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