Originally published in the January 2016 issue of Veterinary Practice News. Did you enjoy this article? Then subscribe today!
I’m writing this as I return from the 29th annual Veterinary Dental Forum in Monterey, Calif. This year, the forum was combined with the 13th World Veterinary Dental Congress, so leaders in the field from around the world converged upon Monterey.
Here are some of the hot trends and tools for 2016 that I noted at the conference.
Dental Radiography and Dental Teleradiology
More and more general practices are getting digital dental radiography, and with good reason. Dental radiography provides the necessary information to allow veterinarians to diagnose and treat oral diseases. Radiography also provides assurance that treatment has been successful.
The most important thing to do once you purchase a dental radiography system is to use it.
Every patient can benefit from dental radiographs. Learning radiographic positioning and radiographic interpretation takes time. Positioning can be learned with a site visit or by attending continuing education events.
Learning positioning will require some practice with a skull or cadaver to master the intricacies of tube head positioning. Interpretation becomes easier with time, but those initially produced radiographs may require a consultation.
Luckily, multiple dental teleradiology services are available, some of which offer a “stat read” option for a quick diagnosis while the patient is under anesthesia.
Bone Graft Materials
Allograft products are gaining popularity for various uses in dogs, cats and horses. Bone membranes are used as a supporting structure for treatment of oronasal fistulas — see "How to Use an Allograft Membrane to Fix Oral Trauma"— and for treatment of periodontal disease via guided tissue regeneration.
Particulate bone allograft is placed into cleaned periodontal pockets that exhibit vertical bone loss, and this material can be protected from ingrowing epithelium by placement of an appropriately placed membrane.
Thiol Test for Presence of Periodontal Disease
A tableside, semiquantitative thiol test for periodontal disease has been available for years in dogs (OraStrip).
A 2012 study determined that the best place to use the test was along the gingival margin of the maxillary arch (Manfra Marretta S, Leesman M, Burgess-Cassler A, McClure GD Jr, Buelow M, Finn M. Pilot evaluation of a novel test strip for the assessment of dissolved thiol levels, as an indicator of canine gingival health and periodontal status. Can Vet J. 2012; 53: 1260-5).
Oral microbes produce volatile sulfur compounds such as hydrogen sulfide and methylmercaptan. These compounds have been determined to be involved in the development and progression of periodontal disease.
A colorimetric test strip is rubbed along the gingival margin of the maxillary arch on both sides of the mouth to provide a score of 0 to 5. The darker the yellow color — the higher the score — the more thiols are present in the mouth.
A new, yet-to-be published study suggests these strips can be predictive of irreversible bone loss. A study done by Katherine E. Queck, DVM, FAVD, and others showed that OraStrip scores of 4 or 5 (out of 5) had a 95 percent or 100 percent chance of irreversible bone loss, respectively.
Besides detecting severity of periodontal disease on the first visit, thiol tests can be utilized to assess long-term effectiveness of a home care plan in conjunction with a conscious oral exam.
Miniplates for Jaw Fractures
I’ve been using more miniplates, largely because I’ve been seeing more cases of pathologic mandibular fractures due to severe periodontal disease. Miniplates have been my go-to fixator for cases where all the teeth are severely diseased and require extraction.
Depending on the location of the fracture — pathologic fractures often occur at the mesial or distal surface of the mandibular first molar — I may choose an intraoral or extraoral approach. Small enough plates are available to allow for avoidance of the inferior alveolar artery and nerve.
Stay tuned for my future article on using miniplates to treat mandibular fractures.
Proper Dental Education
Practitioners who graduated more than a few years ago — and even recent graduates of schools that have no clinical dental rotations — may not have had much dental education during their formal training. These veterinarians are turning to CE events to learn basic dental techniques, including extractions, nerve blocks and periodontal therapy.
The Veterinary Dental Forum combined a wonderful venue with a world-class educational program. The forum will again offer great lectures and wet labs in September in Minneapolis, and great courses are available from various instructors year-round throughout North America.
Various CE events are held throughout the year at the larger meetings and at smaller dentistry-specific venues.
Another educational dental tool is the Journal of Veterinary Dentistry, which recently acquired a new publisher and a new editor.
After 15 years at the helm of the journal, Mark and Debra Smith ended their terms as editor-in-chief and managing editor. The Smiths have advanced the journal greatly over the past 15 years, and it is now the journal of record for 11 international associations throughout the world.
I am honored to take over as editor beginning with the first issue of 2016, along with the help of an important veterinary technician influence, my wife, Kimberly.
We look forward to continuing to build the journal’s scientific impact while maintaining the important clinical focus from which it arose.
From my family to yours, I hope 2016 brings you all you hope and wish for.
Keep on drilling!