Putting the Treat into Treatment: Teaching Pet Owners to Get Pets from the Living Room to the ...

135 Pages·2016·0.77 MB·English

Putting the Treat into Treatment:
Teaching Pet Owners to Get Pets from the
Living Room to the Exam Room in a Calm State
Mikkel Becker, CPDT
VetStreet.com
Seattle, WA

Walking tools that help owners gain control over their pet’s forward motion and direction without the use of force are front clip
harnesses and head halters. It’s important to use fixed length leashes and to avoid retractable leashes, especially with fearful animals,
as numerous problems are likely to occur with such tools and there’s a general lack of control.
Cat harness and leash can be used to teach kittens and relaxed adult cats to follow and have protected time outdoors. Such walking
devices also make the relationship more interactive and provide another form of control useful for minimal restraint during exam if the
animal is accustomed prior.
Teaching animals to relax in the car is another important way to reduce stress before the animal has even arrived. Decreasing the
anxiety of being in a crate, then reducing aspects of the car that might be stressful (such as noises and motion sickness) along with
Victory Visits to fun places can help reduce anxiety. For some animals simply training outside of the car or sitting in the car while
getting their meal, treats or doing training may be a helpful place to start.
Victory Visits are one way to practice elements of the veterinary visit that are made to be more like the actual vet visit while being
kept positive and at a rate the animal tolerates. Victory Visits are done in preparation for actual exam and treatment at the hospital and
are preventive in building up a positive association with the clinic. Puppy classes and kitten socialization guidance are other strategies
for building a more social, less aggressive and more handling tolerant animal from the start.
To get animals to move on or off of things or to approach something targeting, luring and tossing treats are all helpful strategies.
Treating is one helpful strategy for counter conditioning an animal to the veterinary experience. But, in many cases the treat rate is far
too low and the reward value or treats given is minimal for the animal. Rather than one to three harder treats given during the visit
have an arsenal of available treats, toys and other rewards to employ. And, employ the tastiest, most enjoyable treats possible at a fast
rate to keep the animal occupied during exam and procedures. One tactic is using distractions and feeding or keeping the animal’s
attention on something else throughout the procedure. Or, another useful strategy for decreasing anxiety longterm is conditioning the
animal to tolerate handling.
AAHA guidelines are helpful for incorporating behavior guidelines and checks into regular veterinary visits to address problems
early and often. The sooner a behavior issue is addressed the better chance it has for being resolved. Many issues get worse, not better,
when left on their own without treatment.

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Fear Free Handling-
Understanding the Art, Design, and Feel of this Fashion Tech-Style
Jonathan Bloom, DVM
Willowdale Animal Hospital
Toronto, Ontario, Canada

Many pet owners fail to identify, and are reluctant to address, conditions such as dental disease and arthritis in their pet because they
don’t see the disease, and they don’t appreciate the negative impact that it has on the body. In contrast, most pet owners are EXPERT
at identifying fear and anxiety in their pets, and owners are very much aware of how a negative experience can impact both their pet’s
mental health and wellbeing. Experience and careful observation reveal that those sentiments are not restricted to just the outpatient
visit, but also apply and contribute to the pet owner’s reluctance to hospitalize their pet. In addition, pet owners are reluctant to
approve necessary routine procedures such as blood collection and x-ray for much the same reason. Implementing strategies to
maximize patient comfort is the most prudent way to create successful experiences while visiting the hospital. Pet owners visiting my
practice have been overwhelmingly accepting and appreciative of the efforts made to ease their pet’s fear and anxiety.
Technicians have been performing common procedures such as blood draws, nail trims, and x-rays the same way for decades. But
just because it has become the norm, doesn’t mean that staff like it! No staff member likes being bitten by a dog, or scratched by a
cat. No staff member loves donning protective leather gloves to hold a cat for a nail trim or to remove an IV. No staff member loves
stretching pets out in an unnatural and uncomfortable position to take an x-ray. And no staff member loves working in an
environment with barking and whining pets. We all work very hard and want to be appreciated for what we do. It is much more
rewarding when pets can be gently controlled for nail trims and IV placements, when pets can be calmly positioned for x-rays, and
when the background noise from the dog wards can be kept to a minimum.

Identifying fear and anxiety in the hospitalized pet
A problem well stated is a problem half solved! Proper care for out-patient procedures and for hospitalized pets start with the proper
identification of fear and anxiety. Veterinary healthcare providers need to pay more attention to signs such as trembling, hiding under
bedding, vocalizing, body position, and lack of comfort behaviours etc.

The pet’s surroundings and housing
Common belief has long been that dogs are colour blind. Dogs can however see many of the same colours that humans can see. Fear
Free™ has developed a colour palette that was selected to be both positive and visually comfortable. Bright lighting can also be
uncomfortable for pets. Dimmable lights are ideal. Cages are believed to best suited for housing when there is opportunity for
looking outward with few obstructions, or have the option to retract to an area when less sensory stimulation is present is also ideal.
This can be achieved by providing boxes, tents, or partial covers so pets can choose their level of stimulation.

Sample collection
Attention should be paid to commonly performed procedures such as blood collection, urine collection, IV catheter placement and
removal, treatment of skin wounds etc. Procedures used to make these more comfortable experiences often include the use of
compression wraps, topical anesthetics such as Emla cream, pharmaceuticals, and environmental control.

Radiology
For years, pets have been forced into dark X-ray rooms, stretched out onto hard table tops, placed on their backs with their legs being
squeezed by the vice like grip of lead lined gloves, while their limbs are pulled in 4 different directions. There is nothing natural or
enjoyable about this for pets. Retakes are numerous, and X-rays are often of compromised quality. Several options including
compression wraps, pinch induced behavioural inhibition, or pharmaceuticals are often used to create faster, better quality, more
comfortable x-ray experiences for pets.

Post-operative care
Pets often experience stress and anxiety due to the direct result of pain. Careful attention must be paid to regularly assessing and
addressing pain relief in our hospitalized pets. Environmental control is also critical in ensuring a smooth, comfortable post-op
recovery including consideration given to noise levels, music, pheromones, body positioning etc.
My staff have never been more eager to accept a fresh and innovative healthcare initiative in the past as they have been for FEAR
FREE™. They realized that they are surrounded by calmer, happier, and more easily handled pets. As a result, staff are working in a
more safe and in a more enjoyable work space. Subsequently, staff satisfaction and staff morale have never been higher. The creation
of a Fear Free™ philosophy and culture benefits pets, pet owners, hospital staff, pet healthcare, and the business as a whole.

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Dental Charting:
It is More than Just Xs and Os
Vickie Byard, CVT, VTS (Dentistry), CVJ
PetED Veterinary Education and Training Resources
Warminster, PA

As a frequent consultant and instructor, I have the incredible opportunity to meet many of you within your own practices. When I ask
if you chart your dentistries, most of you enthusiastically report that you do. This is a positive change from the past. Now, I would
like to take this opportunity to look at the dental chart in detail and review the importance of this document.
But before we start looking at the document and how to record your findings, I recommend we review some anatomical terms as
they relate to the mouth and associated structures.
First, you should know the proper and expected dentition of puppies and kittens versus adult dogs and cats. In the puppy, there are
no deciduous first premolars or molars. In the kitten, there are no deciduous molars. Also, it important to know the eruption
schedules. In the puppy, primary or deciduous teeth begin to erupt around 3-6 weeks of age. Usually, by 6 months of age, the adult
teeth are replacing the primary teeth. Also, it should be mentioned here that many of the “micro-breeds” tend to experience a delayed
eruption. This is important information when planning treatment options for extracting retained deciduous teeth.
Begin the assessment of the head by looking at your patient squarely in the face and note any swellings or asymmetry while the
patient is still awake and conscious. Note any facial abnormalities such as unilateral facial swellings.
If the patient is cooperative, a conscious intraoral exam can be very beneficial is case planning as well. Things to note are; the bite,
tooth occlusion and any tooth-to-tooth contact and any tooth-to-tissue contact. The tissues of the gingiva, the mucosa and the lips all
should be examined and notes made of any abnormalities. Also, note any odor, discharge, swelling, tumors, etc.
Once you feel a good conscious intraoral exam was performed, the patient should be anesthetized for the comprehensive
assessment. This is when you are able to gather the most information. One person should be performing the examination and another
should be recording the information. It is a good practice to have the person who is performing the anesthesia make the notations on
the dental chart.

Tooth identification
There are several different methods of referring to each tooth. A tooth can be identified with an abbreviation. For instance, the left
upper fourth premolar would be noted as LUPM4. The benefit of that is that everyone can understand that.
The other method is called the modified Triadan numbering system. The first number refers to the quadrant that the tooth is found.
The second and third refer to the tooth position starting rostral and moving caudally. The right upper arcade is the 100 series, 200 is
the left upper arcade, 300 series is the left lower arcade and the 400 series is the right lower arcade. Tooth 401 would be the right
lower first incisor and tooth 411 is the right lower third molar.
Deciduous teeth are the 500,600,700 and 800 series in the same pattern.
The modified Triadan numbering system applies to the cat dentition as well. The difference is that they have fewer teeth. The cat
have no upper first premolars, they have no first and second premolars on the lower arcades and there is only one molar in each
arcade.
So here are some easy landmarks for you:
 The first incisor is always 01
 The canines are always 04
 The first molars are always 09
Anatomical direction:
 Tooth surfaces that touch the front lips – labial
 Tooth surfaces that touch cheeks – buccal
 Tooth surfaces that touch palate – palatal
 Tooth surfaces that touch tongue – lingual
 Anterior portion of a tooth – rostral
 Posterior portion of a tooth – caudal
So, once you have performed the complete visual oral assessment, it is time to start making notes on the dental chart. The purpose
of a dental chart is to make record of the state of the mouth on that day. A veterinarian that was not involved in the procedure at all
should be able to understand exactly what condition each tooth was in just by looking at this chart.
Often I have gone to practices that state they chart their dentistries. In fact what they do is circle all missing teeth and “x” out all
extracted teeth. Complete charting involves much more than that. There should be adequate room to make notes as to signs,
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diagnosis, treatments, prescriptions and take home instructions. An anatomical graphic showing every expected tooth in that species
should be present and large enough that you can make notations of periodontal probing depths on at least two surfaces.

Periodontal probing
Since the statistic is that 70-85% of all companion pets over the age of 3 have periodontal disease, we need to make notations as to the
pocket depth on each tooth. Without these numbers, there is no way that we can follow the progress of the therapy.
There are a number of periodontal probes available. I find that it is easiest for measurement of pocket depth is you choose a
Williams periodontal probe. This instrument has markings at each mm. There is a heavier band at 4-5mm, 9-10mm, 14-15mm. This
instrument is positioned parallel to the crown and gently guided under the sulcus of the tooth until the tip reaches the ceiling or the
floor of the pocket. The intention of the technician using this instrument is to detect and measure periodontal pockets and clinical
attachment loss. At the very least measurements should be recorded at the deepest pocket depth on the mesial and buccal aspects of
the teeth and the lingual and palatal aspects of the teeth. Any pocket depth greater than 1 mm in a cat or 3mm in a dog is considered a
periodontal pocket.
Other critical notations are tooth fractures; enamel fractures, uncomplicated crown fractures, complicated crown fractures,
uncomplicated crown root fractures, complicated crown root fractures and root fractures. The classification of these fractures can be
found at www.avdc.org.
An explorer is the very pointed tipped instrument used to enhance tactile sensation. This instrument allows the technician to detect
any abnormalities in enamel integrity. The sharp end will transfer a change in feel when in contact with tooth resorptions, enamel
hypoplasia and carious lesions.

Other gross clinical observations
All other abnormalities should be noted:
 Discolored teeth
 Fractured teeth
 Mobility
 Furcation exposure classification
 Tooth resorption classification (www.AVDC.org)
 Fistulae
 Crowding
 Tooth rotation
 Abrasion versus attrition
 Enamel defects
 Foreign bodies
 Oral masses
 Supernumary teeth
 Stomatitis
A very comprehensive list of appropriate abbreviations can be downloaded from http://www.avdc.org/traineeinfo.html.
Intraoral radiographs are taken and those findings associated with each tooth should be noted on the record. Once the veterinarian
has made a diagnosis and treatment plan, this is shown and noted on this chart as well.
As you progress in increasing your dentistry skills, there will be more and more things diagnosed and different treatment options
will be offered and provided. This document will be your way of providing a means of clear communication for individuals within
your practice and to those you are referring care.
The standard of care expected by the state boards in relation to dentistry is increasing every year. AAHA standards also make it
clear that good record keeping and charting for dentistry services provided is expected. Since the down turn in the economy has hit
dentistry services and surgery services hard across the country, we should look at this opportunity as a “speed bump”. Speed bumps
are provided in order for us to slow down and evaluate the current conditions. This is an excellent opportunity for us to take this skill
to the next level.

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Dental Equipment Maintenance and Technician Safety
Vickie Byard, CVT, VTS (Dentistry), CVJ
PetED Veterinary Education and Training Resources
Warminster, PA

A current trend in veterinary medicine is a reduction in elective surgeries in small animal practice. Spays and neutering procedures
are being done earlier and earlier at the rescue or at low cost clinics. That change has affected the small animal practice dramatically
which has focused much attention to the mouths of our patients.
Small animal general practitioners are looking towards dentistry as a way of increasing wellness care while supporting the
operating and treatment room activities. With an increased focus, there is an increase of the number of dental procedures being
performed in practice and this necessitates us to look at both equipment maintenance and technician safety.
There is nothing more frustrating than equipment failure during a procedure for both the veterinarian and the technician.
Therefore, is it important to schedule some time during the week that will be devoted to equipment maintenance.

Dental unit compressor maintenance
Some dental units come equipped with a small compressor. Some practices have a compressor outside of the dental department and
the units are connected with quik-connections. In either case:
Oil-cooled compressors have either a view port or a dipstick with which to monitor the oil level. This should be checked weekly.
Consult your compressor’s owner manual to determine the type of oil required.
Condensation also accumulates in the barrels of the compressors. There are drains (either wing nut type or screw type) at the
bottom of the compressors. These air storage tanks need to be drained weekly for busy dental departments and monthly for smaller
departments.

High speed handpiece maintenance
After use
1. Remove the handpiece from the dental unit tubing.
2. Wipe the outside of the handpiece with a clean gauze or paper towel moistened with water or alcohol. If you have a
handpiece equipped with a fiber optic light source, make sure that is wiped clean as well. Do not use harsh cleaning
solutions and do not vibrate in the ultrasonic cleaner.
3. With the bur in place, spray a short burst of special handpiece lubricant (refer to manufacturer’s owner’s manual) into
the air drive hole. This is usually the smaller and often shorter of the holes.
4. Reattach the handpiece to the dental unit tubing and depress the foot pedal for 30 seconds allowing the lubricant to
circulate through the handpiece and to expel any excess oils from the air line. Allow the lubricant from the handpiece to
discharge onto a paper towel and inspect for color. This should all be clear. If not, repeat the lubrication process
described above until it is clear.
5. Remove the old bur.
6. Dry the exterior of the handpiece thoroughly (any excess oil will soak through the autoclave pouch, disrupting
instrument sterility and will risk paper char).
7. Follow manufacturer’s owner manual for autoclave time and pressure (Never exceed 135 degrees C).
Before use
1. Place a new or sterilized bur in handpiece. Secure in appropriate bur into the chuck of the handpiece and finger tighten
the chuck closed around it by mounting the Chuck Wrench or by releasing the Push Button on the end cap of the Push
Button Type handpiece.
2. Spray lubricant into drive air hole.
3. Allow handpiece to run for 20-30 seconds.
Cartridge replacement
1. If, after lubricating the high speed handpiece, there is excessive drag (the handpiece is not spinning with adequate
RPM), it may be necessary to replace the turbine cartridge.
2. A bur should be in place.
3. Use the manufacturer’s end cap wrench to remove the end cap turning the wrench counter-clockwise.
4. Gently push the turbine out by pushing gently on the bur.
5. Remove debris from the turbine from the inside of the handpiece with a cotton tipped applicator.
6. Insert a new turbine into the head of the handpiece by aligning the locating pin to the guide dot on the head.
7. Make sure the back of the cartridge sits flush with the back of the handpiece.
8. Secure the end cap back in place with the end cap wrench.
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Low speed handpiece maintenance
1. If your low speed handpiece has a motor section with a detachable sheath, the motor does not need to be sterilized.
2. Slide the attachment ring up to detach the sheath.
3. Dental motors and sheaths require a higher viscosity oil than high speed spay.
4. One to two drops of oil in the drive airline is all that is necessary.
5. Attach the motor to the drive airline and run to distribute the oil.
6. Wipe away the excess with a paper towel.
7. The straight sheath does not require lubrication.
8. Clean the outside with a moist gauze or paper towel and dry.
9. Place in a sterilization pouch and sterilize.
Disposable polishing angle
1. It saves maintenance times because you simply through it out.
2. No cross contamination.
3. 90 degrees reciprocating head
a. Does not wind into long hair of some animals.
Autoclavable prophy angle
1. Dip the head of the prophy angle in a small amount of handpiece cleaning solvent.
2. Run for 1 minute changing directions of the gears from forward to backward.
3. Wipe off and insert prophy cup.
4. Periodically follow the manufacturer’s instruction in the owner’s manual and disassemble the prophy angle to oil the
gears.
Hand instrument sharpening
1. Put a drop of sharpening oil on an Arkansas Sharpening Stone
2. Hold the dental instrument either against a firm surface at a 90 degree angle to the floor with the toe facing you.
3. Place the oiled sharpening stone at a 115 degree angle and move up and down until a sharp angle is obtained.
4. Wipe filings and excess debris off with a conical stone.
Winged elevator sharpening
1. Match the angle of the back edge of the winged elevator against the Oiled Arkansas Stone.
2. Hold the instrument steady.
3. Move the stone down the back of the instrument on the right side, then the middle then the left.
4. Use the conical stone on the inside of the winged elevator to remove filings.
5. If there are notches in the instrument left from improper extraction techniques or if the instrument has been bent, send it
off for professional instrument care OR replace the instrument.

Operator/technician safety
Ergonomics
1. Maintain proper posture
a. Upper back
i. Your elbows should be at a 90 degree angle
ii. Use magnification and good lighting to reduce the need to bend the neck and shoulders
b. Lower back
i. Adjust the height of the seat so that your feet are flat on the floor with your knees slightly lower
than the hips.
c. Hands
i. Hold the instruments in a modified pen grasp
1. Neutral position
2. Relaxed position
3. Stabilized hands when possible
Personal safety
1. Contaminants
a. Two foot spray, splash and spatter zone
b. Wear eye protection at all times
i. Goggles
ii. Safety glasses
iii. Chin length full face shields
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c. Wear mask
i. Have a filtration level of at least 95%
ii. Minimize goggle fogging
d. Protective clothing
i. Really should protect your skin and work clothes (CDC)
e. Gloves
i. Right size
ii. Allow for good tactile sense
2. Radiation
a. 6 foot 8 inches from beam when barriers are no available
b. Primary Barriers (needed when within the beam)
i. Lead gowns
ii. Lead curtain
c. Secondary barrier
i. Dry wall is considered an appropriate secondary barrier
d. Dosimeter
i. Collar level

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Dentistry for Our Feline Friends and Their Special Needs
Vickie Byard, CVT, VTS (Dentistry), CVJ
PetED Veterinary Education and Training Resources
Warminster, PA

One of the biggest revelations for me in my training as a veterinary technician was that cats are not small dogs. That statement is
especially true in relation to the subject of veterinary dentistry.
As with most other subjects in medicine, we must start with anatomy and the differences unique to our feline population as a
species.

Unique anatomy
Tongue
The tongue is covered with papillae. These barbs point backwards and this enables the cat to rasp meat off of bones and to groom
more effectively. Theses barbs catch debris and dirt while grooming. Unfortunately, because the barbs on a cat’s tongue points
backwards, anything that gets attached to these barbs eventually gets swallowed. That includes things like hair and string. Hairballs
are a common issue for cat as are string foreign bodies. Once tangled in the papillae, the material cannot be spit out.
Teeth
Cats have a unique dental formula. Theirs is I3, C1, P3, M1
I3, C1, P2, M1
Their canine counterparts are supposed to have 4 premolars and more than one molar. So, it is important to know that when
charting the feline patient, their teeth on the maxilla start at the second premolar (there is no first) and on the mandible, the first tooth
distal to the canine is the third premolar (there are no first and second mandibular premolars).
Gingival probing depths
In our feline patients, normal gingival probing depths are less than 1 mm.
Canine teeth
The canines have a vertical grooves that extends the length of the tooth. These sometimes become stained. It is important to note that
the enamel is thinnest in this area and care must be taken not to spend too much time trying to remove the staining for fear of
damaging the protective enamel.
Also, the pulp canal extends ALL THE WAY to the tip of the crown of the feline canine tooth. Any degree of chipping of these
teeth require investigation. A “wait and see” approach is not appropriate. These injuries must be radiographed. Nearly all fractured
canine teeth are painful and will become infected.

Common feline pathology
Juvenile onset gingivitis
This occurs before cats are 9 months old. There is a severe gingivitis and notable halitosis. Often these cats little to no tartar
accumulation. The exact cause is unknown but treatment involves early detection and frequent (q 4-6 months) professional plaque
removal with elegant home care. Usually, true juvenile onset periodontitis will resolve by the age of 2 years. It is often noted that
juvenile onset gingivitis occurs frequently in specialty cats such as Abyssinians and Persians.
Canine tooth extrusion (supereruption)
Sometimes when a canine tooth is effected by chronic periodontal disease, there appears to be a greater crown height. Although the
etiology is unknown, current studies reveal a statistical correlation between supereruption and tooth resorptive process.
It is important to note; when the veterinarian is making the recommendation for the extraction of a maxillary canine tooth when the
lower canine tooth on the same side remains, it is critical that the client be prepared that there is a chance for maxillary lip
impingement.
Alveolar bone expansion (osteitis)
Caused by chronic periodontal inflammation the alveolar bone around the upper canine teeth. When noted it is critical to evaluate the
periodontal structures of these teeth radiographically to stage the periodontal disease in order to know the appropriate therapy. By
Stage 4 periodontal disease and 50% bone loss, tooth extraction should be considered.
Tooth resorption
Tooth resorption is a common ailment in our feline population. Studies have reported anywhere from 20% to 75% of the feline
populations will experience this disease process. These lesions are usually noted buccally but can occur on any surface. Statistically
the most commonly affected teeth are the mandibular third premolar. On the cheek teeth, the lesions are commonly noted at the
cementoenamel junction and with hyperplastic gingival tissue covering the affected portion of the tooth.
In the canine teeth, it is common to see tooth resorption more apically and may not be clinically apparent.
At one time these lesions were called neck lesions, FORLs (Feline Odontoclastic Resorptive Lesions) and cervical line erosions.
The current terminology is tooth resorptions. They are classified:
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 Stage 1: Mild hard tissue loss
 Stage 2: Moderate hard tissue loss but that does not extend endodontically
 Stage 3: Moderate hard tissue loss but that does extend endodontically but most of the tooth integrity is maintained.
 Stage 4: Extensive Hard tissue loss that extends endodontically
 Stage 5: Crown has fractured off due to hard tissue weakness and the gingiva has extended over top of the remaining
root tissue.
The etiology of this disease process is unknown and being researched extensively. Recent studies have grouped these lesions into
two groups:
 Type 1: Resorption associated with periodontal disease where the tooth retains radiographic evidence of a periodontal
ligament and a pulp canal. These teeth need to be treated with complete extraction.
 Type 2: Lesions associated with bone replacement. These teeth can be treated with crown amputation with intentional
root retention.
Determination of treatment options can only be made radiographically.
Stomatitis
This is one of the most painful conditions for cats and definitely one of the most frustrating syndromes to deal with for the owner
AND the practitioner.
The etiology is unknown specifically but appears to be associated to an immune mediated reaction to either dental plaque or the
tooth structure itself. Usually there are many factors involved; genetics, environmental stress, diet and viral infections. Although, for
a while it was suggested that feline Bartonella virus was responsible for stomatitis cases. However, although many cats may be
infected with Bartonella, it is more probably an opportunistic pathogen ad not the primary cause.
These cats present painful. They often drool, have a history of weight loss and poor appetite and their coats are unkempt due to
their inability to groom themselves comfortably. Some cats only have inflammation around the caudal cheek teeth, while others
exhibit a generalized inflammation.
This disease is very frustrating. Medical therapies such as corticosteroids, antimicrobials, Gold Salts, Interferon all have mixed
long-term results.
When feline patients present with inflammation associated only with the teeth caudal to the canines, surgical extraction of the teeth
and all root fragments caudal to the canines is the treatment of choice. It is recommended that if one is to treat a stomatitis case, they
must have intraoral radiology capability. It is critical that all root tissue be removed as well. The accidental retention of root tissue
will lead to continued gingival inflammation. Since in the best case scenario, extraction can provide a 50% chance of resolution, post-
op radiographs are vital to insure that the case has been properly treated.
Patients also should be supported via feeding tube if anorexia is an issue until they are able to eat on their own.
Post-operatively most veterinarians will put these patients be on appropriate antibiotics for 2 weeks post-op with appropriate pain
management.
In summary, feline patients have some unique issues that the trained veterinary technician should be aware of in order to support
the veterinarian and the owners.

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Out of Sight!
Are Intraoral Radiographs Important for a
Complete Dental Assessment?
Vickie Byard, CVT, VTS (Dentistry), CVJ
PetED Veterinary Education and Training Resources
Warminster, PA

Are dental radiographs essential for professional veterinary dental care? Absolutely! In practices that use radiology to evaluate
dentistry patients with obvious clinical findings, radiographs revealed additional pathology in 50% of dogs and 53.9% in cats. In
cases that had no gross pathology present, radiology exposed clinically relevant findings in 27.8% of dogs and 41.7% in cats. So,
when practices are providing dentistry without evaluating the health of the tooth below the gum tissue, they are missing a vast amount
of disease.
To provide this service, a dental X-ray unit is not necessary. For some years, vet dentists used their regular medical X-ray unit
successfully. The key is to use intraoral film. This task is awkward and time consuming. Often it means transporting the anesthetized
patient to a totally different room in the practice. But, it can be done.
Many veterinary hospitals site cost to the clinic as the number one reason for not purchasing a dental radiographic unit.
Unfortunately, they are mistaken. Of all pieces of equipment in a practice, this unit is relatively inexpensive. To purchase a regular
dental X-ray unit, the cost would amount to about $4,000. If the practice goes digital, software and sensor can cost from $6,000 to ~
$9,200.
A cost analysis is valuable when evaluating the profitability of equipment. Let’s say, for example, a practice is performing 3
dentistries per day. On the average they take (and this is very conservative) 10 radiographs per day. The average fee is $10-20 per
view, so let’s split it in the middle…$15 per radiograph. That produces $150 per day. Do these 5 days per week; the practice
generates $750 per week. Do these 50 weeks per year, the practices produces $37,000 per year. The equipment paid for itself in less
than 6 months just on the revenue brought in by the images itself. I haven’t included the increased pathology found and the revenue
generated by treating it. These numbers are very reasonable in a large, multi-vet practice.
Consider a small, 2 vet practice. Let’s imagine they perform 3 dentistries per week. They take 10 radiographs per week at $15
each. That is $150 per week. Do these 50 weeks a year and the practice has grossed $7,500 a year. The equipment in that scenario
paid for itself in less than 2 years. After the equipment is paid off, except for incidental supplies, the rest is all profit.
To use a medical X-ray unit, it is preferred that the head of the unit can be lowered and the angle changed. A focal distance of 12
inches is best. To be able to use the bisecting angle technique is often necessary to reposition the patient. Different X-ray units have
different technique charts but you can try using 100 mA, 65 kVp at 1/10th second and adjust the technique accordingly.
Dental radiographic units have heads that are more adjustable so that the patient does not have to be manipulated and repositioned
as much. The radiographic detail is much better.
So, once a practice decides it is interested in providing this service, some training and education is required. Fortunately, there are
many venues for this education. There are numerous training facilities across the country; there are convenient online courses, many
wonderful books and journals. Recognizing normal versus abnormal requires some knowledge of each.
Safety is also an important factor. It certainly is a fact that digital radiographs require about 1/10th of the radiation required when
exposing film. But, that doesn’t mean that one shouldn’t prudently provide radiation protection. Stay 6 feet away from the head of
the X-ray unit, do not stand directly in the line of the beam, do not hold the sensor with your hand, and always wear your radiation
badge.
There are hand-held X-ray units available. These are often sought because they do not take up a large footprint within the dental
operatory. But, their approval is provided for use at an arm’s length. These units are heavy and that may be difficult.
Once you have obtained the equipment and you have training in getting diagnostic images, it is important to begin to understand
the baseline for normal versus abnormal tooth development and pathology. I recommend the following book when you are first
getting your feet wet in this service:
Atlas of Dental Radiography in Dogs and Cats, 1e by Gregg A. DuPont DVM FAVD DAVDC and Linda J. DeBowes DVM MS
DACVIM DAVDC (Jul 25, 2008)
In a normal, young patient, it is important to know that the dentinal wall is very thin and the pulp chamber is wide. As the patient
ages the dentinal wall thickens hence the pulp canal narrows. Also, in very young animals, the apex of the tooth is still open. As they
age, the apex closes.
Indications for radiographs are vast:
 areas where there are missing teeth
o Impacted teeth often cause dentigerous cysts. As the tooth is developing, there is a sac of epithelium that
covers the crown of the tooth. During eruption through the gingiva, the sac is lost. If the tooth is embedded,
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