Vet360 Vol 4 Issue 4 August 2017 Vet 360 | Page 33

DENTISTRY
Postoperative discomfort
Probability: Moderate
Prevention: Provide local and systemic anaesthesia
and analgesia before, during and after a procedure in
which pain may be expected.
Figure 1. A veterinarian dedicated to tailor anaesthesia protocols,
monitor effects and make anaesthesia modifications during the pro-
cedure. (All photos courtesy of Dr. Jan Bellows)
Jaw fracture
Probability: Extremely rare
Prevention:
1. Obtain radiographs of all teeth and surrounding tis-
sues before extractions.
2. Use your surgical expertise as well as patience, illu-
mination and magnification, especially in cases of
advanced periodontal disease extending to the man-
dibular ventral cortex.
3. Consider referral if you are not comfortable with the
surgical extraction—or refuse to do the procedure if
you feel that jaw fracture is a significant risk (Figure 3).
Coughing
Probability: Moderate to high
Prevention:
1. Use sterilised, appropriately sized endotracheal tubes inflat-
ed to proper cuff pressure.
2. Avoid excessive head movement during the procedure.
3. Disconnect the endotracheal tube attachment from the an-
aesthesia machine when the patient is moved from side to
side.
TOOTH EXTRACTIONS
Excessive bleeding
Probability: Moderate with extractions
Prevention:
1. Appreciate vascular anatomy before any extraction.
2. Raise the patient’s head and apply haemostatic powder to
control excessive bleeding (Figure 2).
3. Consider referral in cases of persistent excessive bleeding at
an extraction site with root fragments r emaining.
Figure 3. A radiograph of a difficult extraction of the left mandib-
ular first molar, potentially leading to jaw fracture.
Surgical site infection, dehiscence
Probability: Rare
Prevention:
1. Explain to the client that sometimes after surgery a
dog or cat opens its mouth too far and sutures fail
to hold tissues together. Usually the surgical site then
heals by secondary intention.
2. Create a flap that will allow closure without tension.
3. Consider sending a patient home with a cone to de-
crease oral cavity self-trauma.
Figure 2. Hemostatic powder applied to stop hemorrhage from a
fourth premolar extraction site.
Remaining root fragments after surgical extraction
Probability: Rare to moderate
Prevention:
1. Obtain and examine intraoral radiographs on all
teeth to be extracted before and after the procedure.
2. Refer tough cases if you are not comfortable, such
as multirooted teeth and tooth resorption (Figure 4).
Issue 04 | AUGUST 2017 | 33