Veterinary technicians often play a key role in performing dental cleanings and client education. At the Atlantic Coast Veterinary Conference (ACVC) in Atlantic City, Denise Rollings, CVT, VTS (Dentistry), founder of Pet Dental Education, presented an overview of dental and oral lesions that may be encountered. Although she noted that veterinary technicians have legal limitations to diagnosing disease or oral pathology, she countered that this does not diminish the clear need for technicians to be able to recognize pathology and report it to the veterinarian as well as to create an accurate dental chart.

With regard to lesions affecting the teeth themselves, several conditions may be observed. Dental abrasions (AB) are wear of a tooth from an external course, typically related to chewing such as abrasive toys or cage chewing. In some cases, this can be so severe that the teeth wear down to the level of the gingiva. Attrition (AT) is also wear of a tooth, but in this case, it is caused by tooth-to-tooth contact from malocclusion (not chewing on external materials). Although these factors cause slow wear of the teeth, in which dentin will form to repair the wear and protect the pulp cavity. Where wear occurs more quickly, dentin may not form and the pulp cavity may be exposed. In such a situation, the tooth may need to be repaired or removed.

Fractures may occur, which can be classified according to their extent of injury to dentin, root, or pulp cavity (or combinations thereof). Fractured teeth in which pulp is exposed are very painful and require treatment via repair or removal.

There is also a condition in which teeth may be non-vital (T/NV). Another term for a non-vital tooth is pulpitis. This typically occurs because of trauma. These non-vital teeth will initially appear gray, pink, or purple, and may become tan or brown over time.

Rollings also discussed that dogs can get cavities, called caries or carious lesions (CA), just like people do. Caries are tooth decay caused by acids that are a byproduct of bacterial fermentation of carbohydrates. Caries are recognized by their brown color, and that a dental explorer will “stick” in the area. Although caries can form anywhere among the teeth, they most commonly occur on the occlusal surface of the maxillary first premolar in dogs. If caught early, they can be repaired similar to the method used for human cavities. If advanced to the point where the pulp cavity is affected, the tooth should be removed.

Abnormalities of dentition also occur, in which there may be missing teeth (either previously extracted, unerupted, fractured, or lost), crowded teeth (CWD), rotated teeth (ROT), supranumerary teeth (SN), or persistent deciduous teeth (DT/P). Where teeth are missing, radiographs must be taken to ensure there are no retained roots present and hidden below the gumline, impacted or embedded teeth, or dentigerous cysts present that could cause bone destruction. If identified, these things must be removed.

Supranumerary teeth are extra teeth. These may or may not cause problems, but where crowding occurs due to this, the supranumerary teeth should be removed. Persistent or retained deciduous teeth may also cause malocclusions or crowding. They may also be associated with unerupted adult teeth. Radiographs can determine whether this is the case, and if so, the retained deciduous tooth can be removed to allow the adult tooth to erupt.

Tooth resorption (TR) may occur in both dogs or cats, although the clinical effects are somewhat different between species. The cause of resorptive lesions is unknown, but results in the destruction of mineralized tissues (including enamel, dentin, and cementum). Resorptive lesions fall into 3 types, and 5 stages of severity. In cats these are thought to be severely painful, and should be addressed promptly. In dogs, resorptive lesions are thought to be due to aggressive chewing, trauma, or malocclusion that creates excessive force on the periodontal ligament. In dogs, unlike cats, resorptive lesions are thought to be non-painful unless it occurs at the crown or gumline, in which case the tooth should be extracted.

Enamel hypoplasia (EH) may also be noted during examination and occurs when enamel fails to fully mineralize and develop. This most commonly occurs if the animal has a high fever during dental development during their first few weeks of life.

There are several soft tissue conditions that may be identified during dental examinations. Oronasal fistulas (ONF) occur when periodontal disease erodes the bone between the oral and nasal cavities. This is most commonly associated with the maxillary canines but can occur anywhere along the maxillary arcade. Clinical signs commonly include sneezing or nasal discharge. Probing on all surfaces of the tooth (particularly the palatal aspect) may yield a defect. Treatment involves the removal of the tooth and closure of the soft tissues.

Stomatitis, also known as caudal mucositis, results in halitosis, inappetence, ptyalism, or pain when grooming, eating, or yawning. The cause is unknown, and treatment often requires full mouth extractions to mitigate the severe pain caused by the disease. In some patient’s treatment with steroids or laser therapy may be required. Chronic ulcerative paradental stomatitis (CUPS), also known as buccal mucositis, occurs more often in dogs. With CUPS, any tissue in contact with the frown surface of the teeth will become inflamed as a result of an immune response targeting the bacteria in plaque. Much like caudal mucositis, this condition is also extremely painful and may require full mouth extractions.

Periodontal pockets (PP) should be evaluated in every tooth in every patient. Pocket measurements should be evaluated around the circumference of every tooth, and recorded in the dental chart. A normal gingival sulcus in the dog is 3 mm (up to 5 mm for giant breed dogs). In cats, there should not be any depth to the sulcus. Where pockets are increased in depth, closed root planing (for pockets 3 to 5 mm), or open root planing (for pockets > 5 mm) can be performed to aid gums in reattaching to the root. Daily home care is important in these patients as well.

Other conditions that should be evaluated during examination include furcation exposure, tooth mobility, and malocclusion. Furcation exposure (F1-3), in which case there is horizontal bone loss between the roots of a multi-rooted tooth. There are 3 grades of severity used to describe furcation exposure, with the most severe grade requiring extraction. Tooth mobility should also be evaluated during dental examination. Mobility (M1-3) is also classified into three levels of severity. Again, teeth classified in the most severely affected grade should be extracted. In some cases, a tooth may be avulsed or partially avulsed. This is considered a dental emergency, as rapid treatment may allow the tooth to be salvaged. 

Malocclusion should also be evaluated (MAL/1-3).MAL/1 describes normal jaw position, but where malocclusion is due to one or more teeth causing contact with other teeth or soft tissues, resulting in an uncomfortable bite. These conditions may require extractions, crown reductions with vital pulpotomy, or orthodontic correction. MAL/2 describes mandibular brachygnathism (overbite), and MAL/3 described mandibular prognathism (underbite). For MAL/2 and MAL/3 treatment may be required, including extractions, crown reductions with vital pulpotomy, or orthodontic correction.

In addition to the above abnormalities, Rollings also noted that a thorough oral examination requires attention to the presence of oral masses (OM). All oral masses should be biopsied and evaluated for histopathologic diagnosis. Common benign oral masses include acanthomatous ameloblastomas, gingival hyperplasia, and papillomas. Malignant oral masses commonly include fibrosarcoma, malignant melanoma, and squamous cell carcinomas. Depending on the type of mass, treatment modalities and prognosis will vary.

Even within the confined of practice law, it is very important that veterinary technicians have a thorough understanding of these oral and dental conditions, to provide quality care to their patients, perform accurate charting, and be able to relay important information to the veterinarians managing the patient’s care.

Dr Rebecca Packer is board certified in neurology by the American College of Veterinary Internal Medicine and is an associate veterinarian at BluePearl Specialty and Emergency Pet Hospital in Lafayette, Colorado.

She is also the founder and owner of the Pre-Veterinary Mentoring Group, LLC, through which she provides mentorship for pre-veterinary students during their path to veterinary school, and is the founder and owner of The Pocket Neurologist, LLC, a vet-to-vet teleconsulting service.

Editors note: All veterinary technician content for this month is supported by Banfield Pet Hospital.

Articles

Although veterinary technicians can encounter legal restrictions, these team members play a key role in distinguishing oral and dental abnormalities in patients.

Recognizing dental and oral abnormalities 

The Veterinary Well-being Choice: Prioritize, Cultivate, and Maintain

Reshape the culture within your practice and reignite your passion. In this talk, we address the core underlying issues that lead to poor well-being, and we provide well-being strategies and principles that will stand the test of time. Attendees will be given practical, useful, and effective tools and strategies to help them create an ideal veterinary experience, regardless of circumstances, conditions, and home/work events. By the end of the session, attendees will feel confident in their ability to prioritize themselves while caring for patients and serving clients.

This session will provide an overview of the emergency department approach to patients with acute abdominal pain combined with gastrointestinal signs, such as vomiting and diarrhea. The discussion also will include diagnostics to determine the cause as well as initial medical stabilization.

Breaking Up With Breaking Down — A Review of IMHA

This lecture will review immune-mediated hemolytic anemia (IMHA). You will learn the ins and outs of IMHA, including pathophysiology, symptoms, and treatment options.

Veterinary Therapeutic Radiation: A Multisite and Multimodal Approach

Learn about the multisite network of PetCure Oncology. Included will be brief descriptions of the referral process, multimodal cancer treatment options, and the potential for treating multiple sites within the same patient with therapeutic radiation.

How to Be a Customer Service Rock Star Using Virtual Care Services

In this course, you will explore how to increase the customer service experience using virtual care platforms. This course explores the use of videos, pictures, and pet education tools in the context of telemedicine and teletriage.

Today’s Featured ACVC sessions: 10/13

, rehabilitation practitioner Kirsten Oliver, VN, DipAVN (Surgical), CVT, CCRP, CVPP, VTS (Physical Rehabilitation), discussed modalities for rehabilitation in veterinary medicine. View the video for the full dialogue.

Kirsten Oliver, VN, DipAVN (Surgical), CVT, CCRP, CVPP, VTS (Physical Rehabilitation):

 When we discuss physical rehabilitation, what we’re discussing is taking an animal that is either presurgical or postsurgical and returning them—or attempting to return them—back to their previous surgical state.

Videos

Kirsten Oliver, VN, DipAVN (Surgical), CVT, CCRP, CVPP, VTS (Physical Rehabilitation), discusses modalities for rehabilitation in veterinary medicine. 

Modalities in Veterinary Rehabilitation

The world is becoming increasingly digital, with technological conveniences providing instant access to shopping, requesting rides, watching television programs, and connecting with friends and family. Access to almost anything is at our fingertips. Yet, communicating with veterinary providers lags behind when compared to the technological access in our everyday lives. With people of all generations desiring, and even demanding, such conveniences, it is worth taking to heart how we can incorporate technology into providing veterinary service.

In his recent lecture at the Atlantic Coast Veterinary Conference (ACVC), Eric Garcia, IT expert, digital marketer, and founder of Simply Done Tech Solutions, a digital marketing company serving veterinarians, discusses ways in which we can incorporate digital technologies into our practice. Given that communication apps, as well as the use of online pharmacies, provide greater convenience to pet owners, Garcia points out that incorporating these into your practice is attractive when promoting your practice and retaining client base. Technology is a way of life these days, and depriving pet owners of such a convenience can be frustrating for all. They can message their physicians, refill prescriptions online and have them arrive at our homes, and even access some medical records.

Some of the areas in which Garcia suggests incorporating technology into veterinary practice include telemedicine, online pharmacy access, and communication. Communication via text message is natural to most people. Although occasional pet owners may prefer phone communication, these preferences could be noted, and for those who prefer text messaging, apps can provide more rapid access to providing patient updates, answering questions, and providing greater access to information such as future appointments, when their pet is due for a visit, and more. Certainly, some topics warrant face-to-face or phone conversations; however, brief updates or organizing patient dismissal logistics are things that easily and efficiently can be managed via messaging apps.

Such apps not only provide a convenient route for communication but could also allow owners instant access to some of their pet’s medical records, should they need copies or wish to refer back to medical recommendations at a later time. However, Garcia warned that only 1 or 2 apps out there offer full medical record access so make sure to research and ensure you have the app that best fits your needs. 

Garcia also explains that online pharmacies are becoming more and more utilized by pet owners. Practices can provide this convenient service as well, by partnering with existing online pharmacy providers to serve their clients. For those practices that have an online pharmacy partnership, this should be promoted to pet owners.

Similarly, Garcia notes that telemedicine provides a convenience to pet owners that could allow them to minimize taking additional leave from their workday. Although some visits must be conducted in person, particularly to establish an active veterinary-client-patient relationship (VCPR), other follow-up visits may be amenable to telemedicine and may provide greater convenience to owners.

Although there is not a one-size-fits-all approach to using technology in veterinary practice, it is clear that in many practices, technology is underutilized. And that incorporating its use in some of these areas can promote practice efficiency and improve client relationships.

Dr Rebecca Packer is board certified in neurology by the American College of Veterinary Internal Medicine and is an associate veterinarian at BluePearl Specialty and Emergency Pet Hospital in Lafayette, Colorado. She is also the founder and owner of the Pre-Veterinary Mentoring Group, LLC, through which she provides mentorship for pre-veterinary students during their path to veterinary school, and is the founder and owner of The Pocket Neurologist, LLC, a vet-to-vet teleconsulting service.

Learn how easy digital communication, E-commerce, and telemedicine can be for you and your practice.

Bringing the digital world into your practice

According to Charlotte Lacroix, DVM, JD, owner of Veterinary Business Advisors Inc. (VBA) in New Jersey, tons of employment law and Human Resource issues have emerged in veterinary medicine within the past 2 years. In a recent interview with dvm360

 at the Atlantic Coast Veterinary Conference (ACVC), Lacroix discussed 3 different drawbacks veterinary professionals are braving plus a few solutions to help. 

One major issue that LaCroix identified is how operations at practices have changed due to the COVID-19 pandemic. Clinics began reimagining how they provide and practice veterinary care by offering services such as drive-up appointments, telemedicine, curbside care, and touchless pay options. Though these innovations do not come without a few caveats, Lacroix firmly believes these adaptions—especially telemedicine—are here to stay.

“I think telemedicine is going to change how we deliver our services because there are just not enough veterinarians to see every patient,” explained LaCroix. “If we can find a way to deliver or use telemedicine just like the human physicians do—not to replace the VCPR [Veterinarian-Client-Patient Relationship]—but as an extension so that when veterinarians think it is appropriate they can go ahead and help patients until they can get into our practices.”

To learn more about the employment laws affecting veterinary teams and their clinics, watch the full video below. It is also not too late to attend our Atlantic Coast Veterinary Conference (ACVC)! So make sure to register 

Attorney and veterinarian Dr Charlotte LaCroix shared 3 different employment law challenges veterinary professionals are facing, plus a few pro-tips to help.

Employment law: What is affecting veterinary medicine? 

It seems all too common a situation lately, that veterinarians are feeling overworked, unappreciated, and consider leaving the profession. Patricia White, DVM, MS, DACVD, CPC, and certified professional coach, discussed what it means to be a heart-centered veterinarian, and how you can regain your sense of purpose and passion for your profession during her keynote address at the Atlantic Coast Veterinary Conference (ACVC) in Atlantic City.

White started by explaining that being a heart-centered veterinarian is a state of mind in which what we do is aligned with who we are. It occurs when we take responsibility to create and live in alignment with our values, desires, purpose, and passion. She reminded us that this is not an easy task and does take work. The success of a practice, whether as an owner or associate, depends on relationships and communication. All people, whether those who run the business or are served by it, have a need to be valued, seen, heard, and cared for. A component of this need requires an accurate awareness and expression of oneself.

To better define who we are, what we want, why we want it, and why we chose a certain path, White talked about listening to our internal guidance system (IGS). Our IGS is much like a GPS that tells us if something we are doing or a decision, we are making is aligned with who we are or not. She also talked about how our feelings are not good or bad, but rather they are information to help guide us as to whether or not we are still moving towards fulfilling a need. We are meant to pay attention to this information and allow it to guide us.

It is also important to have clarity on what our core values are, as they have a strong influence on our behavior. Our core values represent who we are and form the basis of our personal code of conduct. They are evident in how we serve others and are a defining factor in our morale and motivation. White pointed out that if there is a mismatch between our core values and those of our employer, we will likely not be happy. If you are a practice owner, then your core values likely set the foundation for the culture of the practice and set the tone for what you expect from your employees. Honoring our core values leads to feelings of fulfillment. If we are feeling negatively about our work, we should consider whether or not our work environment (either as employers or employees) matches our core values, as sometimes this is not clear without closer thought.

“Values serve to set the tone and quality for what you expect from your boss and as a boss, from your employees,” White said. “[Your values] serve as a compass, a blueprint, that actually can attract people with similar values.”

White then went on to discuss the importance of identifying our passion and purpose and emphasized that these need not be veterinary-related. If you are unsure what this is for you, she suggested that you start by thinking about a topic or activity that you enjoy, comes naturally to you, energizes you, puts you in flow, and makes time go by quickly. These things are your passion.

“Your passions can change over time, but it’s important to know what they are,” she added, “Pay attention to these things that light you up, then make a movement toward [them].”

Your purpose is related to passion and your core values. White explained that your purpose is the “big why,” the blend of your passions and skills that align with your values and is the answer to the deeper meaning of why you do what you do, that moves you in the direction of living your passions, and that how you are getting to that direction is in alignment with your core values. When all of these things align, you feel happy and productive. This, White told us, is how we live with purpose.

Purpose is fundamental to the concept of ikigai, which embodies words like alive, life-purpose, worth, and relates to broader actions such as to serve, create, teach, delight, nourish, provide, heal, connect, and build. Overall, the concept of ikigai is to do those things which fulfill you, excite you, make you happy, and anticipate the next opportunity to do these things again.

When we are not aligned with our passion and purpose, our body sends signals of discomfort. Common mental and physical manifestations of this malalignment are low energy, fatigue, feeling trapped, digestive problems, forgetfulness and inability to concentrate, headaches, anxiety, depression, insomnia, and others. When following our purpose, we should feel lightness, freedom, and energy. We should feel less stress, sleep well, and overall feel healthier.

That is not to say that this is easy to attain. White reminded us that this takes work. There are hurdles that need to be overcome. In a survey she conducted, veterinarians stated that the 3 most common challenges that prevent them from living with purpose, included limited time and money. There are only so many hours in a day, and often we put others ahead of ourselves in that priority scale of taking care of others, family, and ourselves. We may feel we do not have the financial affluence or additional time to alter that order.

“Put what you love on your calendar…and set aside time that you honor like any appointment—don’t make excuses, don’t cross it off and put something else there…even [with] that small step you’ll see things will change,” White advised.

Another challenge was fear. In some cases, this was fear of success, failure, judgment, disappointment—we all have experienced that concept of not yet feeling ready to do something, and that it may be better if we have more time, or money, or experience, to ensure success. These reasons we use to determine readiness, White explained, are really a mask for our fear. This fear prevents us from achieving our goals. It is worth really examining these feelings and determining if we truly want to do something and are held back by fear, or if we perhaps do not have such a strong desire to do it (in which case perhaps it is not aligned with our passion and purpose). The third challenge highlighted in the survey was a lack of clarity about what one’s core values are, or how to incorporate these values into the practice.

Ultimately, when determining our work environment and life decisions, White’s advice is that we should focus mindfully on our core values, our passion, and our purpose. This is where the spirit of our work or business develops, and this may differ from the vision that others feel we should have for our work or business. Following these principles will provide the energy to venture out of our comfort zone and provide sustainability in our work.

White concluded by quoting Joseph Campbell: “The privilege of a lifetime is being who you are.”

During her keynote address at the Atlantic Coast Veterinary Conference, Patricia White, DVM, MS, DACVD, CPC, helped attendees rediscover not only their passion for their profession, but how to regain their sense of purpose.