Leischmania
spp.
Figure 16.18 Pemphigus foliaceus lesion present on the lips of a cocker span...
Figure 16.19 Pemphigoid oral lesion
Figure 16.20 Juvenile facial dermatitis in a puppy.
Figure 16.21 Punch test in a Doberman pinscher to observe mucosal bleeding t...
Figure 16.22 Osteopenia juvenalis in a kitten with malnutrition: (a) lack of...
Figure 16.23 Hyperparathyroidismus associated with renal insufficiency causi...
Figure 16.24 Hyperparathyroidismus associated with a geriatric parathyroid t...
Figure 16.25 Hyperostosis of the rostral mandible, mimicking acromegaly.
Figure 16.26 Uremic ulcerations and mucositis in a cat with chronic renal in...
Figure 16.27 Chemical burn of the oral mucosa caused by caustic soda: (a) im...
Figure 16.28 (a) Lingual mucosa damage and (b) multiple teeth fractures in a...
Figure 16.29 Mucosal proliferation in a Japanese chin of unknown origin trea...
Chapter 17
Figure 17.1 Monitoring until completely awake is crucial for safety.
Figure 17.2 (a) A mandibular right first molar (409) which is clinically unr...
Figure 17.3 Dental charting is a mandatory part of oral examination. It shou...
Figure 17.4 Mandibular tumor (melanoma malignum) in (a) clinical, (b) radiog...
Figure 17.5 Transillumination of (a) the vital tooth is different than that ...
Figure 17.6 Calculus on the palatal aspect of the teeth is often missed duri...
Figure 17.7 Retained root tips and roots that require action after poorly pe...
Figure 17.8 (a) Apparent odontogenic abscess caused by (b) a foreign body (g...
Figure 17.9 Incidental discovery of a retained root of the right maxillary s...
Figure 17.10 (a) Oronasal fistula. (b) After repair.
Figure 17.11 Iatrogenic left mandibular fracture caused during an extraction...
Figure 17.12 (a) Poor extraction technique in this cat and lack of suturing ...
Figure 17.13 Root pushed into nose, diagnosed after several months of nasal ...
Figure 17.14 Keeping an index finger close to the working tip of the elevato...
Chapter 18
Figure 18.1 Persistent deciduous dentition causes numerous problems, includi...
Figure 18.2 Juvenile gingivitis in (a) cats and (b) dogs can be associated w...
Figure 18.3 The gingival sulcus cannot be correctly developed in the presenc...
Figure 18.4 (a) By definition, persistent deciduous teeth are those whose en...
Figure 18.5 Adverse dental interlock caused by persistent deciduous dentitio...
Figure 18.6 Class II malocclusion is very often traumatic, regardless of whe...
Figure 18.7 A fractured deciduous tooth always requires action.
Figure 18.8 Complications of neglected tooth fracture: periapical lesion in ...
Figure 18.9 Dentigerous cyst associated with an impacted canine tooth (Aster...
Figure 18.10 Radiographic appearance of a dentigerous cyst associated with a...
Figure 18.11 Enamel hypoplasia present on multiple teeth.
Figure 18.12 Periostitis ossificans visible in a young dog mandible as a “do...
Figure 18.13 (a) Fused incisor teeth in a six‐month‐old whippet. (b) Invagin...
Figure 18.14 Proliferative juvenile gingivitis in a Maine Coon cat.
Figure 18.15 (a,b) Periodontal disease and (c) oral tumors occur more often ...
Figure 18.16 Ankylosis and teeth resorption are more frequent in geriatric p...
Figure 18.17 Tooth resorption may be associated with oral tumors. In this do...
Figure 18.18 Bad habits like chewing on hard objects cause generalized teeth...
Figure 18.19 Right maxillary canine tooth (104) extrusion in a cat can be as...
Figure 18.20 Transparent and brittle enamel can be one of the signs of teeth...
Figure 18.21 Alveolar bone atrophy is often diagnosed in older toy‐breed dog...
Chapter 19
Figure 19.1 PetSmile Campaign posters.
Figure 19.2 Incidental finding of oral growth in a patient undergoing nonden...
Figure 19.3 Whiteboard drawing explaining a problem to a pet owner.
Figure 19.4 Example “against medical advice” (AMA) release form.
Figure 19.5 Example estimate and consent form.
Figure 19.6 Example anesthesia record.
Chapter 20
Figure 20.1 Use of visual educational materials during conversation with a p...
Figure 20.2 A veterinary technician (nurse) properly attired in PPE.
Figure 20.3 Manual descaling forceps in action.
Figure 20.4 Cooling spray (cavitation) from an ultrasonic scaler, associated...
Figure 20.5 Use of the terminal 1–3 mm of a mechanical scaler tip is recomme...
Figure 20.6 The cooling spray prevents thermal injury to vital tissue by the...
Figure 20.7 Correct grasp of a mechanical scaler handpiece.
Figure 20.8 The working tip must be placed almost parallel to the tooth surf...
Figure 20.9 The quality of the working tip must be checked on a frequent bas...
Figure 20.10 The places predisposed to periodontal diseases which require pa...
Figure 20.11 A manual scaler can only be applied supragingivally.
Figure 20.12 Modified pen grasp of a curette Source: Emilia Klim.
Figure 20.13 Position of a scaler's blade (a) at the gingival margin and (b)...
Figure 20.14 (a) Universal curette. (b) Gracey curette.
Figure 20.15 Manual subgingival scaling step one: The blade of the instrumen...
Figure 20.16 Manual subgingival scaling step two: The curette is rotated so ...
Figure 20.17 Manual subgingival scaling step three: The curette is inserted
Figure 20.18 Manual subgingival scaling step four: Once the bottom of the po...
Figure 20.19 Mechanical subgingival scalers.
Figure 20.20 Mechanical smoothing of the root surface: (a) removal of the ca...
Figure 20.21 Checking the descaled crown surface with an explorer.
Figure 20.22 Coating the tooth surface prior to polishing.
Figure 20.23 Polishing the crown starts from the gingival margin.
Figure 20.24 Gingival sulcus lavage with the use of a blunt‐ended cannula.
Figure 20.25 Application of fluoride foam in a cat following professional te...
Figure 20.26 Probing the gingival sulcus of the right maxillary canine tooth...
Figure 20.27 The minimum six places around the tooth that should be probed (...
Figure 20.28 Normal probing depth in toy‐breed dogs (≤2 mm).
Figure 20.29 The Triadan system of dental nomenclature: (a) cat; (b) dog.
Figure 20.30 Preliminary radiographic assessment can fit in six radiographs:...
Chapter 21
Figure 21.1 Use of a tissue marker helps the surgeon follow section margins ...
Figure 21.2 3D reconstruction utilized after CT scan helps in planning surge...
Figure 21.3 It is essential to be able to see the structures during oral sur...
Figure 21.4 Use of operating microscopy.
Figure 21.5 Live presentation of a procedure on a display screen, which was ...
Figure 21.6 Scar tissue (circle) in the oral cavity is elastic and functiona...
Figure 21.7 Application of laser surgery during excisional biopsy.
Figure 21.8 Application of electrosurgery with radio frequency: (a) gingival...
Figure 21.9 Application of piezosurgery in (a) TMJ arthroplasty in a cat (b)...
Figure 21.10 The use of stay sutures preserves the wound margins.
Figure 21.11 During segmental mandibulectomy, it is important first to (a) i...
Figure 21.12 It is important to identify the palatal artery when doing palat...
Figure 21.13 A triangle flap is created by making a vertical incision at one...
Figure 21.14 Fenestration involves cutting the periosteum to extend the flap...
Figure 21.15 A partial‐thickness flap is created during pedicle sliding flap...
Figure 21.16 Suturing a dressing to the skin to provide compression is indic...
Figure 21.17 Perpendicular piercing reduces the amount of damage caused, whi...
Figure 21.18 Double‐layer suturing in major oral surgery (e.g., maxillectomy...
Figure 21.19 (a) A distance of 2–3 mm should be kept between the wound edge ...
Figure 21.20 Standard interrupted sutures are often associated with irritati...
Figure 21.21 Incisional biopsy with the use of trephine should be performed ...
Chapter 22
Figure 22.1 Preoperative radiographs allow visualization of (a) tooth abnorm...
Figure 22.2 The first step in extraction is to cut the gingival attachment. ...
Figure 22.3 The index finger should be placed near the tip when using an ele...
Figure 22.4 Once the elevator is (a) inserted in the space between the bone ...
Figure 22.5 Initial insertion of an iM3 Vet‐Tome blade into the periodontal ...
Figure 22.6 Further steps in extraction with iM3 Vet‐Tome lead to (a) pullin...
Figure 22.7 Use of extraction forceps to pull out a loosened tooth.
Figure 22.8 Retained roots are a very common complication associated with de...
Figure 22.9 Closure is best performed with a simple interrupted pattern, pla...
Figure 22.10 When sectioning teeth, if possible start at the furcation and w...
Figure 22.11 In multirooted teeth, (a) crown resection may be used prior to ...
Figure 22.12 Designing an envelope flap for extraction of the maxillary cani...
Figure 22.13 A full flap includes two vertical releasing incisions, which sh...
Figure 22.14 Removal of the buccal alveolar bone helps in providing superior...
Figure 22.15 Fenestration releases tension and extends the flap before closu...
Figure 22.16 Tension‐free flap covering surgical access.
Figure 22.17 Luxating elevators.
Figure 22.18 Small‐sized extraction forceps are convenient for use in the mo...
Figure 22.19 LaGrange tissue scissors.
Figure 22.20a,b Two different extraction kits organized in an autoclavable c...
Figure 22.21 Selection of burs recommended for surgical extraction.
Chapter 23
Figure 23.1 Oral injuries are very often the result of head injury, which ma...
Figure 23.2 Distant complications of head injury: (a) TMJ ankylosis of the r...
Figure 23.3 Measurement of intraocular pressure with a tonometer provides in...
Figure 23.4 Example standard 2D imaging of the feline head (a) feline TMJs (...
Figure 23.5 3D imaging allows for detailed information about the structures ...
Figure 23.6 (a) Stable (fracture that runs in rostroventral direction) and (...
Figure 23.7 Predisposition to pathologic fracture at the mandibular first mo...
Figure 23.8 Tape muzzle on a cat.
Figure 23.9 Stout multiple‐loop interdental wiring can be applied for a mand...
Figure 23.10 Maxillary/mandibular fixation in a cat. Source: Emilia Klim.
Figure 23.11 (a) Nonstable fracture of the left mandible. (b) Stabilization ...
Figure 23.12 (a) Combination of interdental wiring and acrylic splint applie...
Figure 23.13 Microplate application in multiple maxillofacial and cranial fr...
Figure 23.14 Lower‐lip avulsion in a (a) dog and (b) a cat.
Figure 23.15 Dorsorostral left TMJ luxation (circle) associated with left ma...
Figure 23.16 Intracapsular bilateral TMJ fracture (arrows).
Figure 23.17 Extraoral radiograph of Caudoventral TMJ luxation in a cat.
Figure 23.18 Tape muzzle application in a dog, step by step.
Figure 23.19 Tape muzzle application in a cat, step by step.
Figure 23.20 Dentinal bonding procedure, step by step: (a) Uncomplicated cro...
Figure 23.21 Radiographs of (a) symphyseal separation and (b) symphyseal sep...
Figure 23.22 Often, a simple symphyseal separation can be stabilized by a si...
Figure 23.23 More complicated symphyseal injuries must be stabilized with bo...
Chapter 24
Figure 24.1 Before oral cavity inspection in a cat, it is worth looking at i...
Figure 24.2 Full‐mouth radiography is the gold standard in feline oral diagn...
Figure 24.3 Some drugs used in sedation (e.g., medetomidine) can affect vasc...
Figure 24.4 Subcutaneous emphysema associated with tracheal rupture caused b...
Figure 24.5 (a) Approximately 2.5–3 cm jaw extension is sufficient to visual...
Figure 24.6 The short infraorbital canal in cats requires careful performanc...
Figure 24.7 Placement of a feeding tube is important in order to maintain nu...
Figure 24.8 The radiographic appearance of feline osteomyelitis can mimic ma...
Figure 24.9 Cat Friendly Clinic certification logo.
Figure 24.10 The feline dental kit may include (from left): LaGrange tissue ...
Figure 24.11 Drooling very often indicates oral problems in cats.
Figure 24.12 Juvenile proliferative gingivitis in a cat can turn into period...
Figure 24.13 (a) Alveolar bone smoothing and (b) gentle removal of granulati...
Figure 24.14 Extraction of the entire dentition or cheek teeth results in to...
Figure 24.15 Use of medical treatment (in this case, Interferon Omega [Virba...
Figure 24.16 Laser ablation of the inflamed and ulcerated mucosa can bring i...
Figure 24.17 Subgingival tooth resorption can occur without symptoms and oft...
Figure 24.18 Type 1 resorption is associated with (a) surrounding tissue inf...
Figure 24.19 Type 2 resorption of 407: (a) clinical and (b) radiographic app...
Figure 24.20 (a) A bump above the gingival margin indicates stage V resorpti...
Figure 24.21 Type 1 resorptive lesions are often associated with alveolar bo...
Figure 24.22 “Ghost roots” indicate an advanced stage of tooth resorption: (...
Figure 24.23 Alveolar bone expansion like (a) that in the area of 104 can be...
Figure 24.24 Juvenile periodontitis in a 12‐month‐old Maine coon cat, requir...
Figure 24.25 EGC can appear as indolent ulcers.
Figure 24.26 Cytology of an oral lesion from a cat showing mixed inflammatio...
Figure 24.27 Pyogranuloma caused by traumatic occlusion of the cheek dentiti...
Figure 24.28 (a) Crown amputation of the mandibular canine tooth. (b) Design...
Figure 24.29 Odontoplasty of 207, 208. (a) Radiographic assessment of the ma...
Figure 24.30 Traumatization of the upper lip by the mandibular canine tooth ...
Figure 24.31 Composite buildup on a mandibular canine crown is placed to avo...
Figure 24.32 Hyperplastic gingiva associated with juvenile gingivitis requir...
Figure 24.33 Closure of a (a) surgical extraction flap should preferably be ...
Figure 24.34 Pharyngotomy intubation.
Chapter 25
Figure 25.1 Complicated crown‐root fracture of 208.
Figure 25.2 Radiograph of 307, 308, 309 with type 1 resorption present in 30...
Figure 25.3 Squamous cell carcinoma of left rostral mandible. Clinical asses...
Figure 25.4 Class IV malocclusion in both side‐to‐side and rostrocaudal dire...
Figure 25.5 Nonstable mandibular fracture with root tip present in the fract...
Figure 25.6 Periodontal disease with pathologic pockets, gingival recession,...
Figure 25.7 Complicated crown fracture of canine tooth 404 in 8 months old d...
Figure 25.8 Palatal defect subsequent to high‐rise syndrome, unsuccessfully ...
Figure 25.9 Left maxillary canine tooth (204) luxated after a dog fight.
Figure 25.10 Right maxillary canine tooth (104) fracture and right mandibula...
Figure 25.11 Left mandibular fracture involving the canine tooth (304) (arro...
Figure 25.12 TMJ luxation causing inability to close the mouth, additionally...
Figure 25.13 Cleft palate in a four‐month‐old boxer puppy.
Figure 25.14 Cat with inability to open mouth three months after maxillofaci...
Figure 25.15 Bilateral impaction of the mandibular canine teeth.
Figure 25.16 Cat with lower‐lip avulsion
Figure 25.17 Buccal alveolar bone expansion and infra bony pocket of the man...
Figure 25.18 Periodontal pocket on the palatal aspect of the left maxillary ...
Figure 25.19 Mass localized under the zygomatic arch, affecting the eye (exo...
Figure 25.20 Class II malocclusion causing palatal defect.
Chapter 26
Figure 26.1 Referral form, Arizona Veterinary Dental Specialists.
Figure 26.2 Example of e‐learning available on YouTube.
Appendix B
Figure B.1 Broken instrument examples.
Figure B.2 Ultrasonic cleaning is very useful for small instruments with are...
Figure B.3 Careful inspection after cleaning is necessary for quality contro...
Figure B.4 Acrylic stick test of sharpness.
Figure B.5 Sharpening equipment includes: oil, acrylic stick and selection o...
Figure B.6 A 110° angle should be maintained between face of a currette and ...
Figure B.7 The tip of an elevator should be sharpened on the convex side.
Figure B.8 A luxator should be sharpened on the concave side.
Figure B.9 Mechanized Hu‐Friedy sharpener for sharpening scalers and currett...
Figure B.10 Testing card for checking the quality of ultrasonic scaler tips....
Appendix D
Figure D.1a,b Extraoral radiograph (a) and CBCT scan (b) of dysplastic tempo...
Figure D.2a,b Supernumerary maxillary incisors teeth in Boxer. Clinical (a) ...
Figure D.3 Cleft palate in boxer puppy.
Figure D.4a,b,c Brachycephalic Obstructive Airway Syndrome (BOAS) can be dia...
Figure D.5 Teeth crowding in maxillary dentition typical for brachycephalic ...
Figure D.6 Lingually displaced right mandibular canine tooth (404) in Bullte...
Figure D.7 Infantile Cranial Hyperostosis (ICH) in a bullmastiff
Figure D.8 Craniomandibular Osteopathy (CMO) in a Cairn Terrier causing sign...
Figure D.9 Lip‐fold dermatitis in a Cavalier King Charles Spaniel
Figure D.10 Eosinophilic Granuloma Complex (EGC) causing proliferative palat...
Figure D.11 Mesioversion of left maxillary canine tooth (204) in an Italian ...
Figure D.12a,b Odontodysplasia present in entire dentition. Clinical picture...
Figure D.13a,b,c Oligodontia in Chinese Crested dog. Clinical picture with n...
Figure D.14 Significant retrogenia in longhaired dachshund
Figure D.15 Chronic Ulcerative Paradental Stomatitis in a Maltese
Figure D.16 Ankyloglossia in an Anatolian shepherd [Courtesy of dr Efe Onur]...
Figure D.17 Vitiligo affecting formerly pigmented mucosa in Tervueren
Figure D.18 Masticatory Muscle Myositis affecting a Rottweiler
Figure D.19 Amelogenesis imperfecta affecting the entire dentition in Samoye...
Figure D.20 Feline brachycephalism. CBCT reconstruction of exotic cat scull....
Figure D.21 Mandibular incisor teeth crowding in a Persian cat
Figure D.22 Juvenile gingivitis in Maine Coon
Figure D.23 Malocclusion resulting from impingement of the fourth maxillary ...
Figure D.24 EGC on the upper lip of a Norwegian Forest Cat.
Appendix F
Figure F.1 Four year‐old flat coated retriever nine months after mandibulect...
Figure F.2 Nasoesophageal tube introduced in conscious cat.
Figure F.3 Esophageal feeding tube placed immediately after mandibulectomy i...
Figure F.4 Food presented one hour after recovery from anesthesia (a) and vo...
Figure F.5 Teethless dogs often have a protruded tongue but they quickly ada...
Guide
Cover Page
Title Page
Copyright Page
List of Contributors
Preface
Acknowledgments
About the Companion Website
Table of Contents
Begin Reading
Appendix A Drugs and Doses
Appendix B Instruments Handling and Sharpening
Appendix C Abbreviations and Dental Charts
Appendix D List of Hereditary Problems and Breed Predispositions in Dogs and Cats
Appendix E Tolerance of Malocclusion and Dental Abnormalities in Dogs
Appendix F Assisted Feeding in Dental Patients
Index
Wiley End User License Agreement
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The Veterinary Dental Patient
A Multidisciplinary Approach
Edited by
Jerzy Gawor
DiplAVDC, Dipl EVDC, FAVD, DVM PhDKrakowPoland
Brook Niemiec
DiplAVDC, Dipl EVDC, FAVDSan Diego, CAUSA
This edition first published 2021© 2021 John Wiley & Sons Ltd
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The right of Jerzy Gawor and Brook Niemiec to be identified as the authors of the editorial material in this work has been asserted in accordance with law.
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Limit of Liability/Disclaimer of WarrantyThe contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting scientific method, diagnosis, or treatment by physicians for any particular patient. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. While the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives, written sales materials or promotional statements for this work. The fact that an organization, website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the information or services the organization, website, or product may provide or recommendations it may make. This work is sold with the understanding that the publisher is not engaged in rendering professional services. The advice and strategies contained herein may not be suitable for your situation. You should consult with a specialist where appropriate. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.
Library of Congress Cataloging‐in‐Publication Data
Names: Gawor, Jerzy, author. | Niemiec, Brook A., author.Title: The veterinary dental patient : a multidisciplinary approach / Jerzy Gawor, Brook Niemiec.Description: Hoboken, NJ : Wiley‐Blackwell, 2021. | Includes bibliographical references and index.Identifiers: LCCN 2020021098 (print) | LCCN 2020021099 (ebook) | ISBN 9781118974735 (hardback) | ISBN 9781118974698 (adobe pdf) | ISBN 9781118974681 (epub)Subjects: MESH: Dentistry–veterinary | Veterinary Medicine | Practice Management, VeterinaryClassification: LCC SF867 (print) | LCC SF867 (ebook) | NLM SF 867 | DDC 636.089/763–dc23LC record available at https://lccn.loc.gov/2020021098LC ebook record available at https://lccn.loc.gov/2020021099
Cover Design: WileyCover Image: Courtesy of Jerzy Gawor
List of Contributors
Mary BergBeyond the Crown Veterinary Education, Lawrence, KS, USA
Eva Eberspächer‐SchwedaAnaesthesiology and Perioperative Intensive Care, Department for Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria
Jerzy GaworVeterinary Clinic Arka, Kraków, Poland
Michał JankDivision of Pharmacology and Toxicology, Department of Preclinical Sciences, Institute of Veterinary Medicine, Warsaw University of Life Sciences (WULS‐SGGW), Warsaw, Poland
Margo KarrikerUniversity of California Veterinary Medical Center, San Diego, CA, USA
Daniel KochDaniel Koch Small Animal Surgery Referrals, Diessenhofen, Switzerland
Victoria M. LukasikSouthwest Veterinary Anesthesiology, Tucson, AZ, USA
University of Arizona College of Veterinary Medicine, Oro Valley, AZ, USA
Lisa MestrinhoAssistant professor, Faculty of Veterinary Medicine, University of Lisbon, Portugal
Kymberley C. McLeodConundrum Consulting, Toronto, ON, Canada
Brook NiemiecVeterinary Dental Specialties and Oral Surgery, San Diego, CA, USA
Peter PascoeProfessor emeritus, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, USA
Zlatko PavlicaUniversity of Ljubljana, Ljubljana, Slovenia
Rachel PerryPerry Referrals, Brighton, UK and Royal Veterinary College, London, UK
Jamie J. SchorlingAmerican College of Veterinary Ophthalmologists, San Diego, CA, USA
Paulo SteagallDepartment of Clinical Sciences, Faculty of Veterinary Medicine, Université of Montréal, Saint‐Hyacinthe, QC, Canada
J. Scott WeeseOntario Veterinary College, University of Guelph, Guelph, ON, Canada
Preface
Being doctors, we do not treat diseases: we treat patients. Our patients' quality of life, functionality, and welfare are the most important goals of treatment.
Controlling periodontal disease is a complex action that requires the joint efforts of several people, including the first‐contact vet, the dentist, and the nurse.
Oral injuries and tooth fractures always require general anesthesia, in order to save the patient stress and provide the opportunity for appropriate assessment and treatment. It is again a team effort to carry the patient through all procedures safely.
Oral problems can affect almost all veterinary patients. Over 10% will become emergency patients and require immediate action.
Dentistry is a very important and interesting subject, but regardless of the technique, instrumentation, skills, and materials, it is all about the patient.
Many oral pathologies are camouflaged or go undiagnosed due to patient behaviors (animals do not express their discomfort), limitations in good access to the oral cavity, and prejudices among veterinarians and pet owners. Therefore, it is very important to educate veterinarians and urge them to pay attention not only to obvious signalments but also to signs of coming problems.
Almost every veterinary practice will claim, “We Do Dentistry” or “We Descale Teeth”, but the overall quality of service is poor. Students lack dental education, and as graduates and young veterinarians they go on to neglect dentistry. More is needed than just a book, but we can at least point out herein what we expect from universities.
Pet owners accept the presence of human dentistry as a separate medical discipline, but for some reason they treat veterinary dentistry as a cosmetic addendum to veterinary services.
There is one thing worse than neglecting dental problems: performing poor dentistry. Thus the aim of this book is thus to present the standards of good dentistry in the most common applications. We hope to remind you that every patient is a dental patient, and to offer advice on how to properly manage them. You should maintain an appropriate attitude toward dental and oral problems in dogs and cats. We offer an interdisciplinary approach to the dental patient, providing perspectives from such disciplines as oncology, cardiology, anesthesiology, and radiology.
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
Acknowledgments
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
About the Companion Website
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.
Part IGeneral Considerations: How to Start Dentistry
1 Establishing a Dental Presence within a General Veterinary Practice
Jerzy Gawor
Veterinary Clinic Arka, Kraków, Poland
1.1 Introduction
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.
1.2 General Considerations: How to Begin Offering Dentistry
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
