2019 AAHA Dental Care Guidelines for Dogs and Cats
Dental procedures - Considerations
Nonsurgical dental procedures must be performed by a licensed veterinarian, a credentialed technician, or a trained veterinary assistant under veterinarian supervision in accordance with applicable state or provincial practice acts. Oral surgery, including surgical extractions, must be performed only by trained, licensed veterinarians. State-by-state regulations concerning what licensed technicians can perform are summarized here.
Anesthesia allows the practitioner and assistants to carry out dental procedures in a safe and effective manner, minimizing the risk of injury. Anesthesia recommendations and techniques are discussed in the “Anesthesia, Sedation, and Analgesia Considerations” section.
All dental procedures need to use a consistent method to record pathological findings, recommended treatments, treatment performed, and treatment declined, as well as future planned treatment and prevention recommendations in the medical record.
Practitioners should be aware that transient bacteremia from the oral cavity is commonplace and increased during oral procedures, and therefore, risk for seeding other remote surgical locations is possible. Combining dental and other surgical procedures should be performed with caution. The risk of multiple anesthetic events should be weighed against the risk of complicated healing in the presence of significant periodontal disease.37
Positioning and safety of the patient is important. The head and neck should be stabilized when forces are being applied in the mouth. The use of spring-loaded mouth gags must be avoided as it may compromise blood flow, which may cause myalgia, neuralgia, blindness, or trauma to the temporomandibular joint. If a mouth prop is necessary, do not fully open the mouth or overextend the temporomandibular joint.38
Whenever possible, practitioners and assistants should demonstrate healthy ergonomic practices to avoid chronic injury. Activities and procedures that cause excessive reaching, bending, and twisting should be limited. For example, instruments and equipment should be arranged where they can be easily grasped. Supplies should be placed as close as possible to the working area and at working height to decrease stretching and bending. Sufficient space should be allowed to enable turning the whole body, using a swivel stool.