VetTips: Dental Radiology Part One

Tip 1: Dental X-Ray Machines

You don’t need a special machine! but you will need to work out a chart of settings. A starting point might be: kVp of 65 (small/toy breed dog and cats), 70 (15kg dog), 75 (25kg dog) and 85 (large breed dogs), mA of 100. Time depends on the film used, of course. If you are using standard cassettes, a time of 0.05 seconds is required, whereas for Ultra-speed, ‘D’ speed, intra-oral film, a time of 0.1 seconds for dogs and 0.08 seconds for cats will usually produce a nice radiograph. So, lets get started!

Tip 2: Dental Radiology

We are missing 27-53% of dental pathology by avoiding dental radiology. In a study published over 10 years ago, it was found that full mouth intraoral radiographs showed otherwise undetected pathology in 50% of dogs and 53.9% of cats with abnormal findings on clinical oral examination (verstraete et al. Am J Vet Res 1998 59: 692-5). In patients with no clinical abnormalities, significant pathology was found in a 27.8% of dogs and 41.7% of cats.

Tip 3: SLOB Rule (horizontal angulation)

SLOB = Same Lingual Opposite Buccal
Changing the horizontal angulation (oblique angles) allows different views to be taken which aids in separation of superimposed objects. This is most commonly used when imaging the maxillary fourth premolar teeth, where the lateral view results in superimposition of the mesiobuccal and palatal roots. The SLOB rule tells us which root is which – the one that moves in the same direction as we move our x-ray machine is the more lingual (palatal) root.

Dental Radiology Workshop Jun 12th & 13th, VIC

“Dissatisfaction and discouragement is caused by lack of vision.” President Eisenhower

Make dental procedures easier by being able to see what you are treating below the gumline.

This workshop offers a positive approach to veterinary dentistry that will contribute to a calmer and less painful dental protocol in your hospital.

To download the brochure click here.

Or click here to register!

Book before May 12th to receive our Early Bird Special!

Meet Dr Penny Tisdall – VetPrac Education Leader

Dr Penny Tisdall

Qualifications: BSc (Vet) BVSc MVetClinStuds FANZCVS

Position/ Specialty: Specialist in Small Animal Surgery and Senior lecturer in Small Animal Surgery at University Of Adelaide

Penny graduated in 1994 and spent 3 years in private practice before starting a residency in Small Animal Surgery at the University of Sydney that was completed in 2000. Since this Penny has been in private referral surgical and specialist practice, and locum surgical practice including positions in Sydney and Brisbane. In 2007 Penny moved to Adelaide and for 7 years ran a private referral surgical consultancy practice and was part practice owner. At the beginning of 2015 Penny joined the University of Adelaide Veterinary School where she hopes to make a contribution to building up the caseload of the companion animal hospital and developing the surgical teaching curriculum.

How do you spend your days off?

Gardening , walking, shopping, general domestic goddess

What is it about External Fixation that you find interesting and that you believe general practitioners would benefit from learning and performing better?

External fixation is a versatile and somewhat technically forgiving method of fracture repair that is relatively affordable to use and carry as inventory in your practice. A sound approach to case selection, planning and an understanding of the principals and the equipment is required to optimise surgical outcomes.

What have you learned from experience that you didn’t learn from a textbook? 

Textbooks are a great way to get information about new procedures but it is always more helpful to see someone with experience perform the technique or even just discuss it with them, as there are often little nuances about procedures that are not covered in textbooks.

Examples include how to best place bone holders to help reduce fractures, techniques to overcome muscle forces etc – working smart rather than hard. If using texts, my advice is always to read a few different approaches rather than just one. Yes, that means you need multiple textbooks and new editions as they come out – but the investment is worth it, in my opinion.

What procedure, technology or medication have you used and realised that there was a better alternative?

The components available for external fixation have evolved a great deal in the last 10 – 15 years. If you are still working with old systems it might be time for an upgrade as the newer components allow use of much simpler external fixation frames.

Tell us about a practical surgical tip that you learned from experience

Always focus on taking good radiographs. In the current age of digital radiographs there are no film costs so if you are not happy with radiographs take more, take oblique views if indicated. I routinely radiograph the whole limb and often the opposite limb. You will sometimes miss other pathology that was not evident on examination but that may change the way you think. If you are worried about costs develop charges that are for a limb series rather than charging for individual plates.

Use foam blocks, doughnuts and wedges in radiology to assist positioning of patients. It is much faster and more convenient then sandbags or tape and safer then holding the patient.

What advice would you give new graduates?

Don’t work too hard and try to enjoy what you do. Once uni is finished keep seeking new information to help you stay at the fore front of recent knowledge, attend courses, read texts and as you gain more practical experience you will understand the information more completely. Join the AVA if you are not already a member. Our profession needs advocates and everyone should be involved.

If you’d like to get hands on External Fixation training from Dr Penny Tisdall take a look at our upcoming External Fixation Workshop running May 8 – 9th, at the University of Adelaide. 

If you have any questions feel free to leave a comment below!

 

A Vet Student in India

As I write this I am sitting in an airport; I’m sleep deprived and craving the creature comforts of home that I’ve been missing… namely a warm shower – something I haven’t had in over a month. This is because I’ve been In Tamil Nadu, India, developing my surgery skills as a part of animal birth control (ABC) charity work on behalf of the Worldwide Veterinary Service (WVS). For people who are involved in ABC work already through any number of organisations (Vets Beyond Borders and AMRRIC to name a couple) what I am about to share will likely be very familiar. This is what a spey/neuter project in India is like:

Arriving at the project location on the first day we were struck by the beauty of the scenery. Our accommodation overlooked a foggy valley with tea plantations below and colourful houses covering the hillside. Greeted by the resident dogs and one of the supervising vets we toured the facilities and met other students ready to hone our skills over the next two weeks. Day one was all about learning our anaesthesia and surgery protocols – a very different arrangement to the state-of-the-art equipment and set ups that many of us were used to at our universities. Nevertheless the dogs undergoing their operations as demonstrations recovered quickly, with minimal hypothermia, and no signs of pain. Which just goes to show that even if your supplies are limited, you can still get excellent outcomes. 

Now – the difficult part – the surgeries! With a limited experience in surgery, and with over two months since the end of the university year many of us were rusty to start. However once settled in, our countless hours of practice on couches, bananas, and whatever else we could get our hands on finally became useful! Within a few days everyone’s surgery had improved dramatically and we were performing our surgeries one after the other like a well-oiled machine. Once one surgery was nearly finished the next dog would be sedated, ready to use the empty table. This was only possible of course thanks to the help of the excellent veterinary assistants who would restrain the not-so-friendly dogs and help in anaesthesia monitoring. 

As incredible as the surgery training was, we got a real indication of the importance of the work when we visited local towns to vaccinate animals against rabies. This was the reason we were controlling the population – to reduce dog bites, reduce the prevalence of rabies in the canine population, and therefore reduce human rabies cases. Making our way through neighbourhoods as variable as industrial areas, farming villages, and markets we encountered a huge spectrum of dogs. What was good to see was the large proportion that had been desexed as a result of the work people like us had done. What was even better to see was the love that many people have for their pets. It’s a very different scenario to most of Australia – dogs roam freely much of the time – but people with barely enough food to feed themselves look after their dogs with care and compassion when they can. By vaccinating and desexing these dogs we can make sure that they will have a longer and better life, won’t contribute to the stray dog population, and most importantly, won’t infect any humans with the horrible disease that is rabies.

India was an incredible experience – I’m sure I’ll be back. There is so much to do in the fight against rabies, and there is evidence that veterinary ABC work and rabies vaccination is the best tool that the world has. It’s an empowering thing to realise that the skills we possess as veterinarians can have such a huge impact on the life of so many people. If you are considering getting involved with work in the area of ABC I highly recommend it. Can you tell I’m hooked?

By Zachery Laderhose

‘Zachary is a fifth year Veterinary Science Student studying at Charles Sturt University in Wagga Wagga. His veterinary interests include public health, mixed practice and emergency medicine. What time isn’t taken up by Vet School is spent catching up with friends, reading, binge-watching F.R.I.E.N.D.S., competing in orienteering, and writing for his blog [seeingpractice.com‘].