So welcome to enhancing dental surgery outcomes, and I do think that the veterinary nurses can have a real role in helping to improve our patient care and avoiding any post-op complications. So I wanted to have a real think at sort of the literature that I could find and just what we do on the daily that we may not even realise has such a big effect for our patients and our level of care, or maybe something that you're not doing that other places might be doing. That you could implement that could make, infection control a little bit easier.
So if we think about what the number one cause of wound breakdown, and we're talking obviously here about dentistry, mainly extractions, then unfortunately that does fall down to poor surgical technique. Now as nurses, we're not doing extractions, or we shouldn't be in the UK, but we may be placing local nerve blocks, we may be taking x-rays, we may be cleaning, so scaling and polishing the teeth, so. All of that could be classed a little bit as some technical, surgical techniques, so you need to be careful that you know how you're doing all of those things appropriately.
But just because that's the number one cause doesn't mean it's not a multifactorial situation, which is why I wanted to talk further into what we can do. To help all the other factors, to avoid post-operative complications. So, when we think about poor surgical technique, if there's too much tension placed on the wound as they're closing, then that is prime for that to break down and that is normally the biggest reason we see post-op complications get referred to us.
And also alongside kind of hand in hand with that is that that a big enough flap wasn't created to close and therefore you've got too much tension. Now, yes, we're as nurses, we're not able to do these extractions or closures, but. Being able to know or have that conversation with your vets as a team if you've got a new gradual vet that's not used to dentistry.
And they don't know that these two things are a big cause of wound breakdown. It's a good conversation and be educated, team approach, I think. Leaving roots behind, that could be avoided if you're comfortable taking dental radiographs and perhaps your vet isn't so they can actually see that they've left those roots behind.
And, not smoothing the bone over once an extraction's been made. Maybe some of that alveolar bone had to be removed to get that tooth out, but it's now been left really sharp. So even if you do the best flap with no tension in the world, if it's got something sharp and pokey underneath it.
So, again, being educated and being able to share that education and support our surgeons in an area that they may not feel that comfortable in, can be really helpful, because this isn't things that I knew. When I started, entering into dentistry, even during the anaesthesia, not that that's adjust, but doing the anaesthesia and seeing what's going on. If a vet had said to me, you know, what do I think I could do to try and get this to heal nicer?
Oh, I wouldn't have had a clue. So hopefully some of these points will be helpful. And not utilising dental radiography pre and post surgery as well is gonna really.
Not cause post-op breakdown, but if you haven't taken an X-ray before and you haven't realised what the tooth looks like, we'll look at that again shortly. And we haven't ensured all of the tooth is out and everything's happy before you close up. And that's a task that nurses can do is taking dental radiographs so we can really get involved there.
There's a few articles out there, . And I think we always need to bear in mind that when we look online for articles. Owners can do exactly the same thing and read a lot of the same literature.
A lot of it is free. Yeah, we have to pay for some of it, but there's there's nothing stopping most. Lay people doing that.
So just remembering the owners have access to a lot of this literature and information too. So really try and do the best we can do, which we would want to do anyway. But if we haven't done something as simple as maybe take an X-ray and we have dental X-rays, an owner is going to very easily be able to Doctor Google and realise that that should have happened.
And that's just a pickle you don't want to find yourself in. So this was an interesting read from clinician's brief. Top 5 complications of dental procedures in cats and dogs.
So again, quite veterinary surgery led. It's something that I think is super important to be educated in as nurses supporting vets in dentistry. That poor gingival flat peeling, often due to too much tension or not enough flatmate anyway.
An auronasal fistula, which again we need to be, if you're the one examining the mouth and completing the dental chart, you should be able to find, and you also may be one looking at the x-rays and taking the x-rays, and we shouldn't be diagnosing, but it is helpful if you can say, oh, I think is there a neuronasal fistula there? So we know to treat that. Jaw fracture, so we may be able to see x-rays, which I'll show you shortly, which we think, ooh, I'm not sure if we should be doing this because we may be fracturing a jaw.
That could be a team approach to discuss that, particularly if you're the one that's meant to be taking those x-rays, and give you lots of information. Tooth root fracture. And bleeding.
So with these it's all about knowing where your instruments are that you might need to get that tooth root remnant out as well, and if the patient does have some unexpected bleeding, having all the equipment there and knowing how to use it, and the vet knowing how to use it to help support and stop that bleeding. So if you were to get some x-rays and they looked a little bit like this, your surgeon may think, oh, that's a bit close, I think I might refer that, and that's absolutely fine, we see a lot of that. So nurses can help take those x-rays to help that vet make that diagnosis and that decision.
And the same here, and these are both pictures from the same article or clinician's brief. And we've got a lacerated root there. So again, that's more likely to have a tooth root fracture and then you're gonna have to try and find that root.
Do you have the capability and the equipment to do it? If you do, then you can get all that equipment ready, so you're prepared. If you don't, then the vet may decide to refer that out and that's perfectly acceptable too.
But if you're the nurse. In charge of taking those X-rays, it just improves the, sorry, it just proves the importance of gaining them in the first place. And then the second, information that I found from the proceedings of the World Small Animal Veterinary Association World Congress in 2015 by Jersey Gao is what went wrong, Mistakes and malpractice in small animal dentistry.
So it's quite an interesting read, a discussion about intentional, which could be called malpractice, and unintentional, which we would call a mistake, problems in dentistry. So it's a presentation of clinical examples highlighting how you could avoid such problems in daily dentistry. I think it's important to understand what this could mean.
So the term malpractice, which implies an intention to perform an inappropriate procedure. And now I hope that doesn't really happen. We don't go into a surgery with the intention of doing it incorrectly, but if you've willfully neglected to do something that may cause complications.
That falls under malpractice too. So if you just don't take x-rays even though you've got them because you just don't, or you don't know how, but you have it in the clinic, we just didn't do them post-operatively for no good reason. Again this could fall into malpractice, so we just need to be very careful about performing what we can within our capabilities and being honest with owners about what those capabilities are.
So that's covered the kind of more scary bit. Let's have a look at a case together. This is a gorgeous patient that came to see us a little while ago.
So this is a neutered male, he's an 8 year old feline. So, we saw them in last year, but 5 years before that, the, his 204 and 304. So his upper left and lower left canine were on his clinical notes as being fractured, and the owner was told you don't need to do anything about them.
So unfortunately that is incorrect advice already. And the owner was quite upset because she said she would have done something sooner had that been recommended. So we don't recommend that fractured teeth are just looked at, they're not going to grow back.
We were just waiting for trouble and leaving a patient potentially in pain and awaiting an infection. So the owner saw a different vet at the same clinic in August and was told, you know, he'd really have those teeth out as they're fractured, so. Again, that is an appropriate potential.
Treatment choice. Another treatment depending on the fracture is root canal therapy at a dentist. So, we could always be offering referral and GP.
Procedures and the owner can then make an informed decision as to what they'd like to do. Root canal therapy isn't for everyone, but neither is extractions. You also need to make sure you're comfortable removing canines and cats.
Unfortunately, with the teeth being extracted, the wound broke down very, very quickly, and the treatment choice, was steroids. Again, that's not something that we tend to recommend. I know I'm a nurse, I can't diagnose or give treatment.
Or prescribe. But we know that steroids aren't going to offer analgesia or anti very good anti-inflammatories for this kind of breakdown. They actually help delay healing, so it's not something that we personally would decide to pop a wound breakdown on.
This went on for a couple of months on the steroids, nothing got any better, so they went back in the November. Had a repeat surgery, that broke down. The owner was then getting quite uncomfortable with the repetitive anaesthesia.
And unfortunately, they then decided to flush the broken down sockets and corrected this patient conscious, conscious with no analgesia. So you can see the kind of issues that are coming up regularly, of what isn't appropriate, and it's not just inappropriate, but painful, it's actually not going to work either. So obviously this didn't help.
The owner then had a look around and thought, well, is there not like a veterinary dentist? Is that a thing? She realised it was, requested a referral and was told, you don't need to do that.
No need for that at all. You don't need to see a dentist. And it's good for vets to say what they feel is within their capabilities, but it's also not fair to refuse something that an owner is requesting.
Owners may feel very uncomfortable speaking to someone of a higher education to them, perhaps. They may feel that way. This owner did.
She didn't feel she could pursue and say, I really want a referral. She didn't feel comfortable saying that. She didn't want to offend anyone.
However, with things not getting any better. He realised that he could demand a referral. And she came to see us as a matter of urgency.
So what went wrong here? Well, there's a few steps that I think are good learning points. They didn't use dental x-ray, they had it in the clinic, but they didn't use it.
They did not use the correct extraction technique. Steroids is not the best treatment for a non-healing wound. This cat was not offered any analgesia.
We should not be performing any level of dentistry conscious. And we need to be open to listening to owners' wishes. If they'd like a referral or they have a concern about, are you going to take x-rays, we need to be open and honest and have a good conversation with them.
So when this patient came to us, this is what it looked like. Now we can see half of that canine tooth is still in the jaw. So this could have been avoided if they'd taken dental x-rays.
The teeth were both taken out and you can see what we mean by incorrect surgical technique, just simply drilling and burrring at a tooth to hope that you've pulverised it out. The root is not a treatment choice, we need to be, fractured teeth that don't have the correct absorption going on, they need to be fully extracted. So we'll see, as you can see very clearly as soon as we open this wound.
It's not gonna heal, because this is now a big old foreign body, sharp and horrible. And this is not OK. So what happened next, the owner had lost all trust in her usual vet and felt very upset and lost with the veterinary profession.
So she was too scared to attend any post-op checks. We were quite far away from the owner. The cat didn't like travel, and the owner was worried about giving other medications because of that loss of faith.
So he didn't come. He also didn't answer any of our phone calls to see how they were doing. Hi.
I'm not sure why, but that didn't happen. And she didn't give any medication because she was too scared about hurting the cat. So he went home on like gabapentin, Metacas, antibiotics, and none of this was given.
When we did get in contact with her, she said the cat was hiding under the bed a lot, pawing at his mouth continuously, dribbling. He felt hot to touch, he wasn't really eating. So when she realised that this was going on, I think they contacted us and said, actually, I, I don't think he's OK.
So we were like, right, we, we really need to see you, I understand you're worried and the travel. We can prescribe something to help him calm if you'd like. But these are the reasons we we'd really like to see you and see what's going on.
And unfortunately, one site had healed beautifully and this was the other. And this is not ideal. We see a lot of cats for.
Treatment that has broken down, we see a lot of cats with root remnants where dental X-rays hasn't been used. The second surgery on inflamed and angry tissue is, is never as good as that first extraction attempt. And then if you have a patient that's been left in pain and not monitored and has been able to get to that extraction site, it's not common that cats tend to self-mutilate, but given the chronic pain been going on for 5 months, perhaps that should have been foreseen.
So we had a long consultation with the owner. Rachel redid the surgery, we debrided that wound and got that closed again. We went over those written instructions several times because the owner was quite emotional and we just wanted to make sure everything was taken on board.
We reiterated and really, really reassured the owner about each medication that it's not gonna hurt him, and this is how they work and this is why it's really important that we give them. Given the history of self-mutilation, we sent him home with a buster collar. And we said to the owner to, this is the number that we'll be calling you from.
We really want to keep up with you and see how he's doing, and this is a number that you can send or email pictures to, so we can make sure that this is going to heal. The owner was still really quite shell shocked and did not want to go back to her other vets. So we suggested that she has a little read around her local area and sees a vet, so she's not just not seeing anyone.
Have a consultation to see who he feels safe and comfortable with, and suggested that, you know, you go and see them for the post-op checks or come back to us to have stress-free travel if you're happy to give him some medication. But he really does need to be seen and this is why we don't want to do a sort of 4th surgery. So with all of that in place, both us and the owner have learnt what's needed to work together.
Everything healed up really nicely. This patient became very comfortable eating loads, she became very, very happy, and she got a new vet who she said she was feeling very comfortable with. But she was going to send a complaint letter to that first surgeon, which is never nice to receive and in this situation, she had a lawyer as well, so we just can see how it can.
Go into something big very, very quickly, . So if we can take steps to avoid it ever leading to this situation, it's going to be a lot better for, you know, reputation, your mental wellbeing, the patient's health, the owner's wellbeing. So I think, yeah, if we can support everyone to do better dentistry and have less chance of issues occurring.
Then that, that can only be a good thing and unfortunately this guy isn't an isolated case. This kind of thing does happen quite often. So apart from good veterinary education for the correct surgical technique, and you may not be able to do the surgical technique, but if you understand what should be happening, that's something you can talk within your clinic to try and get everyone trained up somewhere to the appropriate standard, then as a nurse it's something that you can help vet's getting really good CPD.
So it really is that team effort. So, you can be the best surgeon in the world, but if you've got really rubbish instruments, you are also more likely to have some issues post-operatively. All instruments once used should be cleaned in an enzymatic cleaner.
They should also be sharpened after each use, ideally, lubricated, and they should be sterile, so they should go through the autoclave. And then stored correctly, so we don't want them all just chucked in a drawer once they've been dried with a tea towel or something, they should be kept sterile and then kept ideally in dentistry cases, sort of in kits, and stacked up nice and neatly in a dust-free, clean area. This should happen between every single patient.
We shouldn't just be dunking the instruments, scrubbing them off a bit, giving them a rinse and going into another mouth. If they did that to me at the dentist, I'd be horrified. So we really don't want to be doing that.
Make sure that we're inspecting our instruments as well. They do get broken, they do get worn down. They're not gonna last forever, even if we're super careful.
So make sure you dispose of those broken instruments. If you've got a periodontal probe that's snapped off, or a pair of scissors where the end isn't quite right, or something's got bent and like the forceps no longer meet up the tissue forceps, then get rid of them, get some new ones. This is what we don't want to see.
We don't want them all just thrown in here like this at any point because they are going to damage each other. And this is what we'd like to see them all nice and sterilised in some sort of tray. This is one of our large dog kits.
And we're also gonna make sure everything, even our periodontal probes and explorers are kept nice and sterile. So I know the mouth is not the cleanest area at all. It's always going to be heavily contaminated with some sort of bacteria.
But there's no need to think, oh well, we don't need to be clean and sterile, because we don't want to add any extra to that load. And before you use the kits, making sure that they have gone through the sterilisation cycle and that that has been successful. So I think it's really important to think about what your caseloads are and the type of patients you're seeing.
So what instruments do you need for your caseload? Do you have left or right handed surgeons, do you have surgeons with big hands, small hands, preferences on different instruments? We can create kits for cats.
So we have 3 cat kits, 2 small dog kits and 2 large dog kits, so we should have enough for every day. And we want to make sure they're nice and accessible, to make sure the correct instrument's being reached for, not, oh, I can't be bothered to go to the next room to get such, I'll just give this a go. It should be the correct instrument and that will be a lot easier if as nurses we've prepped and got everything ready.
Checking the day before if you can, everything is ready, all the correct kits are ready for each surgery and just being aware of your capabilities within your equipment and instruments, so don't book three of the same size patients in one day if you don't have 3 kits, or at least 2 so that you can do the first one. Get that kit sterilised while you're doing the 2nd with the 2nd new kit and then you can reuse that 1st kit because it's had time to go through the cleaning and sterilisation procedure. So that you have a fresh kit for every patient every time.
And then as nurses, something that can be really enjoyable is scaling and polishing teeth, but that needs to be done safely and correctly. If we're doing it incorrectly, then scaling can cause scratches or even burns, damage to the pulp of the teeth. That sharp tip, the bit that you really want to just get in between the teeth, never ever use that on the teeth, because it can cause really bad damage.
And make sure that you are testing the water supply before you place this probe on the teeth as well. Don't spend too long on each teeth. You can read different guidance, some will say 5 seconds, some will say 15.
Just be logical and don't spend too long. Come back to the tooth if you need to opposed to spending too long on it in the first place. And then if you make sure you're wearing gloves, but check the speed of your scale and polisher on your thumbnail and you'll be surprised at how hot it can get quite quickly.
So make sure. That the speed isn't too fast and it's not getting too hot, so you have the correct water supply. If you are doing subgingival scaling, then that needs to be a correct tip, so you need to be looking at your manufacturer's guidelines as to which ones can go under the gum line and which can't.
And these scaly tips do get worn down very quickly, so they should be checked and regularly replaced. They don't last forever. When we are polishing teeth, we should only be using smooth or fine grade toothpaste.
We shouldn't be using anything with a coarse grade. And with regards to the water that is in our dentistry machine, that shouldn't be tap water, it should be purified or distilled water only. So regarding looking after your scaly tips, they should come with the tip wear guide wherever you buy them from.
If not, you can contact them, they can send them out. You just hold them up against this picture like for like, and it will tell you if they've approached the line of needing to be disposed of. They can become very brittle and non-effective.
So brittle in fact that one of my, vets a few years ago now had walked past the dental machine as it was set up the day before. Though a bit of a scratch, didn't think much of it. Fell over somewhere the next day and had a bit of swelling on her arm.
She thought that's really weird, and we couldn't find the scale tip. The next day, we only had one at a branch clinic, we couldn't find it. We found the case for it, but couldn't find it.
It was in her arm, so we placed my magnet of my badge on her arm as a joke, thinking, oh, it's a metal stick, and it did. So she went off to A&E and yeah, the scalet was so brittle that just by brushing past it with her healthy muscly arm, it's gone into her arm. So let's be very careful.
And with polishing, we need to remember the aim is to remove stain and plaque and biofilm that you can't see with the naked eye. We're not trying to smooth out scratches, so we shouldn't be scratching teeth when we scale, and we certainly shouldn't be then attempting to remove so much enamel to bring it down to that level of the scratch with the polishing is, why would you want to remove that much enamel? So that's kind of a.
An old thought process. So it's also important that we're using appropriate analgesia choices to help, hopefully not too much inflammatory soup occurring and being painful. Also, if your patient is painful and they recover, they're more likely to self-mutilate.
They're going to have a longer, more miserable recovery, gonna have more stress catecholamines going around, which does nothing for healing, so making sure we are offering appropriate analgesia choices. And I know as nurses we can't prescribe, but we can be part of that all important conversation of what should we use, what's the treatment plan, what's the protocol going to be for this patient and tailoring it and not just having a chart. You can have a chart of thoughts to go through, are we using a non-steroidal, are we going to use a block?
Are we going to use such and such, is this appropriate to like nudge your brain, that doesn't mean that every patient who's having a dental in brackets should have exactly the same, it needs to be tailored for every patient. The main point here is to be multimodal, so using small amounts of multiple drugs that work well together to the best effect, therefore limiting the more extreme side effects you may see by using just one or two drugs at higher doses. As nurses, as I said, I really think this is where we can strive and getting involved in that decision process.
If you've educated and you understand how these drugs work, we can look at adding in paracetamol for dogs to go home and during surgery, only for dogs, never for cats. Buprenorphine for cats to go home with, not just non-steroidal. If you have extractions, you're gonna want some sort of opioid as well.
How about some gabapentin, is that needed for dogs and cats? Depends on what's going on with the procedure. Do they need any of these drugs preoperatively?
If you've diagnosed, your vet has diagnosed them as being in oral pain and therefore they need extractions because it's painful, perhaps we need to look at getting that on board before surgery. Do we need non-steroidals? And maybe we could look at using a longer acting local nerve block such as bupivacaine so we know in recovery they're going to be more comfortable for that longer period of time.
And then making sure we pain score them through that recovery period at the hospital and definitely prior to leaving the clinic to make sure they're comfortable before they go home, so the chances of eating are higher. And the chances of self-mutilation and being uncomfortable and sad are reduced. And when we're thinking about analgesia.
You know, if you've got a bet that doesn't do a lot of density, they may be more used to saying, right, let's give out X, Y, Z tablets, but you can be like, oh, is there a liquid form or do you think we could use a non-steroidal liquid form, for example, and it's just been something that maybe someone hasn't thought about. So having that conversation again. Be really useful.
It's really important to look after our hand pieces and our drill bits and burrs. So they should, ideally the burrs be single use, so they don't get too blunt. And our handpieces should be sterilised between patients at least every day after use, if you don't have multiple hand pieces, but they should at least be cleaned between every patient.
And lubrication is very important. These hand pieces should be lubricated between each use, otherwise they just get very sad, and these guards are very expensive. They should be sent for maintenance if you're worried they're not working appropriately, but they should not be submerged in water because that will make them very sad.
There's certain bears that are better for certain jobs, so you can create a poster, so you, you can contact your local dentistry supplier. Look at some further dental education or speak to some dental specialists and say what bus do you recommend for X, Y, Z, and pop a poster up so that people can have some guidance. Make sure that you've got them stored nicely, perhaps in something like on the right, that's how we have ours all labelled, easily accessible and that we're keeping those stock levels correct.
So whoever's in charge of stock in the dental room, make sure we include these guys as well. So this is what we wipe down our hand pieces with on the left and then this is how we lubricate them on the right. There should also be autoclaved between patients or at least at the end of the day before the next round of patients, and each part will tell you whether it can be autoclaved.
And to what temperature they can be able to play till as well. Same for your scalar. Make sure they're nice and wrapped up and then make sure they go through the autoclave at the right temperature and then we check that they have been sterilised when they come out.
Now let's have a look at our dental machine. So this can get covered in all sorts of horrible aerosol bacteria. So it needs to be wiped down between patients.
Again, as we said earlier, distilled water in here only. You can use something called the IM 3 straw, which goes in your water bottle, and that can also help to remove any bacteria. Don't just keep topping up that distilled water.
We should be changing it daily, so get rid of the old lock, put some fresh in. Those water lines should be cleaned regularly and you sort of test those water lines regularly as well. This machine also is going to be used pretty heavily in most clinics, so make sure it's serviced correctly with the correct company and within the correct time frames to make sure it's working.
As well as it can be for as long as it can be, and if you've got the pressurised tank, then we need to drain that as directed. Some like it daily, some like it weekly, some are fortnightly. So as we touched on earlier, water supply care, so this is the straw that I was talking about.
This is a microbiological cartridge, which prevents the biofilm from building up within the internal plumbing. This can be changed annually. But do follow the instructions as it needs a little bit of time to be set up while the machine's not in use, so don't try and do it just as you're about to induce your patient.
And you do need to flush this through the whole system through once you've changed it prior to use, but the instructions are very easy to follow. And then with regards to cleaning the water lines, we will use something called Bilprom. You can buy this from Aura Infection Control, and we will do this sort of over the weekend or with us because it's just us using the dental room.
If we're off for a week, then we'll let it sit in the machine for a week in the pipes. Just make sure you leave it very clearly labelled that there is cleaning fluid in this machine so people don't go to use it, on their patient, and we do that every month. And then you can also check with this little guy on the right, this QWS water testing red sampler, and you can check that you can put some of your water supply in there and then see if it grows anything.
And so far with what we've been up to, we have not grown anything, which is good, but these are all really simple, easy ways to improve infection control. And then with your actual patient, we know that if we allow our patients to become hypothermic or hypertensive under anaesthesia and into recovery, it can actually increase their chances of infection, so. We could talk for hours or I could about maintaining body temperature and blood pressure, two of my favourite subjects.
But I'm sure Webinarla, that have got lots in their library for you to look into that. We recommend jackets and blankets, socks, heat pads, bubble wrap, covering their little face, foil blankets, forced warm air blankets to keep your patient warm, as well as other options. And then just, you know, a little side note for blood pressure, if you can reduce that inhalant by performing multimodal anaesthesia and analgesia.
You may be able to maintain that blood pressure more. There's obviously more to blood pressure than that, but the inhalant is one of the things that's going to be quite mean to your patient's cardiovascular system. Really important that you learn how to prevent and treat hypotension.
Perhaps having a flow chart in place and have your whole team trained up of how you would like to have hypotension treated. It's not just a fluid bolus, it's not just a one meds fits all. You do need to really think about.
A flow chart or a discussion about do we know enough about how to treat hypertension and avoid it, and if not, what can we do to increase their education and share it with the team. And the dental room now. Hopefully, and it I'd like to think we'll get in that way, gone are the days of sharing it with a dub tub where you do anal gland abscesses.
And you're doing enemas and anything with lots of poo and things. I think because dentistry is considered dirty, it's often fallen in line with those things like abscesses and enemas, it shouldn't. You are making incisions into your patient.
Now, if you went to the dentist and the person before you had had rectal surgery, you would not be OK with using that same room. So we really need to think about that, and that can be difficult given the setup of your room. But at least if you are going to do that, make sure it's not on the same day or all the dentistry is done first, and the whole room has been deep cleaned if you can't get away from that.
Every day the walls and ceiling, regardless of what's gone on, even if it's just dentistry all day, it should be cleaned. Think of that bacterial aerosol that comes off the teeth as we're cleaning them, as we're, scaling them, as we are having the drillel being used to remove teeth. Empty all the bins between patients, make sure when we are cleaning we use the correct dilutions, and that if you can't get in all those little nooks and crannies of rooms that probably aren't set up for dentistry, that's probably, you know, a side room or a little cubby, then you can use something like the Airgene Airborne disinfection sort of cleaning balms, just follow the directions and be careful if anyone's got any allergies, and that can get in the nooks and crannies as well.
And then you can think about swabbing the. Room, it's a good thing to order and see if you are already growing anything and trying to eradicate that and then keep things at bay. And then our patients were moved from that dental suite, which we've kept beautifully and we've looked after our machines and our equipment and our instruments.
They're lovely, amazing surgical technique, warm, patient, non-attentive, lovely time. If you then just put them in a dirty area to recover, all move on good work could be in vain. So make sure your patient has nice clean bedding, nice clean kennel.
So we don't really want the bedding they've been in dentistry with because it's going to have all that horrible aerosol in, so nice, clean, soft, fluffy bedding. Nice clean kennel if they've done a wee or a poop in before or there was food stains if they stayed in overnight from the day before. Make sure it's nice and immaculately clean.
And then make sure you're cleaning your food bowls well, you should be feeding them post-op, that's good. But make sure those bowls are super clean, so for us they are cleaned and then they will sit in some allergene solution for a while. Not to be sterile, but just to be as clean as possible.
Make sure the food you're feeding them is in dates. Don't leave it out, just to fester all day. Maybe have a little fridge in wards if you need to for food that's been opened.
And if you're looking at the mouth, so performing pain scores, checking everything's OK, then wearing gloves to do that so that if you do have any bacteria in your hands, you're not then putting them right onto the surgical wound. And we kind of looked at this at the very beginning of how important it was. With that feline patient, you know, the owner has to be very educated in post-op care.
It's now completely up to them. With your support, perhaps on the phone or via email and at the post-op checks to maintain and continue the good job that you started. So letting them know what they need to look out for, how to carefully look in the mouth if you want them to.
Let them know not to go over the top of it. We don't want to be manhandling any surgical sites or placing any tension on them, them, you know, massively lifting a lip, and they've pulled against that beautiful flap that the vet's made and sutured, and that tension's then been created by that. We don't recommend that the mouth should be flushed out even with water, it's gonna just keep removing.
Any tissue that's being laid down to heal, a horrible smell is not normal, bleeding is not normal, hiding away is not normal, rubbing at the face is not normal and shouldn't be allowed, it's very uncommon, but let them know if they are to do that, then do they have a busted collar or do they have something that can make that stop. And nothing hard going in the mouth, so soft food only and no access to hard things. So if they're going for a walk, are they a dog that likes to pick up sticks or rocks or pebbles?
Do you normally throw these things for them? Do they have lots of skanky toys at home that's normally fine, but you know, that teddy that they've carried around for the last 10 years has never been in the washing machine, probably got quite a lot of bacteria on. Show them how to give every medication that you're dispensing them and explain why you are giving them and what each one does, they're therefore more inclined to use it and feel more comfortable to do so.
And then it's a lot to pick up your pet, they've had an anaesthetic. You've probably had a stressful, emotional day as an owner. So being given those instructions verbally and written down, is really helpful for you to reflect on when you get home, or if it isn't the main caregiver that's collected them.
Give them that opportunity and time to ask you some questions. We're kind of covered, not, picking up hard stuff. I'm just making sure that the owner is, are you cleaning the water bowl every day?
I think most owners aren't. Do you use the same food bowl for the day and just re-top it up. Please don't do that.
Let's clean them. Let's make sure that everything is as clean as possible that's going anywhere near that dog or cat's mouth. And then if they're raw fed, are they comfortable perhaps giving a complete diet or cooking some chicken or something.
Because we know that there's a potential of bacteria if it's handled incorrectly and we don't want to be putting the bacteria straight into a surgical wound either. Reiterating why it's so important to come for our post-op checks, giving them that communication of a call the next day, maybe the day after that, after surgery. Let them know verbally and again written down how to contact the surgery if they have any concerns, and if they want to take some pictures where they can send those to.
If they were to need the out of hours, is that with you? Is that somewhere else? Don't start cleaning their teeth immediately, you don't wanna be brushing against those sutures.
And make sure they let the whole family know, so if they've got kids that normally play tug of war with them or allow them access to a stick when they're out, just let them know just remind the whole family not to do that. And those phone calls may sound really time consuming, but we do them for all of our patients, and it's a non-clinical person that does that. We have a protocol that they follow and what is discussed, and then they will involve us as a clinical team if there is a concern that's flagged.
They can make sure, how's the medication going? Did you give it? How did you find it?
Are you feeding soft food? Are they eating? How are they in themselves?
I see we haven't booked you in yet for your post-doc, when would you like to come in? Do you have any concerns at all, any questions? I can really help bond a client as well.
And just make them feel a lot better about what's going on. So when they do come back for that post-op check, that could most likely be with you as a veterinary nurse. Put some gloves on, tell the owner what you're gonna do.
Check the whole mouth, not just the incision site, just to make sure nothing is brewing elsewhere, and there's no complications anywhere else from any cleaning or if they've changed the way they're eating. If there is a lot of debris all stuck and gathered around sutures, then you can use a very damp sterile cotton bud very gently, just to remove that amount of crud off the sutures, but again, very, very gently. And we're checking for any signs here of inflammation or potentially infection.
If you have any concerns, get some images for progress and discuss it with the veterinarian. If you can't do it immediately, then taking those pictures and curing them when you can is good too. Have that discussion again, so what they've been eating and have they been eating it well.
Had they been rubbing their face. So if they have been feeding them something wrong we can course correct. If they've been rubbing their face, we can supply a buster collar or look at their animals, use your protocol with the veterinary surgeon and maybe get that tweaked.
So we've covered quite a lot and I think there's more than we originally think as nurses that we can potentially get involved with dentistry and enhancing surgical outcomes, even though we're not the one doing the surgery. So I hope you've enjoyed it. And I would encourage you to have a think if there's any changes or tweaks that you would like to make in your clinic and how you could go about that.
So thank you very much for having me, and I hope to see you at another webinar vet session soon.