Surgical endodontics: When all else fails...May 6, 2019In my previous two columns, we looked at conventional (orthograde) root canal therapy, along with vital pulp therapy. This time, we will discuss surgical (retrograde) endodontics. In instances where orthograde root canal therapy has failed, a decision needs to be made to either perform a second orthograde root canal therapy or to proceed to the next step: surgical endodontics. Extraction would be a third option for a failed root canal procedure if the owner no longer chooses to salvage the endodontically diseased tooth. Besides its use as a treatment when orthograde root canal therapy fails, retrograde root canal therapy may be the chosen course of action when an instrument breaks off while performing an orthograde procedure. Instruments most likely to break off in the canal include Lentulo spiral paste fillers, barbed broaches, and rotary files. Sometimes the detached instrument portion can be entombed in endodontic filling material during orthograde obturation, but if not, a retrograde procedure may be warranted. The procedure What is surgical root canal therapy? A surgical approach is made over the apical portion of the root, and bone is carefully removed to expose the root area (Figure 1). The apical 4 mm of the root is surgically …
SPONSORED CONTENTA Modern Approach to Parasite PreventionWith evolving parasite threats, traditional preventatives may not be enough. Discover how innovation is changing the landscape of protection. + Learn More
Vital pulp therapy in dogs and catsMarch 29, 2019Last month, we discussed the rationale behind and approach to conventional (orthograde) endodontic therapy. Orthograde root canal therapy removes the entire contents of the pulp chamber in the root canal system. Vital pulp therapy is a different kind of endodontic procedure, performed instead on teeth that have had recent pulp exposure. Determining whether it's best to perform vital pulp therapy or orthograde root canal therapy for an individual tooth is a judgment call. Most dentists gravitate toward orthograde root canal therapy whenever possible, since it involves removing the entire contents of the pulp and minimizes the likelihood of possible future pain and infection by not leaving to chance whether remaining pulp maintains its vitality. However, orthograde root canal therapy may not be an option for young teeth, as they lack a closed apex. In the past, it was a rule of thumb that vital pulp therapy be performed within 48 hours of pulp exposure in dogs older than 18 months of age and within two weeks in dogs younger than 18 months of age. However, the sooner vital pulp therapy is performed after pulp exposure, the better the chance of success. Therefore, even when a patient is younger than 18 …
Veterinary Dentistry Specialists expands with new clinic in Chadds Ford, PaMarch 13, 2019Dogs and cats in Chadds Ford, Pa., will now have access to advanced dental care by board-certified veterinary specialists in dentistry and anesthesia. Veterinary Dentistry Specialists (VDS) is opening a second clinic, expanding its services from its original location in Mt. Laurel, NJ. Owned by Carlos Rice, DVM, DAVDC, Veterinary Dentistry Specialists is one of few dentistry practices where a full-time, board-certified veterinary dentist and a full-time, board-certified veterinary anesthesiologist work alongside each other. Veterinary dentist and Veterinary Practice News columnist, John Lewis, VMD, FAVD, DAVDC, and veterinary anesthesiologist, S. Bryce Dooley, DVM, MS, DACVAA, will be at the helm of the new clinic. "We spent a large amount of time and resources creating a facility showcasing the future of veterinary dentistry," Dr. Lewis says. "I think it's safe to say this facility rivals even the best medical facilities for humans. We are excited to open our doors and provide concierge-level care for pets in the region." VDS offers advanced services for the care of orofacial conditions and diseases, which affect the mouth, teeth, jaws, and face. The services cover tooth restoration, periodontal surgery, oral oncologic surgery, jaw fractures, salivary gland diseases, endodontics, orthodontics, palate surgery, etc. There are …
AAHA releases 2019 Dental Care Guidelines for Dogs and CatsMarch 7, 2019The American Animal Hospital Association (AAHA) has updated its dental care guidelines with the goal of decreasing oral pain and improving the quality of life for dogs and cats. While not always apparent to pet owners, by the age of three, dogs and cats have some level of periodontal disease. Updated from the 2013 edition, the 2019 AAHA Dental Care Guidelines for Dogs and Cats are designed to help veterinary professionals expand their current client education efforts, so pet owners understand periodontal disease can be avoided through regular dental checkups and proper home care. The new guidelines also help veterinary practitioners address the fear of anesthesia among pet owners, as it is the most common reason for declining dental procedures. "Regular dental care is one of the most powerful ways we can improve the quality of life of our patients," said AAHA chief executive officer, Michael Cavanaugh, DVM, DABVP (emeritus). "AAHA continues to support the use of general anesthesia in dental procedures to promote appropriate diagnostic capabilities and decrease patient stress, injury, and risk of aspiration. Because home care is crucial in the support of a healthy, pain-free mouth, client communication and education remain central to these guidelines." Detailed …
How to improve client compliance for dental proceduresFebruary 11, 2019This month, veterinarians are being encouraged to raise awareness of oral care as a component of general health for animals and increase routine dental checkups.
Bad breath could be a sign of diseaseFebruary 7, 2019As part of Pet Dental Health Month, the American Veterinary Medical Association (AVMA) is advising veterinarians to encourage pet owners to make their pet's oral health care a top priority and to schedule professional exams. According to AVMA president John de Jong, DVM, pet owners should be made aware that poor oral health could lead to potentially life-threatening damage to their pet's internal organs as a result of periodontal disease. "Oral disease is the most frequently diagnosed health problem for our pets," says Dr. de Jong. "In addition to causing receding gums, tooth loss, and significant pain, bacteria in the mouth enters the bloodstream potentially affecting the heart, liver, and kidneys, which can be life-threatening." AVMA reports most dogs and cats have some evidence of periodontal disease by the age of three, indicated by bad breath, a change in eating or chewing habits, pawing at the face and mouth, and depression. A study published in the Journal of Veterinary Dentistry (JOVD) showed that only two percent of dog owners follow through on brushing their pets' teeth. In addition, a survey of pet owners showed that only 14 percent of dogs and nine percent of cats receive dental care at the …
Dentistry—A discipline in need of changeFebruary 4, 2019I am writing this article as I travel home from Phoenix, after attending a successful Veterinary Dental Forum (VDF). This event is the official annual meeting of the American Veterinary Dental College (AVDC), Academy of Veterinary Dentistry (AVD), and the Foundation for Veterinary Dentistry (FVD). This year, VDF drew its largest crowd yet, partly due to general practitioners that are filling an educational void by attending lectures and wet labs in the various disciplines of dentistry and oral surgery. In this month's column, and in honor of National Pet Dental Health Month, I'd like to discuss a challenge for the veterinary profession, specifically dentistry training at the veterinary school level. It's not a new problem, and it doesn't exist at every school, but its significance is greater today than ever before, due to the changing needs of successful general practices. Decreasing significance The number of didactic teaching hours available within the veterinary curriculum is not getting any larger. In fact, teaching hours dedicated toward a specific topic are becoming more difficult to obtain due to new specialties, expanding knowledge base, and justifiable shifts in curricular focus to feed not only the IQ, but also the EQ. Ask any small-animal …
Five reasons clients will love your dental experienceFebruary 4, 2019What if clients loved their pets' dental experiences at your veterinary hospital? As most dogs and cats have periodontal disease by age three, you will speak with clients multiple times about dental treatments over their pets' lifetimes. Creating a positive experience for the first dental procedure can set you up for success when you need to present future care. Here are five strategies for creating stellar client satisfaction through your dental services. 1) Tackle paperwork in advance. Don't wait until the morning of procedures to get signatures. Clients may have experienced road rage while driving to your clinic, chased the cat for 45 minutes trying to get it into the carrier, and were late for work. Instead, have clients sign treatment plans and anesthetic consent forms on the day of diagnosis when they book procedures. At my recent seminar in Reno, Nev., a technician testified this tactic reduced a 20-minute surgical admission to seven minutes. A backup plan is to use text and email together. Two days before the procedure, text the client to confirm the admission appointment: "See you tomorrow at 8 a.m. for <pet name's> dental admission. No food after 10 p.m. Water is OK. We emailed …
Confessions of a veterinary dentistJanuary 15, 2019When it comes to preventing progression of periodontal disease, tooth brushing is the least expensive and most effective home-care method to help avoid the need for future extractions.
Idiopathic osteomyelitis/osteonecrosis of the jaw in dogsDecember 13, 2018Osteomyelitis of the maxilla, mandible, or incisive bone, can occur due to severely diseased teeth in an area, but some cases don’t seem to be simply the result of an extension of periodontal or endodontic disease. These cases are often more than just osteomyelitis. Instead, they show evidence of dead bone, often in the form of a sequestrum, a necrotic piece of bone that may want to come out in one large piece during surgical exploration. In the absence of any history of radiation therapy or bisphosphonate administration, these cases are best described as idiopathic osteomyelitis/osteonecrosis. When they enter your exam room, you will smell what’s going on before you are able to see it.
