Good evening, everybody, and welcome to this Tuesday night's webinar. Kindly and sponsored by Mars Pet Care. More from Mars as we go along, but a huge big thank you to them.

If it wasn't for their kind and generous sponsorship, we couldn't bring this to you as a free webinar. So thank you, Mars. Little bit of housekeeping.

My name is Bruce Stevenson, and I will be chairing tonight's session. If you have any questions for our presenters, we will hold those over to the end. But just move your mouse across the screen.

You'll see a little control bar pops up. It's normally a black bar at the bottom. There's a Q&A box there.

Just click on that and type all your questions in there, and we will get to as many of those as we can, this evening. If we don't manage to get them finished this evening, we will certainly get those answers to you afterwards. So you're in for a treat tonight.

Our first speaker is Tom Williams, and he graduated from the University of Bristol in 2007. His interest in veterinary dentistry started somewhat by chance in 2009 when he attended a wet lab, which was followed the next year by a more advanced course. Tom enrolled in the Australian and New Zealand College of Veterinary Sciences programme and passed his membership exams for small animal dentistry and oral surgery in 2018.

Since then, Tom has enjoyed expanding a dental referral service to cater for the whole of the Southwest of England. He regularly offers CPD for veterinarians and has also taught at Bristol Vet School and Surrey University. He is the current president of the British Veterinary Dental Association.

Tom, welcome to the webinar vet, and it's over to you. Thank you very much for the introduction there. Well, we're talking tonight about tooth fractures, the whys, wherefores, and and what to do.

And I was very happy to say yes to, this webinar. Honoured to be asked, but it's very important to discuss a discussion to have. Why is it so important to talk about tooth fractures?

Well, we're gonna start with the idea that they are hugely painful. I think we can also do better as a profession when we're giving advice to clients. We need to we there is some misunderstandings and, and mismanagement unfortunately that still happens.

And also it's incredibly important to talk about these things because they're so common. Let's just start with the idea that we are talking about something that's hugely painful. When we are considering a, a, a dental fracture, we are typically talking, got a bit ahead of myself there, about a fracture that can, cause pulp exposure or sometimes very near exposure.

But let's just consider pulp exposure. Pulp is a, neurovascular, neurovascular tissue with connective tissue, and it's incredibly sensitive. And when it gets exposed, it will get inflamed and we get pulpitis.

Now that is. Not pleasant, that's, that's particularly painful. But then what happens, afterwards is arguably worse.

Pulp is a very flimsy tissue and it doesn't stay long in this state of inflammation. It will die, and it's not necessarily if it will die, it's when it will die. It's, it's pretty inevitable.

Well, it is inevitable. And then when we consider that we have, this dead pulp, exposed to the bacteria in the mouth, infection is inevitable also. And as bacteria and other microorganisms invade our our pulp canal, we we, we talk about the idea that it will just track all the way down to the root tip where we will get a peri-apical infection.

Or there's nothing wrong with using simple kind of terms for owners to understand, whether it's absolutely accurate or not, there's nothing wrong with perhaps using the term a tooth through abscess, because that's a very human term that people can relate to. Now this slide is a, a corker, isn't it? This is, I, I don't think many of us ever really consider what pulp looks like, but this is pulp, and this is me fishing the pulp out of a a pulp canal, a root canal.

This tooth had suffered a fracture, and this is the pulp, being, removed. It's very satisfying when it comes out like this. It doesn't always happen.

But what we can see here is we can appreciate this looks like living tissue. This looks like tissue that probably until very recently had a, had a good blood supply to it, so this is not necrotic pulp. But it's very lovely pulp.

And here's just another slide which just illustrates quite clearly and nicely where our pulp is. Sorry, this is probably teaching you to suck eggs, but this is, this, this, real opaque area here is, is where the root canal and where you see this, bright white, that is where pulp was. So, here's a, here's a living pulp, pulp exposure equals pulpitis, so we'll we'll say this is a, a pulp with pulpitis at the moment.

And here we have an example though of pulp necrosis. Another neat slide I think to just sort of bring these sort of dental, talks to life really. But interestingly enough, this is not necessarily the sort of clinical picture you're gonna get with a, with a fracture.

This is a necrotic pulp that has been pulled out of a, a discoloured tooth. And and and that is why this tooth got treated. You can see in the background this kind of dull pinky discoloured tooth there.

But with our fracture cases, and necrotic pulps are gonna be infected and they look a heck of a lot worse than that. And they stink. They smell.

They really do make you gag sometimes when you fish them out. These horrible little grey slugs. Very satisfying work.

I, I do love fishing them out, but they are disgusting things. And they can degrade further than this. If they go much beyond this, we will be, not necessarily considering something that even looks like a pulp anymore.

Sometimes we're just talking about like a dark slime, like a film, and, and, and that stinks as well. And you know, in, in terms of again trying to bring these, this idea of a tooth through abscess to life, look, this is, this is a radiograph of, of, of what these things look like. It's quite nice when we're considering the mandibular canines because we can get, left and right next to each other and we can have a bit of a spot the difference exercise, which isn't necessarily that easy to do on, on the other teeth and the mouth, but this, this shadow is not normal.

We're seeing the loss of jaw bone here because of infection and and there's no way that that's gonna be anything other than uncomfortable. And here's another stonker up here. Look, I mean this is, like I said, I can't get them on the same plate when we're talking about the maxillary canines, but we have over here, if you follow my cursor, top right, this is a normal comparison compared to this horrible thing over here.

So Not just canines, I mean, this talk is not just about canines and in fact there's there's a real emphasis and we'll get onto the carnational teeth, but yes, you see these periapical lucencies on all sorts of teeth. And this is just a slight angle change so we can have a better look at those two routes which in the previous slide are quite superimposed on each other. But peri apical lucency.

Periacal lucency, this is a very, very unhappy tooth indeed. I, I can't help and, and, and possibly I'm just getting a little carried away because I have a captive audience here who, where, where I can educate you about some dentistry. So sorry if I've gone too far here, but I also quickly wanted to mention another couple of radiographical changes when we have a a a dead infected pulp.

You need a living pulp for a tooth to age, and as a tooth ages, we get thicker dentine walls. So What we can see here when we play spot the difference is this, this pulp here looks a lot wider than this pulp here. And This is because this pulp is dead and it can no longer age.

This one is alive and so it can get thicker dine and walls. A a tooth will be frozen in time once the pulp dies. And, and, and here's a really nice, I say a nice, it's quite an upsetting example of, of, of what I've just told you there.

This is a 9 year old German shepherd dog that came to me and . I'm happy that the teeth we're seeing, it's, it's not a terrific radiograph in terms of how well scented it is, but you can make out a very, very thin pulp here and a thin pulp here and nice thick denting walls, and this is what I would expect to see in a nine year old dog. This tooth up here looks more like it looks like it belongs in a 1 year old dog's mouth.

And that's because unfortunately we, we can look at this and say, OK, a tooth root lesion, a 1 year old tooth. OK, 8 years this poor dog's been suffering a a really, really unpleasant disease, a very painful disease, so. That's I just want to bring to life what actually is happening in real terms with these, these tooth fractures.

And just quickly, occasionally we'll get tooth resorption, not just a feline thing, it happens in dogs too, with, with nasty periaical infections, you can get these kind of very moth eating appearances or, to, to, to the, to the actual dental tissues. X-rays are all well and good, but I often find owners respond to, these sorts of clinical photographs really nicely. And again, brings things to life really vividly for us.

When we look at the apex of this fractured tooth, we can see it's, it's grotty, for want of a better word. I mean, it just looks disgusting. It looks like it would smell bad.

It looks like it would feel bad. It's, it's, it's just that horrible sort of grey, brown colour. We can actually see there's some tooth absorption going on here.

And there's no way you can have that sat in your jaw bone and it cause anything other than pain, a lot of pain. I've had one of these, it was bloody awful, . I always draw people's attention to, to, the fact that it's an incisor.

And, and, and just, just be mindful, that it doesn't need to be a big canine or, or, or a kind nationalal tooth, for us to get upset or, or, or, or interested in a, in a tooth fracture. This may, you know, just be an incisor in inverted commas, but this is still going to be causing an awful lot of discomfort and pain to, to our patients. So, .

Look out for them, now we're gonna rattle through some photographs now of just some, some clinical appearances of of of of these fractures. Pretty self explanatory, we we have pulps showing here, but look at these ridges here. I'll get no prizes for my colouring in, but I'm just trying to highlight that there for you.

Classically, with carnacal fractures we'll we'll often lose that, dental tissues off the outside surface of the tooth, a slab fracture. This is another slab fracture, and, and but this is also quite a classic presentation, for, the, the, these kind of national fractures, and that is to say that the, the slab is not always displaced. The gingival attachment, .

It will sometimes keep that slab very much in place and it can actually make it tricky to see. I, I appreciate it doesn't look tricky to see in this, picture because I'm, I'm using my periodontal probe to make it look very, very obvious indeed. But some, sometimes, the fact that the slab, is not, displaced and it's held there by the gingiva can make these harder spots.

And sometimes they are incredibly hard to spot. But that doesn't mean we shouldn't try, right? This is a, about as subtler, a case of, pulp exposure as you'll ever get.

There's just this hint here that this groove we're seeing here might be, the, the pulp cavity and with magnification and good light, trust me, you could just see a, just see a pink sliver here. And then this is the amount of, this is kind of an outline of the, the, the dental tissues we've lost, so. But sometimes there are things that can really help us spot these things, little, little things which help us in the, in the clinics.

And a discharging sinus is certainly one of those. If you think back to those radiographs I showed you where we've got the, the, the lucency and we've got the bone loss, and we've got, you know, infection up there. The inflammation infection, the, the, the, the pus, it, it can find and will find its way out sometimes, and we will get discharging, sinuses like this.

This is a classic location, this junction between where we've got, gum tissue and the mucosa on this line, just above this line is, is a classic place to see these discharging sinuses, and that, that is a red flag that's basically waving at us telling us that there is a big problem up there. I'm also my eye is also drawn in this case to this, this, this sharper ridge down here. You can just imagine if that caught your hand, it would feel scratchy.

I mean, I, I, I appreciate these are pretty sharp teeth anyway. But sometimes you just get these kind of scratchier edges, with, with fractures as well. Also you'll have to just take my word for it, but there's, there's a much more calculus on this tooth than some of the other teeth in the mouth.

Now I'll I'll explain why in a moment. I've removed all the calculus in the next slide. And and and what we're seeing is a lot of exposed dentin here.

And plaque tartar, it will find it just a a touch easier to adhere and stick to dentin than it might do enamel. So these fractures can often get quite well hidden by by calculus. With the calculus gone, we can also see where this is no longer a, a bleeding living pulp, this is, this is just muck, this is stinking brown grey muck it's, it's a long standing fracture this.

Another real common clinical scenario where you'll get discharging sinuses is on deciduous teeth when they fracture. These, these, it's, it's slides like this which remind us that we, we shouldn't be encouraging puppies to, to get a hold of tug toys and, and kind of get swung around the living room floor, like my parents were doing with their puppy, with, with his tug toy or, or his kind of, squirrel toy, you know, they are delicate things, these teeth, and we've got to be careful that they don't fracture. It can't necessarily be helped if you've got a puppy bite in the bottom of your jeans when you're just trying to walk from A to B, but, there you go.

Now, just to, to, to, to tune you all in, we've got a poll coming up now. And that would be great if you could participate because it's all anonymous. And you don't need to worry about getting the answer wrong.

But what are we recommending for a fractured pup tooth just like the one we've just seen. Are we, are we saying A, it will fall out soon enough, so no action is needed, watch this space. Treatment might be needed if this pup deteriorate deteriorates clinically.

And by that, let's say that this pup seems happy enough at this moment in time. Antibiotics, pain relief and monitoring is option C, or prompt extraction, semi-urgent, and medication in the meantime is option D. Thanks, Tom.

The poll is open. Most people already know what to do. For those of you that don't, just simply click on the answer that best represents your thoughts.

As Tom said, it is anonymous. So, if you really are not sure, take a guess. Tom is gonna discuss it with us and, and give us some answers at, in the next 30 seconds or minutes or so.

I'm going to extend this slightly, Tom, because there's still a lot of people answering at the moment. So, we'll just give it another 15 seconds or so, and then I will close that poll. So no worries.

Click on the one that you feel best represents what you would do in this situation. Right, a couple of stragglers still coming in. Let's close that and give you those answers.

There you go, Tom. Fantastic. We, we get a .

It's like on Who Wants to Be a Millionaire when you see them backing the right answer, . So yeah, look at that 67% who have gone for the prompt extraction, it pleases me, because that that's the right answer. We can't really rely on the idea that the, the, the tooth might exfoliate and, and, and we don't really need to do anything because first of all, in, in that time, we might have a patient in quite a lot of discomfort and that look, it might not actually exfoliate as we anticipate when we get a a a devital tooth, a dead tooth, it doesn't necessarily always play the game that it should.

Watching this space, well, unfortunately we can't necessarily rely on the patient to communicate the pain that's in us accurately in, in, in our line of work, . And, and, and we have to assume that this is painful. The reason why prompt extraction is required is, is, is to alleviate the discomfort, but also a an infection up where our adult tooth is developing at this moment in time.

Think of the adult tooth if you like in an embryology state at this moment in time. It, it's It's very vulnerable. So in infection and inflammation can actually cause us things like enamel dysplasia and this is, this is the sort of thing we might see.

It's quite I, I, I wouldn't say this is common, but it's definitely possible. Just back to discharging sinuses, they are sometimes cutaneous and should not be confused with, well. I appreciate that skin conditions might need to be on the radar with a a clinical picture like this, but in that particular location, always think of potential injury or, or infection of, of the carnational tooth.

And this is the classic discharge and sinus area of, of, of a malar abscess. And, and if not, discharging swellings in in the area can can can certainly or should certainly sort of pique your interest in the in the dentition there. So just quickly, I don't wanna be sound like I'm giving the profession a hard time, but I do think we can do better as a profession when it comes to the management and the advice we give with with the fractured teeth.

We need to get better at identifying pulp exposure. This fractured tooth of the dog's lower left canine was referred to me, but it, it was not on the the referring vet's radar at all that this lower right canine had an issue. It was just thought that it had been flattened by playing with a ball.

But I can tell you now this is very, very much, very, very clear certainly through through my eyes, pulp exposure. As is the picture at the top of the, top, top left as we look now, so that that dog's lower left canine where we have also a very sort of black unpleasant looking cavity. What confuses the issue is when we look to the, the, the picture on the right, we will sometimes see dark spots on flat teeth due to ball wear.

And what can happen is, is . In response to abrasion and playing with a ball a lot, that new dentin can be made, which effectively protects the pulp from pulp exposure, and that new dentin can discolour quite readily. It can stain and and it can actually get quite dark at times, but I would usually expect there to be, if not completely symmetrical, at least something which feels nearly symmetrical about the clinical picture, whereas you can see on the picture on the left, absolutely.

Not symmetrical. But look, just looking at these things and just trying to call symmetry or not is not the way to to do it. We, we should probe these teeth, and I have just said there, please don't ever do that conscious.

I, I, I, I do sometimes see it in clinical notes, that vets have kind of put needles into teeth, just to try and see whether or not there is a cavity there. It, it's only a matter of time till you hit sensitive pulp and, I, I, you know, if you get bitten doing that you probably deserve it, so, . Don't do this conscious, but with something like a needle or a sharp explorer, if we've got pulp exposure, we will not have a glass smooth sur surface as we would in on these teeth, you would actually find the tip of of your explorer falling into a cavity.

It would be catching. Also Where you've got radiographs, you're certainly taking radiographs to to to check for the other signs that we've spoken about already. I also think we need to get better at just making sure we try and see the whole mouth that routine checks.

And a lot of the fractured carnationals we've already seen in this presentation, they've been in the upper carnationals. And certainly, the lower carnational teeth are hard to examine. In fact, all the, mandibular molars are, are trickier to spot because of the, the overlap you get with the upper teeth, but.

I, I, I do think if we're saying that we've examined the dog's mouth at the at the time of like a vaccination or a health check, we, we really do need to try and make sure we've seen the whole mouth where it's safe to do so. And certainly if we've got a patient in having a general anaesthetic and we're intubating an animal and we're having a, you know, they, they're in for something else, look at their teeth, you'll you'll, you'll see a lot of fractured teeth once you start looking. And my absolute pet peeve, and, and, and this I do find really hard to sort of make an excuse for, but when I see that fractured teeth have been identified and pulp exposure has been spotted, but I see things written like the tooth was still solid, so we didn't need to do anything, or there was no reaction when I flicked the tooth, so I didn't do anything, or the.

Or the patient's still eating, so we don't need to do anything. Let's see how it goes. That's, that's not OK.

We do need to treat teeth, with pulp exposure. Now It is worth knowing just quickly, you'll see at the bottom of this slide I've written, please just keep this in the back of your mind somewhere. I don't want to spend ages talking about it, but there is a, a third option, with young teeth.

If we know they've had a very recent fracture, we need to get onto those fractures nice and urgently, and we can do something called a vital pulp treatment, which is quite a nice option. But let's just consider. That for tonight anyway, we've got two options, we're gonna extract them or we're gonna perform a root canal.

It's not always an option to, to do the root canal when we've got a catastrophic fracture like this. But on a. Clinical picture like the one on the screen at the moment, or certainly this one I showed you earlier, we have got both options.

Now I'm just intrigued with an audience of vet nurses on the information you've got at this moment in time, what would you do if it was your pet dog or your pet cat, I'm intrigued. Thanks, Tom. Poll is open and the, votes are coming flooding in.

It's absolutely lovely to see so much participation. So thank you for that. And, let's keep those, those answers coming in.

Remember, it is anonymous. So if you are not sure, do, a best guess estimate or a guesstimate and Well this one, yeah, there's no, no right or wrong answer here. There's there's I'm just, I'm just doing some market research and and and .

Here we go. Let's give you those results. OK, yeah, 23, 13 roughly.

Which, you know, it's, it's fair enough. Now I, I do just want to say though, because a lot of people, the root canal, it can seem like a much bigger procedure and a and a and a bit more faff, but let me just talk you through a. Couple of things briefly Bear in mind that extraction is, is an active surgery, particularly when we're talking about an open, extraction, it's not an insignificant amount of surgery when we start talking about, moving the soft tissues out the way and burring away jaw bone.

So it's much more invasive. And we certainly can get complications with things like wound breakdown or incomplete extraction. Here we have a discharging sinus because some root that's been left behind.

Or a nasal fistulas, we might see. Or we might see iatrogenic injuries such as a clipping a, the maxillary artery. That will, that will focus your attention, believe me.

But something like a fractured jaw also with, with a with a mandibular, canine, . By comparison, it's much, much less invasive to make a very small hole in a in a tooth and and place slender endodontic files in there. There is, however, yes, there is the the the the expense certainly can come into it.

And there's certainly some fa factor involved, like sometimes repeats general anaesthetics, distance for referral, and, and you can unfortunately sometimes get delayed treatment failures. So, you know, it's it's not for everyone, but I did just want to fly a bit of a flag there for the less invasive root canal. Finally, why is it important to talk about tooth fractures?

Well, look, they're incredibly common. And here we have another poll. What proportion of dogs coming through a vets do we think are gonna be affected by dental fractures?

About 1 in 25, about 1 in 10, about 1 in 4, or around half. Tom, it's fun to be playing this pole game tonight because we've got such an engaged audience. It's lovely.

I don't have to beg anybody to answer. So, thank you, folks for being so attentive. And, yeah, just click on the, the best guess estimate that you've got for us.

And, then you can compare your answer to what Tom is discussing with us once we reveal those answers. I'm just gonna give it another 10 or so seconds cause there are still some people's results coming in. Right, let's end that and show you.

So if we're a millionaire, we'd be, well we could be misled by the audience here we're we're not coming out with the majority of the right answer there, it's actually 1 in 4. So if you take my advice I gave earlier and you start, really looking at all your anaesthetized animals when they come through, you'll, you'll certainly be able to believe that that 1 in 4, they are common, very common. Not, not quite 1 in 2.

But yeah, common things. So look, why so common? We have daft dogs, dogs aren't necessarily always making the the brightest decisions with what to use their teeth for.

This is my lovely old boy who's no longer with us, . He never did suffer a dental fracture, but this is a photo of him looking daft, so I hope you enjoy it. We have daft owners.

Now I absolutely should have put a picture of my brother-in-law here, who, who is a very daft owner because despite having me as his brother-in-law, he still throws, throws stones for his dog. Anyway, this is my daughter, and I used her photo because I, I think I can give permission to use her photo, and it's cute. And, also though, it does bring me, it's, it's a bit mean spirited, perhaps calling kids daft, but, stone throwers are often kids, you know, they're a day at the beach, a day at the riverbank.

I see a lot of referrals for dental fractures where kids have lobbed the stone. And yeah. But look, sometimes we've actually got perfectly sensible owners who actually just need more help from us.

We, we shouldn't be calling, all owners daft. I think if you throw a, a half a brick up in the air for your dog to catch, you're daft, but otherwise, let's give them the benefit of the doubt and say we just need to help them more. Now What's, what started to happen about 10 years ago is vet dentists were increasingly concerned about, increased incidence of, of dental fractures, but particularly carnacal fractures.

These are chewing injuries. This did coincide with the increase in popularity of very hard to choose, and when I say we can help owners more, look, vet practises were even selling these things, and some still do. But there are no there were no industry guidelines on how hard was too hard.

And Mars, to their great credit, decided to, to get scientific about this issue and get some data for us. And so they teamed up with Pennvet or University of Pennsylvania, where Professor Alex Wrighter led the team. And us vet dentists were overjoyed to have a a a a paper confirm what we we anecdotally we thought was the case.

And What we found, oh sorry, what, not what we found, what was found is a bite force of around 1300 Newtons at the right angle. If we had ourselves something that did not yield as in the chew or or or or the toy did not yield that those sorts of forces, then the tooth certainly would, and, and we would get fractures. And the, the, the really kind of a key thing in all of this is that force is within the, the the capabilities of what a dog can generate when they're chewing.

So that gave us the evidence to say that certainly some chooses are too hard, and we have that evidence that helps us educate clients and Mars continues to do that with the European Veterinary Dental Society. Now that is me. Thank you for listening to me.

I will hand over to, James now and we'll be back for questions. Thanks, Tom. Yes, we are going to hold all those questions over to the end.

So, if you wouldn't mind just stopping sharing and James will bring up his presentation for us. And, while he's doing that, I can just let you all know that Doctor James Greenwood is a practising small animal GP in Bristol. He has worked in first opinion equine and small animal practise since qualifying from Bristol University in 2007.

As well as his first opinion work, James also works across television, radio, and various media outlets to help educate and inform pet carers on how to best look after their pets. He himself has 20 sheep, 6 hens, and a rescue Labrador called Dolly. James, away you go.

Yes, hi, thank you, everybody, and, and good evening and thank you very much to Tom as well. Really insightful, looking to fracture. I could almost smell those, fractured teeth coming through my laptop screen.

So I'm gonna talk a little bit more on, you know, we're talking about owners, the relationship we have with choosing dog chooses, and, and go into a little bit more about how that sort of what that means practically on the ground, for us in practise and how to communicate that to, to dog owners. So. There's a few things we're gonna sort of talk through.

First of all, a little bit more on why tooth fractures matter, what this textural safety research means for not only owners but also as as veterinary professionals. Why chewing is so important for dogs, why do they love it and why is it great to let. Our dogs chew.

And then some of the hidden dangers around some of these chews, plus some tips on how to communicate that with, with our owners and also try and just encourage them to adopt a slightly change in their habits and then some alternative ideas for enrichment. So, first of all, we have got a case study. So this here is lovely Monty, who is a 3 year old cockapoo.

He suffers with a pretty nasty autoimmune condition, that he was referred for. Started when I was about one year old, came, the owners, so I'm gonna use the term, owners. I, I know there's the sort of the debate around whether we call them pet carers, pet owners, but there's ease of everybody understanding, I'm gonna just keep using the word, the, the term owners, but his owners came very close to unfortunately losing him, but he, he struggled with weight loss, struggled with some muscle.

Muscle damage, nerve damage. He's now on daily steroid therapy, and supplements, and thankfully, he's gone on to recover very well. He's very loving, but, you know, not to, cast any sort of stereotypes, but he is a little bit anxious, you know, he is, he is our cockapoo of the, of the group, and he lives with his sister, Mabel.

So, in terms of what types of toys, what types of games does, does Monte enjoy, well, He has plenty of soft toys. He loves tug of war, which obviously Tom sort of talks a little bit about there. He will chase balls, will chase toys, sometimes he retrieves, not always, but, his owners also have from a very early age offered him, some of these hard shoes, so antlers, buffaloes, buffalo horns, yak chews, er, as they'd read that these were, were good for his teeth.

So you can probably slightly guess where this is going, er, but despite their best intentions, unfortunately the, the, the worst case scenario did become a reality. So, his owners had read that yak bars especially could help reduce, the plaque on his teeth, and that they would help as a calming strategy for his anxious behaviour. That as a high value treat led to a little bit of resource guarding between the sibling dogs, and to quote his owners, Monty liked to manically chew that, that yak bar, er, which made a lot of noise, and then when his owners checked inside the mouth, they realised something wasn't right.

So quick trip to the vets, and he had sadly suffered a complicated slab fracture to the, carnasal tooth. So after consultation. It was decided the best thing was to surgically extract that tooth as it was beyond repair.

So the outcome of this, you can see the fracture here. So this is a bit like the one that we've seen on Tom slides, there's the, there's the fragment there still attached. But Monty underwent general anaesthetic, he had two surgically extracted, which with, you know, the concurrent immunocompromised illness added a little bit of extra stress, a little bit of concern, and as well, you know, there was the increased expense there for, for the treatments.

So as all owners do, they reflect and look back and obviously they have since thrown out all of his hard shoes and and sadly have kind of learned through hindsight, you know, and I, in general practise, I do find that this isn't necessarily an uncommon owner experience, that it's only through hindsight that we can kind of slightly get the message across. But this is a quote directly from them that they now say that, you know, these shoes are expensive, they do huge damage and we encourage all that we know not to use them, so that's from Monty's owners themselves. So just before we go any further, I've also got a few polls coming up, I hope you don't mind, but again, I think it's just really interesting, around what shoes are on sale in general practises.

So, I've put a few options here, you can answer as many as you, as many as you want. It's not a, it's not a single choice, but I'd love it if you would just, again, no judgement, but just, just feel free to sort of pick a few of the, of the, the options that you're selling in your best practises. Right, folks, do you know how this works.

Click on, the answer, or in this case, answers that, represent what you do in your practise. As James said, it is no judgement. I'm sure James is going to go on to give us, some ideas about what we should be thinking about with these, shoes and, and, toys that are available, especially after that fantastic first case that he gave us.

So, Just give us a, a click on, on as many of those answers as what you have in your practise. Jo, I'm gonna give it another 5 or 10 seconds because we still have a few people selecting here. And we seem to be coming to the end.

Right, let's show you. Oh wow, OK. So there's, there's quite a, there is quite a a mix there, isn't there, but interestingly, we do have some tennis balls.

We've got bones, antlers, nylon chew bones as well. A nice, a nice result there on the pedigree denta sticks. But there's a, there, you know, there's an interesting mix, isn't there, and some people are not selling anything at all.

So I think it's, I think it's really worth us just bearing in mind what products we are selling as vets, as vets, you know, vets practises to our clients, because I think this, you know, this new research, it does, it does potentially make it quite hard to justify some of our, our products on sale generally. So. Oh, I can't seem to move my screen.

Oh there we go. Sorry, everybody. There we go.

So, the, just to touch a little bit on the, on the textual research that er Tom just alluded to there, er, the University of Pennsylvania Pennsylvania and Mars Pettka, they have investigated, er what the forces are that sort of require for these, these fractures to to occur. And interestingly, it, it's now absolutely on paper that dogs routinely exposed to these hard treats and toys are definitely at an increased risk of tooth fracture. And even though this study kind of only really confirms what many of us have already suspected, it does still change everything really as now because as we, as veterinary professionals, vet nurses, vets, we've, we've got the evidence to support these concerns.

So then when we are advising pet owners on the types of shoes that they should or perhaps more importantly should not be offering to to their dogs. So. I think there's, there's a, there's a sort of a question here on why, why do people give their dogs shoes, and, and why is that great for dogs?

Well, you know, anecdotally, I think in practise, there's, there's two, there's two real reasons that I, I sort of hear when I hear people, talk about why they, why they give their dogs chews. So anecdotally. I think there's two things.

I think first of all, behavioural or enrichment purposes. So chewing, licking, dissecting, it's really great behaviour for our dogs. It reduces boredom, relieves some of the frustration, and it can help to reduce some of the destructive behaviours that we see.

So especially in younger dogs, it can help to direct their natural desire to chew, and it can help to build some independence, especially, you know, when we're talking about dogs being left on their own. So I think overall we'd all agree that chewing really is great for our dogs. And then secondly, there's this genuine or perhaps perceived benefits to oral health.

So some owners, you know, they're very aware that we need to be thinking about the health of our, of our dog's mouths. But for some reason, toothbrushing is just very, very difficult. They either can't do it because of the time or possibly even the dog's temperament.

So they might choose to use a dental or a product. With a reputation for dental care such as a chew. Now these are easy, they're convenient, but the big question really is, are they effective?

Are they proven, and in some cases might they actually be quite dangerous? So it's very important that we're aware of the hidden dangers with some of these chews. So I think when it comes to selecting chew toys for our, for our dogs, it's really important for owners to consider two factors.

First of all, I always encourage owners to really be on the lookout for science, you know, select a toy or a chew that has got the backing of some really decent scientific studies to prove their effectiveness, as an aid to oral health. You know, we've all heard it that owners maybe use carrots or anything that they sort of feel might help their teeth, whilst some of those things won't do any harm necessarily. I think it's really important that we still are only encouraging them to use and put their money into products that they're gonna do what they say on the tin.

And secondly, really, really importantly is to select something that at least will do no harm, you know, we're talking about tooth fractures tonight, and I think it's, you know, it's the, it's the case of trying not to risk creating an even bigger problem whilst you, like a tooth fracture whilst you're trying to solve another problem like plaque buildup. So what are the dangers? Well, we've sort of talked a little bit about it already in Tom's talk, but there are some particular toys or hoes that we can now say are are very much linked to certain types of tooth issues.

So on the top right hand corner there, we've got a very classic tooth abrasion photo, which is from the tennis ball, very likely underneath it, and you can almost imagine the arc of of where that wear has has sort of caused the tooth er to sort of just over time. Be worn down and if you ever pick up a tennis ball, you know, especially if it's been down on the beach, if anybody lives near the sea, if you're lucky enough to live by the sea, and just pick up a tennis ball after it's been on the beach for 10 minutes, and you rub that against your hand, you'll be amazed at how abrasive that actually is. It's kind of like sandpaper.

So you have these dogs that love carrying a a tennis ball around their mouths. That's just a constant wear on, on the, on the, on the enamel. And then secondly, antlers, yak bars, buffalo horns, bones, nylon bones.

We have now got this study which confirms that these do cause these complicated tooth fractures, so we can no longer ignore this or just or or excuse it. Solid frisbees are also another, another problem, so the classic kind of plastic frisbee throws throws through the air, dog jumps up, grabs it, the blunt trauma can cause discoloration. And then most people, I think, no sticks can splinter, can cause foreign bodies, cause penetrating injuries, and then rawhide, Christmas, it's, it's not that far away, dare I say it, but you know, around Christmas time, some rawhide is, is OK, but a lot of it will be far too hard and again can cause fractures a little bit like the, the the picture down on the bottom left, which is actually a case that I saw not so long ago, just a couple of weeks ago.

So I think the key with this, and sort of trying to put this into into practical terms is that. It, it's, it's communication is gonna be key, you know, with when it comes to talking with owners about their choices, I think sometimes owners can feel very, they can feel quite guilty, they can sometimes feel blamed, er, they can feel shame when they realise that the choose they've been offering could potentially cause some serious harm. They could also become quite defensive, but the problem we've got is that misinformation is just rife, you know, it's across social media, across influencers, dog nutritionists, pet shops, trainers.

There's all this conflicting information out there that does confuse owners, so we really do need a, a unified voice on this. And I think owner presumption as well is a key factor here. So if an item is offered for sale from a trusted brand, a pet shop or a retailer.

Again, thinking about the types of products that we've got in vets practises, then an owner's gonna likely make the very clear presumption that a product must be suitable, and unfortunately it is quite a poorly regulated market. But the great thing is that with this new study, we, we can now, as professionals say with confidence that that these these hard shoes, they're just not suitable for us to be using for either behavioural or dental purposes cos the risk of tooth fracture does just far outweigh any benefits. So again, let's just have a little poll again on who, who within your practises runs veterinary nurse clinics for dental care.

I wonder. This is gonna be an interesting one, James, because it really is, a, a, source of, of great information for clients. One of the questions we had coming through earlier was about CPD and educating clients.

And, yeah, these, dental veterinary nurse clinics are invaluable. So, regardless of what the answers are, that come through, my penny's worth is if you're not doing them, start thinking about it. Right, let's share those answers.

Oh, great, so, well, at least we've got sometimes is, but that's looked nearly half of, nearly half of us have, have put never, which actually I think is quite interesting, and I wonder whether the pandemic, which I know we're trying to desperately pretend or forget that that's, that's happened, but I think the pandemic has had a massive effect on, on nurse clinics and how easy it is with changes in how practicable. Run, I think the nurse clinics sadly one of the things that did sort of slightly drop, and, and I think it's really important that we bring those back now, and dental nurse clinics, I think is, it can be such a bond between the, the practise and keeping an owner's interest in their dog's teeth. So I think if you're not doing them again, if there is a way of bringing those in, I think really do have a bit to think about it.

So how can we in practical terms, think about how can we advise our pet owners, knowing what we now know, what, what can we put into practise to try and sort of encourage them to, to sort of make informed choices. There's a few things, some of you may already know this, but I think it's, I think, I still think it's a really nice, very easy way to ask an owner to sort of just slightly take their own kind of control a little bit on how they're choosing toys and chooses. And that's to do the thumbnail test.

So this is something where you literally just take your thumbnail and see whether you can make an indentation into the surface of that chew or toy. And if you can, there's I mean it's, you know, it's not necessarily guaranteed, but there's a higher chance that that's gonna be suitable as a chew or as a toy er to be used as something for, for a dental, you know, as a dental product, . So that's, so that's really great, great thing to consider, and again it can really, it might be worth just going through the products that you do have in your in your own clinics and and sort of just do that as a bit of a test.

Secondly, the Veterinary Oral Health Council. Now this is a list of products. I think it's really important to say, toothbrushing is always gonna be best.

So, you know, we still have to brush our teeth twice a day, and the same ideally would be for our pets. But we do know. That the studies show that actually to ask owners to do that and to ask them to commit to that and keep it up is quite tricky.

So for whatever reason, if owners can't do that, then they might again turn to veterinary products, veterinary products. And this is a great place for, for you to direct the owners to. So this is a list of accepted products by the Veterinarial Health Council.

It's important to say this isn't a test of safety necessarily, but it's a test of effectiveness. So if people are putting their money into products. This is somewhere that they can go to see whether simply ask the question, will it do what it says on the tin, and if it's on this list of products, then the chances are you can be pretty sure that that's, that's gonna be the case.

So it's a really good one to look at and the website's there, VOHC.org. And thirdly, I think this is something, so I, I mean, I, I work really closely with quite a lot of behaviourists as well, dentistry and behaviour are two areas that I find particularly interesting in small practise.

And I often find people, I think we need to sort of separate our mindset between thinking that a dental product needs to double up as an enrichment product as well, . Because that's, that's not necessarily the case, you know, we, we, I hear it quite often. I'm sure if you do do the dental clinics, you probably hear it as well, where people say things like, for example, they may be using dentist sticks, but as soon as they've given them to the dog, they're gone within seconds, you know, chomp chomp and they're gone.

So the kind of owners feel like maybe they're not doing a huge amount. And actually the studies would suggest that even dogs that eat pedigree don't stick very quickly, so 40 to 50 seconds, still does take a huge amount of chewing, so 90 in one it's 90 to 130 chews to consume. Which is still a huge amount, so that, that, and that actually isn't a correlation between how effective that product is versus how long it lasts.

So I think we need to kind of slightly separate this thing that if it's a dental product, it needs to last for a long time, cos that simply isn't the case necessarily. And instead, think about I'm gonna use one thing for the dental care and then maybe something else for enrichment. And so when it comes to enrichment ideas, there is a whole plethora of things that we could be offering which are far, far more safer in terms of looking after our dog's teeth than perhaps using some of these hard shoes that we've talked about.

So I mean I've listed a few here, but you know I'm sure people will have lots of ideas of their own as well, so I. Snuffle mat's brilliant. We're heading into this awful kind of lost cost of living crisis, so, you know, upcycling some things like home knotting sort of clothes or clothes to create sort of rope toys, licking mats again, fantastic, we see loads of those in practises now.

Even again, cardboard tubes, boxes, make puzzle feeders yourself. You know, rolling towels up on the floor with treats in there, or really great ways without having to cost a huge amount of money that we can really engage our, our pets and keep them, keep them sort of keep using their senses. Kong's, I think everybody's everybody's favourite, a kong, a stuffed kong, even a frozen stuffed Kong, absolutely brilliant at keeping our dogs occupied and engaged.

Again, if you've got a dogs that love love carrying sticks or go and find sticks out on walks, then investing in a safe stick is is a great idea, and then you can just take that with you on or encourage owners to take that with them on, on each walk. Again, things you can do around home, how you can seek games, decompression snifaris, these, these are brilliant, so this is basically. Instead of going for a regimented walk, just especially for older dogs, just take them out and have 20 minutes of just letting them sniff a new area.

And again, it uses all these different sensors. Puzzle feeders are brilliant, build an agility course. I mean, my, my dog would probably look at me and think, oh, there's no way I'm doing that.

But some dogs, you know, if you've got collies maybe, it could be an idea. And then creating sand pits, again, you know, if you've got diggers, give them something to do, give them an area to dig in the garden. So this is a bit of a, it's a bit of a messy slide, but there's a few examples there of some of these different enrichment ideas that you could easily sort of talk to owners about to try and just bring their mind away from thinking that it needs to be a long lasting chew and instead thinking of other ways that you can keep a dog occupied.

So there's a great website that prevented that, I'm not gonna go through all of these, but just sort of look at them, go on your own time, and just sort of, you know, think of some creative ways that we can, we can engage our, our owners. So I think in conclusion, you know, we know that there's currently, or there was currently no limit for the textual properties or harness of choose. So, you know, we've been trying to raise awareness of this.

Tooth fractures as we now know, they're extremely common, they severely impact our dog's wellbeing. And it can be very hard for owners to spot. But vets, vet nurses, you know, we're all in the best position to offer advice to our dog owners.

And I think enrichment, yes, it's really, really, really important, but treat that separately from dental care, but I think the most important thing of all of it is that we should only really ever be recommending products that will do no harm. And on that note, I'm gonna hand over to Marie Louise. Perfect.

Thank you very much, James. Yeah, so I work for Mars Pett Care. I'm a scientist by background and I've run oral health research for a long, long time and now work in scientific communications.

And I just wanted to bring your attention to some resources that we have, that you can go ahead and take a look at yourself. So we've, I work, although mostly with pedigree these days, I work in, in, Close conjunction with Royal Canan. So we have this really nice Royal Canan virtual event centre, which is like an exhibition hall that you kind of walk in virtually, and you'll find loads of resources in there.

If you follow the link and go towards the back right hand corner of that exhibition hall, you'll see an oral health corner there. And then if you click on the information arrow that you can see in that, The picture on the bottom left there that takes you to a load of resources, essentially that you can download. So there's lots there that you hopefully will find useful.

There's the Pennsylvania study that the chaps have covered this evening in, in a lot more detail if you want to read a bit more about that. We have some downloadable resources as well, so dental chart pads and things you might find useful in practise, leaflets on how to choose a, a, choose safely or, or a toy, so you can maybe run a print of that and, and give those to your new dog owners and so on. And, and of course, within that corner as well, we have these webinars and, and other webinars that we've done previously that you can watch in your own time.

So, yeah, just want to draw your attention to that and also just mention that any of the questions, we probably have a little bit of time to try and answer some now, but all questions will be answered regardless. It might just be that we'll come back to you via email. Thanks, Marie Louise.

That was great. And a huge big thank you to Mars for for sponsoring this evening. I know their slogan is a better world for pets, and, and certainly, I think tonight's webinar with your sponsorship is well on the way to achieving that from an oral perspective.

So, thank you very much to you. And thank you also to our two speakers, Tom and James for sharing their knowledge. We do have loads of questions that have come through and Marie Louise, you, in fact, answered the one from Anastasia about the websites and dental products and everything else.

Do you want to just add something to that? Yeah, sorry, I, I tried to paste the link in. It might not have worked, but it's just VOHC.org is where you can go to see the list of approved products from a dental efficacy point of view.

There you go, Anastasia. Tom, loads of questions coming through by, from young vets and vets generally about, you know, where, where can they learn more? How can they start learning to do root canals?

How do they get into dentistry? I think you've really lit a fire there, but what would be your advice to, to follow down, the route of, of, specialising in dentistry? Well, look, worldwide, not just in the UK, but there's, there's, it's pretty well accepted that the the education just isn't there in in at university to, to, to leave you in a position where you're confident or, or gonna enjoy dentistry, .

And the what absolutely changed it for me, I had to get over that kind of knowledge threshold where where I knew enough to enjoy it and actually start making informed educated decisions. And it and it'll start with a wet lab. You, you do need to get some extra training that you just won't have got, well, most people won't have got a university, and most people won't have got just going into first opinion practise, cos generally in, in first opinion practise I'm afraid you usually find you haven't got anyone to learn from within that practise.

So you, you do need to go out of your way and enrol on. Good courses, and where you will, and, and I do think the wet labs, the practical labs are, are the best. Yeah, I agree with you, because, as you say, in practise, you, you, a lot of people are scared of dentistry.

And, and the fear of dentistry really comes from, the unknown, as it were. I, I personally am a little bit of a closet, closet dentist. And also, my passion was lit at a, at a wet lab.

You know, once you see somebody actually getting proper exposure for an extraction, you just go, well, that's not so hard. Yeah, yeah, but bad habits can come down the, from more experienced colleagues and, and, and older vets and . I, I, I do think that's why it's worth taking a step sideways and learning from people who really do know their stuff, rather than just, rather than just trying to learn from, from what others might be telling you in the practise.

Yeah, and we've got a lot of great, sort of specialised dentists, like yourself around. And, a lot of them will allow people to shadow them and have a look and see what's going on. And, a lot of the specialist centres will run.

You know, a, a course where they can have people shadowing them after a wet lab for a day or so, which just enhances it even further. So, asking questions and getting exposed to the right people. Yeah, if I'm allowed to quickly plug the, the British Veterinary Dental Association, you know, we're a non-profit organisation, just trying to improve veterinary dentistry in, in, in Britain, but also, you know, we got a lot of members from overseas these days, but.

We've got a very good Facebook page which is worth, looking up, for kind of clinical discussions, and we also run, we have actually just run a wet lab, our very first, wet lab in a in a while, post COVID, and, and we will also occasionally have sort of educational, webinars also. So it's just worth, you'll find us if you just Google or do a Facebook search on, on BVDA. I think there is another organisation with that acronym as well, but you'll be able to tell us apart.

Yeah, I can't remember what it is, but it's it's quite amusing. Yeah, but you plug away at the British Veterinary Dental Association is an amazing organisation. And for anybody, young vets, especially, who want to get involved in dentistry, that's great advice.

It really is. James, here's one for you to make you smile. You were talking about ches and pushing thumbnails into it and that sort of thing.

I'm not sure. I'd, I'd love to see your face reaction on this one. Thomas says, I once got advice regarding choice of twos that said you should be able to slap it on your knee without hurting yourself.

Otherwise, it is too hard. Is this a reasonable tool for discernment? Wow.

I think, I think the answer there has to be that whilst we don't want to cause any harm to a dog's tooth, we also don't want to cause any harm to ourselves. So, I think the, the problem with that is the only way you're gonna know if it is too hard is that you're gonna hurt, it's gonna hurt you. So, I don't know.

I mean, I think, I think the thumbnails, the thumbnail's a nice way of doing no harm to anyone. Like, let's put it like that. Yeah, no, we just had to lighten the mood a little there.

Folks, we, we've got a lot of questions coming through of people asking, can we just go back and can you cover that again? And can you show that slide again? Remember, please, that these webinars are recorded and they will be up on the webinar.

It's fantastic website. Normally within 48 hours, but the technical guys are on the ball, so often it's 24 hours. You can go back and you can go and watch the recording and you can rewind the recordings and that.

But unfortunately, live, we, we can't go back again, on that side of things. James, another one for you. Maybe even Maurie Louise can come in on this one.

Do dentist sticks contain a high fat and sugar content? If owners are giving these daily, can they lead to issues of tooth decay? Well, as, as I understand it, it's 10% reduction in the you should have, well, I, I'm gonna do you know what, I'm gonna let Marie Louise answer this.

Yeah, OK, so yeah, they, they are low fat. They're officially, classed as a low fat product. It's about 2% roughly fat content.

There is no added sugar in them at all. We can't say no sugar because they're made with a bit of starch, and during the heat process that breaks down a little and gives trace sugar, which is like 0.0003.

And because that happens you aren't allowed to say no sugar. You can only say no added sugar, but essentially they're sugar free pretty much. And yeah, James is right.

You you compensate, they're obviously a calorie load, but they're around about 10% of of daily calorie intake. So you just drop main meal down by 10% to compensate for the treat. And 10% is a figure that Mars use for treats.

The industry standard for treats is 15%. But we, as, as a company recognise the fact that a lot of dogs are overfed generally everything, so main meal and scraps and everything else. And so we, we kind of put a more stringent, Maximum on our treats of 10%, so they won't exceed that daily.

And, and so it's, and it's also 10% is quite an easy figure for people to calculate if they weigh out a bit of dry food, they can work out how to reduce it by 10%. And to remember. Yeah, exactly.

Tom, here's a good one for you. How are teeth? Incredibly rare.

Almost almost not necessarily worth thinking about too much the the pathological fracture side of things if I'm honest. I mean the . Yeah, that, that's that's absolutely fine.

I say that. Yeah, it's, it's, I'm trying to think of of of pathological fractures I I have seen with with teeth and and I'm not too sure. I, I, I, you, you could sometimes have enamel fractures, for example, where you, you might lose, technically it's a fracture, but if you had, an enamel dysplasia, hyperplasia or dysplasia of a tooth, you, you, you might, see some minor fractures like that, but the, the idea that you're gonna get fractures, like we've covered tonight in the slides I've shown you where you've got pulp exposure and, and, and, disease of the pulp.

No, no, it, it's, it's not necessarily gonna be be pathological fractures, yeah. Here's one for you. You're not allowed to redo half the webinar to answer this.

But Christine asked, can you ever just remove the slab and leave the rest of the tooth there if there is no pulp exposed? So, yeah, great question. OK, .

You would still want to be keeping pretty close wraps on that tooth because dentin is porous in a way that enamel isn't, and when we actually expose a large surface area of dentin, there is a mind blowing number of little tubules that become exposed to the mouth which do directly communicate with the pulp. So what you're talking about there is a non-complicated fracture. But the exposed dentin could very much give you complications.

So the term non-complicated, I'm afraid is a bit misleading there. Also, if you've got a large slab fracture, we've actually got quite a change the shape of the tooth, and, typically that will open up that tooth, to being a lot more prone to periodontitis, especially if you've got that slab fracture going down below the gum line. You, you, you've, you've disrupted your periodontal tissues quite a lot and, and it's a real risk for periodontitis.

But. It you could is the short answer. Other complications are likely to follow is the longer answer.

Yeah, case by case there's no 11 size fits all. Yeah, I, I, I wouldn't recommend doing that if that's what the question is, it is, it's, it's generally more appropriate usually to, to be thinking about extracting, yeah. Yeah.

Or it out indeed. Yeah. Here's another hot potato for you, which is gonna be a difficult one to answer.

And I'm sorry to leave you on the last, the last answer for the evening of this one. But Becky asks a fantastic question, and she says, if a tooth fracture happens out of hours, would you consider that to be an emergency in terms of getting pain relief on board? Or would you be happy for it to wait until the following day?

Well, I wouldn't necessarily say I'd be happy for the doctor to wait for analgesia, but you, you know, we. We do get these scenarios, not not not similar to a dog rips a claw off out of ours and we have an exposed nail bed and and a quick, I mean it's uncomfortable, . Sorry if this is a city on the fence politician type answer, but it would be, it would have to be a a discussion between the out of our provider and and and the duty vet and, and, and the owner's anxieties and and perhaps taking a history and trying to work out actually maybe what what the patient is doing is also, and you'd have to throw all those in the mix and come up with a conversation.

I mean, I, I would a lovely get out, type answer here is if the owners at home had access to analgesia, which a lot of owners often do have maybe some, some medications which can give, provide pain relief in the house, I, I would certainly say that that's something I would perhaps talk an owner through and say, absolutely you can give some pain relief. If it meant them perhaps incurring a 300 and more pound fee. And coming in at sort of midnight, it's a bit, you know that that that is case by case and and I, I can imagine a lot of the time they might just be left till the morning.

I'm I'm not saying I'd necessarily be happy about that, but I can imagine that happening. Yeah, yeah. I did apologise before I threw that one.

I'll I'll have to give her a hard time. Maybe the question should be, would you, would you leave it if it was your tooth? Oh, there you go, yeah, I'm staying very quiet for this one.

Yeah, I mean it is, it's the equivalent of going, shall I wait to see an emergency dentist in the morning, or do I need to go to A&E now? That would be the equivalent. I don't think many of us are actually going to.

A&E for the analgesia. I, I think in a blind panic we might have this kind of, ah, I've got to save my tooth, and, and, and rush to a hospital or something, but yeah, good question. I wonder if it's whether, would it, would it change anything in terms of what we would do maybe, you know, if, if it's.

You know, if, if it's not gonna change the overall plan, if we're not gonna necessarily do an extraction at midnight, so whether that might incur some influence over or root canal. No, no, I play nicely children. I, I don't think many owners would be coming in, in, in, in the small hours of the morning for something like that if I'm honest, .

If an owner was absolutely adamant their dog was in distress. Yeah, I'd I'd see them. I, I don't think that's likely.

Yeah. Yeah. I think again it comes down to education and and understanding.

You know, we see so many vets themselves and, and we are the trained professionals who would say, well, let's see how it goes. So to expect an owner to be able to understand the intensity of pain, if the animal's not showing it may be quite a difficult sell. It's what James touched on there though, it it you're not gonna shoot yourself in the foot by it, it wouldn't affect you haven't missed the boat on any treatment options by by not seeing it urgently.

Yeah, yeah. Folks, I'm afraid as much as there are loads of questions and we could go on and on and on, we have run out of time. We will get as many of those questions, answered by our panel tonight for you.

So, don't think that you've missed out. But, I would just like to once again thank Marie Louise and Mars for the fantastic sponsorship for tonight. We really do appreciate it and for those of you attending, remember, let's support those that support us.

So yeah, Mars has stepped up, so let's support them with, with their efforts in, making a better world for pets. And then to Tom and James for sharing their knowledge tonight. Thank you so much for your time, guys.

We really appreciate it and I'm sure we will be able to get you back on in the future and keep talking about this wonderful topic. Not that I'm biassed. No, thank you for having us.

Thank you. And for everybody who attended tonight, a big thank you to you. It's, you guys that make the channel possible.

And thank you for your attendance. And last but not least, to Dawn, my controller in the background. Thank you for making everything run smoothly.

From myself, Bruce Stevenson, it's good night.