The Veterinary Dental Patient: A Multidisciplinary Approach. Группа авторов

the complications and limitations of nonanesthetic dental (NAD) procedures. They should emphasize that NADs do not allow for cleaning below the gumline, where disease can lead to destruction of the supporting tissues and bone, posing a risk of injury to both the pet and the individual performing the procedure. Complete oral exams and dental radiographs are not possible without general anesthesia (See more in Chapter 8 Section 8.12).

In many veterinary practices, the receptionist is responsible for scheduling appointments and procedures. Give them guidance on how to efficiently work with your schedule. If a patient has had a conscious oral examination, the anticipated level of disease should be recorded. This level will help the receptionist know the correct amount of time to allot for a future procedure.

Figure 4.1 The first impression when a client enters the clinic: North Downs Specialist Referrals reception desk.

      Source: Rachel Perry.

      The receptionist should be encouraged to watch a procedure from start to finish, in order that they understand the importance of proper dental care. Each step should be explained as you go. An option might be to perform the procedure on the receptionist's own pet and let them see the effect on its overall health. This will allow them to speak from personal experience as to the benefits of a comprehensive dental procedure.

      The receptionist is the bridge between the client and the rest of the veterinary team. They will often be the person who schedules a procedure, and likely the person who meets and receives the patient on the day. They should collect contact information from the client, provide them with an informed consent form and get their signature, reassure the client that their pet will be well cared for, and inform the client that the veterinarian will contact them once the oral exam and radiographs are complete with an updated treatment plan. If the client is not readily available by phone during the day, the receptionist should schedule a time for them to contact the practice for an update, and communicate this information to the dental team for proper scheduling.

      The receptionists should maintain a clean and pleasing waiting room; however, the current trend is to move the patient and client to an examination room as soon as possible. While the client waits, the receptionist should offer them reading material or videos covering the value of good oral home care options, the safety of anesthesia, periodontal and other common oral diseases, and – if appropriate – dental care for exotic pets.

      The receptionist can be also responsible for putting together estimates and collecting dental fees. This can be a positive experience for the client, and they may thank the team for an exceptional experience – or it can be a negative experience, if the client feels they have been overcharged or not kept informed of the cost of treatment. A positive outcome can be ensured by discussing financial concerns early on and revisiting the status of the case frequently. Ideally, the veterinarian or nurse will discuss the findings and review the dental radiographs and (hopefully) photographs with the client before billing them out. A positive, well‐informed, and educated receptionist can reassure the client over costs and explain any additional items should the client question them at discharge.

      The receptionist is also responsible for ensuring that all referral paperwork is complete and gets sent to the specialist in a timely manner. It is helpful to teach them how to send digital dental X‐rays and dental charts.

      Many practices are moving to online scheduling for appointments and procedures. The receptionist must be versed in the use of such systems, as well as any text messaging systems: calling or texting clients to remind them of their next appointment is also their responsibility.

4.3 Kennel Assistants

Many veterinary practices offer boarding services for their patients. It is important that kennel assistants be trained to examine patients' teeth when the client brings them in for boarding (Figure 4.2). They should show the client any calculus or red, swollen gums and ask if they would like their pet to have a more advanced oral examination and possible dental cleaning and treatment while they are boarding. They should also examine for damaged teeth upon intake, as this can avoid a complaint of teeth breaking during boarding, which is not an uncommon occurrence (Figure 4.3). The kennel staff should be empowered to discuss the importance of good oral home care with the client and offer to brush the pet's teeth or perform other home care while boarding. They can be taught to recognize basic pathology and bring it to the attention of the veterinarian. They can also inform the client if the type of treats or chews they have brought for their pet might cause dental injuries, and recommend safe, effective alternatives. These simple things can help emphasize the importance of oral care to the client.

4.4 Veterinary Care Assistants

      The veterinary care assistant plays a huge role in dentistry within the practice. Their work can be divided into three areas: preoperative, intraoperative, and postoperative.

Figure 4.2 The kennel assistant, a first‐line dental team member.

Figure 4.3 (a) This patient came to boarding with a fractured 304. (b) An uncomplicated crown fracture in 404 was identified on evaluation.

Preoperatively, the veterinary care assistant should be trained to ensure that the dental suite is cleaned, fully stocked, organized, and set up and ready for each patient. They should inform the veterinary nurse or practice manager when an instrument needs sharpening or replacement. In addition, they should pay attention to when ultrasonic tips or burs require replacement, as well as any supplies that need to be ordered. Finally, they should organize and pack the dental kits to optimize use for the veterinarian (Figure 4.4).

Figure 4.4 Veterinary care assistant packing a dental kit.

Figure 4.5 Four‐handed dentistry: examination and charting.

Intraoperatively, the veterinary care assistant serves as the technician/nurse's assistant in dental procedures by recording findings on the dental chart, helping with patient positioning, and assisting with pre‐ and postoperative dental photos and X‐rays. Four‐handed dentistry, in which two people work together to record findings on the dental chart and operate the dental software during X‐ray can decrease the procedure time and ensure a thorough dental examination and cleaning (Niemiec 2010) (Figure