Patient Injury & Complications In Veterinary Dentistry

The nature of anesthesia brings risk in general. In veterinary medicine, during dental procedures, pets are often placed in vulnerable positions which can lead to increased risk of injury and medical complications.

These risks can be minimized or entirely avoided with careful consideration, and proper training and continuing education of staff. Listed are a few of the more common injuries that can occur during a dental procedure.

Aspiration Pneumonia

Aspiration pneumonia in pet patients occurs when the patient inhales a foreign substance and develops lung inflammation and infection as a result.

The most common occurrence during dentistry is water and debris entering an unprotected airway, hence allowing fluid and debris to enter the lungs. This can occur from an underinflated tracheal tube, or repositioning during the procedure that allows fluid to enter the airway.

Aspiration pneumonia can also occur if the patient vomits or regurgitates during anesthetic recovery.. To reduce the incidence of dental-related aspiration pneumonia, maintaining the patient on their back during the procedure, and avoiding repositioning has proven to not only lessen the risk of aspiration but also lessens the amount of anesthesia needed during the procedure.

In addition, antiemetic medications given during the premedication phase can help reduce the incidence of post-anesthetic nausea and vomiting. Caution should be taken during the recovery phase to wait until the patient is alert and responsive enough to deflate the cuff and remove the tracheal tube.

Tracheal rupture

Tracheal rupture in dogs and cats are more frequent during dental procedures than any other medical procedure. Seventy-five percent of tracheal ruptures are thought to be associated with oral surgical procedures with the incidence more common in cats than dogs.

Tracheal injury can cause symptoms such as mild dyspnea, and even death. The most likely cause of tracheal rupture is thought to be due to an overinflated tracheal cuff, as well as failing to detach the tracheal tube from the anesthesia hose during repositioning, which can cause a torque on the inflated cuff resulting in a tear of the dorsal membrane of the trachea.

Another common cause of tracheal rupture is a patient that is not adequately anesthetized and coughs or lunges upward during intubation, tearing the trachea.

Pressure from an overinflated cuff can cause pressure necrosis of the trachea, showing delayed symptoms of inflammation and scarring.

Avoiding over-inflation of the cuff, using new tracheal tubes, testing the cuff to ensure proper inflation prior to use, avoiding repositioning as much as possible, and ensuring a level plane of anesthesia prior to intubation can help minimize the risk of tracheal rupture.

Artery Damage during Tooth Extractions

Arterial damage to arteries such as the palatine artery which runs the length of the mandible can accidentally occur during routine tooth extractions where the instrument can slip from the practitioner’s hand.

These injuries can be mild to more severe requiring surgical intervention.

The most effective way to avoid this type of injury is to implement extraction techniques involving gingival flaps where the roots are exposed, and more easily undermined, and extracted. 

Written by: Dr. Tammy Powell, DVM

Good Exam Room and Dental Lighting: Why It Matters

When it comes to upgrading your veterinary practice, maybe the first things that come to mind are new exam tables, high-tech anesthesia monitoring equipment, or an in-house chemistry analyzer.

Was a new LED exam room light also on your list? If not, it should be. Here’s why…

While lighting is often overlooked, just think about how many times per day a good, strong light could make your life easier.

Times, when a high-quality LED light could come in handy in your exam room, include the evaluation of…

• Lesions and wounds.

• Dental disease or oral lesions.

• Ocular health (you’ll use your ophthalmoscope and other equipment for a more detailed exam, but good room lighting can help you pick up subtle lesions during a routine checkup).

• Paw pads and the spaces between the paw pads.

• External ear structures.

• Dander, fleas, and other skin and coat issues.

These are a few good examples—but really, good lighting can help with much of the physical exam by making it easier for you to accurately document tissue colors, textures, lesions, and other notable abnormalities in your medical record.

Good lighting is essential for dental procedures and surgeries

In our last blog post, we gave some advice on how to pick a good surgical light.

And along those same lines, don’t forget about dental procedures!

The mouth is like a dark cave, making it difficult for you and your staff to see what you’re working on if you don’t have good lighting.

Some things a good light will help you visualize include…

• Calculus that needs to be cleaned—and verifying that all calculus was removed.

• Enamel defects and small chips or fractures. 

• Staining, or other color changes such as pulpitis.

• Subtle bleeding or mild gingivitis.

• Oral abnormalities such as masses or inflammation.

• Pharyngeal or tonsillar abnormalities.

• Extraction sites—before, during, and after the extraction.

• Placement and manipulation of small sutures.

Not to mention, a good overhead light can aid your laryngoscope light during intubation. 

How affordable are good LED lights?

In the past, LED lights were very expensive compared to halogen bulbs—so it’s understandable if you’ve not purchased one before.

However, some brands are now 30-40% less than previous LED prices.

So, LEDs don’t have to be expensive anymore. And considering their performance and efficiency, a good LED light can be a great addition to your practice.

Plus, many cities, counties, states, and even electric power companies offer rebates for upgrading to LED lights, due to the decrease in power used.

Specific requirements for rebates vary by location—so be sure to check with your local municipality and utility providers to see what’s available in your area. Because it’s always great to get a cash rebate that can help cover the cost of your upgrades!

How do you choose a good exam room or dental light?

When it comes to selecting the best lighting, there are many things to consider…

• Affordability. LED lights are much more affordable now than they used to be, so shop around and be sure you’re getting a good deal (to be sure you’re comparing apples to apples, check for the other factors on this list, too).

• Quality and dependability. Plus, a good-value warranty helps to back up your investment.

• Lighting adjustability in terms of intensity and dimming options, as well as area of focus.

• Precise positioning. The light head and arm should be easy to move and manipulate—but then, stay right where you put it without drifting. 

• Easy to clean.

• User-friendly, with simple controls on or near the handle.

• Shadow-free illumination—or at least a design that minimizes shadows as much as possible.

• Mounting options that match the layout of your rooms.

• Comfortable and safe for pets, with adjustable settings you can change as needed, and low heat output.

Here’s what we recommend…

We recommend the new Burton veterinary LED exam light because it checks all the boxes listed above.

Plus, it has a high-quality LED (virtually heat-free and with a 75% energy savings compared to halogen), is assembled in the USA, and is backed by an industry-leading 5-year warranty.

At a competitive price point that optimizes design, performance, and value, it’s pretty hard to pass up!

Why invest in new lighting?

As we said, lighting is often overlooked in terms of equipment upgrades…

But, just think of how many times per day you’ll use a good-quality light in your exam rooms or dental area.

In terms of cost per use, that can make new lighting a great investment—something you’ll benefit from using many times per day.

And if your new light makes your life easier in terms of visualizing the patient and making accurate medical notes… that’s an investment that could save you time and headaches, and be well worth it!