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Doing veterinary dentistry right

Incorporating dental services into your practice is a matter of getting the correct equipment and developing your skills

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According to many veterinary professionals, the single greatest piece of advice for purchasing veterinary dentistry equipment is: don’t skimp.

“Many veterinarians are frugal and feel that dental equipment is not worth the cost and tend to purchase the less expensive equipment believing it is all the same,” said Mary L. Berg, BS, LATG, RVT, VTS (Dentistry), with Beyond the Crown Veterinary Education in Lawrence, Kan. “It’s not. It is better to talk with experts in the field and other colleagues to determine the quality of the equipment.”

Those looking for value should first consider the value good dental equipment can bring to a practice, according to Barden Greenfield, DVM, DAVDC, a board-certified specialist in dentistry practice limited to dentistry and oral surgery, and president of the American Veterinary Dental College.

“They worry and they mull over how to pay for it,” Dr. Greenfield said.

Greenfield, an educator with Midmark dental equipment manufacturer, said he often hears from practitioners who say they aren’t interested in purchasing dental X-ray equipment because of its high cost.

“Dental radiograph equipment will be paid for in a matter of months,” he said. “It’s the most profitable piece of equipment in hospital, bar none.”

Dental equipment is typically used every day by a practice for diagnosis and treatment, he said.

“Treating the problems make a happier animal, you do procedures, and it’s better for the practice,” he said. “It’s a win-win situation.”

Equipment essentials

When it comes to dental equipment, many practitioners perceive value the wrong way, said Christopher Snyder, DVM, DAVDC, a clinical associate professor of veterinary dentistry and oral surgery at the University of Wisconsin-Madison.

“Veterinarians are very cost-conscious,” Dr. Snyder said.

Inappropriate or poorly maintained equipment may be among the reasons some veterinarians have reported having bad experiences with dentistry, he added.

“I think having instruments that are not sharp or don’t stay sharp, or using dental instruments that are not robust and strong, people have a negative experience because instruments don’t behave like they expect,” he said. “Instruments that don’t stay sharp like they should break when they shouldn’t, creating a negative experience all the way around. You don’t need to buy the Ferrari of dental instruments, but when buying middle-of-the-road instruments, the expectation is they should hold up and they should last for a reasonably long time if cared for appropriately.”

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Of course, incorporating dental equipment goes beyond earning more income for a practice and making patients happier.

For Snyder, X-rays and lighting are keys to providing better dental services.

“I think many veterinarians are intimidated by extractions or they encounter challenges performing extractions due to difficulty visualizing what they’re doing,” Snyder said. “The capacity for performing dental X-rays is becoming a must in most practices.”

Appropriate lighting also is vital, he added.

“Eyeglass-mounted loupes can be really helpful in feeling confident, knowing what you’re looking at, and executing dental procedures safely and effectively,” he said.

One of the most important dental tools a practice can purchase is a high-speed delivery system, according to Greenfield.

“With that, it is really important to have a swivel tip handpiece with help facilitating extractions and bone removal,” he said. “It’s just invaluable.”

Greenfield also emphasized the importance of hand instrumentation.

“All hand instruments need to be sharp; therefore [veterinarians should] ensure they have a sharpening stone, or even better—a sharpening wheel,” he said. “There’s not a veterinary dentist who doesn’t have one—they’re awesome.”

Essential equipment includes a dental unit with high- and low-speed handpieces, a scaler, and an air/water syringe, according to Dr. Berg. These tools make the entire procedure—from cleaning to oral surgeries—faster and more efficient, she said.

“It is vital to remember to replace the bur on the high speed often—sometimes multiple times for one patient,” Berg said. “If the bur does not move through the tooth like a hot knife through butter, it’s dull, which can lead to patient complications and cause damage to the turbine in the handpiece.”

Understanding when and where to use various scaler tips also helps maximize efficacy, she added.

“A gross removal tip or beaver tail tip should be used on the crowns of the teeth, while a periodontal tip is finer and allows for better access below the gumline,” she said. “It may take a few seconds to change the tips, but the overall time savings will make it worth it.”

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A winged elevator set is another tool to consider purchasing, said Jan Bellows, DVM, DAVDC, DABVP, with All Pets Dental in Weston, Fla.

“It’s a way to take out teeth with instruments that wrap around the entire tooth,” Dr. Bellows said. “They make procedures so much easier.”

Additionally, she recommends going beyond simple skull films.

“You can’t do a god job in dentistry without intraoral X-rays,” Bellows said. “You want to see what’s below the gumline.”

A periodontal probe marked in millimeters allows for more accuracy, Bellows said, adding that he prefers a No. 11 blade to a No. 15 because “it’s pointier.”

Beyond the tools

The right equipment is only the first step, according to Curt R. Coffman, DVM, FAVD, DAVDC, with Arizona Veterinary Dental Specialists.

“Equipment alone will not make the DVM an overnight expert,” Dr. Coffman said. “Proper training and education to understand the science behind the equipment and the technique necessary to implement the equipment, as well
as didactic practice using the equipment, is necessary.”

A human doctor of dental surgery must complete four years of postgraduate education, while most graduate DVMs have less than 10 hours of actual dental education and little if any didactic experience, he said.

“To expect DVMs to understand and provide optimal dental and oral surgical treatment with a single weekend course or one weekend CE lab is not realistic,” he said. “Continued CE and clinical practice are necessary for the DVM to develop the basic dental skills to confidently and successfully provide general dental care.”

According to Curt R. Coffman, DVM, FAVD, DAVDC, equipment alone will not make the DVM an overnight expert. “Proper training and education to understand the science behind the equipment and the technique necessary to implement the equipment, as well as didactic practice using the equipment, is necessary,” he adds.

Purchase and practice tips

Christopher Snyder, DVM, DAVDC

  • Purchase equipment that will be versatile and help with big-picture problems. Don’t look for niche purpose burs or root-tip removal gizmos; look for quality equipment that will stay sharp and improves visualization of the surgical field.
  • Choose manufacturers with a proven track record that will provide support for big-ticket items. When purchasing dental radiography equipment, look for companies offering good customer support and in-person training. Someone showing you how to use the equipment will optimize success.

Jan Bellows, DVM, DAVDC, DABVP

  • Take full-mouth X-rays for every case.
  • Keep on hand clotting powder to help with excessive bleeding.
  • Make very large flaps to provide maximum exposure to see what you’re doing.

Barden Greenfield, DVM, DAVDC

  • Take X-rays on all dental patients, as 30 percent of dogs and 40 percent of cats have disease beneath the gum line that only X-rays can diagnose.
  • Magnify and illuminate. Both are important because working in the mouth is a high-detail endeavor. Use at least 2.5x magnifying glasses or loupes to get a better view of the field, and also use a headlight.
  • Ensure all patients are charted and probed and that team members know how to probe and chart, otherwise you can miss pathology. l
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