The Veterinary Dental Patient: A Multidisciplinary Approach. Группа авторов

      Almost every veterinary practice will claim, “We Do Dentistry” or “We Descale Teeth”, but the overall quality of service is poor. Students lack dental education, and as graduates and young veterinarians they go on to neglect dentistry. More is needed than just a book, but we can at least point out herein what we expect from universities.

      Pet owners accept the presence of human dentistry as a separate medical discipline, but for some reason they treat veterinary dentistry as a cosmetic addendum to veterinary services.

      There is one thing worse than neglecting dental problems: performing poor dentistry. Thus the aim of this book is thus to present the standards of good dentistry in the most common applications. We hope to remind you that every patient is a dental patient, and to offer advice on how to properly manage them. You should maintain an appropriate attitude toward dental and oral problems in dogs and cats. We offer an interdisciplinary approach to the dental patient, providing perspectives from such disciplines as oncology, cardiology, anesthesiology, and radiology.

      In order for our profession to continue to improve in protecting and improving the oral and general health of our patients, I believe two things are required. First, clinicians in general practice need to ensure that they have adequate training and are suitably equipped with dental diagnostic tools, from periodontal probes to X‐ray machines. Second, and perhaps more importantly, the curriculum in our veterinary undergraduate programs needs to include practical training in dental and oral diagnostics.

      My professional experiences are different from those of most specialists. Over 60% of the dental patients I see come from education, promotion, and prophylaxis. The remainder come through referral. My perspective is thus non‐academic; I deal with patients at all different levels every day. I hope I may be of help to those in developing countries as well as to graduates and professionals in the developed world.

       Jerzy Gawor

      Acknowledgments

      The two things in life which give me the greatest pleasure are my family and my profession. Without the support and encouragement of the former, I would never have been able to achieve so much or have the motivation to go still further in the latter. Furthermore, the daily interaction I have with my clients and patients has given me tremendous job satisfaction and allowed me to become the man I am.

      I owe my patients a debt of gratitude which surpasses that due to my professional discipline of veterinary dentistry. I always strive to be a better veterinarian and dentist by putting my patients’ welfare first, and to this day, difficult cases teach me humility and challenge my skills. Throughout my career, I have become increasingly aware of the need for the entire practice team to focus on the requirements of the dental patient.

      Teaching is an important part of being a specialist, and writing this book as an educational tool has presented a unique set of challenges to myself and my associates. Special thanks go to Emilia Klim, my mentee who contributed to the selection and production of pictures; my friend Brook, who is always ready to share projects, challenges, and commitments; my wife Grażyna and our kids Jerzy, Antoni, and Mela; and my parents and brothers.

      Finally, to all my veterinary dental patients of all species, small and large, old and young: my heartfelt thanks.

       Jerzy Gawor

      About the Companion Website

      This book is accompanied by a companion website:

      www.wiley.com/go/gawor/veterinary‐dental‐patient

      The website includes:

       Further content on ‘Assisted feeding in dental patients’

      Scan this QR code to visit the companion website.

Part I General Considerations: How to Start Dentistry

1 Establishing a Dental Presence within a General Veterinary Practice

       Jerzy Gawor

       Veterinary Clinic Arka, Kraków, Poland

1.1 Introduction

      This chapter will cover the creation of a dental presence within a general practice. In addition, it will discuss how to create a business plan and how to design a consulting room and dental operatory. It will describe all the necessary equipment, instrumentation, and materials. Finally, it will cover the practical use of instruments.

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 small‐animal 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 28–62% (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 small‐animal dentistry: diagnostics, prophylactic procedures, and extractions. These also make up a significant part of the day‐to‐day 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 small‐animal patients require what is known by the general public as “dental” or “prophy.” The Veterinary Internet Network (VIN) refers to this instead as “comprehensive oral health assessment and treatment” (COHAT), which much better describes the essence of prophylactic procedure. According to American Veterinary Dental College (AVDC) nomenclature, the current preferred term is “professional dental cleaning”. This procedure will be detailed in Chapter 20.

      It is possible to perform professional dental cleanings within a general practice with a dedicated and well‐equipped dental room along with a skilled veterinarian and personnel. Considering the number of dental cases which may