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Common dental frustrations and how to overcome them – part six

Common dental frustrations and how to overcome them u2013 part six

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Common dental frustrations and how to overcome them – part six

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  1. Common dental frustrations and how to overcome them: Clients that ‘get away with it’ Rachel Perry BSc, BVM&S, MANZCVS, Dipl.EVDC, MRCVS European Veterinary Specialist EBVS®, Dentistry RCVS Specialist, Veterinary Dentistry

  2. “..but they’re eating fine…” • Cats and dogs rarely stop eating with any dental diseases • The exceptions are those with an ulcerative component, such as chronic gingivostomatitis in cats when dysmasesis and dysphagia is often seen

  3. “..but they’re eating fine…” • Evolutionary pressure urges dogs to eat despite oral problems, so that they still receive food in a pack situation • If you’ve ever had toothache, you also probably didn’t stop eating- you may have avoided certain foods, or avoided chewing on the painful area

  4. Compare the inflammation Dermatitis Periodontitis Hidden from client’s view Hidden from veterinary view until examination under anaesthesia • Very obvious for client Credit: Dr Anita Patel BVM, DVD, FRCVS   RCVS recognised specialist in Veterinary Dermatology

  5. The surface area of inflammation with periodontitis • Has been shown to be the size of the palm of your hand • This would not be ignored anywhere else in the body Leira Y et al. Acta OdontologicaScandinavica 2018; 76 (3):195-198

  6. Explain the ability to eat is.. • No indicator of absence of pain • No indicator of overall health and wellbeing My cat with a fractured left maxillary canine tooth and pulp exposure. Still eating normally!

  7. Detection of oral pain • Signs can be very subtle • You must take a thorough history • You must perform a thorough oral and clinical examination

  8. History • What food is the animal eating? • What treats does it receive? • Any homecare performed? • Any changes in eating habits? • Dropping food? • Eating more slowly? • Chewing on one side of the mouth? • Avoiding certain toys? • Less playful? • “slowing up”

  9. The ‘retrospectograph’ • It is often only after a dental procedure that the the client will realise how ‘under the weather’ their pet has been. • They will often remark that they are like a puppy/kitten again, being more playful/keen on walks. • Keep these client testimonials, and display them in dental leaflets/waiting room noticeboards

  10. Physical examination: extra-oral • Full oral examination • Musculature • Symmetry • Lymph nodes • Salivary glands • Eyes/nose

  11. Physical examination: intra-oral • Full oral examination • Occlusion • Gingiva • Oral mucosa • Tongue • Hard palate • Tooth surfaces • TMJ movement • Dental deposits

  12. Physical examination • Don’t forget the rest of the body!

  13. Signs of possible oral pain • Any mucosal ulceration • Fractured teeth with pulp exposure • Worn teeth with pulp exposure • Discoloured teeth • Mobile teeth • Draining sinuses • Asymmetrical calculus

  14. Asymmetrical calculus • Suggest chewing preferentially on one side of the mouth • Show this to the client!

  15. Periodontal disease is an infectious disease • Many clients do not perceive periodontal disease as an infectious disease • Furthermore they do not understand the bacteria in the mouth can enter the bloodstream simply by daily chewing Paquette DW. J IntAcadPerio 2002; 4 (3): 101-109 Forner L. et al. J ClinPerio 2006; 33 (6): 401-407 Tomás I. et al. J ClinPerio 2012; 39 (3): 213-228

  16. Summary • Periodontal disease is largely hidden from view- the area of inflammation can be large and would not be ignored elsewhere in the body. • Pets rarely stop eating with periodontal disease or painful teeth. • A thorough history and physical examination can help us detect possible signs of oral pain. • Commercial information guides can help strengthen the recommendation for treatment.

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