Nurse Stream

Canine oral discomfort is a commonly underdiagnosed condition and it can manifest in different ways. Luckily there are ways we can identify and manage this discomfort. During this lecture we will touch upon the different oral disease processes which are associated with oral discomfort as well as take a detailed look at how we can manage this pain. We will look at what considerations we need to consider in these cases as well as look at a case example at the end.
A lot of our cases are very stoic and tend to show very minimal signs of pain, continuing to eat and play as normal, which can make diagnosis very difficult. In these cases, we rely on more subtle signs such as they may eat on one side more than the other or they are preferring a soft diet over a hard diet. Behavioural changes such as aggression and anxiety have been seen in these cases as well as the dogs appearing to have reduced activity levels similar to an older dog. Some cases can present with more obvious signs such as rubbing at their faces and anorexia. With most of these cases, a lot of the changes are noticed following treatment, where a lot of clients realise that there was something wrong prior to the treatment and they note that their dogs appear to have regained their youth. This shows how detrimental oral discomfort can be.
There are multiple conditions of the oral cavity which can cause oral discomfort which we will discuss in detail. These include inflammatory conditions such as periodontal disease and canine chronic ulcerative stomatitis, traumatic injuries, malocclusions as well as abscessation and oral tumours. We will also cover tooth resorption and whether it is considered painful in dogs.
In veterinary dentistry we have access to a range of different forms of analgesia which work on different areas of the pain pathway. These include opioids, non-steroidal anti-inflammatory drugs, α2 agonists, acetaminophen (paracetamol), GABA analogues and NMDA antagonists. We use this in combinations and at different doses depending on each patient whether it be pre-, post- or during the procedure. By using combinations or medications, we can ensure that the patient remains pain free and we can lower the amount of anaesthetic agents used. In some cases, we cannot use high doses of systemic analgesia and therefore, we also use local anaesthetic nerve blocks. We will discuss all of these analgesics in detail.
Finally, we will look at a real case and our approach to managing its pain pre-operatively, during and post-operatively. This case involved resection of a large maxillary mass and had some complications which we will discuss. We will also focus a lot on the post-operative nursing care for this case. This case is a great example of the use of multimodal analgesia for oral pain management.
The aim of this lecture is to help you identify key signs of oral pain and how to manage them effectively using a multimodal analgesia approach. By effectively managing each patients pain, the anaesthetic and recovery process will be improved.

Patients undergoing dental or oral surgery are known for suffering from hypothermia for numerous reasons.
Hypothermia brings with it many negative effects including:

• Increased oxygen requirements, by 40% when shivering
• Prolonged recoveries
• Painful to shiver after surgery
• Reduces MAC requirements, by 5% for every 1c dropped
• Overdose more likely
• Will not respond to anticholinergics
• Blood viscosity increases
• Arrhythmias with nonresponsive bradycardia
• Delayed wound healing
• Increase infection rates
• Death

All patients can suffer from hypothermia, so we must be pre-emptive in how we try to prevent this from occurring. This session will cover multiple ideas as to how we can avoid this, or indeed treat it, if hypothermia occurs.
We will also cover what to be careful of when ‘heating’ patients, and the important of avoiding hyperthermia, which, yes can happen when we implement good patient warming and hypothermia prevention!

It is easy to put on our blinkers and just focus on the tooth or the oral surgery involved, but what happens when you have done an amazing job in surgery?
The patient care does not, and should not end there. Recovery starts the moment you turn off the inhalant and start to bring your patient around to consciousness, right through until they have been signed off from their surgical procedures, which could be 3, 5, 10 days or more, depending on the treatment they required.
This session will guide us through how to ensure our patients make it through the initial recovery period safely, how we should be monitoring them, pain scoring, post op instructions for owners, completing immediate post op checks, and what to expect for different procedures.
We will also include examples of when interventions have been needed post operatively.
The recovery of a patient requires a collaborative approach between the surgeon, nursing team, client facing team and the client themselves.

There are many things to consider when implementing dentistry procedures into a veterinary general practice, such as supplies, instruments and equipment. Dentistry can be a very profitable part of the practice, but a large initial investment must be made in order to provide the best possible care for patients. Large items are required, such as the dental unit, dental radiography, high speed handpieces, and periodontal and surgical instruments. Routine maintenance and cleaning are needed to keep all of these items in proper working order and to increase longevity before replacement is necessary.

Objectives
• Compile a list of necessary supplies and equipment for dentistry procedures.
• Create a maintenance schedule for all equipment.
• Determine when to repair/replace dental instruments.

Providing professional dental care requires a sharp sense of vision during the procedure. Attempting this without magnification and proper lighting hinders our ability to deliver the necessary level of care, preventing us from accurately observing our actions and increasing the risk of causing harm through poor head, neck, and back postures. This lecture aims to outline the essential factors for making informed decisions about purchasing and using magnification and personal lighting systems for professional veterinary dentistry, as well as the risks associated with poor postures and inadequate lighting. A discussion on ergonomic seating and the importance of adjustable table heights will also be included.

Objectives:

1. Learn the fundamentals of magnification lenses and how to choose a system that meets your needs as a veterinary dentistry provider.
2. Understand which light source is the safest and most suitable for veterinary dental applications. Identify and evaluate essential components for ergonomic seating in the dental operatory.
3. Develop strategies to create an ergonomic focus for your dental workspace and personal requirements.
4. Determine what will work best for you by integrating adjustable tables, seating, lighting, and magnification to prevent work-related musculoskeletal disorders.

Items Learned:

The need for magnification, safe and proper lighting, ergonomic seating, and adjustable tables cannot be overstated. Dentistry involves repetitive motions that can cause operator pain and lead to time lost at work. Using the right equipment and fixing poor ergonomics can help reduce these risks, improve procedure outcomes, shorten procedure times, and enhance patient safety.

In order to be efficient and work properly when doing a root canal treatment, having the right equipment on hand and knowledge of how to take care of it is of upmost importance.
It is also a great addition to the team if the nurse/assistant know what is needed and when so the veterinarian can save time and work in an aseptic matter.
There are an array for equipment and materials that can be used in a root canal treatment.
Usually there is need for dental radiographs, instruments for assessing the fracture, gain access to the canal, clean and prep it, and obturation and restoration of access point and crown. And local blocks.In order to work as sterile as possible when working in the mouth, a rubber dam should be applied. This can sometimes be a little tricky but with good clamps and practice its is possible. Before starting the procedure make sure that all instruments, equipment and materials are present, clean and ready to be used. A good routine is to have sets for these procedures, then you know that what you need should always be ready. All fractured teeth require treatment! But not all fractures need root canal treatments. Before gaining access to root canal we need to assess the fracture both clinically and with dental radiographs to make sure what treatment is the right treatment.
The veterinarian will assess both fracture and radiographs to check for symmetri of the canal, if there is any opening into the canal from the crown.

1. access canal
2. debridement and shaping canal
3. clean and dry canal
4. measure canal length and width (write this down)
5. Obturation of canal
6. restoring access and crown

During the procedure there are several dental radiographs taken in order to make sure everything is going to plan. There should be at least 3 radiographs pre, master files to apex, and post.
After procedure the tooth is ready to be used, but we always recommend to keep a close eye on it, and control with radiographs after 4 months and then annually. Owner should also reach out if they notice anything changes post treatment.
For dogs in active service like police, military, dogs with large buccal musculature (staffies and such) and search and rescue dogs placement of a titanium crown might be recommended. Root canal treated teeth are usually a bit more brittle than a vital tooth.

Program Description: The lecture aims to teach attendees how to identify dental instruments that need sharpening. Videos will demonstrate a simple sharpening technique for maintaining dental tools such as winged or straight dental elevators, dental luxators, periosteal elevators, curettes, and hand scalers.
Learning Objectives:
a. Recognize dental instruments that require sharpening.
b. Evaluate instruments before and after sharpening to recognize the original design and how to maintain the instrument’s integrity through the sharpening process.
c. List the items needed to sharpen dental instruments.
d. Create a standard operating procedure around instrument sharpening protocols.

Contextualised Care in Veterinary Dentistry: The Role of Veterinary Nurses in Optimising Patient Care.
The reasons pet owners decline, or delay dentistry treatment are multifactorial and include their perception of dental disease and treatment, fear of anaesthesia, personal circumstances and finances. For example, periodontal disease is the most prevalent condition in cats and dogs, but many pets fail to receive timely treatment.
Contextualised care is currently a significant focus within the veterinary profession. It acknowledges there are different ways to provide treatment, and this should be tailored to the individual patient and owner’s needs.
Although diagnosis and treatment recommendations lies with the veterinary surgeon, veterinary nurses have a crucial role in veterinary dental care. The lecture will explore how utilising veterinary nurses in dentistry can increase the availability of care, improve standards and efficiency, and facilitate client education and communication through dentistry consultations. Therefore, optimising patient care for all dentistry patients.
Intended Learning Outcomes:
Define contextualised care in veterinary dentistry and its requirement in modern veterinary medicine.
Analyse nurse led dentistry and its contribution to patient centred care and improving the management of dental conditions such as periodontal disease.
Discuss if effective utilisation of veterinary nurses increases the opportunity for providing transparent, standardised dentistry care in your practice.
Understand how veterinary nurses educating pet owners through dentistry consultations leads to improved communication and transparency.

Appropriate nutritional support is important for healing from trauma or surgery. In head trauma or post-operative CMF surgical cases, the use of feeding tubes (nasogastric or esophageal) is sometimes needed in order to keep up with the patient's caloric need.
This lecture will focus on NG and E-Tube placement, care, and the various forms of nutritional support that can be utilized with these feeding methods. We will learn how to calculate RER for the healing patient, as well.
Trouble-shooting of obstructed feeding tubes will be discussed, as well as pros and cons for both.