1. Veterinary dental nursing procedures
SAFETY, ANESTHESIA, POSITIONING

2. Usual GA precautions Appropriate monitoring equipment
IV catheter and fluids as required
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3. Contaminated Surgery
Veterinarians should in general avoid performing “dirty” dentals on an individual animal at the same time as major sterile surgery
Bacteria entering the blood stream during dental work can lodge in the blood clots of the major surgery site.
5888H - Veterinary Dental Nursing

4. Safety Considerations
Patient safety
Operator safety
Special considerations:
Head movement > endotracheal tube induced tracheal trauma; if tracheal trauma:
subcutaneous emphysema – if tracheal air escapes
tracheal stricture – can appear days or weeks later.
Head movement > tube twisting and kinking
Head tilted up > fluids, blood, blood clots, calculus easily enter trachea.
Cuffed tube > distal cuff still permits fluid to enter proximal trachea.
Wet face, cold table/grill > greater heat loss and hypothermia
Wet ET tube tie > loosens and falls out easily
Risk of being bitten
Aerosol in eyes
Special anaesthetic procedures:
Use cuffed endotracheal tube – just enough to occlude air leakage
Ensure good grip on tube tie; might use:
Rubber elastic band (not too tight on face)
Drip tubing (not too tight on face or tube)
Disconnect anaesthetic conduit when turning or moving animal.
Don’t turn over the back (turn with legs kept underneath) – reduces chance of fluid entering trachea
Slight incline for trachea
Tilt table, or
Use padding (eg bubble wrap) with more under shoulders, less under neck.
Place absorbent wad in pharynx
eg swabs, throat pads
caudal to root of tongue
REMEMBER TO REMOVE when finished – have a reminder check system – eg a marker on the ET tube when swab placed
Ocular lubricant to protect eyes from aerosol
Use mouth prop to protect and improve visibility – not too wide
Heating mat, bubble wrap, water bottles. Some methods need care as may have risks of scalding and electrocution
Head on a grill to keep it drier
Monitor rectal temperature.
Recovery:
Place in lateral or sternal recumbency with the head and neck extended, preferably head below thorax
Monitor temp, pulse, respiration, consciousness until able to maintain sternal recumbency
Keep orifices clear, clean and dry
Remove pharyngeal swabs
Remove endotracheal tube at appropriate time
Analgesics as indicated
Report recovery problems
Final grooming before discharge
^ Can use a rubber band to achieve a secure grip on a cuffed endotracheal tube. Need to take care however that tension around back of head or across muzzle is not excessive.
Usual anaesthetic procedures:
appropriate monitoring equipment
IV catheter and fluids as required
Veterinarians should in general avoid performing “dirty” dentals on an individual animal at the same time as major sterile surgery. Bacteria entering the blood stream during dental work can lodge in the blood clots of the major surgery site.
5888H - Veterinary Dental Nursing

5. Patient Safety
Head movement > endotracheal tube induced tracheal trauma; if tracheal trauma:
subcutaneous emphysema – if tracheal air escapes
tracheal stricture – can appear days or weeks later.
Head movement > tube twisting and kinking
Head tilted up > fluids, blood, blood clots, calculus easily enter trachea.
Cuffed tube > distal cuff still permits fluid to enter proximal trachea.
Wet face, cold table/grill > greater heat loss and hypothermia
Wet ET tube tie > loosens and falls out easily
5888H - Veterinary Dental Nursing

6. Use Cuffed ET tube Just enough to occlude air leakage
5888H - Veterinary Dental Nursing

7. Good grip on ET tube Ensure good grip on tube tie; might use
Rubber elastic band (not too tight on face)
Drip tubing (not too tight on face or tube)
5888H - Veterinary Dental Nursing

8. Good grip on ET tube
5888H - Veterinary Dental Nursing

9. Disconnect Tube When turning or moving animal
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10. Don’t turn over the back
Turn under belly
with legs kept underneath
reduces chance of fluid entering trachea
5888H - Veterinary Dental Nursing

11. Slight incline for trachea
Tilt table, or
Use padding (eg bubble wrap)
More under shoulders, less under neck
Just think of airway position!
5888H - Veterinary Dental Nursing

12. Patient Positioning Options Dorsal Lateral
Lateral: Most veterinarians and veterinary nurses prefer lateral recumbency.
Place a towel or sandbag under the neck of the patient and tilt the head downwards, so as to ensure adequate drainage of saliva, blood and irrigating fluid. A cuffed endotracheal tube and pharyngeal pack (Metropack™) is essential to prevent aspiration.
5888H - Veterinary Dental Nursing

13. Dorsal Recumbency 5888H - Veterinary Dental Nursing
Dorsal recumbency offers the advantage of superior visualisation of all aspects of the teeth, especially of the maxillary dentition.
The patient can remain in the same position throughout the procedure in a standard fibreglass cradle. The operator needs access to a 180-degree arc at the end of the table - preferably seated on a wheeled chair.
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14. Lateral Recumbency
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15. Place absorbent wad in pharynx
eg swabs, throat pads
Past hump of tongue
REMEMBER TO REMOVE when finished
have a reminder check system – eg a marker on the ET tube when swab placed
5888H - Veterinary Dental Nursing

16. Pharyngeal Packing · 5888H - Veterinary Dental Nursing
One of the main hazards of dentistry and particularly dorsal recumbency is fluid aspiration. A cuffed endotracheal tube and pharyngeal pack is essential to prevent aspiration.
Ensure the palate is in a horizontal plane and lower the head end of the table.
Place a towel or sandbag under the neck of the patient to hyper-extend the neck. Use a gag to maintain the mouth in an open position, but always beware of over-opening the mouth and straining the TMJ's over a long period of time.
5888H - Veterinary Dental Nursing

17. Ocular lubricant To protect eyes from aerosol Artificial tears
Lacrilube
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18. Care with Mouth Prop
Is used to protect operator and improve visibility
But not too wide!
5888H - Veterinary Dental Nursing

19. Warmth
Consider
Heating mat
Bubble wrap
Warm water bottles
Some methods need care as may have risks of either scalding and/or electrocution
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20. Head on a grill To keep body and face drier
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21. Monitor Temperature Usually rectal temp measured
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22. Recovery
Place in lateral or sternal recumbency with the head and neck extended, preferably head below thorax
Monitor temp, pulse, respiration, consciousness until able to maintain sternal recumbency
Keep orifices clear, clean and dry
Remove pharyngeal swabs
Remove endotracheal tube at appropriate time
Analgesics as indicated
Report recovery problems
Final grooming before discharge
5888H - Veterinary Dental Nursing

23. Operator Safety What operator safety precautions shown here?
Considerations:
Risk of being bitten
Calculus flicked into eyes
Aerosol in eyes > possible conjunctivitis
Large numbers of bacteria in aerosolised water droplets > possible inhalation and bacterial pneumonia
Build up of debris on the skin or under the fingernails.
Calculus debris may be flicked into eyes.
Moisture contaminates clothing (hospital hygiene).
Posture - scaling and polishing teeth can be a lengthy procedure that requires the operator to be in one position for a period of time. Often, dental procedures are performed at a dental station, a stainless steel bath on top of which a grill is placed on which the patient is positioned. As the dental station is usually of a fixed height, the operator should sit on an adjustable stool, which will allow them to sit comfortably without 'stooping'. Fatigue or back pain can lead to loss of concentration, which in turn may extend the length of the procedure and compromise the patient.
Sharps. Many dental instruments must be sharp in order to be effective. Knowledge of their correct usage is essential.
Anaesthetic gases. Need to protect the operator from waste anaesthetic gases.
Lightly anaesthetised animals can bite operator
Electrical heating mats – electrocution
Precautions to take:
Face mask** - discard after use, quality type, well fitted
Gloves
Eye protection – goggles or visor
Cap
Apron - waterproof
Stool - adjustable
'Sharps' container – dispose of scalpel blades and burs
Well-fitting endotracheal tube
Anaesthetic circuit/system is free of any leaks
Adequate scavenging system.
Mouth prop – to prevent animal biting on fingers
Use heating mats that are safe in presence of water (i.e. well insulated if electrical)
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24. Risk of being bitten Especially under light GA Use a mouth prop
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25. Eye protection . Risks Protection Calculus flicked into eyes
Aerosol in eyes (possible conjunctivitis)
Protection
Full head visor
Goggles or glasses
5888H - Veterinary Dental Nursing

26. Pneumonia Large numbers of bacteria in aerosolised water droplets
These small droplets float deep into lungs
Possible bacterial pneumonia
Use face mask
Quality type, well fitted
But discard after use
5888H - Veterinary Dental Nursing

27. General contamination
Build up of debris on the skin or under the fingernails
Moisture contaminates clothing (hospital hygiene)
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28. Posture Often a lengthy procedure in fixed posture
Use adjustable stool
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29. Sharps
Discard of scalpel blades, needles, old burs into sharps container
Care with handling sharp instruments
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30. Anaesthetic gases Usual scavenging systems
Good fittings required if patient movement
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31. Electrocution Electric heating mats Faulty electric dental equipment
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32. Other protection Gloves Cap Apron - waterproof
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33. The End
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