Your primary mandate is to do no harm. If a pet requires treatment that you are not comfortable performing, then recommending a referral is absolutely appropriate. Try and explain to your client what their pet requires, what you are comfortable doing, and how their pet does not fit within that scope. No procedure is “too small” or “too simple” for me; I will perform any oral treatment that is required, even if it is “just a COHAT with extractions.”

You should also refer to me or a dentist if your client requests it or if your client is interested in a root canal treatment, orthodontics, or other advanced procedures. You should also very likely refer through the ER any fractured jaw. If an oral biopsy result shows a malignant or invasive mass or cyst, that should be a referral.

Be honest with them about the reason for the referral. Explain that it starts with a consultation, which allows them to hear the dentist’s expertise and make an educated decision about their pet’s oral health. As the referring veterinarian, you will also receive a report from the consultation, which you can review with them and discuss the options for their pet afterwards if needed.

You can’t make the decision for them. Your role is to advocate for their pet, explain your reasoning, and ensure they understand the expertise the dentist will provide. It’s often helpful to know the cost of the consultation and a rough estimate for procedures; you can inquire with your local veterinary dentistry team for this information.

My team and I are here to take on your referrals, providing care for your patients and clients and sending you a report on the treatment they receive while with us.

We’re also available to assist with any dentistry and oral surgery-related questions you might have. Whether you need advice on a case, are unsure if a referral is necessary, or need a quote for your client, don’t hesitate to reach out. We’ll help you as best we can.

Technically, all fractured teeth could potentially benefit from a root canal treatment (RCT), but we need to evaluate the long-term benefits. There is no specific time frame cut-off for performing an RCT; the fracture could be recent or old. If little to no crown structure remains, RCT may not be feasible. Additionally, if the fracture extends below the gumline and compromises the tooth's periodontal health long-term, RCT might not be the best option. In such cases, a gingival flap should be used to assess the situation before making a final decision. Overall, most fractured teeth can undergo RCT, and if preserving the tooth is a priority for the client, a consultation is the logical next step. 

Note that even teeth with periapical lucencies on dental radiographs can be candidates for RCT.

No. "Uncomplicated" fractures are not simple. Uncomplicated means the enamel and dentin are fractured but the pulp is not exposed. Despite no macroscopic pulp exposure, the dentin is porous, leading to potential microscopic pulp exposure. When dentin is exposed, the tooth should form tertiary dentin to fill the exposed tubules. However, if this response is delayed or insufficient, microscopic pulp exposure could lead to pulpitis and eventual pulp necrosis. Therefore, all teeth with uncomplicated crown fractures should be assessed radiographically for signs of non-vitality. If no signs are present, the tooth should be re-radiographed in 12 months to ensure no signs of non-vitality have developed, as initial radiographs might be taken before any signs become apparent.

As soon as you note a fractured deciduous tooth, it should be extracted. Puppies may not show obvious signs of oral pain, but fractured teeth are indeed painful. Additionally, fractured deciduous teeth are at risk of infection if the pulp is exposed, which could potentially affect the adult tooth bud at the apex. Therefore, it's crucial to either extract the tooth or refer for extraction, even if the tooth is expected to fall out soon.

If the biopsy results indicate that the mass was incompletely excised or is malignant, you should refer the case. If you are not comfortable performing a biopsy or removing the mass in its entirety, refer the case. If you have previously attempted an excision and it has regrown, refer the case. If extraction sites are not healing properly, you should either biopsy or refer. Additionally, if you are excising or biopsying a mass, make sure to take a picture before cutting.

Yes, if you are comfortable, please remember to take a picture of the mass, enlargement, or lesion before cutting and include it in the medical record. Ensure that you take a diagnostic, representative sample of the mass or lesion.

Yes, but I don’t recommend it. Oral growths do not exfoliate well, and overall most slides will have no or few cells. An FNA will not be representative. Taking a biopsy is the appropriate course of treatment in my opinion. Always take a picture before the biopsy.

No. Skull radiographs are hard to interpret even when taken perfectly. There is far too much superimposition in these 2D images to assess most of the mandible, TMJs, and entire maxilla. Even radiologists will recommend a CT for better images and to confirm the suspected diagnosis. It is almost always better to rely on your oral exam and to refer to a facility with a CT if you are concerned about the jaws. Skull radiographs do not have enough detail to assess dentition.

It is my professional opinion that oral assessments or oral surgery should only be performed in conjunction with dental radiographs. Without dental radiographs, periodontal disease cannot be appropriately staged, and non-vital teeth, impacted teeth, and tooth resorption can all be missed. Additionally, performing extractions without the ability to confirm complete extraction with radiographs is incomplete and irresponsible.

When it comes to Feline Chronic Gingivostomatitis (FCGS), which is a debilitating disease that requires complete extraction of all dentition for resolution of this painful inflammation, it is my opinion that any treatment performed without dental radiographs to confirm complete extraction is malpractice.

If you explore this website, you will find resources for both yourself and your clients. You can also follow me on Instagram (@toothy.thomson), where I share fun and educational content. I have CE courses available on obivet.com as well.

Yes, every few months I offer small group extraction labs in Mississauga, Ontario. Inquire through the form on this website.