WELCOME to the winter edition of the AVDS Newsletter! The AVDS newsletter for this quarter is full of information and right on time for Pet Dental Health Month! We hope you enjoy reading the latest edition and look forward to hearing your feedback.

AVA National Conference Wrap Up Pet Dental Health Month – New theme! Looking for Ideas and Support? Free Webinar – 19 August Practical Tips for PDHM Horses : Smile, It's your birthday! Case Report: Unilateral Facial Swelling in a dog Further afield: ANZCVS Science Week report Anaesthesia free dentistry – Why is it an issue and what is the AVDS going to do about it?

             

Australian Veterinary Dental Society Newsletter

Winter 2014  

AVA National Conference Wrap Up

The AVA National Conference was held in Perth this year from 25-30 May. For those of you who made the distance, there were plenty of dental lectures to attend! Some of the lectures were shared with other streams such as the practice management and equine streams, which helped to foster relationships with other groups and acknowledges the part dentistry plays in many aspects of veterinary practice. Dental foundation topics such as conducting a thorough examination, radiology, analgesia and extraction tips were all there on the program. Along with some challenging and thought provoking lectures on improving on-farm presence through dentistry, and looking at teething problems in pups. A copy of the proceedings will be available soon on the AVA website. Congratulations to EVDS who won the 2014 Best Exhibition Stand as chosen by delegates! All that rugby viewing and those Bollywood dance lessons paid off!!

At the Annual Meeting of AVDS new office bearers were elected – we thank the outgoing President Christine Hawke for all her wonderful work and wish her family well. Dr Rod Salter will take up the reins for 12 months till Dr Tara Cashman begins her presidency in 2015. Dr Amanda Hulands-Nave is the Secretary/Treasurer for the next 2 years. Thanks also to David Clarke, Wayne Fitzgerald, Aaron Forsyth, Gary Wilson, Olivia James, Jessamy Alexander, Kevin Ng, Lian Yeap, Oliver Liyou and Helen Robinson who have all agreed to support the executive and serve you, the Dental SIG members.

 

PET DENTAL HEALTH MONTH

- what lurks beneath……

August is Pet Dental Health Month and the theme for this year is “What lurks beneath!” The theme was chosen to encourage discussion about the nature of periodontal disease, as the condition is frequently misunderstood by pet owners who think that what they can see is all they need to worry about.

Visual examination during a consultation only assesses the tip of the iceberg. No vet can assess in a consult room the true nature of periodontal disease. A thorough examination under general anaesthesia is required with the concurrent use of dental radiographs. Client education is necessary so that they realize that it is what lurks beneath that is important to the periodontal health of the animal.

Get involved and help raise the profile

of veterinary dentistry in your practice – your patient’s will thank you for it!

• Check out these great resources available FREE from the AVA website:

For your practice:

☺ Pet Dental Health Month Flyer ☺ media release template – just fill in the blanks!

For your clients:

☺ client handouts on: " Dental health for your cats and dogs " Caring for your horse’s mouth " About your rabbits teeth

For your education:

☺ FREE WEBINAR - Aug 19 @ 6pm (EST) ☺ a Veterinarian’s guide to gum disease in dogs and cats ☺ You can search all past AVDS conference and AVA

proceedings online via the “VETED” tab at the top of the screen. There’s also an international journal search as well!

Also available on the AVA website if you search “dental policy” in the search box you will find details of the following AVA policies: 6.9 Guidelines for dental treatment in dogs and cats 7.2 Equine dentistry 17.9 Dental Guidelines for small mammals

LOOKING FOR IDEAS AND SUPPORT?

www.ava.com.au/dental-

month dental-month

• When: Tues 19 August 2014 • Time: 6-7pm (Sydney time!) • Where: online wherever your computer

goes! • Host: Dr Anthony Caiafa • Cost: FREE to members (non-members

$75) • Topic: What lurks beneath!

What you will learn!

Periodontal disease is no longer considered a local disease affecting only the mouth. Participants will learn about the current human and veterinary research that is looking at the links between periodontal disease and important diseases affecting other parts of the body. This lecture will also look at the similarities between periodontal disease and other chronic diseases such as osteoarthritis. REGISTER ONLINE www.ava.com.au/node/14822

FREE WEBINAR

PRACTICAL TIPS FOR PDHM: ☺ send out a press release to your local paper, remember they

love photos of cute pets. Template available on the AVA website for those not keen to write it themselves!

☺ host a talk or hospital tour of your dental facilities. Give a demonstration of equine dentistry at the local horse club.

☺ create a “smile book” of photos before and after a dental

procedure. Suitable for all species including rabbits and horses. Consider a digital photo frame that continually cycles through the images.

CHECK OUT THIS

FRONT DOOR!

☺ get creative and decorate your waiting room with a set of

false teeth or a huge toothbrush – children’s poster paint and recycling materials such as cardboard and foam packing are all you need.

☺ make sure all the nurses ask every client – “what do you do

to keep them smiling?”

☺ local service clubs such as Lions Club are often looking for a speaker for their meetings. Just ask!

☺ share the AVA resource brochures (in print or online) on

dogs, cats, rabbit and horses with your clients – they are bright, colourful and have no company logos!

☺ use social media such as Facebook and Twitter to tell others

what you are doing. Ask for smiling pet photos as a clinic competition. Update your website news section.

Horses : Smile…It’s Your Birthday! by Dr Olivia James

As August 1st rolls around again, we celebrate that horses in the Southern Hemisphere officially turn one year older (except for the standardbreds, they have to wait until September 1st !). When a horse ‘smiles’ (or has a flehmen response), the lips are curled back and we can see the incisors and canine teeth. Canines are more common in geldings and stallions compared with mares, and adult canines erupt around age five. As canines are not actively used in a mechanical fashion for grinding foodstuff, they can often have a build up of calculus. Sometimes the calculus can be so thick it almost completely obscures the underlying tooth. Removal of the calculus often causes the underlying, inflamed gingiva to bleed, and the gingival margin should be probed to identify any deep pockets (see photos below).

Incisors will often also have calculus present on the gingival margin, this is usually easily removed with a sickle scaler, and the calculus can be kept at bay with a simple toothbrush and Hexarinse (dilute chlorhexadine solution).

Explaining to owners that periodontal disease is the most common disease of horses (and their horse has it) can be a good way to motivate them to be more aware of their horse’s oral health. Of course a complete oral exam and treatment is necessary for good oral health, not just the ‘cosmetic’ appearance of the more visible teeth.

DID YOU KNOW?  This  year,  equine  veterinarians  were  encouraged  to  donate  a  dental  to  a  charity  or  deserving  horse  as  an  initiative  of  Equine  Dental  Vets.  Now  more  horses  can  enjoy  their  birthday  carrots  –  way  to  go  guys!!

Always think - “What lurks beneath!”

– use a periodontal probe – consider dental radiographs – remember how the dental health of the patient can

relate to their overall health.  

CASE REPORT : Unilateral facial swelling in an elderly dog.

by Adjunct Assoc Prof Anthony Caiafa

Introduction  A  9  year  old  desexed  male  Golden  Retriever  cross  Labrador  “Foster”  was  referred  to  a  Veterinary  Specialist  Referral  Practice  with  a  history  of  a  sudden  onset  of  a   firm  swelling  ventral  to  the  left  eye  (figure  1).  The  dog  had  a  history  of  occasionally  being  offered  bones  to  chew  as  well  as  playing  games  of  retrieval  of  large  sticks  with  the  owner.  The  dog  had  also  recently  been  on  a  farm  with  other  dogs.  Since  the  swelling  had  come  up,  the  dog  had  become  slightly  lethargic  but  was  still  eating  but  had  no  pyrexia  on  presentation  to  the  referring  veterinarian.        The   referring   veterinarian   did   not   have   intraoral   radiography   capabilities   and  assuming   that   the   swelling   was   dental   in   origin   and   mostly   likely   a   tooth   root  abscess  involving  the  maxillary  4th  premolar  (208)  or  maxillary  1st  molar  (209),  the  veterinarian  could  only  offer  the  client  extraction  of  one  or  both  teeth.  The  referring  veterinarian   did   however   offer   the   option   of   referral   to   a   facility   that   could   take  intraoral   radiographs   and   thus   determine   the   origin   of   the   swelling.   The   client  accepted  this  advice.    Examination  (awake)  including  whole  body,  extra-­‐  and  intra-­‐oral  examinations  On   presentation   to   the   referral   practice,   the   dog   appeared   well   with   no   raised  temperature.   The   swelling   just   below   the   left   eye  was   firm  and   fixed   and   the  dog  resented  the  mouth  and  muzzle  being  handled  on  that  side.  There  was  no  pain  on  opening  the  mouth.    The  left  draining  mandibular  lymph  node  was  slightly  enlarged,  non-­‐  painful  on  palpation  and  mobile.  A  cursory   look  at   the  maxillary  caudal   teeth  on  the  left  side  revealed  no  obvious  crown  fractures.  The  medical  history  revealed  a  long   history   of   atopic   dermatitis   which   had   been   controlled   by   cyclosporine  (Atopica®  capsules,  Novartis  Animal  Health,  Australia).        Since   unilateral   facial   swelling   (especially   being   just   ventral   to   the   eye)   is   often  associated  with  an  endodontically  involved  tooth  or  teeth  and  because  a  concussive  or  subluxation  injury  to  a  tooth  does  not  always  lead  to  crown  fracture,  but  can  still  cause  a  pulp   to  become  necrotic,   at   the   top  of   the  differential  diagnoses  was  pulp  necrosis  due  to  concussion  or  subluxation  injury  of  the  maxillary  4th  premolar  (208).  The  most  likely  cause  was  bone,  rock  or  stick  chewing.  The  client  was  also  advised  that  other  causes  of  the  swelling  could  be  due  to  foreign  body  penetration,  dog  fight  or  considering  the  age  of  the  dog,  a  facial  tumour  was  possible.      The   dog’s   pre-­‐anaesthetic   blood   analysis   was   unremarkable   and   there   was   no  evidence   of   a   white   cell   elevation   or   hepatopathy   (a   known   contra-­‐indication   for  long  term  cyclosporine  use)  in  the  biochemistry  results.  

Extra-­‐  and  intra-­‐oral  examination  under  general  anaesthesia  Under  general  anaesthesia,  an  examination  of  the  facial  mass  revealed  it  to  be  firm  and  slightly  mobile.  A  fine  needle  aspiration  revealed  some  whole  blood.  There  was  no   purulent   discharge   present   in   the   sample.   The   draining   left  mandibular   lymph  node  was  slightly  enlarged.      An  oral  examination  revealed  evidence  of  abrasive  wear  of  the  teeth  (rocks,  bones,  sticks).   Periodontal   probing   depths   were   generally   4mm   or   below   (normal   is  <3mm)  and  there  was  some  evidence  of  generalised  gingival  hypertrophy  (a  known  side  effect  of  long  term  cyclosporine  use)  (figure  2).  There  was  also  a  papilloma  like  mass  just  dorsal  to  the  left  maxillary  3rd  premolar  (207)  (figure  3).  Another  known  side  effect  of  cyclosporine  usage  is  verruciform  lesions  or  papilloma  formation.    Because   of   the   dog’s   age,   the   client   requested   a   whole   mouth   series   of   intraoral  radiographs  to  rule  out  any  other  oral  pathology.  A  whole  mouth  series  of  intra-­‐oral  radiographs  were   taken  using  a  size  4  phosphor  storage  plate  (5.7  x  7.5cm)  (Durr  CR7,  iM3  Inc.,  Sydney,  Australia).  Because  the  dog  was  a  large  breed  (32Kg),  the  size  4  plate  was  ideal  for  the  task  and  reduced  the  number  of  exposures  required  to  do  the   whole   mouth   series   of   radiographs   from   the   usual   10   or   sometimes   more  exposures   (with   a   size   2   film)   down   to   6   exposures.   This   helped   reduced  anaesthesia  time,  as  well  as  being  more  diagnostic  by  covering  more  of  the  oral  and  nasal  cavities  in  the  one  exposure.      Imaging   of   the   left   (figure   4)   and   right   caudal   maxillae   (figure   5)   revealed   no  obvious   dental   or   nasal   problems   (if   in   doubt,   when   faced   with   unilateral   oral  disease,  radiograph  the  other  side  for  comparison).      Having  ruled  out  an  obvious  dental  cause  for  the  swelling,  it  was  decided  to  make  a  small  incision  into  the  mass  and  with  a  5mm  skin  biopsy  punch,  and  take  incisional  type   biopsies   of   the   facial   mass   (figure   6).   The   biopsied   tissues   were   firm   and  greyish-­‐  red  in  appearance.  The  oral  papilloma  type  mass  apical  to  the  left  maxillary  3rd   premolar   (207)  was   also   excised   just   in   case   it  was   associated  with   the   facial  swelling.  On  biopsy  of  this  wart-­‐like  lesion,  the  lesion  disintegrated  and  revealed  a  mucous  blood   tinged  discharge.  Mosquito   forceps  were  used   to   enlarge   the   cavity  below   the   intra-­‐oral   lesion   and   a   size   60   gutta   percha   point   was   placed   into   the  facial  swelling  and  found  to  communicate  with  the  intra-­‐oral  lesion  (figure  7).      Exploration  of  the  lesion  inside  the  mouth  revealed  a  small  grass  seed  (figure  8)  and  this  was  removed.  No  other  grass  seeds  were  found.      A   diagnosis   of   foreign  body   granuloma  was  made   and   the  dog  was  discharged  on  amoxicillin/  clavulonic  acid  combination  for  7  days.  Within  4  days  post-­‐  surgery,  the  facial  swelling  had  reduced  significantly  (>80%)  and  by  7  days  had  disappeared  and  has   since  not   returned.   “Foster”   is   back   to   his   normal   self,   but   is   having  his   teeth  brushed   regularly   to   help   control   plaque   accumulation   due   to   the   cyclosporine  induced  gingival  hypertrophy.    

Figure  1:  “Foster”  with  left  side  facial  swelling      

Figure  2:  Cyclosporine  induced  gingival  hypertrophy  (mild)    

 Different  case  For  comparison,  Figure  9  demonstrates  another  case  involving  a  dog  with  true  oral  disease  caused  by  trauma  and  pulp  necrosis  of  RHS  maxillary  4th  premolar  (108).          Conclusions  Sometimes,   diagnostic   tests   such   as   radiographs   are   taken   to   rule   out   pathology  rather   than   to   detect   it.   The   referring   veterinarian   was   to   be   commended   in  referring   this   case.   Years   ago,   when   intra-­‐oral   radiographs   were   not   available,  unilateral   facial   swellings  were   always   assumed   to   be   related   to   dental   pathology  unless   proven   otherwise   (often   belatedly   after   the   tooth   had   already   been  extracted).   This   lead   to   a   number   of   healthy   teeth   being   extracted   without   the  resolution   of   the   patient’s   presenting   complaint.   It   is   my   opinion   that   before   too  long,  a  minimum  standard  of  companion  animal  practice  will  require  veterinarians  to  either  offer   intra-­‐oral   radiographs   to   their   clients  or   to   refer  patients  with  oral  disease  to  a  practice  that  can  offer  such  a  service.   It   is  well  accepted  that  without  the   use   of   intra-­‐oral   radiography,   a   number   of   feline   tooth   resorptions   will   be  missed  and  a  number  of  teeth  will  have  fractured  roots  left  behind  after  extraction,  often  leaving  the  patient  in  continuing  pain  and  discomfort.  

Figure   3:   Gingival   wart-­‐   like   lesion   LHS   apical   to   tooth   207.   Lesion   is   possibly  associated  with  cyclosporine  administration  

 Figure  4:  LHS  Maxilla  demonstrating  the  premolar  /molar  teeth  (teeth  206,  207,  208,  209,  210).  There  is  no  dental  pathology  visible.  The  caudal  extent  of  the  nasal  cavity  also  looks  normal.  (Size  4  Phosphor  Storage  plate)       Figure  5:  RHS  Maxilla  demonstrating  the  caudal  premolar/  molar  teeth  (teeth  106,  107,  108,  209,  210).  (Size  4  Phosphor  Storage  plate)

Figure  6:  Incisional  biopsy  including  skin  and  greyish  red  firm  mass        

Figure  7:  A  gutta  percha  point  (flexible  radio-­‐opaque  root  canal  filling  point)  is  placed  into  the  facial  swelling.  It  is  following  the  path  of  least  resistance  (the  sinus  tract)  and  is  pointing  to  the  LHS  Maxillary  3rd  premolar  (207)          

 Figure  8:  Grass  seed  foreign  body  found  within  the  firm  facial  swelling  

Figure  9:  Apical  periodontitis  showing  a  radiolucency  involving  the  distal  root  apex  of  tooth  108  (different  case).  This  tooth  should  be  either  extracted  or  root  canal  

treatment  performed  on  it      

FURTHER AFIELD: ANZCVS REPORT

Current College Veterinary Dentistry Chapter Secretary and fellow AVDS member Dr Kevin Ng sends this report from “Science Week” – 3 days of advanced dental education in small animal and equine topics. Interested vets are more than welcome to attend any of the sessions regardless of whether they have attained Membership to the College. If you are looking for more, this is the place to start in 2015!  

 

 

 

ANZCVS Science Week 2014 Report

Science Week 2014 was held on the Gold Coast from 10-12 July. This year marked 21 years since the creation of the Dentistry Chapter of the Australian and New Zealand College of Veterinary Scientists. In honour of this, Dr. Rod Salter BVSc MANZCVS coordinated a fantastic 3-day program covering multiple aspects of both companion animal and equine dentistry. 21st birthday celebrations were also conducted in a more social setting at the Chiangmai Thai restaurant in Surfer’s Paradise with a delicious 5-course banquet. The lecture program this year included a collaborative day-long session with the Emergency, Critical Care and Anaesthesia Chapter, a keynote presentation on rotary endodontics by Dr. Ross Applegarth BDS MDSc FICD MRACDS (Endo), and the inaugural Dentistry Chapter workshop on rotary endodontics conducted by Dr. David Clarke BVSc DAVDC FAVD MANZCVS. We are lining up another exciting program from 9-11 July 2015. Details and registration forms for Science Week 2015 will be available on the College website at www.anzcvs.org.au in due time and registration is open to all veterinarians. The Australian and New Zealand College of Veterinary Scientists provides professional qualifications to veterinarians with superior competence. Entry to the College is by examination. If you are interested in becoming a Member or Fellow of the College, relevant information can be found on the College website at www.anzcvs.org.au.  

Anaesthesia free dentistry – Why is it an issue and what is the AVDS going to do about it? by Dr Amanda Huland-Naves  Some of you may have come across services that are offered by lay dentists and groomers call “Anaesthesia-free dentistry”. The marketing of these services prey on the public’s unnecessary fear of anaesthesia for their pets and also perpetuates the myth that dentistry is merely a cosmetic procedure. Anaesthesia-free dentistry has been made illegal in California and there has been a recent conviction of a lay dentist there after performing anaesthesia-free dentistry on small animal patients on the grounds that it constituted animal cruelty. So, what is all the fuss about? Well, there are several risks posed by anaesthesia-free dentistry. Risks to the patient :

" Pain from sharp instruments " Inadequate pain relief (maxillary nerve blocks can only be administered

under general anaesthetic and local anaesthetics, general anaesthetics and pain relief drugs are all Schedule 4 drugs unavailable to lay people)

" Stress from excessive physical restraint (if no chemical restraint is used) " Risk of serious injury from movements due to stress and sharp

instruments " Risk of airway compromise due to large amounts of water being used to

cool instruments and flush away tartar. Dogs cannot be trained to spit this water out

" Inadequate diagnosis of periodontal disease as intraoral radiography cannot be performed in a conscious animal and the technician needs to hold a radiation licence to perform radiography (70% of dogs >3 years old have periodontal disease as their primary dental disease and this is a disease of the tissues BELOW the gum line)

" Ongoing pain, periodontal disease and resultant organ disease due to inadequate diagnosis and treatment

Risk to the technician :

" Risk of causing serious injury from trauma inflicted by the patient (due to a combination of stress, fear and pain). This is a considerable Occupational Health and Safety risk to the technician.

Risk to the owner : " A false sense of security that they have adequately facilitated the

treatment of their pet’s dental disease " Paying for a service that has failed to deliver the promised outcome

What protections are in place? In states where there are defined “Acts of Veterinary Science”, it can be argued that use of ultrasonic equipment, especially once it is inserted below the gum is in breach of the act. In states where there are no defined “Acts” within the legislation, there is nothing to prevent this occurring. The Victorian Veterinary Practitioner’s Board has stated that it is powerless to act unless these lay people are misrepresenting themselves as veterinarians. Currently lay people cannot access licences to hold and use radiation equipment or S4 or S8 drugs. They have avoided the need to hold pharmaceuticals by not using them and creating a marketing scheme that makes this a “favourable” thing, even though we know it to be cruel and inadequate. By making the case for intraoral radiography to be the minimum standard amongst the veterinary practitioners performing veterinary dentistry (and there is a lot of science to support this as the right thing to do) we will help to educate the public as this being a point of difference. Again, without “Acts of Veterinary Science” there is no regulation authority to enforce though. So what is the AVDS going to do?

• The committee is currently reviewing the guidelines for small animal dentistry, emphasising the need for general anaesthesia and intraoral radiography to perform adequate small animal dentistry.

• The committee is planning a position statement on anaesthesia free

dentistry in small animals.

• The AVA Victoria Division is using dentistry as a classic example for

lobbying the Victorian State Government and Opposition in the lead up to the state election for the return of “Acts of Veterinary Science”. The change in this legislation should also go some way in benefitting equine dental veterinarians.

• We also intend to lobby each state government in turn as their Veterinary

Surgeons’ Acts come up for review    

We hope you have enjoyed this edition of the AVDS Newsletter!

If you have any feedback or

have ideas on member services that you would like to see, feel free to contact one of

the committee.

Dr Rod Salter – ozvetden@bigpond.com Dr Tara Cashman – tara.cashman@ava.com.au Dr Amanda Hulands-Nave – Amanda@bellvet.com