When to refer?

When to refer?

There are multiple reasons to consider referring a patient to a veterinary dental specialist. Factors to consider when deciding on when to recommend a referral include the patient's problem, the primary veterinarian's level of expertise, available equipment, and the individual client and their expectations regarding patient care.

Some pet owners will have an expectation to be referred to a specialist for any problem other than the very basic, and they are pleased that in addition to the general practitioner, their pet also sees specialists.

The American Veterinary Dental College (AVDC) is the dental specialty group recognized by the American Veterinary Medical Association (AVMA) and the American Board of Veterinary Specialists (ABVS). Specialists of the AVDC who accept referrals can be located by logging on to the AVDC Web site ( http://www.AVDC.org/). There may be other veterinarians in your area that accept dental referrals. These might include members of the Academy of Veterinary Dentistry (AVD) or veterinarians with a special interest in veterinary dentistry. Human dentists also may work under the direct supervision of a veterinarian to provide veterinary dental care. When offering a referral, the client should be advised whether they are being referred to a veterinary dental specialist (AVDC), a veterinarian with special interest in dentistry or a human dentist.

Many veterinarians have received inadequate dental training. Unfortunately, new graduates often are lacking even the basic level of training in veterinary dentistry. The range of dental procedures available today in veterinary medicine is very broad. Clients often have a high expectation regarding the care of their pets, and this extends to dental care.

Specialists in veterinary dentistry can be a great resource for the general practitioner. They may allow the general practitioner to offer their clients diagnostic procedures, advanced dental procedures and expertise that they cannot provide themselves.

Clients generally appreciate that they are given these options regardless of whether or not they actually accept the referral.

What are the reasons to refer a patient to a veterinary dental specialist?

There are several reasons for referral, and they may be as simple as needing a second opinion or as straight forward as recommending a procedure that you do not perform, such as a root-canal treatment.

Table 1: Reasons to refer to a dental specialist
Veterinary dental specialists generally are equipped and trained to diagnose and manage any problem with the dentition or oral cavity. If in doubt, call and discuss the case prior to recommending the referral. Common reasons for referring are listed in Table 1.

A common reason for referring a dental patient is when the general veterinarian does not have a dental X-ray unit, and a dental radiograph is indicated. When the general veterinarian does have the ability to take the dental radiographs, this also tends to increase the referrals because disease is identified on the radiograph that required additional evaluation and or treatment.

•Dental procedures Endodontic procedures are a large part of most veterinary dental specialty practices. Most general practitioners either do not know how to perform root canals or do not do them frequently enough to maintain proficiency. Therefore, referral to a dental specialist is an option available for owners that would rather have a tooth saved with a root-canal procedure rather than having it extracted.

Patients may be referred for difficult dental extractions of multi-rooted teeth, mandibular canines or retained roots. Small-breed dogs with severe periodontal disease may be referred for extractions because the general practitioner is concerned about the possibility of a fracture occurring during the extraction procedure.

Referral for extraction of all premolars and molars in a cat with severe ulceroproliferative stomatitis is frequently done. This can be a difficult procedure, and it is critical to extract all the tooth roots.

•Fracture repair Veterinary dental specialists can manage patients with maxillary and mandibular fractures. When stabilizing these fractures, it is important to avoid damaging the teeth with the fixation. Teeth may have been damaged when the fracture occurred, and it is important to address this as part of the overall case management. A veterinary dental specialist is the ideal resource to help manage many of these patients.

Dr. DeBowes co-owns the Shoreline Veterinary Dental Clinic in Seattle, Wash. She also owns the Veterinary Dental Referral Service of Puget Sound in Tacoma, Wash. She received the Nordan Teaching Award while at Kansas State University and received the outstanding dental resident award from the AVDC. DeBowes served on AVDC's board of directors as well as its credentials and examination committees.