Thoughtful scheduling and effective communication optimizes patient care. As a small animal practitioner, your time is scheduled
for medicine, surgery, client consultation and dental procedures. The area of greatest difficulty in scheduling typically
involves dental procedures.
I strongly encourage staff training to optimize scheduling. Comprehensive dental care is challenging to schedule due to the
variability of dental pathology encountered. A well-planned schedule allows adequate time to provide optimal patient care.
You can complete necessary procedures during a single anesthesia period and minimize complication by operating meticulously,
without being "rushed". I also recommend that you have a realistic view of your procedural efficiency and level of skill.
Do you have experience performing dental extractions? Are you prepared for complications, such as tooth fracture, jaw fracture
or excessive hemorrhage? Is your dental operatory sufficiently equipped? Your staff needs to understand the nature and potential
complexity of dental cases. The older cat presenting with a history of "pawing at the face" and no previous dental prophylaxis
can be a very time consuming case. Do not over schedule oral surgery procedures if you hope to enjoy your day!
Effective client communication is essential in obtaining informed consent, and it minimizes risk of conflict or unhappiness.
You must provide treatment options, cost estimates and potential risks before proceeding into dental procedures. Clients appreciate
having options and involvement in deciding how to proceed in their pets' care. They particularly appreciate your caring attitude
in referral to a specialist to save teeth. Strategic teeth, such as the canines and the carnassials (upper fourth premolar
and lower molars) are especially important for function and should be saved if possible.
Photo 1: Severe periodontal disease is the most common indication for extractions.
Clients are very concerned about how oral surgery will affect their pet. They want to know how much pain their companion will
experience, how their pet will eat and what he can eat. You will prove to the client you care by discussing these issues in
treatment planning (pre-anesthesia exam), during the surgery (on the cell phone) and after the procedure. Effective communication
creates "a win- win-win experience" for the patient, client and veterinarian.
Photo 2: Fractured teeth are sometimes too severe to repair.
1. Indications for extractions There are many indications for dental extractions. The most common indication is severe periodontal disease (Photo 1).i These teeth may be mobile, are often painful and tend to be less difficult to extract. Your client needs to understand that
these teeth are a detriment to their pet, and extraction will eliminate pain and chronic bacterial infection. Additional
indications for extraction include teeth that are fractured (Photo 2), discolored, non-vital, in a fracture lineii, retained decidous or supernumary and for interceptive orthodontics (Photo 3), traumatic occlusion, dentigerous cysts and
other dental pathology (internal or external resorption, or retained root fragments).
Photo 3: Interceptive orthodontics may require extractions.
2. The operatory should include a high-speed dental unit and intraoral radiography. The dental operatory should be well organized and preferably isolated from distracting activities (such as the general treatment
area). This allows the opportunity to focus on the dental procedure. A dental unit should include high and low-speed handpieces
with an air-water syringe for irrigation.
The operatory should also include a dental radiograph machine (Photo 4). Survey skull (screened) films rarely are diagnostic
for veterinary dentistry. I take intraoral radiographs before starting all dental extraction procedures. These radiographs
are non-screened and of higher detail. They are useful for diagnosis, treatment planning, intra-operative orientation and
to document completion of the procedure. Intraoral radiographs are particularly valuable for evaluation of the root anatomy.
Curved (dilacerated), ankylosed, supernumary, fractured, retained root tips and other root anomalies may create tremendous
difficulty and surgical complication, without radiographs. Radiographs exponentially improve your efficiency and effectiveness
in dental extraction procedures!
Photo 4: Dental radiographs key to understanding root anatomy prior to an extraction.