Dentistry - especially feline

Re: Dentistry - especially feline

Evelyn Barbour-Hill — Thu, 26 Mar 2015 16:55:50 GMT

[quote user="Anthony Todd"]My point is that just because there is a root fragment apparent on Xray does not mean it has, is or will cause the animal any discomfit or problem and that removal may cause more pain and discomfit than leaving it in situ.[/quote]

Who is arguing with that? What of it?

It's irrelevant to this:

[quote user="Rob Davis"] I did say that I think it's impossible to do a THOROUGH job without radiography.[/quote]

which is exactly true.

If you'll excuse me now, I have to get my airpump mended in case I get another milk fever tomorrow, otherwise I might have to resort to that calcium injection thing.

Re: Dentistry - especially feline

Anthony Todd — Thu, 26 Mar 2015 16:48:59 GMT

[quote user="Rob Davis"]Some root fragments will be detectable without radiography, but some won't.[/quote]

True.

My point is that just because there is a root fragment apparent on Xray does not mean it has, is or will cause the animal any discomfit or problem and that removal may cause more pain and discomfit than leaving it in situ.

It is not that leaving root fragments is desirable or a good idea.

My experience would be that root fragments much below the gum margin didn't cause the animal any problem if there was no overt signs in the mouth and my personal experience is that gross pathology on Xray, if symptom free, can be left well alone.

Re: Dentistry - especially feline

Rob Davis — Thu, 26 Mar 2015 16:19:40 GMT

[quote user="Anthony Todd"]To say that it is not possible to find root fragments and perform dental procedures without intra oral Xrays is not my and other dinovets experience.[/quote]

I'm not aware that anyone has said that. I did say that I think it's impossible to do a THOROUGH job without radiography. Some root fragments will be detectable without radiography, but some won't.

Re: Dentistry - especially feline

Anthony Todd — Thu, 26 Mar 2015 16:03:41 GMT

[quote user="Rob Davis"]We've been here before, Anthony[/quote]

[quote user="Rob Davis"]

[quote user="Evelyn Barbour-Hill"]

[quote user="Anthony Todd"]

[quote user="stuart mcmorrow"]Without doing dental radiography are we leaving ourselves open to being sued and more importantly not doing a good enough job for our patients and leaving them with chronic pain?[/quote]

Then you do the Xrays or just have look...... usually it's very obvious, even without an Xray.

[/quote]

No it isn't.

[/quote]

We've been here before, Anthony, so I'm not going to repeat myself - see previous discussions! http://www.vetsurgeon.org/forums/p/20923/126076.aspx#126076

[/quote]

Yes we have; but I replied, which you didn't include......

As I said then and again dental Xrays are a nice addition when there is a dental problem and I would have used them if they had been widely available.

To say that it is not possible to find root fragments and perform dental procedures without intra oral Xrays is not my and other dinovets experience.

Re: Dentistry - especially feline

Rob Davis — Thu, 26 Mar 2015 10:36:19 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Anthony Todd"]

Then you do the Xrays or just have look...... usually it's very obvious, even without an Xray.

[/quote]

No it isn't.

[/quote]

We've been here before, Anthony, so I'm not going to repeat myself - see previous discussions! http://www.vetsurgeon.org/forums/p/20923/126076.aspx#126076

Re: Dentistry - especially feline

Anthony Dennison — Thu, 26 Mar 2015 09:41:27 GMT

[quote user="Martin Atkinson"]PS I already achieved more than my required 35 hrs CPD this year excluding any self-directed learning or article writing. Anyone else achieved that yet?[/quote]

Yup. But only because I finished a CertAVP module in February which counts for 100 hours.

Re: Dentistry - especially feline

Bob Russell — Thu, 26 Mar 2015 09:33:02 GMT

[quote user="Anthony Todd"]

Then you do the Xrays or just have look...... usually it's very obvious, even without an Xray.

[/quote]

PS but only if there is some pain or other sign of discomfit. As I said, rely on the patient, not the Xray.

[/quote]

Nonsense!

Early resorptive lesions don't show up without X-rays. Retained roots don't either. It is better to have the whole picture. Once you routinely have X-rays at your fingertips, I doubt you would want to go back to dentistry without.

X-rays are a brilliant education tool for owners as well. It is a good way of explaining why there should be no such thing as a £70 dental!

Re: Dentistry - especially feline

Stephen Courtney — Thu, 26 Mar 2015 07:39:19 GMT

Cripes, sorry, Stephen, you've misunderstood and I should have foreseen that. I was not directing these comments at you nor attacking you. The quote was merely the hook upon which I hung my comments, much as if I were speaking after you in a discussion. I'm well aware that yours is a practice where dentistry is done right. "You" did not mean you personally.

Maybe my comments were grumpy but I won't retract a single one. Sometimes I hate this "dental" monster which I may even have helped, inadvertently, to create.

---------------------------

OK thanks for clearing that up - it read as though i was personally responsible for irritating you.... now I feel better, thanks!

Given that I wholeheartedly agree with you, I was a bit taken aback.

Re: Dentistry - especially feline

Suzanne Kelly — Thu, 26 Mar 2015 00:54:32 GMT

Our dental x-ray generator broke a few weeks back. I phoned the owners and gave them their options - proceed without x-rays or postpone until the machine was fixed. They all chose to postpone. Just as well, one of the dogs was a terrier that I was half thinking of chancing it without x-rays - turned out to have a mouth full of CORLs. I'd have made a mess of his mouth without radiographs. We have our machine for 3 years, which means I spent 17 years in blissful ignorance thinking I was doing a perfectly adequate job at "dentals". I wasn't, I feel bad. Animals don't express dental pain the way we expect them to, "he seems fine" is not the same as "he's pain free".

From a personal point of view I'm rubbish at bisecting angles, it sometimes takes me a few goes to get good maxillary teeth pics so I'd lose the will to live with film.

Re: Dentistry - especially feline

Evelyn Barbour-Hill — Thu, 26 Mar 2015 00:02:20 GMT

[quote user="Anthony Todd"]

Then you do the Xrays or just have look...... usually it's very obvious, even without an Xray.

[/quote]

No it isn't.

Re: Dentistry - especially feline

Evelyn Barbour-Hill — Wed, 25 Mar 2015 23:59:59 GMT

[quote user="Stephen Courtney"]

[quote user="Evelyn Barbour-Hill"]

[quote user="Stephen Courtney"]as for vets, the biggest cause of frustration at 'dentals' is poor equipment[/quote]

So get better equipment before you do another "dental".

[quote user="Stephen Courtney"] We believe that small animal dentistry is one of the last real welfare areas[/quote]

Every vet and his mother is apparently "doing dentistry" to small animals these days (kudos to the BVDA and to such people as Colin Harvey). Unfortunately many of them are doing it very badly, yarking the bad 'uns and doing a purely cosmetic bit to the rest, boasting about their "state-of-the-art" dental equipment to the public (it means they have a bog-standard airdriven unit), talking of dentistry as a "revenue stream", persuading the gullible public into a need for the "annual dental", happy in their ignorance as they milk the cash cow.

[/quote]

Please explain why you quoted me in this way - it seems you are having a go at me personally and i don't understand why. My comments were in support of improved standards of dentistry, which i would have thought you would approve of.

Our practice has excellent dental facilities and equipment and has provided excellent training for the vets who perform dental procedures. We also have a visiting veterinary dentist. What on earth led you to make these comments and apparently direct them at me?

[/quote]

Maybe my comments were grumpy but I won't retract a single one. Sometimes I hate this "dental" monster which I may even have helped, inadvertently, to create.

Re: Dentistry - especially feline

Stephen Courtney — Wed, 25 Mar 2015 21:48:24 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Stephen Courtney"]as for vets, the biggest cause of frustration at 'dentals' is poor equipment[/quote]

So get better equipment before you do another "dental".

[quote user="Stephen Courtney"] We believe that small animal dentistry is one of the last real welfare areas[/quote]

[/quote]

Re: Dentistry - especially feline

Nicola Lawlor — Wed, 25 Mar 2015 21:42:38 GMT

I wouldn't go back to not having dental xrays now I have used them. Today I could have spent a silly amount of time looking for roots on two diseased teeth in a cat. Without the xrays I had no idea about the health of the roots, but xrays clearly demonstrated type II lesions, clearly resorbing roots and therefore crown amputation quick, easy and the correct way to deal with the issues. If I had gone looking for roots I would have eventually realised I guess that they weren't there, but I would also have caused more oral trauma to the patient in the process.

People are used to having dental xrays taken, I have very little resistance from people about paying for their pets dental xrays when it is explained properly to them. Dental work is a necessary procedure in many patients and where owners are properly informed about the work to be undertaken and the efforts and methods involved they start to understand why these procedures are seemingly costly. Compare the costs of our work with an equivalent in a human dental clinic and it actually becomes more than good value for money.

Re: Dentistry - especially feline

Anthony Todd — Wed, 25 Mar 2015 19:57:13 GMT

[quote user="Anthony Todd"]

Then you do the Xrays or just have look...... usually it's very obvious, even without an Xray.

[/quote]

PS but only if there is some pain or other sign of discomfit. As I said, rely on the patient, not the Xray.

Re: Dentistry - especially feline

Anthony Todd — Wed, 25 Mar 2015 19:54:36 GMT

Then you do the Xrays or just have look...... usually it's very obvious, even without an Xray.

Re: Dentistry - especially feline

Martin Atkinson — Wed, 25 Mar 2015 19:10:38 GMT

[quote user="Thomas Johnson"]or 'a steroid'?[/quote]Not quite there yet fortunately!

Re: Dentistry - especially feline

Evelyn Barbour-Hill — Wed, 25 Mar 2015 18:42:58 GMT

[quote user="Stephen Courtney"]as for vets, the biggest cause of frustration at 'dentals' is poor equipment[/quote]

So get better equipment before you do another "dental".

[quote user="Stephen Courtney"] We believe that small animal dentistry is one of the last real welfare areas[/quote]

Re: Dentistry - especially feline

Evelyn Barbour-Hill — Wed, 25 Mar 2015 18:33:20 GMT

[quote user="Anthony Todd"]

My lower incisor was root canaled then crowned. A subsequent Xray [whole of mouth, very impressive and expensive but "routine"] showed a large radiolucent area under the root tip, totally symptomless. Dire mentions of apicectomy or worse etc. etc but 20 years later still no symptom.

A crowned molar with a retaining peg penetrating the lateral root wall, again dire predictions, but apart from a reducing swelling over the years no signs.

[/quote]

So lucky you. At least the dentist and you knew after Xrays what was going on inside you and could treat or monitor appropriately.

[quote user="Anthony Todd"]I have to say sometimes dental Xrays will be another example of reading a test rather than reading the signs[/quote]

No, it's gaining valuable – possibly essential – further information.

[quote user="Anthony Todd"] to pursue a root fragment with no signs or symptoms just because it is visible on Xray,[/quote]

Who is suggesting that? Nobody is suggesting that.

Sigh.......

Re: Dentistry - especially feline

Thomas Johnson — Wed, 25 Mar 2015 17:36:26 GMT

[quote user="Martin Atkinson"]

[quote user="Anthony Todd"]Agreeing with MA, crikey, he must be getting old[/quote]I was about to say the say the same thing, maybe I've stopped evolving and the asteroid is about to strike.

[/quote]

'asteroid' or 'a steroid'?

Re: Dentistry - especially feline

Martin Atkinson — Wed, 25 Mar 2015 17:26:38 GMT

[quote user="David Mills"]No. I have a life.[/quote]Ah...but two weeks worth of the qualifying days were on overseas conferences in ski resorts so my retort is...get a life!!

Re: Dentistry - especially feline

David Mills — Wed, 25 Mar 2015 17:15:50 GMT

[quote user="Martin Atkinson"]PS I already achieved more than my required 35 hrs CPD this year excluding any self-directed learning or article writing. Anyone else achieved that yet?[/quote]

No. I have a life.

Re: Dentistry - especially feline

Martin Atkinson — Wed, 25 Mar 2015 17:12:58 GMT

[quote user="Anthony Todd"]Agreeing with MA, crikey, he must be getting old[/quote]I was about to say the say the same thing, maybe I've stopped evolving and the asteroid is about to strike.

PS I already achieved more than my required 35 hrs CPD this year excluding any self-directed learning or article writing. Anyone else achieved that yet?

Re: Dentistry - especially feline

Anthony Todd — Wed, 25 Mar 2015 17:00:50 GMT

[quote user="Martin Atkinson"]No doubt radiography is a good idea[/quote]

to which I would add "if there is a problem" and I'll give two very personal examples.

A crowned molar with a retaining peg penetrating the lateral root wall, again dire predictions, but apart from a reducing swelling over the years no signs.

I have to say sometimes dental Xrays will be another example of reading a test rather than reading the signs and is also seen with the modern practice of treating a blood value rather than the cause of the abnormal value.

Sure, if there's a mouth problem an Xray is, I'd say, a real help, but it is easier to look at the root to see if it is complete rather than an Xray to determine the same thing.

I was always surprised to see just how symptomless retained roots usually were even when there was a whole row of them at gum level, not that I suggest that is a good practice, but I really question whether it is fair on the animal or client to pursue a root fragment with no signs or symptoms just because it is visible on Xray,

Agreeing with MA, crikey, he must be getting old.....

Re: Dentistry - especially feline

Stephen Courtney — Wed, 25 Mar 2015 16:03:29 GMT

BSVA Congress Programme Committee are increasing the amount of dental lectures at Congress. There is some really good stuff including 2 lectures on dental radiography in the pipeline for 2016, and there is some stuff this year as well. We believe that small animal dentistry is one of the last real welfare areas for otherwise well-cared for pets.

as for vets, the biggest cause of frustration at 'dentals' is poor equipment - which translates to a poor standard of dental welfare in our patients. there is a learning curve here for vets but also for owners. Personally i feel the best thing is to make prophylactic dentistry more affordable, and extractive 'toothanasia' type work as expensive as any other kind of surgery is.

The BVDA training courses are excellent and real value for money - mine was an eye opener - and was a game changer for me.

As an aside, we do have digital dental radiography at 4 sites - it doesn't cost all that much and the costs are quickly recouped, and the benefits of knowing where the roots go make extractions a lot easier. Especially once you have been taught to do proper surgical extractions.

i do struggle with getting good pictures though, especially caudal teeth in small mouths like cats. It takes practice, and to be honest if I was faffing about with wet chemistry I'd probably end up shooting myself....

Re: Dentistry - especially feline

Evelyn Barbour-Hill — Wed, 25 Mar 2015 15:07:21 GMT

[quote user="stuart mcmorrow"]

I know we should all be doing this but have never seen this been done anywhere I have worked or seen practice.

[/quote]

I was about to give you a but really I'm not surprised. There's a great deal of dentistry being done in practices these days and a lot of it is probably still b. awful. Yark out the horrible ones and do a cosmetic scale of the rest, here you are Mrs. Bloggs he'll be fine till his next "annual dental" is due. Ka-ching!!!

Possibly.

Wot Rob and Bob () said.

Get a textbook and some dental film or sensors and start radiographing. You can do this if you have to with the main practice generator and dental films processed in jamjars. A dental Xray generator makes life much easier, as does a digital system: either a dental DR or a CR system that will accept dental sizes.

Keep an eye on both BVDA (www.bvda.co.uk) and BSAVA for courses.

Also I may have mentioned before that there is this really cool guy in North Wales who will come to your practice and instruct you on your own equipment.