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 smallâanimal 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 28â62% (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 smallâanimal dentistry: diagnostics, prophylactic procedures, and extractions. These also make up a significant part of the dayâtoâday 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 smallâanimal patients require what is known by the general public as âdentalâ or âprophy.â The Veterinary Internet Network (VIN) refers to this instead as âcomprehensive oral health assessment and treatmentâ (COHAT), which much better describes the essence of prophylactic procedure. According to American Veterinary Dental College (AVDC) nomenclature, the current preferred term is âprofessional dental cleaningâ. This procedure will be detailed in Chapter 20.
It is possible to perform professional dental cleanings within a general practice with a dedicated and wellâequipped dental room along with a skilled veterinarian and personnel. Considering the number of dental cases which may or should be performed daily in our practices, a dental Xâray, highâspeed dental unit, sonic or ultrasonic scaler, and polisher are at the top of the list of profitable equipment to obtain for a surgery, and the fastest to pay for themselves.
A clinic's investment plan and equipment selection should be the result of a thorough deliberation on what kind and range of dentistry it wants to offer. Most procedures belong to one of the three aforementioned groups, but the fundamental one is diagnostics. Without appropriate diagnostics, the number and degree of mistakes and the likelihood of malpractice become unacceptably large. Therefore, sufficient investment in diagnostic tools is very important. With improvement in skills and equipment, additional procedures can be performed; however, the majority of cases will still be part of the main three core ones.
The most critical diagnostic element of veterinary dentistry is radiography. One can obtain sufficiently good radiographs with conventional fullâbody XâRay when exposing intraoral films or plates. For many indications in dental and maxillofacial conditions, such a device is likewise useful. For intraoral exposures, dental radiology is more convenient and appropriate. Ideally, practices should have both modalities: dental and conventional fullâbody Xâray machines. The next thing to consider in diagnostic radiography is the selection of a system that will both provide the radiation (generator) and create the image. Analog dental films, which require a darkroom and chemicals, are slowly leaving the market, and being replaced by digital systems. There are numerous products available, and it is not easy to decide between them based exclusively on manufacturer information and advertising.
A professional dental cleaning includes a thorough examination in both the conscious and the sedated patient, radiography (preferably intraoral), a dental exam including periodontal probing and dental charting, supragingival and subgingival deposit removal with the use of mechanical scalers and hand instruments, polishing, and gingival sulcus lavage. An important part of...
