The Veterinary Dental Patient: A Multidisciplinary Approach. Группа авторов

the practice management software, upload photos and X‐rays, and help with the preparation of the discharge paperwork.

Postoperatively, the veterinary care assistant should ensure that the patient is cleaned and ready for discharge prior to release. The patient should be dry, their hair should be brushed, and any remnants of blood should be removed prior to their being presented to their owner. Taking a few extra minutes to perform these tasks can ensure the client feels that this was a pleasant and important procedure. The veterinary care assistant should also perform maintenance on the dental equipment, including cleaning and autoclaving the instruments, assessing the sharpness of the instruments, cleaning and preforming routine maintenance on the dental unit by releasing the pressure of the compressor, lubricating the handpieces, and preparing the operatory for the next patient (Figure 4.6).

4.5 Credentialed Veterinary Technicians/Nurses

      Credentialed veterinary technicians/nurses are essential member of the dental team, as pet advocates and client educators. They are often eager to be empowered, and dentistry is one of the areas of the veterinary practice where technicians/nurses can be fully utilized. It is important to remember that a credentialed technician/nurse can do everything but diagnose, perform surgery, prescribe drugs, and give a prognosis. Empowering a veterinary technician/nurse to become the dental go‐to at a practice allows for both professional growth and pride in their chosen profession, as well as increasing the practice's dental revenue. The dental technician/nurse will be the source for all things dental and have responsibility for the training of the entire staff so that everyone understands the importance of good oral health.

Every practice should have a veterinary technician/nurse whose main emphasis and training are in dentistry (Bellows 1999). The veterinarian is the only person who can make a diagnosis of disease, but a credentialed veterinary technician/nurse with training in dentistry can assist them by gathering an accurate history and recognizing abnormalities and pathology and bringing them to their attention.

Figure 4.6 Preparation of the operatory.

      This technician's responsibilities include:

       patient history gathering

       patient intake

       performing oral examination

       dental prophylaxis and cleaning procedures

       charting

       taking dental radiographs

       assisting in oral surgeries and other dental procedures

       recording information in the patient's medical record

       delivering postoperative instructions

       ensuring the dental operatory is stocked and the equipment is well maintained.

      They should also be allowed to thoroughly discuss home care, client education, and follow‐up visits with pet owners.

      4.5.1 History Gathering

      The veterinary technician/nurse can help the veterinarian gather the information needed to determine a treatment plan. The veterinarian will use a combination of education and observation, comparing abnormal findings with normals (Niemiec 2010). The veterinary technician/nurse has responsibility for gathering the relevant dental information and obtaining an accurate overall health history. This allows the veterinarian to enter the exam room with an understanding of the oral condition and overall health of the patient and to work with the technician and client to prepare the best treatment options for them.

      Some clients are educated and recognize that there is a problem with their pet's oral cavity, but the majority seem to be unaware when there may be a dental concern (Bellows 1999; Niemiec 2010; Perrone 2012). When a client suspects their pet has a problem, it is necessary to interview them to gather the needed information as well as to perform an oral exam of the pet. Veterinary professionals have to rely on information regarding the symptoms of the pet as it is provided by the owner (Perrone 2012). The most common symptom noticed by owners is malodor, but many owners (and veterinary professionals) think that halitosis is normal in pets. Occasionally, they may notice excessive salivation, inappetence, swelling, difficulty swallowing, or indications of oral pain or discomfort (Niemiec 2010; Perrone 2012). All these signs, along with the complete history including past oral examinations and treatments, diet, chewing habits, and home care, are pieces of a puzzle that must be put together (Perrone 2012).

      Most commonly, owners are unaware that there is any problem with their pet's mouth. Dental issues may instead be discovered during the oral portion of an examination. The client may have noticed a change but not thought it important. This is the perfect time for the veterinary technician/nurse to educate them on oral disease and its importance to an animal’s overall health, as well as the typical lack of clinical signs.

The past history of the patient is valuable information that can assist the veterinarian in determining the treatment plan (Bellows 1999). Having a complete history of past oral examinations, extractions, and treatments helps the veterinarian understand the patient's present oral condition and predict the outcome of any procedure. Age is not the most significant factor determining the stage of periodontal disease: frequency of dental cleaning is more important. For example, a seven‐year‐old Yorkshire terrier that has not had any previous oral examinations or treatments is likely to have severe oral disease, while a similar patient that has had annual dental cleanings may only have a mild form (Figure 4.7).

Figure 4.7 (a, b) Seven‐year‐old Yorkshire terrier that has received annual comprehensive oral health assessment and treatment (COHAT) all its life. (c, d) Seven‐year‐old Yorkshire terrier presenting for the first time.

The veterinary technician should ask many questions when interviewing the client about their pet's oral health. Open‐ended questions are best. If a client is not aware of any problems with their pet's oral cavity, they should be asked the following:

       “Tell me about any previous dental work?” The client should be allowed time to volunteer information. If they respond with, “Yes, they had two teeth extracted at my previous veterinarian,” more direct questions can be asked regarding the cause of the extractions, when the procedure was performed, and so on.

       “What are your pet’s chewing habits?” Some pets are very orally fixated, while others may not be chewers. Toys such as tennis balls, ice, cow hooves, pig ears, and hard nylon bones can cause serious trauma in the mouth (Bellows 1999). Clients may not realize the harm that could be caused by what they think is a great toy. This is an opportunity to educate them.

      If the client is aware of a dental problem, ask them when they first noticed it. Again, many owners think that bad breath is normal and are not aware that periodontal disease is likely responsible for the malodor (Lobprise and Wiggs 2000).

      The following questions should be asked in situations where the owner is concerned about a problem:

       “What are your pet’s eating habits?”

       “Does the patient seem to salivate excessively?”

       “Does