24 VETERINARY PRACTICE GUIDELINES
TABLE 2 Materials Needed for the Practice of Veterinary Dentistry*
Necessary materials • Antiseptic rinse • Prophy paste/pumice • Prophy angle and cups • Hemostatic agents • Sealant • Needles and syringes • Intraoral digital system or radiographic film • Measures to prevent hypothermia (e.g., conductive blanket, hot air blanket, circulating water blanket, towels, blankets)
• Gauze and sponges • Antimicrobial agent for local application • Suture material (4-0 and smaller) • Bone augmentation material • Local anesthetic drugs
Necessary equipment
• Equipment to expose and process intraoral digital radiograph system or intraoral films
• Suction • A high- and low-speed delivery system for air and water • Fiber optic light source • Equipment for sterilizing instruments • Low- and high-speed hand pieces (minimum two of each) • Various sizes of round/diamond and cross cut fissure burrs • Powered scaler with tips for gross and subgingival scaling (ultrasonic, subsonic, or piezoelectric) • Head or eye loupes for magnification
* Please note that disposable items are for single use only. TABLE 3
Instruments to Include in the Dental Surgical Pack*
• Scalers • Curettes • Probes/explorer • Sharpening materials • Scalpel • Extraction equipment (e.g., periosteal elevators, luxating elevators, periodontal elevators, extraction forceps, root tip picks, root tip forceps)
• Thumb forceps • Hemostats • Iris, LaGrange, Mayo, or Metzenbaum scissors • Needle holders • Mouth mirror • Retraction aid (e.g., University of Minnesota retractor)
* Instruments must be sterilized by accepted techniques prior to each use. Hand instruments must by properly sharpened and cared for.
Trends magazine, April 2013
When either an anesthetic examination or procedure is not
planned in a healthy patient, discuss preventive healthcare, oral health, and home oral hygiene. Options include brushing and the use of dentifrices, oral rinses, gels and sprays, water addi- tives, and dental diets and chews. Discourage any dental chew or device that does not bend or break easily (e.g., bones, cow/ horse hooves, antlers, hard nylon products). The Veterinary Oral Health Council lists products that meet its preset standard for the retardation of plaque and calculus accumulation.15
Illustrate
to the owner how to perform oral hygiene, such as brushing, wiping teeth, application of teeth-coating materials, and the use of oral rinses and gels. Allow the client to practice so they will be able to perform the agreed-upon procedure(s) at home. All home oral hygiene options, from diet to the gold stan-
dard of brushing, along with any of their potential limitations need to be discussed with the client. It is essential that the oral health medical plan is patient-individualized to attain the great- est level of client compliance. For example, “dental” diets and chews can be used until the client is comfortable either brush- ing or applying an antiplaque gel, rinse, or spray with a wipe. The gold standard is brushing the pet’s teeth using a brush with soft bristles either once or twice daily. If the client is either unable or unwilling to persevere with brushing, use any of the other oral hygiene options that the patient will tolerate. Explain the two-part process involved in a diagnostic dental
cleaning and patient evaluation to the client. It is critical that he/she understand the hospital protocol to minimize miscom- munication and frustration. The procedure involves both an awake component and an anesthetized component for a com- plete evaluation. It is not until the oral radiographs have been evaluated that a full treatment plan including costs of the antici- pated procedure(s) can be successfully made with any degree of accuracy. Evaluation of a patient for dental disease involves the awake
procedure as the first step. This is where an initial assessment is made. Although many problems may be seen at this point of the evaluation, a thorough diagnosis and treatment plan can- not be determined until charting, tooth-by-tooth examination of the anesthetized patient, and dental radiographs have been taken and evaluated. Studies have demonstrated that much of the pathology in a patient’s oral cavity cannot be appreciated until dental radiographs are taken and assessed; therefore, have protocols in place within the practice to give clients ample time to make an informed decision on how they want to proceed with the proposed treatment plan.16 Some hospitals may want to do the awake examination and
the anesthetic component (charting, cleaning, and dental radio- graphs) as the first procedure. They can then stage the treat- ment plan as a second procedure. This will give the hospital staff adequate time to explain to the client the treatment plan, including giving educational information on the diagnosis, reviewing radiographic findings, and going over costs. Other
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