Vet360 Vol 4 Issue 4 August 2017 Vet 360 - Page 32

Article reprinted with the permission of DMV360 - April, 4 2017 DVM360 MAGAZINE is a copyrighted publication of Advanstar. Communications inc. All rights reserved. DENTISTRY The ABCs of Veterinary Dentistry: By Jan Bellows, DVM, DAVDC, DABVP, FAVD "I" is for Informed Consent An in-depth look at what can go wrong during a dental procedure and how much to share with veterinary clients . My sister asked me to accompany her to a surgical consultation for an elective procedure. After the doc- tor finished reviewing the proposed surgery plan he said, “Now let’s talk about what can go wrong,” listing infection, dehiscence, suture reaction, scar formation and significant postoperative discomfort, which rare- ly occurs. He followed with, “Now what questions or concerns do you have?” Why did he do that? To wor- ry us? To talk her out of the procedure? Not at all. He wanted to properly inform us—and in some way to be brutally honest that things do not go perfectly every time. The informeddiscussion and my sister’s consent was founded on her right to make health decisions based on explanation and understanding the risks and benefits of treatment and nontreatment. Immediately after the visit, I consciously incorporated “Now let’s talk about what can go wrong …” during all client discussions on proposed surgeries or diagnos- tics that carry risk. For a general physical examination, radiography, electrocardiography (ECG) and blood draws, implied consent is assumed. For diagnostics and treatment with risk or alternatives, we need to give our pet own- ers enough information for them to make informed diagnostic and therapeutic decisions. Blindly sign- ing a consent form without reading and discussing content is not ethically adequate. Informed consent needs to be a communicative process, presented several times during the professional oral assess- ment, treatment and prevention (oral ATP) visit. This informed discussion should include: 1. The nature of the procedure 2. Reasonable alternatives if any vet360 Issue 04 | AUGUST 2017 | 32 3. The relevant risks, benefits and uncertainties related to each alternative 4. Confirmation that the client understands the above 5. The acceptance of the decision and procedure by the client Deciding how much “what can go wrong” information to give the pet owner can be challenging. Fortunately, adverse events rarely occur. For example, a dog or cat hardly ever loses its hearing—even temporarily—from acoustic nerve trauma caused by the ultrasonic scaler. Even though it does happen, it has never clinically occurred in one of my pa- tients. But it could, so do I discuss it beforehand? No, be- cause it is rare and not life-threatening. Compare this to adverse events that can occur secondary to general anaes- thesia. Even though these are also extremely rare, they can be devastating. For that reason, we discuss anaesthesia in- formed consent with every case. Examples of common informed consent topics to consider discussing relating to dental procedures GENERAL ANAESTHESIA Adverse anaesthesia events including death Pobability: Extremely rare Prevention: 1. Evaluate the patient beforehand with a physical examina- tion, laboratory testing, ECG, ultrasonography and radiogra- phy, as indicated. 2. Choose an anaesthetic protocol tailored to the patient. 3. Monitor vital signs during and after the procedure. 4. For compromised patients or intense clients, consider using a veterinary anaesthesiologist or referring to a facility with one (Figure 1).