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Common dental frustrations and how to overcome them – part one

Common dental frustrations and how to overcome them u2013 part one

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Common dental frustrations and how to overcome them – part one

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  1. Common dental frustrations and how to overcome them: The client coming to the clinic for something else Rachel Perry BSc, BVM&S, MANZCVS, Dipl.EVDC, MRCVS European Veterinary Specialist EBVS®, Dentistry RCVS Specialist, Veterinary Dentistry

  2. Prevalence of dental diseases

  3. Prevalence of dental diseases- cats • Periodontal disease is the most prevalent disorder of cats presented to primary care veterinary clinics in England O’Neill et al. The Vet Journal 2014; 202 (2): 286-291

  4. Prevalence of dental diseases- dogs • Periodontal disease is one of the most prevalent disorder of dogs presented to primary care veterinary clinics in England O’Neill et al. (2014) Prevalence of Disorders Recorded in Dogs Attending Primary-Care Veterinary Practices in England. PLOS ONE 9(3): e90501. https://doi.org/10.1371/journal.pone.0090501

  5. Prevalence of other dental diseases • Tooth resorption • Dogs up to 55% dogs Peralta et al. Am J Vet Res 2010;71:784–793 Peralta et al. Am J Vet Res 2010;71:794-798

  6. Tooth resorption- 7 types Internal Resorption External resorption Surface Replacement Inflammatory Peripheral inflammatory/cervical root surface • Surface • Replacement • Inflammatory Peralta et al. Am J Vet Res 2010;71:784–793 Peralta et al. Am J Vet Res 2010;71:794-798

  7. Tooth resorption- 7 types Internal Resorption External resorption Surface Replacement Inflammatory Peripheral inflammatory/cervical root surface • Surface • Replacement • Inflammatory All types identified in dogs except internal replacement Peralta et al. Am J Vet Res 2010;71:784–793 Peralta et al. Am J Vet Res 2010;71:794-798

  8. Prevalence of other dental diseases • Tooth resorption • Cats: up to 70% cats • Clinical appearance similar but dental radiography required to make a diagnosis and ensure correct treatment Lommer MJ & Verstraete FJM. J Am Vet Med Assoc2001; 218:2302-34 Girard N et al. J Vet Dent 2009; 26 (3): 147-155

  9. Tooth resorption- cats Internal Resorption External resorption Surface Replacement Inflammatory Peripheral inflammatory/cervical root surface • Surface • Replacement • Inflammatory Two main types identified in cats Peralta et al. Am J Vet Res 2010;71:784–793 Peralta et al. Am J Vet Res 2010;71:794-798

  10. Tooth resorption in cats External inflammatory External Replacement resorption Type 2 • Type 1 © AVDC ®, used with permission https://www.avdc.org/Nomenclature/Nomen-Teeth.html#resorption

  11. Tooth resorption in cats External inflammatory External Replacement resorption Type 2 Crown amputation may be appropriate • Type 1 • Full extraction required

  12. Fractured teeth- pulp exposure • Fractured teeth with pulp exposure are painful • Pulp becomes immediately infected and unlikely to survive • Can lead to years of chronic pain

  13. Fractured teeth- no pulp exposure • Fractured teeth without pulp exposure can still be painful and lead to pulp infection via dentinal tubules • Can lead to years of chronic pain

  14. Worn teeth-can lead to pulp exposure • Inappropriate choice of toys/chews can lead to enamel and dentine loss, potentially exposing the pulp

  15. Malocclusions • Can lead to pain, oronasal fistulae, periodontal disease….

  16. All of these conditions can lead to pain • Detection of oral and dental pain in animals is hard • There cannot be any verbal description of symptoms • Animals rarely stop eating with oral/dental pain • If you recall a time you had a toothache, did you stop eating?

  17. Do clients know there is a dental problem? • Clients do not usually bring their pet in with a perceived dental problem • The pet is usually still eating and behaving ‘normally’ • Dental problems are therefore usually detected during the clinical examination (e.g. during vaccination or presentation for another problem)

  18. Is there time? Is there enough time during the vaccination consultation to discuss everything? • Vaccination protocol, anti-parasite programme, body weight, dental disease?

  19. Is it appropriate? Is is appropriate to discuss noted dental diseases if the client presented their pet for another health issue, such as a painful ear?

  20. Is it appropriate? The client is worried about the other problem

  21. Therefore.. • Discuss the presenting problem first and reassure the client • Identify the dental problem • Treat the presenting problem • Offer a FREE consultation to come back and discuss the dental problem in depth

  22. If client returns.. • Client is already motivated to take action • You have 10-15 minutes to discuss the dental problem in detail and make a strong recommendation for treatment • Book the pet in!

  23. If client doesn’t return.. • Nothing lost! • Potentially make a follow-up phone call in a week

  24. Summary • Dental diseases that cause pain are common in dogs and cats, but client rarely present their pet for this problem. • Address the client's primary concern and expectations, but do make time to follow up on the detected dental problem.

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