5 practical tips to improve efficiency and safety in veterinary dental procedures

Editor’s note: Mary Berg, BS, RVT, LATG, VTS (Dentistry) is unaffiliated with C.E.T. and the content of this interview has been in no way influenced by the awareness month sponsor.

This dvm360 interview with Mary Berg, BS, RVT, LATG, VTS (Dentistry), outlines pragmatic workflow interventions that veterinary teams can implement to improve efficiency, safety, and clinical outcomes during dental procedures. Berg discusses performing diagnostic radiographs early in the anesthetic protocol to enable concurrent review and treatment planning, prescaling mechanical reduction of plaque to decrease aerosolized bacterial load, and deliberate selection of ultrasonic tips to accelerate calculus removal while preserving periodontal tissues. The recommendations are presented with a focus on team training and simple, reproducible techniques that practices can adopt immediately to optimize operatory throughput and patient care.

Transcript

Berg: Well, I think some of the things I'd like to help practices understand are how to have a good flow for the anesthetic procedure from start to finish. One of those things is to take your radiographs first. The way I teach radiographs, I do them in sternal and dorsal so the animals are ready in sternal during intubation, making sure that the patient is connected to the anesthetic machine, the monitors, and is nice and toasty warm. Then, as soon as they're at a surgical plane of anesthesia, take the dental radiographs. That allows the veterinarian to review those rads while the technician is charting and cleaning. That way, if something comes up that you weren't expecting to see, you have a chance to call the owner without having to stop in the middle of the procedure to get permission to treat. It just helps with the overall workflow to do those first.

Other things I see hospitals could improve on are making sure their teams are well trained on how to chart and how to evaluate the oral cavity, knowing what is normal so they can recognize abnormal findings. In addition, a really simple thing that makes a huge difference in the cleaning process is something we do when we go to the dentist. Most people brush their teeth right before they walk into the dental office because we want the dentist and the hygienist to think we're doing a great job. I chart first because I want to see the gingivitis and evaluate gingival health. After charting, take a soft-bristle toothbrush and thoroughly brush all of the tooth surfaces, then use the air-water syringe with both buttons depressed to wash the mouth out. You are removing over 80% of that plaque bacteria.

Why is this important? When we use the power scaler, we aerosolize that bacteria; it can travel up to six feet around the operatory and stay in the air for eight to 12 hours. Rinsing with chlorhexidine helps, but that is not instant. Brushing the teeth and removing that bacteria down the drain makes a huge difference, not only for aerosolization but also because now I can dry the teeth a little and target the calculus. Plaque is easy to brush off but harder to remove with a scaler. When I evaluate products for the Veterinary Oral Health Council seal of approval, this is how we do it: we disclose the plaque, grade it, brush it off, rinse and dry, and then grade the calculus. This procedure shortens the time frame and gives you a cleaner work environment. I have been doing this for 34 years. Just brushing first makes a huge difference, and it's just water and a wet toothbrush. You don't have to do anything fancy.

Here is another trick. We do not like to share toothbrushes, so soak the toothbrush in a cup of chlorhexidine solution, rinse it out well, and send it home with the pet. Now they have their own toothbrush.

One area many hospitals miss is using the right scaler tip in the right area of the tooth. Almost every hospital I go to uses only the universal tip on their power scaler. The universal tip is designed to be used on the crown and below the gum line, but it is too slow to do a good job on the crown in a short time and too large to get into periodontal pockets. You will speed up the dental cleaning if you use the beavertail tip on the crowns of the teeth to remove gross calculus quickly. I use only the distal three millimeters of the edge of the beavertail tip and move quickly with a light touch. Once I have cleaned the crowns in the area, I switch to the periodontal tip to get below the gum line and clean out periodontal pockets. Even though it takes a few seconds to change tips, the time you save overall is phenomenal. It takes forever to clean a big dog's teeth with only a small universal scaler.

One last tip: instead of filling the polishing cup repeatedly with pumice and polishing each tooth one by one, I spread the pumice paste on the teeth with my finger and then polish. That saves time over the course of the procedure.