Small Animal Dental Radiology Author: Dr. James Anthony, DVM, BSc (Agr.), MRCVS, FAVD, DAVDC, DEVDC, PAg

Intra oral dental radiology is fundamental to the practice of veterinary dentistry.

Radiographs show pathologic lesions or foreign bodies that cannot be identified in any other way and assist in the localization of these objects. Visualization is the key for successful dental treatment. Visualization can be accomplished by inspection (magnification loops and operating microscope), surgical exposure, or dental imaging (dental radiographs, MRI, CT). Radiology is as important if not more in dentistry as it is in other medical disciplines. Without dental radiography the operator is attempting to operate blindfolded. Oral radiology is comparable to having a boxed gift; you have an idea what’s in it, but until you open it you can’t be sure. Why is dental radiology important? It allows the operator to look beyond the obvious, it allows examination of the dentition and supportive structures, it allows for better treatment planning, and it allows for a more successful outcome. This results in a planned procedure without unexpected surprises, a healthier patient and a happier satisfied client.

SEPTEMBER 2013

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Dental radiographic images can help the operator identify tooth, bone, or soft tissue pathology. They help establish diagnosis, in treatment planning and in performing dental procedures. These images allow the operator to verify that the procedure(s) have been accurately performed and for documentation in the medical record for future follow up.

The indications for dental radiology are: periodontal disease, extractions, fractures, non vital pulps, resoptive lesions, missing dentition, orthodontic treatment, oral masses, endodontic therapy, oral abnormalities, and implantology to name a few. Radiographs are also an important part of the patients’ records. It justifies the reason for the procedure and documents the pathology as the information contained in a radiograph is not easily matched by written records. Radiographs are also much more indisputable than a written statement in the event of a disagreement or lawsuit. Communication with the client is facilitated by visualization of the pathology via radiographs.

Dental radiology can also be of benefit in non dental related areas such as: extremity evaluation of small animals, small exotics, nasal disease, and margin evaluation of

post op hard tissue masses.

The best source of radiation is from a dental x-ray unit. These machines are compact, maneuverable, and have limited settings with low radiation exposure. The biggest benefit is that there is no patient transport. It is far easier to move the head of the dental x-ray unit than the animal. Most machines have settings in the range of 0.1-1.0 sec with 10 mA, 70 kvp and a focal distance of 20cm (for a standard x-ray unit). The cost ranges from $4,000-$8,000.00.

Due to the release of radiation, safety is of great concern. It is important to educate everyone in the hospital on radiation safety. The use of positioning devices or holders is encouraged. Always have

individuals in the area protected with a lead barrier and away from the direct beam. Anyone using the radiographic unit should have radiation monitoring badges.

The use of intra oral film is key in successful dental radiography. There are a number of different sizes of films (sizes 0-4). The most commonly used film sizes is number 2. The speed of film most commonly used is “D” (ranges from A-G). Each dental film contains an outer covering where the white portion faces the beam and the back has a tab to peel for developing. Next in the back is a lead foil to prevent scatter radiation. Then there is a folded black paper that folds over the film (dull green colour) to prevent light leakage. On the white portion of the outer covering of the film the operator will notice a raised dot which is by convention always to face the mid point of the mouth (area between the central incisors). This way the operator can identify which side of the face the film is showing.

Developing dental films can be accomplished via using existing dark room tanks, piggybacking the dental film on a standard film via an automatic processor, using a dental automatic processor, using self developing film, or by most commonly using a chair side developer. The chemicals can be evaluated via the use of step wedges. Film clips and drying racks will be required.

Digital radiographs are the next step in the evolutionary process of oral radiology and in my experience offers many more benefits than films. The advantages are numerous, some of them being: labeling and dating the images, receiving an image in seconds, the image can be enhanced and commented on, the operator can magnify the image, the radiographic image doesn’t degrade over time, the image can be enhanced with contract if too light or dark, radiation exposure is decreased 80% over D films, there is no chemical disposal, there are no storage issues (computer), pictures of the radiograph can be easily obtained to educate and give to the client and one can send the images electronically. Digital Radiography is an initial investment over film and you should be sure to have a good warranty program to cover your investment, and specifically, the digital sensor.

The operator can always use a standard radiographic unit, but is not recommended because of the fore mentioned reasons. The cost of time and frustrations of positioning and transport far outweigh its use for dentistry. There are two basic positioning techniques used in veterinary dental radiography

Small Animal Dental Radiology (continued)

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Dr. Anthony shares his extensive dental expertise

with the group and explores the basics of dental

radiology and positioning and includes a number of

fascinating case studies for discussion and interpretation.

For more information visit:

www.scilvet.com

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Gray Falcon Size 2 Digital

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These positions are the parallel and bisecting angle technique. Dental radiographic interpretation is very important. The equipment necessary is some form of magnification, a view box, and a darkened room if film is used. If a digital system is used, knowledge of the program is essential to maximize the full benefits of the software. Evaluating dental radiographs is dependent on the operators’ knowledge of normal dental anatomy. The normal should be studied properly in order to understand pathological images. The operator needs to identify positional artifacts such as the middle mental foramen. Having a skull available will allow for easier study when looking at dental radiographs. Bottom line; know the normal anatomy. Remember to always correlate the images with the patient’s physical examination. The veterinarian should always interpret the radiographs to ensure proper treatment planning. For complete radiographic interpretation the material should be supplemented with a good oral pathology text or referred for a second opinion with a person with advanced knowledge in veterinary dentistry.

Dental radiography not only will benefit the patient but can also be a profit center for the hospital. Full mouth radiographs are recommended for all patients undergoing an oral hygiene procedure since studies have shown that 30-40% of oral pathology is missed with a comprehensive oral clinical examination; even under general anesthesia. Any tooth that is to be extracted should be radiographed to document the reason for extraction (would you repair a leg fracture without a radiograph? I feel it is a dis service to the patient and client not to take these radiographs when a tooth is extracted) and allow for proper treatment planning facilitating its extraction and a post-operative radiograph should be taken documenting its complete extraction. Just these two reasons will allow for a rapid ROI (return on

investment) and pay off the software and equipment in less than a year. Investing in good veterinary dental radiographic equipment and software is an investment for the future improving the hospital bottom line but more importantly offering proper patient treatment resulting in a happier pet and client.

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The use of diagnostic ultrasound in veterinary medicine is increasing rapidly, in part due to the affordability and compact

size of modern ultrasound equipment. For example, the GE Logiq E is

less than 10 pounds and can fit into a conventional laptop bag! This

compact machine is not short of capabilities, either; with a large

selection of ten probes, it is capable of scanning the vast array of

patients seen in the veterinary setting, from a small rodent to a large

dog, including advanced cardiac capabilities such as tissue velocity

imaging. The capabilities of this unit stretch well beyond small animal

medicine, as demonstrated by our recent installation at the

Vancouver Aquarium! The veterinary team at the aquarium needed a

machine that was durable enough to tolerate regular daily travel from

the clinic to the outdoor pool side, and that was capable of imaging

anything from a small reptile to one of their beautiful Pacific

White-Sided Dolphins, which are capable of reaching over 150 kg.

Small Animal Dental Radiology (continued)

VA: 45⁰ (bisecting angle technique)

VA: parallel technique

A Day at the Aquarium Author: David Walklate, RVT

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Good Salesmen Don’t Wear Jogging Pants Part II Author: Jason Grant ,Creative Director Fifth & Missing Design Group

In part one of this article, we discussed the importance in dedicating dollars to quality advertising efforts, primarily as a means to draw customers to your clinic versus your competitors. We’re now going to showcase five time-tested marketing initiatives you can implement to bring in new business and retain your current clientele. 1. Website If your clinic doesn’t have a website, it’s time you got one. Immediately. If you do have a website, is it being updated? Is it being treated as a resource for your clients and perspective clients or is it simply an ‘About Us’ site? Do you know how many people are visiting your site? How are you marketing your site? A website is an absolutely must-have for any business and from an ROI perspective, it also happens to be one of the most cost-effective methods for marketing your business. However, a poorly designed site, and we’ve all seen them, has the power to drive business away. It’s vital your site is designed with care and thought. Don’t leave such a valuable tool in the hands of your neighbour ‘s cousin’s son… 2. Direct Mail No, direct mail is not dead. In a recent study it was determined that ”physical material involves more emotional processing, which is important for memory and brand associations” and “Physical

materials produced more brain response connected with internal feelings, suggesting greater “internalization” of the ads”. In other words, until that dark, dark day when we’re replaced by robots, your clinic should be factoring in the human element when planning an advertising campaign. This human element includes both sight and touch, which is exactly what direct mail appeals to better than most other media (online, radio, etc.). Direct Mail is also a worthwhile investment because done through the proper channels (e.g. Canada Post), your mailout will reach only those people who, for example, have pets. While conversion rates are notoriously low (only 2-3% of recipients will respond to the call to action), you’re not wasting your money on unqualified leads.

3. Magnets & Business Cards Both are sorely underutilized but we believe they should be a staple part of your marketing efforts. Cost-effective, magnets and business cards will unquestionably be used by pet-lovers as a quick and easy contact reference, especially in emergencies. 4. Branded Items Think outside of the box. There are dozens of great and unique ways to keep your clinic’s name at the front of someone’s mind. Leashes and dog bowls with your clinic name and website, branded sticky notes with reminders about pet health, branded “What To Do If…”

The new Logiq e BT12

fit their bill perfectly,

with incredible new

abdominal presets on

the 4C transducer that

provides exception

image quality and

penetration in large

patients. The

ultrasound studies of

the dolphins include frequent urogenital and

reproductive studies, whereby their ovaries can

be measured and assessed, and their bladders

are imaged for size and volume. The veterinary

team and handlers are working on training the

dolphins to provide a urine sample on command,

and the ultrasound is an invaluable tool in

evaluating the urinary bladder making sure they

have “goods”, per say, to provide.

A day at the Aquarium (continued)

5

Good Sales Men Don’t Wear Jogging Pants Part II

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Speaking of Websites What can scilvet.com do for you?

quick reference guides (e.g. What To Do If…my dog eats paint, etc.), branded chew toys, and so on. Chances are your competition isn’t doing anything like this, so now’s your chance to really get noticed! 5. Email Blasts Cheap, quick and easy, email blasts are a must for any clinic that is serious about driving new business. Send out an email blast at the start of heartworm season. Send another one out containing a great tip on cat health. And another on a community event your clinic is attending. Make them short, relevant and include some kind of call to action. Use an email blast program (MailChimp, etc.) that offers analytics. An email campaign is virtually irrelevant if you have no idea what people did with your email. These are just a few quick ways you can improve you clinic’s reach and marketing image, both of which will unquestionably drive in new business and improve your bottom line.

In the article Good Sales Men Don’t Wear Jogging Pants Part II our expert spoke about the importance of your website and what it can do for your customers. So, what can scilvet.com do for you, our customers?

Live Chat

Our expert live chat agents are waiting to assist you while visiting our website. Need help

finding something on our website, or looking for some technical support? Let our agents

help you, all you need to do is type!

Support Documentation

Visit our downloads section where you can search by product for great support material including manuals, FAQS

and troubleshooting suggestions.

Seminars

scil Vet Novations offers a wide range of CE events Nationwide. Visit our seminars

section to see the entire course calendar and download registration forms.

Online CE

Our newest edition, online CE brings our Ultrasound education right to your home or

clinic for all skill levels. Now you can earn CE credits and learn ultrasound at your own

pace in the comfort of your own home!

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