No veterinary patient ever read a book on how s/he should look or behave! All patients are individuals, and no mouth is conformationally perfect! At ADCS, each patient is considered individually, and treatment plans are formulated based upon the use/lifesytle of both the animal and the owner. The goal of veterinary dentistry is to improve the patient's longevity and quality of life by maintaining a functional, pain-free mouth!
Professional ethics dictate that all veterinary services require a patient be examined and that a diagnosis be made before any treatment is performed! Veterinary clients have the right to make informed healthcare decisions for their pets, and at ADCS we will discuss each of these steps as a case progresses.
Examination: In addition to written medical records, digital photography is routinely used to document examination findings.
- Regardless of the species, the evaluation of a dental or head problem begins with a General Physical Examination of the patient's overall health condition to ensure cardiovascular fitness and to rule out systemic conditions that might contraindicate dental treatment.
- All teeth are attached to a head! The general examination is followed by an Examination of the Head. Head conformation intimately effects oral/dental conformation, and dental disease often extend regionally into the adjacent head structures. In horses, nasal and sinus disease is common secondary to dental disease. Nasal & sinus disease are evaluated using Rhinoscopy & Sinoscopy when indicated.
- All teeth reside in a mouth! The head examination is followed by an Examination of the Mouth. The most common "dental disease," periodontal disease, effects around 70% of domesticated animals and is actually a disease of the gums and supporting bone in the mouth, not the teeth themselves! Additionally, the initial presenting signs of several significant systemic diseases are oral lesions. (e.g. Rabies, Vesicular Stomatitis, Kidney Failure) For small animal cases, a preliminary unsedated oral examination is performed during the initial consultation so that a tentative treatment plan & fee estimate can be established; however, definitive oral examination can only be performed while the patient is under general anesthesia. Owners are called with the actual treatment plan (see below) and fee estimate after the anesthetized evaluation is performed. In horses/large animals all oral examinations are performed in sedated patients.
- The final examination is the Dental Examination during which the tissues and structures of each tooth is individually examined. Mammals can have up to 44 teeth (Incisors, Canines, Premolars, & Molars) and each tooth is comprised of 3 different dental tissues (enamel, dentin, & cementum).
- Oral & dental examination in large animals is routinely augmented by Oral Endoscopy.
Diagnostics: Based upon the examination findings, Diagnostic Imaging and Testing is performed.
- Radiology: Since teeth, the jaws, and the head are primarily comprised of hard tissues, radiography is an essential diagnostic tool in veterinary dentistry. Baseline dental radiography is the standard of care in small animal veterinary dentistry; therefore, dental X-rays are taken in all cases. In large animals, head and dental radiographs are indicated in approximately 1/3 of primary evaluation cases and all referral cases.
- Biopsy & Histopathology: Hard and soft tissue biopsies are required to identify oral/head masses before definitive surgery. Biopsies are also used to determine the disease process in abnormal noncancerous tissues. (eg. Allergic, Inflammatory, Infectious)
- Laboratory Testing: Culture and Sensitivity and other tests may be performed to identify infectious agents and choose the best antimicrobial treatment.
- Advanced Imaging: Computed Tomography is currently the best diagnostic imaging modality for dental studies and may be indicated for some complicated cases. ADCS does not own at CT, but has relationships with diagnostic centers that can provide this service.
Diagnosis: Definitive Treatment requires a Definitive Diagnosis! Rushing into surgery based upon a tentative diagnosis is a common emotional mistake. Misdiagnosis often leads to unnecessary or inadequate treatments which almost always result in continued patient suffering and additional treatments & expenses. Measure Twice, Cut Once!
Treatment Planning: Once a diagnosis has been established, the treatment plan, aftercare, prognosis, and fee estimate are discussed with the owner.
How long does the diagnostic process take? Depending upon the complexity of the case, this process can be as short as 1-2 hours or may take several days. Typically, dental procedures and oral surgeries in small animals are performed or begun the same day, immediately following the diagnostic workup, due to the requirement for general anesthesia. Since equine/larger animal procedures are performed under sedation, they are typically scheduled on another day to allow more time to review the diagnostic findings.
For most referral cases in small animals, the initial consultation and dental procedure are scheduled for the same day; however, a procedure can be scheduled for another day after the initial consultation, if a client prefers. Treatments may be staged over 2 or more days for patients requiring multiple procedures. Consultations are seen in the morning with dental procedures immediately following preanesthetic evaluation. Most small animal patients are discharged the same day.
The diagnostic evaluation in horses/large animals usually takes several hours; therefore, dental procedures are typically scheduled for another day. Horses undergoing dental extractions are usually hospitalized for 1-3 days. Horses undergoing sinonasal surgery are typically hospitalized for 3-7 days.