Remember these tips to help your first dental go as smoothly as possible.
While your brain may be focused on the teeth, anesthesia is every bit as important. (Actually, given that anesthesia is a matter of life and death, it could easily be argued that it’s even more important!) Take the time to carefully calculate drug doses, review your anesthetic plan with the veterinarian, and ensure that all of your anesthetic monitoring equipment is ready. Leak-test your anesthetic machine prior to inducing anesthesia and make sure that you have several endotracheal tubes available. After intubation, inflate the cuff carefully to prevent leaks without causing trauma to the trachea. Ideally, you will have another vet tech available to monitor anesthesia while you are working on your patient’s teeth, but that often isn’t the case. Don’t get so focused on your dental care that you forget to perform proper anesthesia monitoring!
When we think about a dental, many of us automatically focus on the cleaning aspect of the procedure. Our first inclination, once the pet is anesthetized, is to start removing all of that nasty tartar! Before jumping into cleaning, though, take a couple of minutes to perform a thorough oral exam. Don’t just examine the teeth; examine the gums, palate, tongue, tonsils, oral mucosa, and every other structure that you can locate within the mouth. Do this first, to be sure that there isn’t something more urgent than dental care that needs to be addressed.
When positioning your patient, ensure that fluid doesn’t enter the airways. A lap sponge or 4x4’s can be packed into the pharynx around the endotracheal tube, to reduce the likelihood of aspiration. (It’s important to have a system in place to ensure that this doesn’t get forgotten at extubation.) The pet should also be placed with the head lower than the body, to further facilitate drainage of fluid. Also, think about how you can position the pet to make your job easier. You will have to move the patient several times as you take dental radiographs, but think about your ideal starting position and work from there.
When scaling the teeth, you may encounter some teeth that require more work than others. It’s important to avoid scaling any one tooth for too long, to avoid heat damage to the tooth. The scaler should be used on a tooth for no more than 10-15 seconds before moving on to the next tooth. If that isn’t enough time to remove all of the calculus, take a break and come back to that tooth later.
Excessive polishing can lead to enamel wear. When polishing, apply just enough pressure for the prophy angle cup to flare around the tooth. Each surface of the tooth should be polished for no more than two to three seconds before moving onto the next surface or tooth.
Here’s an embarrassing confession: when I performed my first dental extractions as a new grad vet, the client didn’t give authorization for it. I was seeing exam rooms and the surgery vet was tied up in a lengthy abdominal surgery, so the surgery tech grabbed me between appointments to “do a few extractions.” (This was back in the days before routine dental radiographs, so decisions were made just on clinical appearance.) I agreed with her assessment that the teeth needed to come out, so I extracted them… but I never called the owner. I assumed that we already had authorization, based on her tone, but I didn’t confirm. She was called in to help the surgery vet while I did the extractions, so she didn’t realize that I didn’t call the owner before beginning the extractions. Needless to say, the owner was furious… and rightfully so! I tell you this story to emphasize the importance of client communication. Work with your veterinarian to determine who is responsible for contacting the client with a treatment plan; then, double-check with each other to ensure that no one forgets. It’s easy to get so focused on the patient in front of you that you forget to make those important phone calls!
Even after the pet’s teeth are clean, your job isn’t finished. In addition to recovering the pet and monitoring it for the rest of the day, someone needs to talk to the owners about post-anesthesia care and dental home care. In many practices, this is the vet tech’s responsibility. Take the time to speak to the owner at discharge, reviewing findings and instructions thoroughly and answering any questions the client may have. In some practices, before and after photos are used to help clients understand their pet’s procedure; in others, radiographs are printed out for the owner to review.
As you gain more experience as a small animal vet tech working in general practice, dentistry will probably become an increasingly routine part of your job. In the beginning, however, take your time (within reason). Dentistry is not a race and it’s important to ensure that you are doing the most thorough job possible, for the health and safety of your patients.