Veterinary dentistry and oral surgery for geriatric patients
Geriatric veterinary patients have a variety of health care needs. Topping the list is the need for thorough physical and oral examinations. These evaluations, along with a thorough history, help veterinarians recognize existing conditions and alert them to potential problems. These issues need to be diagnosed, prioritized, and addressed in a timely fashion in order to optimize patient comfort, safety, and overall quality of life.
Many older patients also have oral, dental, and periodontal problems. These problems are frequently painful and, in some cases, create problems with food prehension or mastication. Treating these problems can dramatically improve geriatric patients' quality of life, and the clinical data clearly illustrate the benefits dental and oral surgery can provide for these pets.
DiagnosisA problem-orientated approach to veterinary dentistry and oral medicine is helpful, especially in working with geriatric patients. Information from the signalment, history, physical exam, and a minimum database of blood work allows for problem identification. From there, fundamental diagnostic tests, such as dental radiography, and periodontal and dental probing, are used to refine the issue. While rhinoscopy can help access the respiratory tract for biopsy, advanced imaging techniques, particularly computed tomography (CT), and magnetic resonance imaging (MRI), can be especially helpful with diagnosis, establishing an accurate prognosis, and for treatment planning.
While the equipment needed for these procedures is not available to all veterinarians, clients often appreciate it when their veterinarians refer them to a facility where the tests are available. Diagnosis should precede treatment planning and definitive therapy.
Understanding the client's priorities is fundamental to treatment planning. For each problem, treatments should be developed with direct client consultation. Each potential diagnosis, the nature of any problems, all treatment options (with cost estimates), and prognosis are discussed. The impact of the problem, diagnostic procedures, and definitive treatments on the patient's quality of life, are generally important to clients. Elimination or minimization of pain is always prioritized.
The practice of treating the treatable focuses on prognosis with regard to geriatric patients. As an example, I frequently perform an incisional biopsy to establish the diagnosis of an oral mass. For malignant tumors, a CT scan is performed before definitive surgery to determine the extent of the tumor and whether the neoplasm is resectable.
Obtaining informed consent allows clear communication between the client and the operator. Risks associated with treatment plans and benefits for the patient are discussed.
*The following cases illustrate the benefits of treatment for senior dogs.