As veterinary surgeons we all swore an oath when we graduated, the last part of which was “above all my constant endeavour will be to ensure the health and welfare of animals committed to my care.” There is an onus upon us, then, to do just that. Now clearly there are other factors at play, and part of the skill of being a vet is to try to effect a working balance between all of these factors (owners’ wishes and beliefs, financial constraints etc.), but the fact remains that we are obligated to put animal health and welfare top of the priority list.
Studies have indicated that periodontitis is the most common oral disease in dogs and cats and possibly the most common disease seen in small animal practice. Indeed, evidence suggests that approximately 80% of dogs and cats over the age of three have periodontal disease. Whilst the early stages of periodontal disease (and indeed the gingivitis that precedes it) are probably not particularly painful to the animal, the later stages can be very uncomfortable and the sequelae can have very serious consequences. Periodontal disease has been linked to disease of the heart valves, kidneys, liver, pancreas and lungs, all of which can result in a significantly reduced life expectancy in animals suffering from this insidious and under-estimated phenomenon.
There are also many other forms of dental disease besides periodontitis, including apical abscesses, feline odontoclastic resorptive lesions (FORL’s – in cats), tooth fractures, caries (in dogs), gingiva-stomatitis (in cats) and more. Some of tehse have a greater impact on animal health and wellbeing than others, but in most cases intervention can improve quality of life for the affected animals.
Because of the nature of the anatomy in the oral cavity (specifically the facts that a large amount of each tooth is hidden below the gum line and that the lips usually cover the teeth) coupled with the fact that not all animals are overly willing to allow their mouths to be examined, many of these disease processes can go unnoticed for far too long. Even when owners do notice something is wrong (usually either because the halitosis becomes too much to bear or the animal appears to go off its food), there is only so much that we as vets can diagnose simply by looking in the animal’s mouth.
Radiography offers a way to visualise the entire length of every tooth in the mouth of a cat, dog or rabbit (with special rabbit dental plates now available for some dental x-ray processors), including the surrounding bony anatomy. This provides a wealth of information about the disease status of the teeth, allowing the vet to make a much more informed decision about what treatment is required and how to formulate the best treatment plan; it also allows monitoring of the success (or otherwise!) of treatments and interventional procedures.
As previously mentioned, animal welfare comes top of the priority list. That being said, veterinary practice in the UK is largely a private industry and has to be profitable to succeed. Performing dental radiography is a directly chargeable service and in that sense will contribute directly to practice revenue and therefore (theoretically!) profit. However, the financial implications are much more far-reaching. Being able to detect pathology more accurately and reliably will lead to an increase in the revenue from corrective treatment as well as all of the peripheral sales associated such as chews, prescription foods, toothbrushes and toothpaste etc.
As a practice if you provide dental radiography as a service that your competitors do not then your client base will perceive this higher standard of care – indeed, the RCVS Practice Standards Scheme Section 6.2 states that “Evidence must be provided of diagnostic quality radiographs of all parts of the range of species treated.” And later: “Radiographic facilities must be suitable and adequate for the needs of the hospital and be readily available at all times.” In addition using dental radiography will reduce the likelihood of missing pathology (particularly significant with, for example, pre-existing disease affecting the bone of the mandible resulting in weakness that becomes a fracture during a dental procedure!) or providing incomplete or ineffective treatment (for example failing to completely extract a tooth and leaving in tooth fragments).