The phrase “it’s like pulling teeth” arose for a reason. Having the right equipment and supplies can help. This article is the first in a two-part series discussing essential tools of the trade. After 29 years in practice, I finally figured out why most veterinarians do not like dentistry. When I travel to visit veterinary colleagues at referring practices, it becomes clear most are lacking the resources they need to make surgical extractions easier. Sometimes, the problem is the lack of training because dentistry as a discipline did not have much of a foothold in their veterinary school’s curriculum. This is unfortunate, since dentistry is a huge part of the graduating veterinarian’s daily life. A lack of training can be addressed even after graduation by enrolling in an appropriate continuing education program. No matter what level of dental training vets have achieved, there’s always an opportunity to take it to the next level. The two most important tools in the diagnosis of a variety of different dental conditions are the digital dental X-ray unit and the periodontal probe. In the late 1990s through the early 2000s, digital dental radiography was a benchmark for whether a general practice was keeping up with the times. Twenty-five years later, it is safe to say performing surgical extractions without having dental radiography in your practice does not meet a minimum standard of care. X-ray units Direct digital systems are typically attached directly to a computer via a cord. The immediacy of direct digital systems is a great benefit when learning positioning techniques. Direct digital radiography (DR) systems provide instant feedback, so if tube head positioning is elongated, the X-ray tube head can be quickly adjusted to see the benefit of repositioning. Historically, one disadvantage of a direct digital system was that sensor sizes were limited to sizes 0, 1, and 2. However, there is now a size 4 digital sensor on the market. Plastic sleeves are placed over the sensor to protect it from moisture, and care should be taken to prevent a patient from biting down on it. A variety of direct digital systems exist for veterinarians, and it is worth looking at each available type to ensure you are happy with the sensors and their individual software. Different systems have different defaults for how much image processing occurs to the image prior to it showing up on your computer screen. Nearly every digital system, direct or indirect, allows for default settings to be modified to your individual interpretation preferences. Indirect or computed radiography (CR) systems utilize reusable phosphor plates that are scanned to provide an image on the computer screen within seconds of exposing and scanning the plate. As the plates are fed into the machine, the image on the plate is scanned into the computer software, and the image is cleared from the plate so it is ready to be reused. The plates are available in a variety of sizes, including size 4 or larger. The phosphor plates can become scratched, so plastic covers are necessary to prevent damage and to prevent moisture and hair from getting transported into the scanner. The amount of radiation needed to provide an optimal image may vary when comparing new phosphor plates to those that have been reused many times. Phosphor plates are much less expensive to replace than a damaged direct digital sensor. Probes Now, an ode to the probe! The periodontal probe/explorer is the most common double-ended diagnostic instrument, however, there are variations. A probe or explorer can also be purchased in a single-ended version, and double-ended instruments are available with two different probe types or two different explorers on each end. The probe helps determine and measure pocket depths when measured at multiple sites around the circumference of the tooth. The normal gingival sulcus depth for a cat is less than 1 mm, and less than 3 mm for a dog. Probing determines if there is a normal anatomic gingival sulcus or an abnormal periodontal pocket due to attachment loss. My favorite type of probe for use in veterinary dentistry is one called a UNC-15, which has easy-to-spot markings up to 15 mm (Figure 1 A). This probe can also be used to measure and document the dimensions of small oral masses. Figure 1A. Photo courtesy Dr. John R. Lewis The explorer is used to assess whether fractured teeth have pulp exposure, assessing the gingival margin of the tooth for evidence of early tooth resorption, and feeling for subgingival calculus. Figure 1 B shows two different types of explorers. The TU #17 (or its similar counterpart, the Orban #17) is helpful for finding subtle tooth resorption in cats that might be missed with larger explorers such as the #23 shepherd’s hook. Figure 1B. Photo courtesy Dr. John R. Lewis The high-speed/low-speed dental unit is the third essential piece of equipment that every practice should have. Most units run on compressed air, but in recent years, electric units have been gaining momentum in veterinary dentistry and oral surgery. The electric unit handpiece is heavier than an air-driven handpiece, but its main benefit is the torque it can generate. Regardless of whether you use an air-driven or electric handpiece, having an assortment of burs is essential. This is the working end of your handpiece, and a variety of burs allows for a variety of functions. Figure 2 shows an assortment of burs that are helpful in general practice, including carbide round burs, crosscut fissure burs, and diamond burs. Most carbide burs are best purchased in surgical length rather than standard length. Figure 2. Photo courtesy Dr. John R. Lewis Next month’s column will dive deeper into helpful equipment that makes dental extractions easier, including some newer options for your armamentarium. John Lewis, VMD, DAVDC, Fellow- AVDC OMFS, teaches at Silo Academy Education Center and practices at Veterinary Dentistry Specialists in Chadds Ford, Pa.
