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Compendium February 2010 (Vol 32, No 2)

Dental Radiography: Putting Teeth Into Your Veterinary Dentistry Practice

by R. Michael Peak, DVM, DAVDC

    A colleague recently asked me a question that made me take pause and think about the state of our veterinary practices. He asked, “Would you go to a human dentist who doesn’t have dental x-ray capability?” My immediate thought was Absolutely not! Then I stopped and thought about how I practiced before I had dental radiography. I thought I was doing a good job for my patients, but as I learned more about veterinary dentistry, I found dental radiography to be the single most valuable diagnostic and educational tool, not only for myself but also for my clients. I could not do what I do without it, nor would my clients understand what I did or why I did it.

    It is amazing how the scope of veterinary practice has changed over the past 20 to 30 years. Although I graduated a mere 15 years ago (I like to say “mere”—it makes me feel better), I, like so many other practicing veterinarians, was involved in veterinary practices well before veterinary school. I spent my early years absorbing as much about veterinary medicine as I could. Even then, there were few things I would rather have been doing than helping around the surgery suite, relishing in the success of a parvo survivor, or sneaking a peek at something as exciting as ear mites under the microscope!

    One aspect of veterinary practice that was conspicuously missing in those days was dentistry. This was certainly no fault of the practice I grew up working in; rather, it was a reflection of the state of practice at that time. Even throughout my years in veterinary school, little attention was paid to dental care, and I had the impression, “If it were important, I certainly would have been taught this.” Imagine my surprise, and reservation, the first time I was asked to extract a maxillary carnassial tooth.

    Luckily, great strides have been made in veterinary dental education over the past 20 years, thanks to the tireless efforts of those who organized the Veterinary Dental Forum; those who have lectured and taught wet labs at national, regional, and local meetings; and those who have brought veterinary dental education to the universities and colleges. I, and all the pets that have benefited from their efforts, owe a debt of gratitude to them.

    Research in veterinary dentistry has shown how common dental disease is in dogs and cats.1–3 We are also constantly uncovering the association between dental and systemic diseases,4,5 and studies have lauded the importance of dental radiography in accurate diagnosis and determination of proper treatment options of these common diseases.6–8 Yet, while some have urged that dental radiography become part of the standard of care for veterinary dentistry, many veterinary practices have yet to recognize its value.9,10

    Since this is the time of year we historically turn to veterinary dentistry (National Pet Dental Health Month), I would urge you to reconsider the benefits of dental radiography if you are not currently using it in your practice. Consider that much periodontal disease is subgingival and how you, your staff, and your clients will not be able to see the actual extent of disease in most cases. Think about tooth resorption in cats, how common it is, and how many lesions can be detected with dental radiography that might be missed otherwise.6 Contemplate how many patients can benefit from treatment of painful oral conditions and how dental radiography can isolate areas of oral tumors to help stage neoplasia by recognition of bone involvement. Consider how your clients will feel when they can see the actual disease process, the extent of disease, and why you made the diagnostic decisions you did. Understanding the process and feeling involved with the decision making creates more value for clients. Finally, think about how dental radiography can document and record pathology for future reference and the return on investment to your practice if you recognize and act on the numerous indications for dental radiography.

    Those of you who use dental radiography on a regular basis already know its benefits, and I hope you are nodding your head “yes” at this point. If you have not considered implementing dental radiography in your practice, or if you have the equipment but haven’t started using it, I encourage you to invest in training and continuing education so that you and your patients can benefit. There are many CE opportunities to help you get trained and up to speed on dental radiography, such as those offered by the Veterinary Dental Forum (www.veterinarydentalforum.com), the North American Veterinary Conference Institute (www.tnavc.org), and regional programs (see the American Veterinary Dental College Web site, www.avdc.org). There are even services that help with interpreting dental radiographs (www.vetdentalrad.com).

    To bring this full circle, my answer to my colleague would still be “no.” I don’t think I would be comfortable having any dental examination without dental radiography, just as you probably would feel a little uncomfortable practicing in general practice without standard radiography. If you have not considered using dental radiography in your practice and would like to open up a whole new area of practice, I strongly encourage you to look into it. I think you, your clients, and your patients will be glad you did.

    Dr. Peak is the immediate past president of the American Veterinary Dental College.

    1. Harvey CE. Periodontal disease in dogs. Etiopathogenesis, prevalence, and significance. Vet Clin North Am Small Anim Pract 1998;28(5):1111-1128.

    2. Lund EM, Armstrong PJ, Kirk CA, et al. Health status and population characteristics of dogs and cats examined at private veterinary practices in the United States. JAVMA 1999;214(9):1336-1341.

    3. Van Wessum R, Harvey CE, Hennet P. Feline dental resorptive lesions. Prevalence patterns. Vet Clin North Am Small Anim Pract 1992;22(6):1405-1416.

    4. DeBowes LJ, Mosier D, Logan E, et al. Association of periodontal disease and histologic lesions in multiple organs from 45 dogs. J Vet Dent 1996;13(2):57-60.

    5. Glickman LT, Glickman NW, Moore GE, et al. Evaluation of the risk of endocarditis and other cardiovascular events on the basis of the severity of periodontal disease in dogs. JAVMA 2009;234(4):486-494.

    6. Lommer MJ, Verstraete FJ. Prevalence of odontoclastic resorption lesions and periapical radiographic lucencies in cats: 265 cases (1995-1998). JAVMA 2000;217(12):1866-1869.

    7. DuPont GA. Radiographic evaluation and treatment of feline dental resorptive lesions. Vet Clin North Am Small Anim Pract 2005;35(4):943-962.

    8. DuPont GA, DeBowes LJ. Comparison of periodontitis and root replacement in cat teeth with resorptive lesions. J Vet Dent 2002;19(2):71-75. Erratum in: J Vet Dent 2002;19(4):230.

    9. Colmery B. The gold standard of veterinary oral health care. Vet Clin North Am Small Anim Pract 2005;35(4):781-787.

    10. Holmstrom SE, Bellows J, Colmery B, et al. AAHA dental care guidelines for dogs and cats. JAAHA 2005;41(5):277-278.

    References »

    NEXT: In Practice: Tools for Practice Success: Caring, Compassion, Confidence, and Communication

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