Concious dentals

Re: Concious dentals

Sarah Keir — Thu, 01 Dec 2011 16:39:34 GMT

[quote user="David Mills"]

Incidentally, has anyone had a rabbit survive where the caval blood vessels have been traumatised? We've had it happen a couple of times with particularly horrid mouths/molars and by the time it's packable the rabbit's pretty much gone (although neither have been tubed)

If so, how do you stop the haemorrhage? And does it recur once awake/eating again?

[/quote]

I've only had one (and that was a rabbit under GA) - cotton bud soaked in adrenaline, pressure for what seemed like an age (10 mins I guess), bleeding stopped and a few days later my blood pressure returned to normal.

I would never consider doing any work on a rabbits molars without heavy sedation/GA, for all the reasons covered above. But a new nurse started with us recently and when I asked her to set up for a rabbit dental she was very surprised that I was going to GA it - she used to work for a certain well know chain of countrywide vet practices, so I wasn't wholey surprised!

Sarah

Re: Concious dentals

Hannah Wynne Richards — Tue, 29 Nov 2011 09:59:02 GMT

Rabbit dentals are hard enough when you can see what you're doing,and the patient is still

Same reason I won't rasp a horses teeth without sedation and a head torch

Wynne

Re: Concious dentals

Ian Mostyn — Mon, 28 Nov 2011 22:41:42 GMT

I had it happen once but I managed to control the bleeding with a carefully placed cotton bud. It did require the use of topical phenol and plenty of pain relief to finally stop. Absolute nightmare but the rabbit did survive and is still well 2 years on.

Ian

Re: Concious dentals

David Mills — Mon, 28 Nov 2011 21:12:28 GMT

If so, how do you stop the haemorrhage? And does it recur once awake/eating again?

Re: Concious dentals

Evelyn Barbour-Hill — Mon, 28 Nov 2011 16:09:11 GMT

[quote user="Mark Rowland"]rumour that the latest Rabbit BSAVA manual is going to include some references in favour of concious rabbit molar dentals.[/quote]

Words fail me.

Re: Concious dentals

Mark Rowland — Mon, 28 Nov 2011 09:56:45 GMT

Hmmm sorry to bump this up but I heard a rumour that the latest Rabbit BSAVA manual is going to include some references in favour of concious rabbit molar dentals. I for one shall not be recommending it to anyone if this prooves to be the case.

Le sigh.

Re: Concious dentals

plantagenet — Mon, 15 Aug 2011 09:17:26 GMT

[quote user="Louise Alexander"] As for using them in feet pads, has any of you ever had a stone in your shoe?!! [/quote]

Sorry, dog's sound, walked out of the consult room sounder than it came in. Done it before after I saw the results by another vet. If it caused the dog pain and discomfort, I obviously wouldn't do it! It saved the owner a packet - and deprived me of one I suppose, but I'll live with that.

Re: Concious dentals

Mark Holmes — Fri, 12 Aug 2011 23:00:54 GMT

I would agree I LOVE staples. Use them almost routinely in non routine surgery and they DO work in "old" wounds. If you think about it, old woulds heal by contraction largely. Staples speed that process by approximating the edges and reducing the tissue deficit to fill with granulation tissue. They are almost completely non irritant and even if they are removed 3 weeks later there is no tissue reaction. I removed some recently that had been in place for > 12 months. Not sure I would put them in a pad though.

Re: Concious dentals

Edward Jones — Fri, 12 Aug 2011 22:26:10 GMT

[quote user="Louise Alexander"]Staples don't work in old wounds with healed edges[/quote]

Staples can work brilliantly to encourage a bit of second intention healing (old fashioned but modelled by thousands of years of evolution) in 'old' wounds.

Re: Concious dentals

Louise6732 — Fri, 12 Aug 2011 21:16:24 GMT

I think you misunderstand me, the colleague I'm referring to puts staples in the most inappropriate wounds without preparing the wound at all. I'm quite sure staples would work if you debrided old wounds with healed edges, but to do that you're likely to need sedation or GA, and if you've gone that far why not just suture?

I rarely use staples, because of the diasters I have seen with them. They certainly have their place, but not the way I've seen them used. As for using them in feet pads, has any of you ever had a stone in your shoe?!! Again colleague used staples on the foot pad of a dog, completely inappropriately I feel, and the dog was consequently non-weight bearing lame on that foot (until I took the staples out) wouldn't let anyone near it's feet again. Not ideal.

Re: Concious dentals

plantagenet — Fri, 12 Aug 2011 17:03:47 GMT

[quote user="Louise Alexander"]Staples - I hate them, unless the wound is very small and very fresh, I just don't use them. I've seen them used inappropriately all too often, much better job done by sedation+local or GA and DEBRIDE and suture. Staples don't work in old wounds with healed edges, as I've tried to tell some colleagues [/quote]

Staples are great in the right place, I have just stapled a very old pad wound in the surgery (after dressing has healed the crack) to prevent the gaping getting back to square 1, 2 clicks a slight jump from the dog and she wagged out of the consulting room. I'm affraid the client would not have paid for sedation and stitching and I've always had excellent results before.

Re: Concious dentals

Simon Neuhoff — Fri, 12 Aug 2011 13:21:28 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="robloxley"]How many people will happily lance the cat bite abscess, staple the clean skin laceration or whip off the dangling dew claw conscious, where sedation may be argued to be less stressful or achieve a neater quality result?[/quote]

Not me. I don't do them under sedation either. They get a quick GA.

The reason for sedating or anaesthetising rabbits to work on the cheek teeth is because you can't do a proper job without.

[/quote]

Completely agree.

For what its worth I do think burring rabbits incisors in less stressful and safer than trying to do the molar teeth consciously. Many tolerate it very well - I don't believe there is NO stress, but I don't fight with the rabbit, if it won't tolerate it happily then it gets a GA. If it needs repeated ga's for incisor burring then we consider incisor extraction.

Re: Concious dentals

Julian Earl — Fri, 12 Aug 2011 12:14:17 GMT

[quote user="Louise Alexander"]

[quote user="robloxley"]poke around with a metal otoscope speculum in a conscious rabbit,[/quote]

I think this is less stressful and less risk of trauma than rasping, I can't do much harm with an otoscope.

Staples - I hate them, unless the wound is very small and very fresh, I just don't use them. I've seen them used inappropriately all too often, much better job done by sedation+local or GA and DEBRIDE and suture. Staples don't work in old wounds with healed edges, as I've tried to tell some colleagues

Having attempted a dental in a rabbit masked (because I'm crap at tubing rabbits) when it started getting jaw tone/chewing reflex back, was very hard to get anything in the mouth and I was concerned I would cause damage if the gag was there and the rabbit was trying to close its mouth!

Louise

[/quote]

If we're worrying too much about stress then perhaps these animals shouldn't be coming to see us. The reality is that a certain amount of stress is inevitable and we are the best people to judge whether what we are doing is excessively stressful, i.e. potentially harmful, or just temporary stress that has no great significance.

Secondly, I for one am a fan of staples, wounds seem to heal quicker, although they can be tricky to remove sometimes. Re. healed edges, that's nothing to do with the pros and cons of staples, sutures won't heal those either. Having said that, I have seen a colleague "staple" a dog's pad with them and the staples obviously and clearly barely reached the dermis, if at all. Wonder why that didn't heal?

As someone who doesn't particularly want to inhale a lot of isoflurane, I would not try and do a dental under masked anaesthesia. Also, the stop-go nature of the work (yes, I have tried in the past) is a major hindrance to doing a decent job.

Re: Concious dentals

Mark Rowland — Fri, 12 Aug 2011 10:01:42 GMT

gotta see me if you dont want me to bleed

Re: Concious dentals

Mark Rowland — Fri, 12 Aug 2011 09:13:37 GMT

Im with the others on the other points.

Specifically with dentals:

I am ammused by the "fine diamond rasp" idea that you are using a precision instrument to do a precision job.

What you are in fact doing is introducing a sharp metal object into an area that you cannot see, risking trauma to mouth ulcers you cannot see and worse risking potentially fatal haemorrhage by way of trauma to the large blood vessels in the cave. I assume there is no back up plan for iatrogenic haemorrage after all the concious rabbit isnt going yo let you attempt to control the haemorrage with pressure, you would then have to anaesthetise a rabbit choking on its own blood. nice one for the clients to see.

Is incisor burring stressful? Probably. but if done correctly with a burr and a properly restrained rabbit it is quick there is minimal risk of trauma and importantly you can see what you are doing. Yep, sedation would be better imo and for those that require regular repeats, incisor removal is a better option.

Im not sure which is worse in my opinion, puting a gag and dilators in a concious rabbit or putting a sharp (sorry fine) file into a mouth where there is no visual access to the pathology you could be rasping away at and risking severe trauma.

I have a 9 year old rabbit with thoracic neoplasia diagnosed for over a year that comes in for molar burring uga so these days, I dont think the age issue is relevant anymore

imo

Re: Concious dentals

Rob Loxley — Fri, 12 Aug 2011 00:12:53 GMT

[quote user="Louise Alexander"]

[quote user="robloxley"]poke around with a metal otoscope speculum in a conscious rabbit,[/quote]

I think this is less stressful and less risk of trauma than rasping

[/quote]

and burring incisors conscious, maybe with a stressed rabbit throwing it's head around in panic??

[quote user="Louise Alexander"]Forcing a rabbit's mouth open with a gag and rasping would be more stressful in comparison [/quote]

[quote user="Louise Alexander"]when it started getting jaw tone/chewing reflex back, was very hard to get anything in the mouth and I was concerned I would cause damage if the gag was there[/quote]

I'm still playing devil's advocate (as I believe it's less than black and white), but is is absolutely wrong in a well-handled, compliant rabbit with minor spurs, without the gag, to rasp the molars? Is there any Evidence behind any stance?

[quote user="Evelyn Barbour-Hill"]The reason for sedating or anaesthetising rabbits to work on the cheek teeth is because you can't do a proper job without.[/quote]

I don't necessarily disagree with you. But if we are going to get het up about one thing we should at least be consistent (which it seems you are, but for example I wonder what the stress level of bunnies having their incisors burred is?)

Re: Concious dentals

Evelyn Barbour-Hill — Fri, 12 Aug 2011 00:06:55 GMT

Not me. I don't do them under sedation either. They get a quick GA.

The reason for sedating or anaesthetising rabbits to work on the cheek teeth is because you can't do a proper job without.

Re: Concious dentals

Louise6732 — Thu, 11 Aug 2011 22:41:25 GMT

[quote user="robloxley"]poke around with a metal otoscope speculum in a conscious rabbit,[/quote]

I think this is less stressful and less risk of trauma than rasping, I can't do much harm with an otoscope.

[quote user="robloxley"]lance the cat bite abscess, staple the clean skin laceration or whip off the dangling dew claw conscious, where sedation may be argued to be less stressful or achieve a neater quality result?[/quote]

Cat bite abscess - cats are different to rabbits, it is not stressful to restrain minimally and lance an abcess consciously, unless it's close to an eye, then I'm happier with sedation! Forcing a rabbit's mouth open with a gag and rasping would be more stressful in comparison to lancing an abscess, I'd say.

Dew claws - depends how attached it is, you can often whip them off without the dog noticing.

Louise

Re: Concious dentals

Rob Loxley — Thu, 11 Aug 2011 19:18:47 GMT

I think your two options are very black-and-white so I've not voted.
I also think you need to better define 'molar dental'.

Playing devil's advocate: I'd much rather do a good, safe job with a good view under heavy sedation/anaesthetic, but have equally had one or two patients that just need and will happily (IMHO) tolerate a fine rasping (minus dilators/gags) that have had previous poor recoveries from sedation/anaesthesia.

How many of the never-in-a-month-of-sundays voters will burr incisors with a noisy dental burr and would poke around with a metal otoscope speculum in a conscious rabbit, but would never put a fine diamond rasp in there conscious?

[quote user="Marie Kubiak"]Cannot condone any procedure that means patient stress is increased and quality of work is decreased[/quote]

Does burring incisors count as such a procedure?

How many people will happily lance the cat bite abscess, staple the clean skin laceration or whip off the dangling dew claw conscious, where sedation may be argued to be less stressful or achieve a neater quality result?

Is life always black and white?

Re: Concious dentals

James Laidlaw — Thu, 11 Aug 2011 18:56:44 GMT

I didn't even know this was something that existed... Is it? I've done incisors conscious, but never molars.

Re: Concious dentals

pjmontgo — Thu, 11 Aug 2011 18:25:03 GMT

We have a dental rabbit who comes in every 4 weeks to have his teeth trimmed under ga, he started having dental problems in 2007, has increased in frequency since then but as you can imagine he has undergone a number of general anaesthetics, he is now 6yo and and next time will be GA number 38!!!

Re: Concious dentals

Claire Edgington — Mon, 16 May 2011 16:34:51 GMT

I can understand why people feel the need to do it - anasthetic risk, the need to do it regularly etc.. Personally I hate doing it. I can't see how you could possibly get a good job done so the chances are you'll be needing to do it more often anyway. It's interesting you say that the VDS may not support you if you perform a concious dental. I've never had a client complain once you explain that anaesthetising is less stressful and you get a better job done.

Re: Concious dentals

Marie Kubiak — Mon, 16 May 2011 16:25:58 GMT

You already know my views on this one! Cannot condone any procedure that means patient stress is increased and quality of work is decreased.

Marie

Re: Concious dentals

Andrew Kent — Mon, 16 May 2011 15:47:37 GMT

Not only do I think conscious dentals and dangerous and incredibly stressful for the patient but I was under the impression that the VDS would frown on this practice and it would be a difficult practice to defend?

Andy

Re: Concious dentals

Mark Rowland — Mon, 16 May 2011 15:43:28 GMT

Ok im getting the trend. But please dont let the result put people off voting. The weight of numbers would certainly help me an I pack my tents and fill my water bottle for the impending crusade.