Feline extraction advice

Re: Feline extraction advice

Anthony Todd — Mon, 07 Jul 2014 16:37:17 GMT

[quote user="Rob Davis"]I appologise, Anthony, I misunderstood![/quote]

No probs.

Mind you I used to do postop checks for someone else's op and all I'd have is "for/op", absolutely nothing else, even the fee was N/P [not paid, for the pedants].

That was a bit of a challenge!

Re: Feline extraction advice

Rob Davis — Mon, 07 Jul 2014 14:42:06 GMT

[quote user="Anthony Todd"]

[quote user="Rob Davis"]Actually we just entered "D/O"[/quote]

Oh for heavens sake, I'm talking about a generic term to distinguish it from a cat spay, aural resection, fractured tibia, constipation or a booster etc.

We used dental charts, made notes of what had been done, but even modvets can't do that until they do the job!

[/quote]

I appologise, Anthony, I misunderstood!

Re: Feline extraction advice

James Laidlaw — Thu, 03 Jul 2014 21:10:01 GMT

And some of them don't even write notes either!

Re: Feline extraction advice

Anthony Todd — Thu, 03 Jul 2014 20:23:49 GMT

[quote user="Rob Davis"]Actually we just entered "D/O"[/quote]

Oh for heavens sake, I'm talking about a generic term to distinguish it from a cat spay, aural resection, fractured tibia, constipation or a booster etc.

We used dental charts, made notes of what had been done, but even modvets can't do that until they do the job!

Re: Feline extraction advice

Rob Davis — Thu, 03 Jul 2014 19:23:59 GMT

[quote user="Anthony Todd"]

I'd be surprised if there was a vet, vet nurse, drug rep or person in the street who didn't know what "a dental" meant.

Actually we just entered "D/O"

What do others call it?

[/quote]

Writing "had dental" or similar in the notes and nothing else is equivalent to writing "had orthopaedic op" with no more details. I would hope that we are all better at writing notes than this!

Re: Feline extraction advice

James Laidlaw — Thu, 03 Jul 2014 14:15:14 GMT

Enthusiasm plays a massive part in educating and inspiring clients to accept a procedure or follow up at home. I have almost no interest in orthopedics or ophthalmology so often defer to others or a specialist for more major problems, but I have sparked an interest in dentistry and there are cases through the door EVERY DAY with problems that either haven't been identified or discussed or understood. It takes time to look, explain and educate that most people don't have time for. I've gone from a 20 min consult clinic to a 10 minute consult, but I'm not overly worried about running over provided I have given everyone due care and attention most clients are happy to wait a little or a lot on a bad day. If you can't care less about teeth, in my experience, you don't look, you don't discuss and you don't advise about dental care. Hard for a client to then be enthused about anaesthetic, investigation and treatment if the vet isn't really interested either, no?

Re: Feline extraction advice

Anthony Todd — Thu, 03 Jul 2014 14:14:17 GMT

You've got me, I surrender, fortunately I don't have to book anything in now so I can't mislabel anything.

Re: Feline extraction advice

Evelyn Barbour-Hill — Thu, 03 Jul 2014 13:12:23 GMT

[quote user="Anthony Todd"]

[quote user="Evelyn Barbour-Hill"]That depends on what you mean by a "dental",[/quote]

Another "come on", sorry.

I'd be surprised if there was a vet, vet nurse, drug rep or person in the street who didn't know what "a dental" meant.

Actually we just entered "D/O"

What do others call it?

[/quote]

What do others call what?

I'm sure every veterinary surgeon, veterinary nurse and veterinary drug company representative (or "territory manager" ) has a definition in their own mind for "a dental" – not so sure about MOP in the street – but it may not be the same as the next bloke's, or yours, and probably not the same as mine.

Call it what you like, what I'm after is what it consists of, in your eyes; what is it that you actually do?

Re: Feline extraction advice

Evelyn Barbour-Hill — Thu, 03 Jul 2014 10:38:58 GMT

[quote user="Anthony Todd"]My only anecdote is that owners, after a "mouth exam and attention [that OK?] often said the animal seemed brighter than for years etc. etc.[/quote]

Quite so. That's one of the ways by which I know I'm doing good by what I do now.

[quote user="Anthony Todd"]"mouth exam and attention [that OK?][/quote]

No. It depends on what attention.

[quote user="Anthony Todd"]Animals with grotty mouths seemed oblivious unless there was something very minor like a loose incisor.[/quote]

I'll let you off defining "grotty mouth". What's your point?

Re: Feline extraction advice

Kathryn Burton — Thu, 03 Jul 2014 10:11:44 GMT

I have some clients who are excellent with their pet's dental home care. I find comparing pets to us does help - we brush our teeth every day but still need regular attention from a professional... (cheesy, but seems to help explain dental care!)

Re: Feline extraction advice

Bob Russell — Thu, 03 Jul 2014 09:33:40 GMT

Human dentists have hygienists because they do a chunk of their job but a lot cheaper!

There will always be an element of fighting the £90 'dental'. The only way we can get round this is to demonstrate a higher standard of care. This needs to be seen by the owner and not just performed behind the scenes!

I do so called surgical extractions where it makes my life easier. 'Standard' extractions where it is easier.

We have just had Matthew Oxford (New Forest Dental Service) in to demonstrate/teach us to use the dental X-ray system that we have been half using for over a year. Now everyone understands the contortions as I work out bisecting angles and there is a fight to get to the X-ray system first!

I cringe to think of some dentals from the past!

Re: Feline extraction advice

Anthony Todd — Thu, 03 Jul 2014 09:22:12 GMT

[quote user="James Laidlaw"]Another point about in the past they did fine so we never done wrong.[/quote]

We kept statistics latterly.

Dental [or whatever name you call it] percentage per contact varied between vets by a factor of 10 ie some vets had 1% of contacts in for a "whatever I should call it" and the best was over 12%.....

My only anecdote is that owners, after a "mouth exam and attention [that OK?] often said the animal seemed brighter than for years etc. etc.

Animals with grotty mouths seemed oblivious unless there was something very minor like a loose incisor.

Re: Feline extraction advice

Anthony Todd — Thu, 03 Jul 2014 09:14:09 GMT

[quote user="Evelyn Barbour-Hill"]That depends on what you mean by a "dental",[/quote]

Another "come on", sorry.

I'd be surprised if there was a vet, vet nurse, drug rep or person in the street who didn't know what "a dental" meant.

Actually we just entered "D/O"

What do others call it?

Mind you one, of my colleagues used just to enter "for op" in the notes, nothing else, and when one had to do the post op check one had to decide quickly, as the beast came through the door, what "op." had been performed without the owner realising one had absolutely no idea!

I'd be interested to know what others think about "home oral hygiene". My impression was that not many owners could, or wanted, to persist.

Human dentists seem all to have an oral hygienist on site so if they can't get people to attend to their oral hygiene what chance have pet owners with a reluctant animal of any size.

I can't see pet owners being very successful. some owners, I'm sure, can manage it.

Re: Feline extraction advice

James Laidlaw — Wed, 02 Jul 2014 23:26:42 GMT

Another point about in the past they did fine so we never done wrong... How often do we all see horrific oral health and dental disease in animals that are just in for a booster and the owner is unaware of pain? Without too much detail, how do you follow up any post op pain if pre op, the owner notices nothing? I've seen many animals that other vets have figured are ok, possibly because they have never bothered to look closely for follow up...?

Re: Feline extraction advice

Evelyn Barbour-Hill — Wed, 02 Jul 2014 22:52:55 GMT

[quote user="K Burton"]I would think that in most cases the time until the next dental is related to the ongoing home care rather than the dental work itself?

[/quote]

That depends on what you mean by a "dental", but if you are talking about periodontal disease you have hit the nail on the head. Almost.

It depends upon the initial procedure as well. The purpose of the procedure is to get things set up so that the teeth and gums can then be maintained at home. We should not be looking forward to "the next dental" (unless it's a "revenue stream" of course ). If we could get everything right there would never be a "next dental" for that patient. Of course, we often can't get things absolutely right, and it's usually the home oral hygiene that fails, yes.

Re: Feline extraction advice

Evelyn Barbour-Hill — Wed, 02 Jul 2014 22:44:31 GMT

[quote user="Anthony Todd"]

Sorry, easier to copy and paste than to type it out.

malar abscess

abscessation at the root of the carnassial tooth (upper fourth premolar in dogs and upper third in cats)

Bit pedantic, I thought. Come on, you knew what I meant, and it's shorter than "carnassial"

[/quote]

Well, I guessed, but extraction of the upper 8 is not in my book a "malar extraction" even if the reason is that thing called a "malar abscess"...... which is I suppose a handy slang term now and then but is a misnomer: the abscess does not often involve the malar bone. And somtimes it's the 9 that's responsible, not the 8. But yes, they are very satisfactory things to treat by a straightforward competent simple extraction.

However, whatever you cut and pasted from is in error. The tooth commonly termed the upper carnassial (there is a lower one as well, I wonder if the author knew that?) is the fourth premolar in both dogs and cats.

While we are on corrections, I might note that it is merely slang which refers to the upper fourth premolar and the lower first molar as The Carnassial Teeth, presumably because of their size. All a cat's teeth distal to the 4s (the canines) are carnassial, and all a dog's teeth distal to the 4s along to the uppewr 8s and the lower 9s; but, strange you may feel, only the mesial half of the lower 9 is carnassial (even though this tooth is commonly termed "the carnassial") . Everything distal intercuspates (like human teeth) and is not carnassial.

[quote user="Anthony Todd"]

Yes, the "dentals" I've seen lately were just like mine, well not so good, 'cos the elevators were not the right size and there wasn't enough patient elevation.

[/quote]

Well yes, I'm sure there are lots of bad extractions being done, 'cos practice owners won't supply proper equipment and often put excessive pressure on junior veterinary surgeons with regard to time (it's gotta be a "profit centre", remember) ; possibly also still due to the lamentable lack of basic dentistry tuition in the schools, although that should be getting better all the time now. I'm sure all your extractions were exemplary, Anthony, just like mine (), and I guess you never attempted those for which periodontal surgery would be indicated.

[quote user="Anthony Todd"]Can anyone say that modvets' dentals last for X% longer before a repeat is necessary, theoretically, certainly but practically?[/quote]

It depends what you mean by "dentals", and before you say "come on, you know what I mean", I don't know what you mean, I really don't.

Re: Feline extraction advice

Kathryn Burton — Wed, 02 Jul 2014 21:50:10 GMT

I would think that in most cases the time until the next dental is related to the ongoing home care rather than the dental work itself?

Re: Feline extraction advice

Anthony Todd — Wed, 02 Jul 2014 21:36:35 GMT

[quote user="Evelyn Barbour-Hill"]Well, p'raps you only ever extracted teeth which had lost considerable periodontal attachment anyway.[/quote]

Well not a freshly fractured canine in an alsatian but sure, some were easier than others.

Sorry, easier to copy and paste than to type it out.

malar abscess

abscessation at the root of the carnassial tooth (upper fourth premolar in dogs and upper third in cats)

Bit pedantic, I thought. Come on, you knew what I meant, and it's shorter than "carnassial"

Yes, the "dentals" I've seen lately were just like mine, well not so good, 'cos the elevators were not the right size and there wasn't enough patient elevation.

And, very last try, if our dentals [I mean your early ones and dinovets every one] were. or are, so bad how do we know?

Repeat "dentals"? Early extractions? Mouth discomfit? What?

If a fracture repair isn't good the signs are there; animal with renal failure, signs are there, root left, usually animal notices, what are the signs in a "poor" "dental" and why doesn't the owner or the animal notice?

I really believe your "dentals" are so much better than mine were but I struggle to believe that the end result. ie the animal's comfort, oral health let alone pain or discomfort, are significantly better than a dinovet's "dental".

Can anyone say that modvets' dentals last for X% longer before a repeat is necessary, theoretically, certainly but practically?

Re: Feline extraction advice

Evelyn Barbour-Hill — Wed, 02 Jul 2014 19:18:52 GMT

[quote user="Anthony Todd"]All I was contending is that I ,and as far as I know, no other dinovet, ever needed to do an "open extraction, in fact I have never heard the term.[/quote]

Well, p'raps you only ever extracted teeth which had lost considerable periodontal attachment anyway.

[quote user="Anthony Todd"]The irony is that dinovets almost certainly have done more dentals anyway.[/quote]

Yeah, but what do you mean by "dentals".......

I've been doing dental procedures for 42 years. When i started out i'm sure I did what I would now consider lousy work, in the blissful knowledge that I was doing what was considered what you did. I rather fear that a lot of "dentals" done even today, generally the ones regarded as a "revenue stream" from the "profit centre" are to much the same standard.

I've given you some clues to indications for periodontal surgery. If you're not interested, leave it at that.

What's a malar extraction?

Re: Feline extraction advice

Anthony Todd — Wed, 02 Jul 2014 18:58:42 GMT

[quote user="Malcolm Ness"]The "get out" of there not being enough evidence is tiresome.[/quote]

Well just hold on for a moment.

This thread started with a question about suturing the gum in open extractions.

All I was contending is that I ,and as far as I know, no other dinovet, ever needed to do an "open extraction, in fact I have never heard the term.

An "extraction" was when you removed a tooth which is what we did.....

I went on to say that we [and I've spoke to another dinovet today], had no problems with ordinary careful elevation with or without an automatic mallet , which none of the modvets have used but dismiss rudely anyway.

The irony is that dinovets almost certainly have done more dentals anyway.

I'm still passionate about vet practice, embrace the new developments, introduced high speed drills and diamond discs to the modvets in my practice but, and I've watched a few, suggest that some modern methods sometimes have no advantage over the "dinosaurial" methods used by those of my generation.

They sure take longer, cost a load more and, reading the thread, seem not to be without problems.

As I said, I think there's loads of good evidence that modern cruciate repair is better than using skin as a ligament but I don't think there is any for turning a malar extraction into a major procedure, particularly in the absence of any evidence that there is the need for a better way.

Re: Feline extraction advice

Malcolm Ness — Wed, 02 Jul 2014 13:33:17 GMT

[quote user="Evelyn Barbour-Hill"]It's just a pity that an interesting discussion about certain points of technique should be taken over by someone who really has no interest in the matter and clearly does not understand what the discussion is about anyway, but wants to bang on about "the old ways" and complain there's no evidence for the assertion that the old ways were inferior when nobody is making that assertion. That's really going to encourage new forum members to read and participate.[/quote]

Agree completely.

The "get out" of there not being enough evidence is tiresome. There will never be enough evidence: we just have to work with what there is and add to it. I find it truly frustrating that at one extreme you get an "academic" quoting a paper and calling it evidence-based medicine and at the other extreme, a general practitioner pointing out the obvious fact that we don't know everything and then using that to justify their own, sometimes random acts.

Re: Feline extraction advice

Kathryn Burton — Wed, 02 Jul 2014 13:07:52 GMT

At a different branch today and found some (in date, don't worry!) 5-0 monocryl - so much better than caprosyn, thanks for that advice!

Re: Feline extraction advice

Evelyn Barbour-Hill — Wed, 02 Jul 2014 11:48:08 GMT

[quote user="Malcolm Ness"]

[quote user="Anthony Todd"]As often is the case there's really no comparative studies to show that the old ways weren't inferior, just forceful opinion and a belief that new is better.[/quote]

It's called, "Eminence-based medicine"

[/quote]

It's just a pity that an interesting discussion about certain points of technique should be taken over by someone who really has no interest in the matter and clearly does not understand what the discussion is about anyway, but wants to bang on about "the old ways" and complain there's no evidence for the assertion that the old ways were inferior when nobody is making that assertion. That's really going to encourage new forum members to read and participate.

I can't stop now, I've a milk fever to go to and I need to get a fresh teat adaptor for my bicycle pump.

Re: Feline extraction advice

Malcolm Ness — Wed, 02 Jul 2014 10:25:34 GMT

[quote user="Anthony Todd"]As often is the case there's really no comparative studies to show that the old ways weren't inferior, just forceful opinion and a belief that new is better.[/quote]

It's called, "Eminence-based medicine"

Re: Feline extraction advice

Anthony Todd — Tue, 01 Jul 2014 20:20:51 GMT

[quote user="K Burton"]When doing open extractions in cats I often struggle to suture them closed afterwards. I 'look after' my flap to avoid damage during the procedure, but often find it impossible to close as my needle cheese wires through the tissues on the lingual aspect of the tooth no matter how gentle I try to be. Any top tips on how to close more successfully?! Thanks 😃

[/quote]

This is where it started [I can find the beginning and even read it all].

And that is where I started too, so it really was all about the idea of suturing gums closed which dinovets never did, AFAIK and the results did not appear to be so bad.

Just sometimes dinovets did a simple procedure quite well.

As often is the case there's really no comparative studies to show that the old ways weren't inferior, just forceful opinion and a belief that new is better.

Always.