(Left to
right): Members of the WSAVA Dental Guidelines Committee during the
launch: Paulo Steagall, Jerzy Gawor, Brook Niemiec, Kymberley Stewart,
Gottfried Morgenegg, Marge Chandler, Rod Jouppi, Ana Nemic, Cedric
Tutt and David Clarke.
Periodontal disease is the
number one health problem in companion animals. By two years of age, around 70
per cent of cats and 80 per cent of dogs have some form of it, with small and
toy breed dogs particularly susceptible. Yet the standard of care is variable.
Additionally, there has been a movement to push anaesthesia-free dentistry.
Untreated and undertreated
dental disease is a significant animal welfare concern, due to the pain it
causes. There are also local health consequences like oronasal fistulas, pathologic
fractures of teeth and/or jaws, bone infection, eye infection and blindness,
and systemic disease including kidney, liver and cardiovascular disease. There
is some evidence that periodontal disease is associated with an increased risk
of oral tumours.
The World Small Animal
Veterinary Association released dental guidelines just last week, available to
all veterinarians around the globe. Importantly, they stress the need for
veterinarians to improve dentistry skills and they “strongly reject”
anaesthesia-free dentistry.
PLEASE NOTE: before you print
these out, the PDF is 161 pages in total. It contains a number of diagrams,
photographs and illustrations. Each section is quite extensively referenced so although
it’s a sizeable read it isn’t quite as big as it looks.
The “Guidelines” are more than just guidelines – they’re a
substantial, well-referenced handbook providing information on veterinary dentistry
and pathology, interpretation of dental radiographs, a dental scoring system,
and best practice recommendations. Evidence-based guidance on periodontal
therapy, radiology and dental
extractions is also included, together with details
of minimum equipment recommendations. It also includes information on home
dental care and nutrition.
Anaesthesia-free dentistry is rejected as it is described
as “ineffective at best and damaging at worst” and a cause of unnecessary
stress and suffering to patients.
The corollary of this is that is it is impossible to
perform a complete dental examination
without general anaesthesia – as there may be no or very subtle signs of dental
disease. The risks and benefits need to be weighed up in each individual case.
The Guidelines address the question of whether sedation is
an appropriate halfway point – but they state that it is “not always safer than
general anaesthesia” and does not facilitate airway protection, appropriate
ventilation and monitoring of cardiovascular function.
The Guidelines were developed by WSAVA’s Global Dental
Guidelines Committee (DGC), comprising veterinary dentists from five continents
as well as contributors from the WSAVA Global Pain Council, Global Nutrition
and Animal Wellness and Welfare Committees.
The aim is to ensure the guidelines are helpful to every
veterinarian, whether in an advanced hospital setting or a context where
companion animal practice is still developing. Not every practice has all the equipment mentioned, but there are alternatives suggested where available.
DGC
Co-chair Dr Brook Niemiec, a Board-Certified Specialist in Veterinary
Dentistry of the American and European Veterinary Dental Colleges and a
Fellow of the Academy of Veterinary Dentistry, said: “Dental, oral
and maxillofacial diseases are, by far, the most common medical conditions in
small animal veterinary medicine. They cause significant pain, as well as
localized and potentially systemic infection but, because pets rarely
show outward signs of disease, treatment is often delayed or not performed with
a corresponding impact on the welfare of the patient. In developing
the Global Dental Guidelines, we felt that the lack of perception of
patient pain was a key issue.”
“Our
Committee members were also unanimous in their opposition to AFD.
We believe that anaesthesia is essential for the execution of any useful
dental procedure and this is a central recommendation of the
Guidelines. To support it, we have provided a detailed
analysis of anaesthesia and pain management approaches.”
“Our patients are not well served by
the current variation in standards of care, level of
equipment and procedural knowledge of dentistry. Misinformation which
clouds the sector is a further hindrance. As clinicians, we
cannot allow a fear of the unknown, the discomfort of client
pushback or ignorance of current techniques to keep us from doing our
best to relieve pain and suffering in our patients.”
The Guidelines can be downloaded for free at http://www.wsava.org/guidelines/global-dental-guidelines.
Their development was sponsored by Addison Biological
Laboratory, Boehringer Ingelheim, Hill’s Pet Nutrition, KRUUSE
and Virbac, however no specific brands are mentioned within the
guidelines.
