Comprehensive Oral Health Assessment and Treatment (COHAT)
1. A thorough patient history and signalment including an assessment of home care and chewing habits.
2. A thorough general physical examination and complete awake oral examination
3. Pre-anesthetic diagnostics including complete blood count, serum chemistries and a urinalysis. Other tests may be required base on health status and age.
4. Preanesthetic and analgesic planning. Patients in chronic pain should be given an intravenous analgesic infusion prior to the procedure.
5. Preanesthetic administration and induction of anesthesia, endotracheal tube placement and maintenance with an anesthetic gas.
6. Comprehensive monitoring with blood oxygen saturation, end tidal carbon dioxide, EKG, respiration monitors, blood pressure and temperature.
7. External warming with Bair huggers, warm water circulated blankets and warmed fluids.
8. Constant monitoring by the three members of the dentistry team, the doctor, the dental technician and an anesthesia technician.
9. Complete intraoral asssessment with visual assessment, entire mouth digital dental radiography, periodontal probing and charting. THE MOST IMPORTANT AMONG THESE IS DENTAL RADIOGRAPHY.
10. Complete scaling and polishing above and below the gum line. BELOW THE GUM LINE IS PARAMOUNT AND CANNOT BE PERFORMED WITHOUT ANESTHESIA.
11, A treatment plan is formulated based upon the above findings and given to the pet parent by phone.
12. Oral nerve blocks are given to allow the patient to stay very light under anesthesia and allow the patient to wake up and remain pain free for up to 6-10 hours postoperatively.
13. Treatment is performed by the veterinarian well skilled in oral surgery and dental radiographic interpretation assisted by the dental technician while monitored by the anesthesia technician to ensure timely progression through the procedure, minimizing anesthesia time. Periodontal flap based surgical extractions are the most common procedure allowing all diseased tissue and bone to be removed and sutured over the extraction site. Extraction of teeth without gum flaps does little to nothing to benefit the patient if all of the disease surrounding the tooth is left. Other procedures may be recommended to save teeth using advanced guided tissue regeneration techniques and endodontic and restorative therapy.
14. Upon completion of the procedure the patient’s oral cavity is thoroughly flushed followed by a quick and uneventful recovery. Preanesthetic medications and analgesics combined with nerve blocks allow for a very rapid recovery by allowing the patient to stay at near waking levels during the procedure. Pet parents are called to inform them that their pet is comfortable once awake and the discharge time is made.
15. Postoperative medications, instructions, contact numbers and recheck information is thoroughly discussed at the discharge appointment.
Images Courtesy of Healthy Mouth Water Additive for Dogs and Cats