Hi everyone, and thank you for joining us for the role of the RVN in dentistry. It's something that I'm very passionate about and a lot of my dentistry colleagues are. There's a lot of involvement for registered veterinary nurses and student veterinary nurses as they're training in dentistry.

And we are going to touch on where we can get involved and how we can best assist and, and sort of broaden the horizon of what we can do within veterinary dentistry. So we will get started. My name's Stacey.

I'm the one on the right in that picture. I qualified in 2014. I've worked at First Opinion vets, and then I moved somewhere with a mixture of emergency referral and first opinion.

And for the last two years I have worked for Perry Referrals, as a referral, anaesthesia and dental nurse. I've gained my uncert in anaesthesia and dentistry, and I work with Rachel Perry, a European dental specialist, and that's her in the background of the picture. So as I said, I work for Perry Referrals, a specialist veterinary dentistry and oral surgery, and we primarily work clinically from North Downs specialist referrals in Bletchingley, which is a multi-discipline centre, fully referral.

So the objectives for the lecture today is to establish what us as RVNs can be involved in with dentistry. We're gonna discuss the consultation, oral examination, PPE, health and safety. We're gonna touch on charting and scaling polishing and talking about the importance of dental radiographs, the surgical kit and its care.

The equipment and how to care for it and post-op care. So already you can see just how much as nurses, we can get involved with within dentistry. Also, we need to plan and monitor the anaesthesia as a team, and that is a separate webinar within the webinar vet series, so it's worth checking it out, as a lot of us, that is our primarily our main role with dentistry at the moment, is to assist with the anaesthesia.

And I know it can be a concern for many. So if you'd like any tips and some advice on dentistry anaesthesia, you could have a look at that webinar. So as nurses, we are legally allowed to obtain dental radiographs, complete the dental charts, scale and polish teeth, help create an anaesthesia and analgesia plan alongside the veterinary surgeon, monitor the anaesthetic and recovery.

And look into the post-op care and maintain the surgical equipment and instruments. What we cannot do is diagnose, prescribe, extract teeth. Even if it's just a simple wobbly one rooted tooth, we still are not allowed to extract that.

And you can see here that the tooth that you may have thought was one rooted at the back on the left there has actually got two roots, or on the picture on the right, it may have a curly root. So it's no longer a simple extraction and particularly if you aren't able to use dental radiographs. It's not something you'd know about, so something that we might think is simple and you know, why shouldn't we give it a go.

One, we're not allowed, but two, it may not be as simple as we first thought. So I do believe there's scope for nurses to get more practically involved in dental surgery, but that's not happening at the moment, and when it does, we will need to have advanced training prior to doing so. The RCBS supporting guidance specifically excludes the extraction of teeth using instruments.

However, veterinary nurses and student veterinary nurses are permitted to extract teeth that are loose enough to be removed using the fingers, and that's how they stand and that Their legality behind it, and I imagine that's because if a dog at home or a cat at home had a very wobbly tooth about to fall out, an owner may be tempted to reach in and remove that. But as I said, as it stands, we aren't allowed to do surgical extractions. We can get really involved with the consultation or an oral exam, and it doesn't have to be when they've come in for that dental check.

Perhaps they've come in for a puppy check, a kitten check, a post-op check for something else, a pre-op check for a neuter, or an admit for a neuter. So check the patient's mouth for any opportunity you have. We're looking for symmetry and palpating the lymph nodes.

We're going to explain to the owner what we're doing at all times. It can be a bit strange, particularly if they're not used to going to the vet or they haven't owned a pet before. When we start having a look in the mouth or or pulling the lips away gently to have a look at the teeth or opening the mouth.

Talk them through what you're doing and make sure you include the entire mouth as far as the patient will let you. And this is the perfect time as well to suggest teeth cleaning, and we'll talk a little bit more about that later. So on the oral exam, we're looking for any helitosis, weight loss, excess salivation.

They might have a matted coat where they're not grooming themselves as well, if their mouth hurts. They could be subdued because they've got that chronic pain going on and therefore playing less. They could have extra teeth, missing teeth, any lumps in there, there could be some puss and some infection.

They might have pain on opening the mouth. They might have a lump above the skin level and that could be where there's an abscess forming, a teeth through abscess. And they could have asymmetry of calculus indicating that they're preferring to eat on one side.

So I've included some pictures. I think pictures speak 1000 words, and then you can have a look at what's going on there. So.

On the left, we have got a maocclusion. The lower jaw is much longer than the top jaw. On the right, we have got a cat who has fractured the upper right canine.

It's minimal. But they've definitely done it, so that one had a root canal treatment. Top left, this dog is holding onto its USK9.

Super important that we don't leave these too long to fall out. If they're not going to come out naturally, we should be surgically extracting them under radio radiographic control. And you can see there that the gingiva can't create a full seal around both of the canine teeth.

So you're asking for pockets of debris to build up and perdonit or disease. Can build there. So it's really best if we can get those teeth extracted.

Super important if you can use dental radiography when you're doing that, because you'll see in the picture shortly quite how long those roots are. And obviously it's an extra tooth, so it's taking up space, so you need to make sure we're not interfering with any of the other teeth, the permanent teeth that have come through. On the right, we've got a resorptive lesion.

Mainly seen in cats, and they're quite painful. On the left, this dog has fractured its upper right canine again. And that could either be extracted or potentially have a root canal treatment depending on what the radiograph said.

On the right, the lower left canine, so the right picture, the lower left canine has been discoloured, and that would be normally from blunt trauma. So when they initially present like this, we'll ask them to send pictures again in 2 weeks and start nonsteroidals, so they're comfortable. And sometimes the discoloration will calm down, that's the tooth bleeding inside.

If it doesn't, we'll take an X-ray and see if the tooth is dead or not, and then we can offer root canal or extraction. The upper left picture is actually a 7 month old cat who still has all of its deciduous dentition, which is obviously quite abnormal. And this cat had a lot of medical conditions.

We only saw it the other week, so I'm not sure of its long term outcome there, but it was quite interesting. And this is a different cat on the bottom right, who has got quite a severe maleclusion and he had fractured his lower jaw. On the left, we have got a young puppy who has a maoclusion.

The lower jaw this time is shorter than the top jaw, and these tend to be the ones that need more attention as a rule. You can see the lower right canine there is digging into the upper jaw, and that's incredibly painful. And puppies grow when they're sleeping, and so if that lower jaw is already too small.

When they close their mouth, they're asleep, and that's when they're doing their growing. That lower jaw can't grow any further. The incisors are trapped below the top incisors, and that canine is wedged probably in a large hole in the, in the palate.

So we do recommend removing deciduous teeth for a maoclusion in the hope that the jaw can then grow to its full potential to give the adult teeth the best chance at arriving in the best situation. And on the lower right, this cat had a RTA and had fractured its palate. The orthopaedic team did some work on it, but after that it came through to dentistry, and you can see it's fractured.

It's molar there, it's very fine. Fracture, but you can see it all the same. So there's some of the things that we need to be looking out for, as well as these intraoral masses or swellings, and we always send them away.

There may not be such a thing as a benign epuli, and we need to know exactly what they are. So always offer the owner the opportunity. We do see cases where they were epuli, not sent away and they've come back and unfortunately it wasn't Eula in the first place.

So always offer the histology to the owner and have a look for masses when we are looking in their mouth. Always look under the tongue as well and in the cheeks, not just along the teeth. And we've mentioned already, check the entire mouth.

This dog had seen its back a couple of weeks before and been told the teeth were absolutely fine, and to be honest, they look beautiful on these pictures. We haven't cleaned them or done anything to them, they're looking very good. Unfortunately, the back of the mouth was a different story, and this was quite a lovely dog.

She does let people look in her mouth. And you can see she's got some advanced periodontal disease, and we can see the roots being exposed there. And the reason that she came to us, was that she couldn't close her mouth, and this was why she had caught a rats, because her periodontal disease was so bad.

The jaw was incredibly weak and it just took biting down on the wrap that she'd caught, to fracture her jaw. So make sure we look at as far in the mouth as the patient allows us, and then we can offer treatment for dental disease before we become in a situation such as this little one. She did really well.

She had a tape muzzle on for 6 to 8 weeks that she could eat and lap through, and the jaw fixed, and we extracted some of those teeth. The best way for owners to achieve oral hygiene, though if I'm going to ask you that, there are diets and additives for water and we've all probably got our opinions on those, and we could create a whole lecture about different ways of maintaining oral health. But by far the best way is to clean their teeth.

We like the busy brush, it comes in small, medium, and large. It's from excessa, and it's a really nice shape and the bristles are quite, they're hard enough to do the job but soft to be tolerated. My cat doesn't mind it at all.

And we recommend Peptent with a chlorohexidine gelin. We normally use the gel. If they don't tolerate the taste of that, then you can try the toothpaste.

And we recommend aiming to clean their teeth every day. And that's probably not gonna happen with most clients, but if they are aiming for every day and they do 3 or 4 times a week, then that's definitely better than nothing at all. So we've all seen lots of fractured teeth, we've just seen some in the picture.

Dogs, what are they fracturing their teeth on? So there's nyla bones, bones, raw hides, antlers seem to be a really popular thing at the moment. The rule of thumb is if you cannot t it with Your thumbnail, then it has the potential to fracture a tooth.

So quite boring, so we do advise no antlers, no bones, no nyler bones, no raw hides, plus no one wants a foreign body, and a lot of these have the potential to cause that as well. Normally on a Friday when we're about to go home. The jaw is incredibly strong, but so are these items in the pictures here.

A tooth is strong, but it's the weakest of the three. So that is what will break if you, clients are allowing them to use these. Cats are a little bit different.

They don't tend to chew on too many things that they shouldn't, although some cats we've seen like to chew on chair legs and they fracture the tooth. It's often trauma with cats, or, often my own cat did this, jumping off a height. He just jumped off the scratch post onto a laminate floor and bopped the end of his canines off.

So indoor cats can fracture their teeth, and owners are always very confused why this could happen, but if they run around like loons, or jump from a height, then in particular that's how they could obtain that fracture. So moving on to PPE I'm sure you are sick of hearing about PPE, during the last 18 months, and we know how important it is. This picture was taken prior to COVID, and this is what I wear most days, different colours depending on how I'm feeling.

But we wear the masks and goggles if you don't already wear glasses, a full length apron and gloves. Rachel will wear sterile gloves for procedures, and we also wear a surgical cap. If you think of the amount of bacteria and dirt and debris that's that's coming out of some of those mouths, and we've all seen some bad ones, you really don't want that in your hair.

To go home with, so we wear surgical hats as well. And we change our aprons and masks, and obviously gloves between each patient. So the dental chart, this is one that Rachel created, everyone may have something slightly different.

The most important thing is is that you're using it if you have them and if you haven't got one, look at using one. You can start with a basic one and work your way up. So we have all the patient details there.

And lots of boxes that can look a little bit overwhelming. The back has the key on there. And then you can write any comments or any treatment and recommendations, and it might be that if we don't get these too messy, we can offer a photocopy to the owner so they can see in a pictureorial form what's been happening, what's going on, and what might need to be done.

We do one for every patient and when we see them back, we can then compare how they're doing. And we used to try the numbering system for dentistry, which, when I first met it was a little bit overwhelming and very confusing. I kind of have to pretend to be the dog or the cat.

So the upper rights always start with 1, the upper left with 2, the lower left with 3, and the lower right with 4. Anything ending 04 is a K9. And then the dentition for deciduous teeth is 567 and 8, starting at the upper right again.

Now you think, why do I need to remember these numbers? The vet shouts at me, I don't know what they are, I don't know what they mean. But it's super helpful, and we'll discuss that in a bit more detail shortly.

When we're charting, we should be sitting nice and comfortably as Rachel is with a straight back, allowing your elbows to do some of the work and not putting too much on your shoulders. Have the chart and pen at the same level and next to the patient if you can, if you've got the room. We could be using a periodontal probe to measure the depths in any pockets and have a good look around the tooth.

The Core is quite an explorer, sorry, the explorer probe on the middle there is quite sharp, so we don't want to be putting that into any pockets. The Explorer probe. Is to see if there's any dents and fractures and such on the teeth as as you slide that over the teeth, it will dip into it and you'll feel it.

So please don't confuse the two. One's quite blunt and has a measurement for you to use, and one is quite sharp. Really important to know your teeth as as best as possible.

BSADA have a really good book, but I think it's only about 2 years old. It's got lots of information for first opinion and referral dentistry. And knowing your teeth can help to understand what's going on.

So when I did my NSA in dentistry, I had to revise lots about teeth. And for me, I work quite well with pictures. So I would draw pictures of teeth and, and I take them and colour them in.

So you can learn what part is doing what. The dental chart should include fractures, levels of calculus and gingivitis, if there's any tooth mobility, vacation exposure, that's the gap between roots, gingival enlargement, are there many teeth already missing? Are there extra teeth, as we saw earlier?

Any masses, the pocket depths, gingival recession, and also mark any teeth that you're extracting today or planning to. Some animals will have very heavy calculus, but that doesn't confirm that underneath you're gonna find really severe periodontal disease. But conversely, you could find really light calculus and think, oh, lovely, that still can be a quick scale and polish, but it doesn't confirm there's mild periodontal disease, you may.

Do the charting, do the probing, find lots of pockets. There might be some mobility. And then when you take the X-rays, it could be a different picture.

So, I guess what we're saying there is, don't judge a book by its cover. Be fully prepared that the sim what you thought was a simple dental could become not so simple. And conversely, the one that you think, my goodness, this will take a long time.

Once you've cleaned, actually, they aren't too bad. Most animals will develop some form of gingivitis. They don't clean their teeth, especially if we're not doing it for them.

It would happen to us if we didn't clean our teeth. Not all gingivitis will lead to perdontitis, but it is, however, how perdontitis starts, and that's why it's important if we're seeing gingivitis in our patients to support and encourage our owners to be brushing their animals' teeth as much as possible. And this brings us back to why have I got to learn these numbers and yes, I can chart, but why apart from giving it to the owner.

It's, I find it time consuming, I find it confusing, and it does take a while to get used to, but once you have, it will save you a lot of time. Imagine if you're writing the notes for the vet or the vet's writing the notes, and they write the lower right canine has a periodontal pocket of 4 millimetres on the buckle aspect, gingivitis 3, mobility 3, calculus 2, and the crown was fractured. And that's one tooth.

Or, as the picture says, you can just annotate it as such. It takes less time once you know what you're doing. And allows you to speed up that dentistry procedure so you can focus your time and ability on making the patient feel better.

So scaling and polishing is something that nurses are allowed to do, but we must be doing it appropriately. So why do we scale the teeth? Now we're scaling the teeth to remove the plaque and calculus.

And we should first of all, make sure that the airway is protected. That's by using a throat pack and allowing natural drainage of the head. We don't want to have the water on too fast.

We should be using a moderate amount of water to avoid any burns, but we don't have to be using too much. You think my goodness, I'm absolutely drenching this area, then you could maybe look at turning the water down on your machine. We should be holding the scalar in a modified pen grasp and check that there is water coming through before we apply it to the teeth so that we can avoid burning the teeth.

You can cause trauma such as the discoloration on that canine by being too heavy handed with your scaling, and that's the last thing we want to cause is to send the animal home that a few days later gets lots of purple bruised teeth. So gentle pressure, less is actually more, that tip vibrates and that's how it works. If you hold it too close to the tooth and too hard on the tooth rather, it can't vibrate, so it's not gonna work as well.

We're using the lateral surface of the tip, not the actual tip. Try not to stay on the same area for too long and work in a methodical manner that works for you. All our patients are on their back for their scaling and polishing, so Rachel has her own method.

But each vet will probably find something that they're comfortable with, and if you can get involved with the scaling, then you should be able to find a method that works well for you. The modified pen graft, it is used for many instruments, and the handle was held with the pads of the index finger and thumb, and the middle finger extends down the shank and the fourth finger used as a finger rest. This will give you a good tactile sensation.

And that's how we recommend you are doing the charting and also the scaling of the teeth. So practise it out with a pen, and when you've got the hand of that you can move on to using the scalar. Just a note, please don't use spring loaded gags for anything.

It creates an awful lot of tension on the jaw. You can imagine after even a short dental, when they wake up, it's going to feel very uncomfortable. We don't use them at all.

We use syringes cut down to sizes for dogs and needle caps cut or used if they are the right size already for cats. You can also cause blindness in cats. If you are extending their jaw too wide for too long.

We also need to polish the teeth. This does not smooth out scratches made by scaling. We shouldn't be scratching the teeth because we're using the lateral surface of the scalar, not the pointy end.

If you're creating scratch. And we need to work on the technique. If you think of the depth of the scratch that you might create, there's no way that this little rubber cup is gonna take off enough tooth to smooth that out, and nor should you want to be removing that depth of tooth.

But it will remove biofilm and plaque and potentially some staining staining that you might find on teeth. So it is important to do. And if you can use the, finest.

Grade that you can find as well, then that will work better and be less abrasive. Should be using it at a very low speed, it should sound like a very gentle lawn mower, not a hedge trimmer. Try it on your thumb first to test the speed, but wear a glove because you'll be really shocked at how slow you need to do it without it burning and hurting your thumb.

Always use the fine grey toothpaste as mentioned, again, light pressure. And we're still spending a short amount of time on each tooth to avoid any trauma. So dental radiography, how important is it?

We're very lucky that we have dental radiography, and it's making its way through the veterinary world more and more so. And I hope that if you don't have it, you will soon. It's really, really important because no one can see what's going on under that gum line unless you take a dental radiograph.

It tells us what treatment is required for feline ordontoplastic resorptive lesions, whether we have to do a full extraction or just remove the crown because the root is starting to be absorbed into the jaw bone. If you don't take an X-ray, you don't know this, and you could be. Trying to extract a root that is no longer there, it's already been absorbed.

So then you are just causing trauma or your surgeon would just be causing trauma to that jaw bone, and that's obviously never a good thing. Or you might just take the crown off and actually the rest of the tooth is there and hasn't yet been absorbed and won't be absorbed, and then your patient will still be uncomfortable and you won't have actually dealt with the issue that they came in for. So type one of the resorptive lesions is called inflammatory, and on the radiograph you will still see the periodontal ligament, and this requires a full extraction.

Type 2 is called replacement resorption. The periodontal li ligament will hardly be seen and decreased radio plasticity of the tooth itself. And that will require a crown amp, not a full extraction.

It will also tell you if we always take post-op rads as well. If the tooth is fully extracted, if there's any osteomyelitis going there, or if unfortunately they have any neoplasia of the jaw. It would tell you, as we mentioned earlier on the left, if there's any extra roots, and the same on the right.

Super important because otherwise if you get the tooth out and it's got two roots, you think you're done, and then the animal comes back and it's just not healing. It's because there could be a root that you didn't know. Or you could cause more damage.

The teeth is more likely to crack if you're working on the one rooted basis and there's a second one snuggled in there. And this is an X-ray of the patient we saw earlier with the retained deciduous canine, and you can see the root of a deciduous tooth tends to be about 2 to 3 times the length of the crown that we can see above the gum line. You can also see how close and snuggled in that deciduous canine is to the other permanent dentition.

So it's really important that we're extracting these teeth under the guidance of the X-rays. And we mentioned the shape of the root can be an issue. That's not gonna come out very nicely because of the curl at the end of those roots, it's also very close to the bottom of the mandible.

So there's different ways of taking dental radiographs, different machines that we can use. We have the handheld that we use at the moment because we were before COVID moving between different practises and also going to the zoo. So that works well.

For us, or you can have the wall mounted ones on the right, which I think is the most popular for majority of clinics. The one in the middle is your bog standard X-ray that you'll use to take a chest X-ray, an X-ray of the limb, and I'm always asked, should I bother if that's all I've got? If that's all you've got, then yes.

Learn to use it to the best of your ability and interpret them as well as you can. But they are clunky, it's going to take you longer, and they're much harder to interpret a lot of the time. We get finer detail by using one of the other two.

And then there's different plates and ways of processing. So the top right is a direct system, so that black chunky area of the wire will go into the mouth, and that's the plate that stays in place, and you take the X-ray and it will pop up on your screen, as long as you've plugged it in, obviously. And then if you do need to move area, you know where you were in the first place to move gently.

The problem that can be found with those if they're very bulky, they're quite thick. And the plate isn't very big, so in a large dog you're taking lots of images. But as we said, the benefit is if you do need to make minor adjustments, the, the plate is where you left it.

We use the CR 7 on the left and it is really good and I think a lot of practises are enjoying using that at the moment. It won't come through automatically. You will need to place the film into the mouth, take your radiograph and then take the film out and pop it through the processor on the right.

You don't need to wait for that to come through. You can just start snapping the rest of them. And what's really good is you can see the different sizes that they come in, and they have a little jacket that you can change between pictures so that the plate isn't getting damaged.

And they're also paper thin. So for those. Brachycephalic for the cats, they're, they're much more achievable, and I think people are getting really good results.

You can get to the back of the throat of cats, and you can see on the very large one on the right, the size 5, we're not having to take loads and loads of X-rays of a large dog's mouth, and that means that for every patient, we can do full mouth radiographs. Cats, I think, only takes about 4 to 6 minutes and, and dogs sort of 8 minutes or so. We must remember though, we have to be careful when we're using radiography.

Make sure the warning lights on and you have the appropriate signs up. Make sure you have your dosimeters on, and as Rachel was wearing there, Wear your X-ray gowns where necessary. Rachel needs to, because she's just holding it, I step outside the room for each radiograph.

And then if you're using the wall mounted ones, it tends to have a long extension on the exposure button so you can all leave the room while that's being taken. So, obviously it would take more than the 45 minutes we have today to discuss dental radiography and the practicalities and how as nurses, we take them. I am 3 have really good guides, literal guides that you can place on the right there, which shows you the angle and the distance for whichever picture you're trying to take, and some really good posters as well.

So it's definitely worth looking into them if you're starting to use dental radiography. It's very user friendly. We move on to the surgical kits.

The better the kits, the quicker your dentistry, if they're blunt, if they're old, if they're rusty, if they're broken, it's gonna be harder. So we need to look after the kit as much as possible. It should be sterile, it shouldn't just be washed and scrubbed and chucked in the cupboard or the drawer.

All of our kit is kept sterile, so we've got a full surgical kit on the left, and we keep a cat kit, several of them, small dog kits, large dog kits, and then root canal treatment kits and other more endedontic kits. But in your first opinion practise, it's good to have. Everything you might need in the one tray.

If you're looking after the anaesthesia while the vet is doing the procedure, the last thing you want to be doing is running around, leaving your patient to find things. It's better to have too many things in a tray and use what you need, and we make sure they're all put through the autoclave. We use sterile swabs for extractions as well.

That's not sterile throat packs, that's sterile swabs, to absorb blood and and to hold the tissue with and such. And then other bits. We have the luxators and elevators.

All different sizes, so we can get them out as we need, and you'll, you'll know by what patient size is coming in once you've got used to dentistry, what, what sizes you may need to get out ready. So we have all sorts of things in our kits. We've got the periodontal probe, a bare box, extraction forceps, tissue forceps, scalpel handle, periosteal elevators, dressing forceps, corrects, needle holders, everything that we could need from the minute we need to make the incision to the minute we need to start suturing.

And as I mentioned, we must look after it. So once we've used it, we should be cleaning and scrubbing all the blood off, which is easier in cold water. Cleaning with an enzymatic instrument and equipment cleaner.

Now you might have the ultrasonic cleaners or you may be doing that by hand. Make sure you rinse them well to get the instrument cleaner off. Dry them well.

We use tea towels, it works better. Towels get a bit fluffy on them and. And blue roll just gets lots of particles on, so we use tea towels and then you can put them through the washing machine, so it's more eco-friendly.

Sharpen them, lubricate them at their joints, package and sterilise them, and store them somewhere dry and safe and labelled so that they're all ready to use. So make sure you're inspecting the items of equipment when you're putting it through for the next use as well. Obviously you don't want to be reaching for these, which could be traumatic if you tried to use them, or you just wouldn't be able to use them, and then we're off to trying to find something whilst the surgery is going ahead.

So have a close inspection of everything as you're cleaning it. We do need to regularly sharpen our instruments, and again, for different instruments, it needs different angles and different sharpening stones. I am 3 do have guides for sharpening each type of instrument.

And so if you look into that, they also have the correct shape sharpening blocks as well. If we're doing it wrong, we could just be damaging expensive equipment. So it's important that we're looking at doing that correctly.

Equally, our scalar tips aren't meant to last forever. They do wear down. They think of everything that they're breaking through in some of these terrible mouths that we see.

And again, I'm not sponsored by IM 3, but they do sell a lot of good dental kits, and they will, when you order the scalar tips, it should come with a tip wear guide, and you can hold the tip up to this little card and you can see when it's time to get rid of it and order a new one. To be careful though. So this is a colleague I used to work with, had done a dentistry surgery the day before.

They couldn't find the scale it. They thought they'd put it out. And then she thought, oh, my arm hurts a little bit.

Didn't think much of it. And then a couple of weeks later, fell over on that arm, and it was really painful when she could feel something hard. And it was the scale tip had ripped off where it was a little bit old and fragile.

She'd walked past it and caught it in her skin. And because it's sharp, it had gone in. So we put a magnet on her arm to think, well, it can't be, can it?

And it, it stuck on her arm. So we sent her to A&E, and there it is on the right, on the X-ray. There's the scale tip very firmly in her arm, and then under local, they removed that for her.

So really important to be looking after our instruments so they don't come and bite you. So we all have a dental machine to perform dentistry, I hope, they can all look slightly different. We've got this nice one on the left, and that's his compressor as a separate unit.

Sometimes that could be in a separate room and it could be piped through if you're lucky, or it could be attached to your dental machine, and we must be looking after these, cleaning them well, offering them an oil when they need it, depressurizing them, and just making sure they're well looked after. We do use a lot of water, for dentistry, and we need to make sure that's topped up, but we also shouldn't be allowing this old water to be at the bottom. So I tend to keep an eye on it and when it's got a little bit left empty it and then put fresh in, we shouldn't be sort of leaving it over the weekend or over a week or something with water and it can get quite stagnant in all the lines, and we don't want to be using stagnant old water.

But also, a story I've heard once in a, I think it was a sort of an M&M. Accidental thing. I think it was somewhere in the states where a greyhound had had a scale and polish, and the next day came back really painful, full of blisters, and it was thought, oh, maybe it's it's greyhounds being a bit worse, but then they looked in its mouth and went, oh my goodness, why is it so ulcerated?

And they hadn't topped up the dental machine with purified water. They used surgical spirit, and I know that some bottles can look very, very similar. So, triple, triple check that you are putting the right liquid, purified distilled water into your dental machines.

Don't use tap water, and it can damage your machine. There's just too many minerals and elements in it. So the purified or distilled water is what we need to refill our machines with.

The handpieces do need to be looked after. We should be changing bus after each patient. A blunt bur will mean that more pressure is applied.

That's not going to help you, that's going to be more traumatic to the tooth and give a more rocky anaesthetic. It's also going to put more pressure on the motor in the handpiece, which means it will break. And some of these are over 1000 pounds.

They're super expensive. They get really heavily used, so we need to look after them. If a bird is stuck, please don't be pushing it against the table to try and get it out.

Find an old extractor forceps and you can usually pull them out with that. We should be lubricating the mechanism inside after every use, cleaning them, and they do come apart and you'll have a look at the parts that will have an autoclave stamp with either 134 or 121, and they should be going through the autoclave. Most practises are unlikely to carry a spare, so really do look after them well, because you don't want them breaking in the middle of an anaesthetic in the middle of a dental surgery.

Be fully prepared, before you start your dental surgery, have everything ready that you might need. We have a swab buffet, I like to call it, of, non-sterile swabs, and also the throat packs, sucu material. The surgical trolley is ready there with gloves and the dental chart and the appropriate size dental kits and any accessories that we might be needing.

The induction tray is there on the left with the premedication. In the middle we've got the induction tray. We use a laryngoscope for all of our inductions.

It's very important that you can assess the airway clearly, and not wait to see whether you can or not. And on the right we have. The pet to put on that and the local anaesthetic.

Really important to keep the local anaesthetic away from your premedication and induction trays, which is why it has its own separate tray, and also have suction ready before you induce any patients. This is our dental table all set up. I've got my multi-parameter.

I've got a way to keep my patient warm. I've got the breathing circuit, my fluids. I've got everything I need right there, so I don't need to leave my patient at any point.

If you want to know more about dental care guidelines, this is a really, really good set of guidelines. It's 2 years old, but I still feel it's very relevant, so you can check into that. And it's really important that we're sending our patients home with discharge instructions, it's.

Usually I would say the nurse that's seeing our patients out, and we don't need to just talk about the surgery, although that's super important, what to expect from a surgical point of view. Also to talk about the fact that animals have an anaesthetic. The discharge instructions should guide the correct care and can help calm the owner, preempt any complication, and divert the owner away from them.

And tell the owner when to contact you. So if they haven't eaten, they've developed a productive cough, there's any bleeding, they're pouring at their mouth, or there's a concerning meditation. And we need to make sure, as I said, we've covered the fact that, one, it's had surgery, and two, that they've had the anaesthetic because both could have complications when they're at home.

And then often us nurses are doing the post-op checks, so has the womb broken down? Is it very smelly in there? Is there lots of debris collecting in the instruction sites?

Are the sutures not dissolving as quickly as we might like and now that's building up bacteria and causing the gums to become inflamed. Good time to discuss teeth cleaning if they've got any left, and if you think the patient would tolerate it to avoid them having to go through a dentistry too soon again. Also weigh the patient, make sure they've been eating well.

If they've dropped weight after a dental, we might be concerned. We'd like them to stay the same or perhaps even be eating more, particularly cats tend to eat more after a dental if they're comfortable, and we can see that in the reflection on their weight. And also ask the owner, have you noticed a difference?

Are they brighter? Are they happier? Are they more willing to interact with you?

And often you'll find that the owner will say, I didn't realise anything was really the matter, until you've done it, and I'm really, really pleased. So definitely communicate with how they're feeling as well about the whole experience. So we mentioned planning and monitoring the anaesthesia.

As I said, we're pretty much done for the lecture today, but it is a separate lecture that the webinar vet has, to support nurses through the journey of dentistry, anaesthesia. So definitely check that out if you'd like to. You're very welcome to contact me, on my Facebook or at my email or my number.

I do, provide warming kits for patients for dentistry. Our patients get very cold and supportive notes, posters and pocket notes for dealing with the anaesthesia side of things. Other lectures, if you are in need of them, you can also email me.

And thank you very much for taking the time to listen to my lecture. It's really good that dentistry seems to be on the up. It's something that us as RVNs can be very passionate and involved in.

So I hope that today's lecture has inspired you to do so or given you some tips or pointers as to where we can get more involved in practise. And thank you to the webinar vets for having me speak for them as well. And as I said, here's my email and my work number.

Feel free to send a text or a WhatsApp with any questions or if I haven't been clear about something, you're very welcome. I love talking to everyone, so feel free to get in touch. Thank you very much.