Hi everybody and welcome to another episode of Vet Chat, and today I am joined by Paul Cooper, who is the extended president of the British Veterinary Dental Association in light of recent events. Paul, fantastic to have you with us. I just wondered if you can tell people in your own.

Words a little bit about, you know, what's going on with with BVDA this year and with the Congress and obviously the er the challenges that you've maybe faced in getting the the physical event from from March, April time to come to fruition with with your digital congress this September. Absolutely. We had worked on having a parallel stream two session event in April this year, pre BSAVA.

We got an amazing lineup of speakers, the new team at BVDA we took over in April 2019, really worked hard, pulled together, got us a great programme, and then of course, at the last minute, BSAVA was pulled, so all the pre-congress meetings were pulled. And then, so we really deflated, but then Chris Allen, one of our committee members, had a brilliant idea of let's do it as a virtual event. And we all thought, really, how do we do that?

And luckily he's done some work with the Webinar vet before, so we contacted Webinar vet and with their help, we've put together basically exactly the same programme we would have had as a live event in April, this month. And it, the, the advantages are phenomenal because you don't need to travel, you don't need to have accommodation. You can watch the event live on the day, and you can choose which stream you watch live.

And then for the next 6 months, you can go back and watch the other one, the other presentations you missed, and also re-watch the ones you saw because there's no doubt that when you sit in a presentation. There are two things you really pick up and go away with. The ones that you, things that you already knew, so confirmational bias comes in, so you remember that bit because it confirms what you knew.

Things that are really brand new and rocket science to you, you remember those bits. But all the bits in the middle where what you potentially have already learned is is a bit wrong and needs to go off in another direction. You don't actually remember those the first time round.

When you watch it all the 2nd time, that's when you pick up the really interesting bits. Yeah, and like you say, that's the real interesting twist twist really with a a digital sort of collection of materials because you can't just redigest them at your own leisure. But of course, you know, the, the digital events aren't the same as the physical events.

And I just wonder on a, on a personal level perhaps, what, what will you miss from that sort of physical BVD DA sort of, you know, day that you have. Have a sort of pre BSAVA every year. What, what, what do you feel as though is, is missing for you in this year?

The human contact and the personal connections one makes at these meetings, particularly in the breaks, when you're meeting old colleagues and having a catch up there, you're meeting new colleagues, you're also having a great one on one talk with our with our partners and sponsors for these events. It's great to actually physically be able able to pick up their instruments, look at their radiography software, and actually see it live. There can't sadly, there can't really be much of a substitute for that interaction.

But we have put together this amazing goody bag, digital goodie bag for our delegates at the webinar event. So our partners have had a massive think together and they've put together wonderful series of little competitions and Incredible prizes for people who log on to their websites and enter the competitions, which we'll go as far as we can and make contact with their partners that way. And I have to say, dental, dental prizes and things are generally pretty good.

I remember the last BVDA congress day I was at, I ended up going home with a set of IM 3 elevators and Luxators, and of course I was the best thing since sliced bread to my bosses because I'd saved them a few 100 quid and I was like, no, no, no, these are my tools. Nobody else is touching them and blunting them. So dentistry is obviously, you know, a topic.

Is, is very much on the upward curve, we would hope across the profession, and it's something that has perhaps been the the neglected arm of GP practise in in years gone by. And I just wonder, sort of looking at your own journey through your career and and your aspirations for, for the evolution of, of dentistry, certainly in GP practise, how have you seen that evolution go and where do you see it sort of advancing in future? I think the evolution has been a relatively snail's pace, and I'm just going to read you a passage out of Professor Millat's book called Animal Dentistry and Diseases of the Mouth.

And he writes, animal dentistry is unpopular, not so much because it is difficult, tedious, and even dangerous, but because it is regarded as of minor importance in the veterinary colleges and by the better class of veterinary practitioners who willingly stigmatise animal dentistry as an unimportant side issue by relegating dental operations to the student, the assistant, the stable helper, the horseshoer, or the horse dentist. This was actually written in 1908. And sadly, in the 112 years that have passed, certainly as far as the veterinary colleges go, this is worldwide, and I don't want to single out anyone.

By and large, that attitude still exists. They now start to say, yes, we're going to teach dentistry, but they tend to relegate it to the the state where they, they just. Delegate somebody and say you're teaching dentistry.

Despite the fact they know nothing about dentistry at all, they're just delegated to do it. So the university then thinks they've ticked the box, but they haven't actually done their students or ultimately the patients a lot of good. BVDA initially, many years ago.

Ran courses, started running courses within universities, and BVDA would go in, volunteers from from BVDA would go in and and teach for one or two days. And We suddenly realised that actually they were then using that as their tick box, so they ticked off BVD had done it. They didn't actually want to put anything in it themselves, so we've started to push back and and gradually we'd stopped doing those courses, but offered support to the universities to help them run their own courses.

And it's a slow process, but this is not, by no means restricted to the UK. This is a worldwide phenomenon, as we know through my work with the European Veteran Dental Society and the American Veterinary Dental Foundation. It, it's a big problem in universities worldwide.

And obviously, you know, the, the education we get is, is, should we go with negligible in terms of the time that can be invested in dental education, because of course, you know, there are only so many hours in the day and so many hours in the academic year, and there is this vast swathe that that universities have to teach us. So there does of course have to be a degree of personal investment in your development. And I think, you know, it it it's only right that, you know, if, if we wanted to.

A good service, we do have to invest in ourselves, especially as younger graduates when we're coming up and through. I just wonder what what BVDA have have in place for those of you that, much like you and I have got the, taste for, for dentistry and enjoy that kind of service because I, I think it is something that is potentially polarising in practise. You're either a lover or a hater in many cases when it comes to dentistry.

Yeah, when I started out, . Interested in dentistry probably 30 years ago now, just over 30 years ago, the BVDA were the only people running courses, postgraduate courses in dentistry, and they were very successful, and most of the veterinary dentists currently active in the UK certainly came up through that route. Now though, there are a number of commercial organisations running dental courses.

The corporates are also running dental courses not only for their new graduates, but a lot of them are starting to run more advanced one, courses as well. So the BVA has stepped back a bit initially from running course or their normal basic courses, and we were about to start running more advanced courses with one of our partners, IM 3 in the purpose-built facility in Dublin. This was all on building up, we had a an idea of how to run courses and then of course COVID came along and everything stopped.

So this is all in the pipeline, so we've got practical courses coming as soon as we're allowed, and that of course has had a setback this week because the Irish government have closed everything down. You're not even allowed out of your own town. So the other thing we started was a regional tour, talking teeth.

So this was a series of regional meetings around the country that would be a little sound little bites. So not just one big talk for an evening. It was an evening of dental education with food, so you could come straight from practise.

And there were, there were about 4 or 5 short talks on practical topics that people would want to know in practise. And each talk each area was a bit different, different mix of speakers. And topics, and this got off to a flying start down in the west country, until COVID came along, and then it all ground to a halt.

But we have got plans to restart as soon as we're available, again, to to get people and a physical meeting, yes, we could hold the Zoom. One of the advantages of physical meeting over the meal and and coffee, we actually all chatted about dentistry as well, so this was a good exchange of. Ideas that were going on and people were able to ask questions and practise that'd been bugging them.

And it was a great forum. We have also got a Facebook forum, Facebook group where people come along and post questions and Almost every day somebody's on there, posting questions and wanting answers. And I think that's one of the great things with BVDA isn't it?

You know, there is this real network of people, you know, that, that are all levels of experience, there's the young and inexperienced who are keen to learn, right up to, you know, diplomat level experience that are all on an even keel and, and happily sharing information and insight with one another, and I think, you know, that is very much sort of testament to the organisation and this sort of community network element that, that, you know, is becoming. More and more commonplace in, in various different subsections of the profession. And, and of course, you know, you look at, you know, we touched earlier on the evolution of of dentistry and practise, but I know that one of the things that's, that's important to yourself is, is, you know, very much having sort of dental advocates in practises.

And I just wonder if you could just tell people a little bit about what the rationale and the thought process is behind that, for, for sort of, you know, maximising dental care to our patients. I think throughout, certainly my career, which started in the 70s, everybody in practise has been expected to do dentistry, small amount of the dentistry we're talking about here, and. As I've retired from full-time clinical practise and done a lot more teaching, particularly for new graduates, it's fairly obvious that there are some small number of individuals who just haven't got the digital dexterity to do it.

And I used to see this in practise with surgery. Some people, when they were spaying a cat, it looked like they were using a pickaxe and a spade and a fork. It really was painful to watch.

And it But those people had other skills, so give me a dermatology case and I lose, lose the will to live. Whereas some of these people, they just love it, and they get in there and they do the full workup and they have a really cured patient and a really happy client. So, I think we should all start thinking about why is it that in small animal practise all vets are expected to do dentistry.

If I diagnosed a fractured cruciate in a practise. I wouldn't expect to do it because I don't have the skills for it. I'd refer it to the orthopaedics, specialists, so why don't we start having in a practise, someone who's a dental advocate, which is a, I think a good term that's that's starting to be used.

Someone who actually does do more of the dentistry and actually like A likes it, B is does the training, so they get good at it. So we actually start to specialise within a practise. So dentistry becomes one of the specialisations, not just.

That everybody's got to do it when they've done, you know, everything else has been done in the day, so dentistry gets left to last and whoever happens to be on that ship has to do it, whether they really like it or not, cos if you don't like something, you're not gonna be good at it and you really won't do the patient. Any great favours? Yeah, and I think there is, there's a lot to be said for, you know, there's some things in practise that you can just say, you know, wham bam, let's get you in, get you out, get you through the doors, and so on and so forth.

But good dentistry, of course, you know, is one of them things that can't be rushed and does take times. And of course we're in times as a profession where we're under increasing time pressure. And I just wonder if you've got any insights to people in busy practises that have maybe got small teams that, you know, can't outsource things here, there and everywhere as to ways in which they can maximise their dental care.

Of their patients and you know, little tips for how to offer that best dentistry for a GP practise where, you know, we don't have all of the bells and whistles. All the bells and whistles, I think. When we talk about doing dentistry to high standard, we are not necessarily talking about being able to do root canals and orthodontics and all the sexy stuff at that end, it's really the bulk of our patients need a really good, Perontal therapy session of removing the tartar, removing the plaque, which is actually the be all and end all, and remembering that the, the tartar that's at the tip of the tooth on the crown, by and large, is of no benefit is of no detriment to the animal at all.

It's the the calculus on tarta, whatever you like to call it, that's at the gum margin and under the gingival margin, that's actually the important bit because that retains plaque. And it plaque that does the damage to the perdontium, which is the pool to the tooth and the gingiva. And once that's gone, the tooth is history, and it has to come out.

So what ends up is that dental courses end up talking about Extractions, how to do extractions, well, that to my way of thinking is like going on an internal medicine course, and the most important thing they teach you is how to euthanize the patient. This is crazy. You extraction of teeth has been called toothhanasia.

We should, if we have to take a tooth out, we, as in we, the vet we include the client in that have failed. That's failure. By the time it comes to that, we should be in there a lot earlier, we should be telling our clients to look a lot earlier so that they actually, Start taking care of the teeth to preserve the perdontium.

And so that extraction becomes much further down the line or not at all. And all these things take time when you're doing a proper job and. Something that Now being talked about is staging dentistry, and I think this for a younger graduate who's not confident and quite slow at doing things because they want to do a really good job.

I don't see any harm in doing it stage, so your first anaesthetic is to. I do a full examination of the the mouth and before the anaesthetic of course, don't forget the pre-anesthetic examination of the. External structures and the occlusion, the occlusion you can only check.

Prior to anaesthesia when the arms was conscious. Your anaesthetizes, you do a full examination, you probably do a scale and polish just certainly a scale just to get, so you can see what you've got. You then do a chart while you're doing that, and then you can make a plan so that if it needs lots of extractions and or periodontal surgery, you can actually then.

Talk to the client and do it as a second procedure and probably a much cheaper anaesthetic for that, so that overall the cost is perhaps a little bit more, but the owner perceives great value because you've had two procedures and you've taken a lot more time, and you've actually discussed this with the client. Nothing worse than somebody dropping off their pet in the morning with a nurse, and then just picking it up and the nurse says, here you are, we've done it, here's the bill. No, explain what you've done, go through it all, explain.

A, what you've done, and B, what the client needs to do to help keep them right. Yeah, and I know I certainly have worked in, in multiple practises that have started doing these biphasic dentals, and it is really interesting to actually see when people have the time. To invest in in educating their owners as to what they're doing, why they're doing, and, you know, this is why this is costing you 500, 600 quid.

Actually, invariably that, that, that conversation flow with an owner is very different because they're looking at it and going, well, OK, now I understand what it's doing, and actually spending this money now is stopping me spending 4 figures in 18 months' time. On treating this or, you know, potentially even less than that, and I think that is something that as a profession, we, I think we are getting more confident at discussing these things with owners, but it's great to see that evolution and, and also to see practises that are willing to say, look, you know, we're not going to compromise on our care. If you want a quick job, go to Joe Do blocks down the road, but actually they're not gonna do the dentistry anywhere near as good as this, which means you're gonna be back spending the same amount again in in in 6 to 12 months' time.

So, obviously you touched on, on periodontal disease earlier, which is, you know, to . To anyone who has a, a, a, a love of dentistry, probably the, you know, the, the the the golden goose and sort of, you know, very much that sort of exciting area of, you know, this is why we're doing what we're doing so that we can slow disease progression here, but I just wonder, looking at at periodontal disease, obviously there is some insights into the agenda with with BVDA this year, but what, what sort of jumps out to you from that agenda? On our webinar event, we, we've got Professor Ian Chappell coming to talk to us on the connection between periodontal disease and systemic disease.

We've, it's been suspected and, and there have been. Studies on Statistical studies showing there's a connection, but actually they're now starting to be able to prove it. Direct causes, not only people but also in animals, and I'm, Of the opinion that having seen lots, I haven't done any surveys on this is only anecdotal and and.

Just observational that a number of animals, older animals, they're slowed down and they get old and they don't want to go for a walk unless it's really good and they plod along. And I've been amazed after cleaning their teeth. How many of these, the owner comes back and, you know, we see them a week later and they say he's so much better, he's brighter, it's like not years off his life and.

It is surprising how often that happens, and the only way I know that is because I like to see all my clinical cases back a week later. Just a, check their healing, discuss post operative care and long term care with the owner, but also it gives me the feedback. So if I'm doing my extractions correctly, I know that A, the animal will be eating that night.

It will be bouncy the next day. The, when I lift the lip and check a week later, I can see the ginger has healed. If I just do the dentistry, and in a lot of practises, the will do the dentistry.

A nurse will see it as a post-op check. The person doing the dentistry never actually sees what the end result is. And I've done some locuming since retiring from full-time clinical practise, and I've been horrified at some of the standards I've seen.

And I've done some postoperative checks in practises where I didn't do the dentistry, and I've just been, oh my God, this person doesn't really know what they're doing. Whereas I'm sure if they saw their own postoperative checks, they would suddenly think, ah. This isn't going quite as it should.

And they would then trigger them hopefully to do a better job. I think that's it is interesting, isn't it, because there's this sort of assumption with a lot of things that we learn about stuff in our early career, and then, well, you know, we just carry on with that, that bit of knowledge through the rest of our career until we retire. But actually, you know, there is this increasing trend, thankfully, that people are, are investing.

Thing in their careers right the way through, and of course you know you could have been in practise 2030 years, and as you say, perhaps not be, should we go with the, the PC approach of not delivering the best dental, dental care to your patients. But, but what about. Sort of, you know, how can people engage with BVDA specifically in order to, to upskill themselves from that dental side of things, because of course CPD is expensive to get for people and, and there is so much that you can do.

Digitally, but, but I think a lot of things, especially with dentistry, does require this, you know, sort of hands-on educational experience in order to do that. So, how can people go about upskilling themselves at all stages of their careers? Me.

Once you join the BVDA you're, you're part of a bit of a community, you've got the support from particularly things like Facebook and emails. Those of us on the committee get a number of emails each month from members who've just got specific queries and and want help on. Where to go for courses and is this any good and have you got any experience of that.

So that's, that's the, the, the core, and then if you really want to go forward, then going on one of the longer term courses rather than just a short course is a great way. There are a couple of certificate programmes in the UK I improve international and CPD solutions run, and also the, the longest standing one, the one I did probably just over 20 years ago, the ESABS. In Europe, I particularly like that one because it brings together a lot of European vets and you actually get to chat and find completely different ways of doing it.

Each country has got different ways, and I think that's always excellent. But just even if you just keep going on our courses, come to regional meetings like our talking tea, you start chatting and absorbing bits, and it's amazing how much you can absorb over the, over a period of time. But practical skills, as you rightly said, are key to this, so you can never learn all of dentistry from a book or from Zoom meetings.

I'm afraid, once this current situation is over, get some practical lessons. You'd be amazed how much you will learn. People who think they know it, when they do a practical session and.

Just suddenly realised that there's so much they were doing wrong and how much easier it is once you're shown the right way. I think one of the great things about that dental community is that people are willing to help, you know, people are willing to, you know, have people into their practises to spend some time with them. I mean, I know I've spent time with 3 or 4 different, diplomats and certificate holders all over the UK seeing practise, and some of the stuff they're doing is just awesome.

But as you said earlier, a lot of that is the, you know, the sexy end of the profession. And the vast majority of what we do for most people in practise is, you know, the scale and polish. But actually, That is the most important element of dental care.

If we get all of that right, well, guess what, you know, other than the odd traumatic injury or, you know, chronic issue that, you know, has, has been unavoidable, the sexy stuff kind of almost dies out a little bit because of better first opinion care. So looking, looking forwards obviously as you. Delve further into retirement and as you, you look to hand up your your presidential scale, as it were, what do you, what do you hope to see in terms of how we as a profession approach dentistry in the future?

I'd like the old idea that dentistry as indicated by Professor Muralla that . It was unpopular and of minor importance, so it becomes more important. I was at a CPD event some years ago now, probably 20 years ago.

And a practise principle of a really large practise said to me, said, pontificating over dinner. Said oh we really like dentals in my practise, we just put them in and give them to the nurses. Really?

That's the nurses have got a a great role to play in practise. There's no doubt that with proper training, they can play a really important part in dentistry, but not actually for taking teeth out, for the diagnosis, but a veterinary surgeon needs to be involved to to do the directing, and the nurses can say, maintain the equipment. They can scale and polish.

They can find pathology to point out the vet, and then the vet can decide where we go with that. But the old idea of a nurse just, oh, we've charged the client for just the nurse cracking off the tartar. And making them look good without actually making any difference to the real periodontal disease under the gingival margin should be consigned to history.

Yeah, and I think that sort of alludes to what you were touching earlier about these sorts of dental advocates, and I think it's great that, you know, practises are looking at working in teams. I know the first, the first teacher I had really, in terms of, my, my interest in dentistry was the head nurse at the practise I was working at, and she was fantastic. But the job had been left to her and her alone really, for a long time, and there'd not been anyone come along who'd been interested.

From a veterinary side of things, and I think unfortunately that is all too commonplace in GP practise, although, you know, again, we touched earlier on the, the ever present time pressures that are on in practise, but I think, you know, a strong vet and nurse team to deliver dental care will actually deliver a hugely profitable service for a practise that, you know, is. Offering the the the the pet owner and the patients best levels of care and has the return for the practise. So, you know, it does really serve everybody to have, you know, an empowered and an educated veterinary dental team in-house.

And of course this year, you know, when you look at this, this empowered, educated team, you guys have thought, right, we're gonna go in at the deep end and we're gonna run two streams at our congress. So, What's the rationale behind running two streams? The idea was that we could actually split the day between those specialists who want, who great at all the the usual dentistry, they, they know all that bit, but they want a discussion on the more advanced things.

And the general practitioner who would like to, who's joined the BVDA to learn a bit more about the basic dentistry. And. What we've tried has always happened in the past, the day has been a bit split, so half the talks are a bit basic for the specialists, and the other half are way over the head of the generalists.

So by splitting it up, we can actually give each group a whole day, but even within that, there's someone I'm chairing the essential stream. And actually I'm really looking forward to it cos I think some of those items, even though it's a re I probably know it, it's actually great just to go over it, review it, and there will almost certainly be tips I learn from the presenters of each of those essentials stream because it's things that I didn't think about and I just do it my way, and then suddenly somebody says, well, I do it this way, and you think, oh, that's a lot better, let's do it that way. And I think it, it's great, isn't it, really, because when you have an interest in a topic, it's great to see sort of the things that can be done, and those things that you, that you know, you strive to achieve in the future.

And I, you know, at the minute I find myself using this analogy quite a bit in that my son's 11 months old, and, and much to my, my wife's enjoyment is learning to. Walk at the moment, so we'd hoped it would take him a bit longer before he can disappear off, but invariably he gets carried away with himself and he's trying to go quicker and quicker and then falls over. And and to me, that is the, you know, it's very easily to draw that comparison with your clinical developments.

You know, it is paramount to have a really solid grounding. In in basic essential dentistry, before you go advancing into, you know, things like root canals and you know, sort of max fact surgeries and things like that. It's not to say that you don't get there and it's great to sort of, Look at these bits of content and sort of say, oh well that's cool, you can do that.

But once you've got that initial grounding, it's great to see those two streams complimenting each other. So, look, this is what you can do in a few years' time, once you've done hundreds of these, and thousands of these, and, and, you know, hopefully keep and engaged with that. So I think it's great that as an organisation, you're not just catering to.

The elite in that particular field, you're, you're really looking at a programme that will deliver an opportunity for everybody from, from, you know, vet nurse to student vet nurse right through new graduate or undergraduate, and, and, and, you know, experienced clinician to develop their skill set. And so I, you know, I for one, again with my obvious dental bias, I'm looking forward to that, so. Paul, it's, it's great to chat, and obviously, you know, best of luck for, for the, the digital congress this year.

What is, what to you would be a successful outcome for this congress? From the feedback forms, I would hope that everybody says, wow, this is great, let's do it again, because at the moment, we, it, things are still in the air for next year, certainly the first half of next year. So if that remains the case, then we probably would run it again.

But we need the feedback to know that. It's also great that this particular congress is not just, if you miss it on the day because you're busy on the day, you can actually log on or you can actually become a delegate any time over the next 6 months. OK, you won't get the live Q&A, but you'll get all.

The both streams, being able to watch it still. So that's a great thing. And really my presidential year, I said when I accepted the challenge of taking on the presidency, I said what I needed, what I wanted to do is grow the the membership.

And actually since the launch of the digital virtual conference, our membership has shot up. Which is fantastic because we've got special member rates, it's cheap. If you're a member of BVDA it's much cheaper to er to become a delegate.

Yeah, and I think that is, you know, it's, as we touched earlier in the, earlier in the conversation, your veterinary life and career, God willing, is long, and, and, you know, rewarding, but to get the maximum amount of the rewards that you, you want out, it is making sure that you put that investment in and, and, you know, making investments in your own interests is massive. So fingers crossed, everybody who comes along gets, gets a load of of insight out of the event. And continues to engage with BVDA moving forward, I think a big thank you to BVDA for having the the malleability to er to say, look, do you know what, we're not just going to shelve this event this year because as, as we've said, dentistry is such an important element of GP practise.

So Paul, it's great to chat, thank you so much for joining us and good luck for the congress this year. Thank you, Ben.