Failing to “KISS” When Taking Radiographs
“KEEP IT SURPRISINGLY SIMPLE” to eliminate frustration and maximize efficiency when taking full mouth radiographs. Below is a link to a video of a full mouth series done at my Atlanta office that shows you step by step how to take the fastest radiographs possible on a large dog patient. This is the exact approach we recommend for all general veterinary practices and will eliminate your positioning headaches. We also discuss a ton of valuable tips and tricks.
Click the image of the skull below to register for a 60 min free live online training that will transform the way you do dentistry.
Cleaning the Teeth First
Veterinary dental radiographs should always be done first so that the veterinarian can evaluate the radiographs and chart the treatment plan while the technician proceeds to clean, polish. Taking radiographs first, allows the technician to avoid cleaning teeth that are to be extracted.
These incisors have severe bone compromise and should be extracted. Cleaning the crowns serves no value here.
Eliminating unwanted anesthesia for veterinary dentistry patients is key to completing these long procedures in the shortest period of time. Cleaning these teeth premolars prior to extraction will only compromise patient care.
Cleaning teeth that are going to be extracted is not indicated because it increases anesthesia time and consequently decreases patient safety. A preliminary estimate can be generated immediately. If you are doing full mouth surveys currently you will agree that extractions comprise the vast majority of the all dentistry procedures where periodontal disease is moderate to severe (almost every one of your dentistry patients!) Save time and increase patient safety not cleaning first.
Detailed Charting of Teeth to be Extracted
Radiographs should always be first for this reason as well. Teeth to be extracted do not need detailed charting! The only notation needed is the periodontal index, based on radiographs. Periodontal Disease Index 3, 4 and in some cases 2 (PDI 2, PD3, PDI4) provide justification for extraction and no further notation is needed. Evaluating periodontal pockets, gum recession or other gross findings on teeth that radiographically have significant bone loss that are to be extracted is not only unnecessary but also wastes valuable anesthesia time compromising patient safety.
Keeping Veterinary Dentistry Patients Too Deep Under Anesthesia
Regional nerve blocks used during veterinary dental procedures, most commonly extractions in dogs and cats, allow patient anesthetic depths to be very light. We try to keep our patients near waking so that they have still retain both a palpebral reflex and a swallow reflex. Properly performed procedures on patients with periodontal disease take 1 1/2 – 3 hours! Keep them light and keep them safe.
Mistake # 5
Not Allowing Enough Time for Each Procedure
Full mouth radiographs will unveil enough pathology that 1 1/2 to 3 hours will be required to properly complete treatment, Multiple extractions comprise the majority of dentistry procedures that are done CORRECTLY in veterinary practice today. Correctly means not just extraction of the tooth but surgical flaps, removal of all granulation tissue and debris under the gum, contouring the bone with a diamond bur, postop radiographs and closure of the flap with sutures.
This patient presented as a rescue to be spayed but has severe periodontal disease. The procedure was delayed to resolve the oral disease first. Near full mouth extractions were performed.
This is the same patient as image 6, three weeks post surgical extractions. Surgical quadrant flaps, extraction, diseased bone and soft tissue removal followed by flap closure produce this result and is the standard of care in veterinary practice today.