Dental after surgical procedure

RE: Dental after surgical procedure

Neil Wheadon — Sat, 19 Dec 2015 14:38:33 GMT

Interestingly I ended up doing a post op yesterday on a bitch that had been spayed and had had a dental, no extractions with a pretty dirty mouth.

I took the temperature and it was 103.5. The wound was OK. Talking to the vet who did it no antibiotics had been dispensed. Interesting and has altered my view slightly that it's OK to do together.

Neil

RE: Dental after surgical procedure

grumpyoldman — Mon, 14 Dec 2015 21:25:39 GMT

I think there is a certain amount of client expectation that the "minor" dental procedure can be performed as an add on , or at a lower net cost because the "main op" is paying for GA which may be covered by the insurance. Quite a few want you to indirectly burn the insurers for part of the dental costs. Maybe everyone should send off a blood culture 45 minutes post dental pre antibiotics just to see how many actually are bacteraemic ?

RE: Dental after surgical procedure

Catriona MacIntyre — Mon, 14 Dec 2015 20:23:16 GMT

I will often do a dental after a minor lump removal. Not generally after a spay unless pretty desperate.

Quite honestly, I don't want to be starting into charting, scale, polish, surgical extractions after an hour of soft tissue surgery, conscious that time is ticking away and I have another 2-3 soft tissue surgery cases to come afterwards. We don't have the room for separate dental theatre and operating theatre. I'd also prefer to concentrate properly on the dental work and do the best job I'm capable of rather than flinging it in as an extra when already under pressure.

RE: Dental after surgical procedure

Gillian Mostyn — Mon, 14 Dec 2015 19:54:22 GMT

THR - total hip replacement

RE: Dental after surgical procedure

Hannah Wynne Richards — Mon, 14 Dec 2015 19:48:04 GMT

What is THR?

Wynne

RE: Dental after surgical procedure

Kate Richardson — Mon, 14 Dec 2015 19:26:13 GMT

Happy to do dental work alongside other procedures but this [quote user="Clive Ansell"]Out of interest I wonder how many referral surgeons would happily do a quick dental at the same time as a total hip replacement, intra thoracic repair of a PSS or brain tumour removal.[/quote] is just a silly question. (and I'm surprised at you Clive)

Ultimately the client comes in for (usually) another problem eg a skin mass, that requires excision, dental disease noted on examination, conversation leads to decision to do both under the same GA. Owners priority is still the skin mass, as that's what they sought an opinion on. Animal's priority maybe the dental disease. Up to us to explain why. But no reason why both can't be treated under the same GA. And theoretically we cannot say the dental disease is more of a priority until we have histopath (if performed), but dental disease more likely to be causing pain and discomfort. Lumps often bother owner more than dog. So its a balance between pleasing the owner, educating them on dental disease, and treating the animal. I would usually perform the 'owner's' problem surgery first, in case of any problems with the GA (rare).

Surgeries such as THR etc are usually prolonged anyway and do not warrant the risk (however small it is) of extension of GA and infection (we cannot even do any dental work in the practice [and we have a separate room]when THRs are being performed). IMO, dental disease needs to be noted, (and any animal under a GA should IMO have a dental exam performed whilst unconscious- take advantage of it!) and owner advised of problems and treated at an appropriate time. They are usually coming back for post xrays or other follow up, assume brain tumour removal would have a follow up CT or similar? so potentially treat dental disease then if indicated? Animal's having advanced surgical procedures need to focus to be on that- would make it difficult monitoring post op if any problems to determine if due to the THR or the dental procedure eg not eating etc. Some common sense required

RE: Dental after surgical procedure

Clive Ansell — Mon, 14 Dec 2015 18:56:51 GMT

[quote user="Anthony Todd"]

[quote user="Clive Ansell"]you've not understood my posts.[/quote]

Snap! Sorry, I was saying, as nobody had reported any problems, ever, with any procedure, therefore there was no cut-off or limit at all.

[/quote]

Fair enough. Out of interest I wonder how many referral surgeons would happily do a quick dental at the same time as a total hip replacement, intra thoracic repair of a PSS or brain tumour removal.

RE: Dental after surgical procedure

Anthony Dennison — Mon, 14 Dec 2015 18:01:26 GMT

[quote user="Michael Woodhouse"]

[quote user="Anthony Dennison"]There was no significant difference in pain scores between the dogs observed in our study compared to the pain scores reported by other papers on midline incisions.[/quote]

I don't believe you can compare pain scores like that. So many variables. Now if you'd done half in India midline and half paramedian that would be different.

[/quote]

This was noted in the discussion, though I admit, it was more of a description and evaluation of the technique rather than a direct comparison.

RE: Dental after surgical procedure

Anthony Todd — Mon, 14 Dec 2015 17:30:56 GMT

[quote user="Clive Ansell"]you've not understood my posts.[/quote]

Snap! Sorry, I was saying, as nobody had reported any problems, ever, with any procedure, therefore there was no cut-off or limit at all.

RE: Dental after surgical procedure

Michael Woodhouse — Mon, 14 Dec 2015 17:23:18 GMT

I don't believe you can compare pain scores like that. So many variables. Now if you'd done half in India midline and half paramedian that would be different.

RE: Dental after surgical procedure

Anthony Dennison — Mon, 14 Dec 2015 16:11:37 GMT

[quote user="grumpyoldman"]I once did a series of 10 flank and 10 midline , same sutures ga ,analgesia etc. The nurses did post op pain scores and observations .They noticed all the flank dogs were much more interested in their wounds while in the cages. All had higher pain scores. The flank ops had no post op problems but generated more post op client enquiries and interaction, I think probably because they could see the wound more they worried about it more.[/quote]

Interesting. I co-authored a study from a neutering project in India where paramedian (not quite 'flank') bitch spays were the norm. There was no significant difference in pain scores between the dogs observed in our study compared to the pain scores reported by other papers on midline incisions.

RE: Dental after surgical procedure

Clive Ansell — Mon, 14 Dec 2015 13:56:38 GMT

[quote user="Anthony Todd"]

OK, last try, just turn it round.

I'll bet we've all done all sorts of "sterile" surgery in an animal with a grotty mouth with no problems yet we can't do a sterile op then cover it up and remove the grotty teeth, clean up the gums etc. etc.

[/quote]

you've not understood my posts. I was trying to say that I am now far more relaxed about it having never had or seen any problems.

I was just wondering where the cut off point is for doing a sterile procedure under the same ga as a dental? which procedures would or wouldn't you do?

RE: Dental after surgical procedure

Anthony Todd — Mon, 14 Dec 2015 11:22:09 GMT

[quote user="Clive Ansell"]Would you be happy [/quote]

OK, last try, just turn it round.

Got to be better, infection wise, than leaving it all to multiply.

And before you say "do the dental first", not wise to delay a smashed femur or a roaring pyo.....

And nobody has ever reported a problem!

I'll get my coat.

RE: Dental after surgical procedure

Clive Ansell — Mon, 14 Dec 2015 10:42:06 GMT

For all the folk happy to carry out "sterile" ops at the same time as dental work, what ops would you do and which would you not? where would the threshold be?

Would you be happy doing a cat spay, bitch spay, liver surgery, thoracic surgery, spinal surgery, THR surgery, brain surgery, limb amputation ??

RE: Dental after surgical procedure

Martin Atkinson — Mon, 14 Dec 2015 10:38:47 GMT

[quote user="grumpyoldman"] I had a problem with a shoulder impingement ( old skiing injury) which was noticeably uncomfortable without being restrictive [/quote]I hurt my shoulder 3 years ago snowboarding. At first I thought I'd fractured something but I could move it and it didn't go crunch so as I didn't want to waste snow time messing around at a doctor/hospital I left it. I've had two frozen shoulders which eventually got better by themselves despite the best efforts of physios so thought it would just get better by itself but it still hurts - maybe its time I got something done about it!!

Back to the OP. I wouldn't want to perform a dental procedure on an animal with fulminating pyorrhoea at the same time as open cavity or orthopaedic surgery but I don't see a basic dental scale and polish is an issue. However I would perform it first so any aerosol that got on the surgical site can be cleaned as would is prepared for surgery.

RE: Dental after surgical procedure

Clive Ansell — Mon, 14 Dec 2015 10:35:17 GMT

[quote user="Phil R."]

Ok , found it.....

https://www.vetsurgeon.org/uk/small_animal/f/161/t/17203.aspx

December 2013 ..... has anyone changed their opinion on this in the last 2 years?

[/quote]

Yes, I've relaxed my opinion somewhat.

I used to be fairly dogmatic and not be happy doing "clean" surgery at the same time as dental work, but after working in charity clinics, practices that do a lot of rescue centre work, and working with colleagues who do, and seeing no problems whatsoever I will now do dental work and some surgical procedures together.

I've got one this morning; 8 year old DSH cat with an eyelid mass that also needs dental scale and polish. Mass been present for > 1 year, and needed dental work > 2 years ago. In my opinion, it's best to get both done together as may never see cat again.

As Michael rightly states it would be good to see some good evidence or science one way or the other.

RE: Dental after surgical procedure

grumpyoldman — Mon, 14 Dec 2015 00:20:45 GMT

[quote user="Anthony Todd"]And I'll bet your sutures aren't too tight.....[/quote]

I don't think so now , but I thought I was possibly getting one a few months ago. I had a problem with a shoulder impingement ( old skiing injury) which was noticeably uncomfortable without being restrictive , I thought it was affecting the pull down on my second throw, I think you tend to go a bit faster when your uncomfortable. Since the IA injections its been fine again.

No problems with the BS either way , most holes are 15-20mm midline, about 7-10mm flank in a jrt, almost the same as a CS. 15-20mm which just gets my index finger in, hands like shovels, less cutting=less sewing.

RE: Dental after surgical procedure

Anthony Todd — Sun, 13 Dec 2015 22:39:50 GMT

[quote user="grumpyoldman"]The flank ops had no post op problems but generated more post op client enquiries and interaction[/quote]

I would accept that, but we were talking about "post-op problems" so you had none either way?

And I'll bet your sutures aren't too tight.....

RE: Dental after surgical procedure

Michael Woodhouse — Sun, 13 Dec 2015 22:39:17 GMT

Grumpy - also disturbing muscle tissue is more painful than linea alba. Never gone flank in a bitch for anything. Do cats flank, but can do it through a much smaller hole than midline and zero risk of evisceration.

RE: Dental after surgical procedure

grumpyoldman — Sun, 13 Dec 2015 22:34:11 GMT

[quote user="Anthony Todd"]Sorry, never, ever, if the sutures are placed correctly[/quote]

Not so sure about that , I often perform BS flank sometimes ex lap , c/sections particularly brachycephalics with respiratory compromise, older rescue bulldogs after multiple c/sections elsewhere before being disowned lots of midline scarring etc . I once did a series of 10 flank and 10 midline , same sutures ga ,analgesia etc. The nurses did post op pain scores and observations .They noticed all the flank dogs were much more interested in their wounds while in the cages. All had higher pain scores. The flank ops had no post op problems but generated more post op client enquiries and interaction, I think probably because they could see the wound more they worried about it more. Clients also preferred midline surgery ,because they prefer symmetry. So I only do flank when there is a good indication, and think that wound interference depends upon wound site all other things being equal.

RE: Dental after surgical procedure

Anthony Todd — Sun, 13 Dec 2015 22:21:02 GMT

[quote user="Michael Woodhouse"]It's fine. People claim it isn't. Many people do so without any problem. There is no evidence it does any harm.[/quote]

The question has come up before and as far as I know nobody has ever reported a single problem linked to this concurrent procedure.

And I've asked before and do so finally again.

Anybody? Ever?

Most of us get slammed when we make an unsubstantiated statement, yet the only "evidence" of the harm of this duality is a theoretical opinion supported by nothing at all except theory.

RE: Dental after surgical procedure

Michael Woodhouse — Sun, 13 Dec 2015 20:31:39 GMT

My opinion (thankfully) is exactly the same.

It's fine. People claim it isn't. Many people do so without any problem. There is no evidence it does any harm.

easy307 - how about grabbing the bull by the horns and making it practice policy to do clean surgery under the same GA as a dental. Audit the outcomes. Prove to the profession they are worrying over nothing. I dare you!! (I'd do it myself if we did lots of small animal work)

RE: Dental after surgical procedure

easy307 — Sun, 13 Dec 2015 12:09:44 GMT

Ok , found it.....

https://www.vetsurgeon.org/uk/small_animal/f/161/t/17203.aspx

December 2013 ..... has anyone changed their opinion on this in the last 2 years?

RE: Dental after surgical procedure

Neil Wheadon — Sun, 13 Dec 2015 11:53:34 GMT

Thanks mainly to Evelyn (and also because frankly most of us don't know enough about it) the search function will be full of dental questions, so don't worry. I liken CPD to throwing mud against a wall, you keep chucking stuff at it, hope some of it sticks, but if you leave it too long, it all drops off. Therefore repeating isn't so bad

Welcome

Neil (Sunday surgery, and more entertaining than vaccines and ears)

RE: Dental after surgical procedure

easy307 — Sun, 13 Dec 2015 11:47:54 GMT

Thanks Neil and others,

I couldn't find the previous thread.

Is there any evidence one way or the other, particularly to support the view of those reluctant to combine procedures?

I personally haven't perceived problems combining the two (20 years small animal practice).

Although I am open to change. I am also aware that we can fool ourselves ( read homeopathy).

It is good to get a better feel of what fellow first opinion practitioners are doing.

Sorry to repeat a previous thread, new to this forum.

Hello all