Test 2 Flashcards

Question

Dealing with dental costs/ estimates Payment options Presenting estimates Client communication

Answer 1

How to create accurate estimates? How to present the estimate? How to communicate with the client throughout the procedure? How to deal with the invoicing drama at discharge time?

Answer 2

Safety Improvements ●Complete physical ●Anesthesia tailored to individual patient need ○Safer, smoother induction, intra-op, & recovery ○Goals of preemptive multimodal analgesia - Decrease patient risk during anesthesia - Decrease total amount of anesthetic needed ●(i.e. vaporizer flow can be decreased)*** - Prevent dysphoria - emergence delirium/rough recovery - Post-op pain control ●Supportive care throughout anesthesia and recovery

Answer 3

Complete P.E + Kidney and liver functions (UA), cbc/pcv TP, ECG + CXRS Kidneys filter drugs Cbc = hemolysis present/ previous + hydration ECG+ XRS to confirm size/ locations of organs

Answer 4

Providing pain control prior to procedure Reduces pt risk during anesthesia Decreases amount of anesthetic gas used Decreases the total volume of drugs given Prevents dysphoria Helps control port op pain

Answer 5

Patient and drug considerations Pre-pre-medication considerations Anxiety - ^ nausea, vomiting Consider antiemetic agent as “pre-pre-medication” A2 agonists include- xylazine, dexmedetomidine Are very sedating Can cause significant bradycardia *Usually too short-acting to be beneficial in dentistry *Emergence delirium Phenothiazines - Acepromazine Quite safe at lower doses Synergistic Anticholinergic agents Prevent/treat bradycardia, dry secretions ■Contraindicated: ■A2 agonists ●Ex. Dexmedetomidine ■Very stressed ■Tachycardic

Answer 6

•Pulse Oximeter •Capnograph •ECG/EKG •Doppler BP or Oscillometric BP •Temperature •Monitor the patient’s depth of anesthesia - how? •ALL patients undergoing anesthesia should receive IV fluids** - why?

Answer 7

To maintain blood volume + BP + HYDRATION

Answer 8

Passive warming* ●Warm water circulation blanket ●Warm air circulation blanket ●Fluid warmer Watch for heat loss through unexpected sources** *risk of injury

Answer 9

The most important thing to manage and monitor when an animal is under general anesthesia 1. CETT 2. Gravity •Gas exchange only occurs in alveoli Dead space

Answer 10

CETT = cuffed endotracheal tube*

Answer 11

•Dead space: alveoli not eliminating carbon dioxide properly: affects proper ventilation, accumulates in the ET tube if it is too long**

Answer 12

Measuring landmarks for ET tubes •Space between nares –Rough measurement of diameter –Better to palpate the trachea •Incisors to cranial end of sternum “manubrium” –Approximate landmark over tracheal bifurcation ***

Answer 13

Intubation: always have laryngoscope w/ light available. Hold tube w dominant hand + left hand holds scope and gauze which helps to hold the tongue in place/ not slip. Always pull tongue forward. Structures noted are epiglottis, arythnoid cartilage. Confirm intubation via condensation which should go away. If not in the trachea condensation will remain. Incisors to manubrium** land marks for measuring ET tube Endotracheal Tubes ●Securing the tube ●Gauze, umbilical tape, tube ties ●Recycled used IV line set ●Tie behind ears ●Test for leaks Cleaning post-op •Inflate cuff •Wash with warm water and chlorhexidine scrub •Use spiral brush to clean inside of tube •Hang to dry •Storage:

Answer 14

Your intraoral exam begins on intubation Pharynx - press down tongue ●Tonsils (usually in their crypts) ●Pharyngeal mucosa Palatoglossal folds *Don’t forget: occlusal assessment prior to intubation Evaluate the soft tissues Examine the lips ●Lip fold dermatitis ●Ulcerations ●Lacerations ●Tumors Examine buccal mucosa (lines cheeks and lips) Examine alveolar mucosa (lies against bone) Caudal cheek lining “Cheek-chewing lesions” “Tongue-chewing lesions” Determine presence of teeth in each quadrant ●Missing teeth should be radiographed Evaluate the periodontium with a periodontal probe - a miniature intraoral ruler ●Measures sulcus depth, pockets, bone & gingival loss, and helps assess mobility & bleeding

Answer 15

Before Scaling Begins 1.Apply Oral Rinse* Products containing i.0.12% chlorhexidine ii.0.2% chlorhexidine 2. Supragingival calculus removal ●Thick/heavy deposits removed first “debulking” ■Tartar removal forceps (?)/ Sickle scaler ■Ultrasonic scaling for large deposits of calculus ■Then hand scale; pull stroke in coronal direction •Modified pen grasp, triangle/forces •Developmental grooves* 3. Subgingival calculus removal ○+Newer compressor-driven dental machines have narrower tips available and proper power setting to enable subgingival scaling without changing inserts or adjusting power setting+ ○Hand curette is best for deeper pockets* Check your work ●You will have to turn off the overhead lighting to see the effects of 1. and 2. Disclosing techniques* to look for missed plaque & tartar 1.Light 2.Solution 3.Blow air from compressor

Answer 16

Polishing ●not cosmetic ●reduces the surface area attachment for plaque and tartar by smoothing the etchings left in the enamel from previously adhered tartar and scaling *The paste polishes, not the polisher. *Flare the cup gently for subgingival/sulcus space polishing.

Answer 17

Rinsing Air/water syringe* (helps visualize sulcus) ●On compressor driven units ●Can cause air embolism and sub-q emphysema Water filled curved tip syringe Fluoride* - apply to dry teeth, allow contact time, wipe out excess 3 benefits* 1.Hardens enamel 2.Decreases tooth sensitivity 3.Antibacterial

Answer 18

Sanos OraVet

Answer 19

Recover in a safe, quiet, warm area+ –Untie ET tube –deflate the cuff (unless brachycephalic) –leave the tube in until gag reflex is present, then remove gently** –leave in as long as possible especially for brachycephalic breeds* •Tape/bandage roll trick ●Keep warm –Dry the patient (hair dryer set to low works) –Groom face as needed (send pet home looking better than when they arrived) ●Monitor* –Q 5 min until extubated –Q 10 min after extubation –Heart rate and quality –Respiration rate and quality –Temperature –Mentation –+/- BG ●Rotate every 15 minutes (if cannot keep sternal) ●Place in bed with the head lowered in readily visible area ●Check vitals every 10 minutes until standing*) *Extubation time is not related to full recovery and mentation status ●patients are still at risk until return of full mentation and complete ability to stand normally ●(could it be that the increase in mortality in cats is due to us recovering them in an out of the way place? After all, mortality risk is increased in recovery vs. peri-operative…) *What do I mean by quality? ●Rhythm ●Sound ○Is it dysrhythmic ○Muffled, gurgled, etc.?

Answer 20

Disinfect sink/station, dental machine, and hand instruments* ■All touch points ●Light fixture ●Radiology head tube ●Computer keyboard ○Do not use alcohol on any plastic or rubber parts* ○Best to use dilute chlorhexidine solution ○Follow exact cleaning, maintenance, and storage protocols for your dental machines to keep them in proper working order ●Extracted teeth ○Clean by soaking in hydrogen peroxide ○Save for owner ●Any medications to go home? ○Antimicrobials •Chlorhexidine oral rinse ○Antibiotics •Systemic abx usually not necessary* unless immune-compromised/geriatric •*Best time is perio-op (or load w/ Convenia morning of) –Clavamox (all bacteria types)* –Cephalosporins also good (lower cost as well) ○Analgesics - should be considered for all patients except routine cleaning •Cats –Buprenorphine - OTM –Onsior (robenacoxib; NSAID) •Dogs - so many choices: NSAIDS, gabapentin ●Complete and/or transcribe dental chart ○Scan and save to EMR ○Copy for owner ●Discharge instructions ○Recheck examination? ○Diet restrictions? ○Toy restrictions? ○Home care restrictions? ○Include before and after photos

Answer 21

Tartar removal forceps Sickle scaler Ultrasonic scaling for large deposits of calculus Hand curette is best for deeper pockets* Power Scaling

Answer 22

●Any medications to go home? ○Antimicrobials •Chlorhexidine oral rinse ○Antibiotics •Systemic abx usually not necessary* unless immune-compromised/geriatric •*Best time is perio-op (or load w/ Convenia morning of) –Clavamox (all bacteria types)* –Cephalosporins also good (lower cost as well) ○Analgesics - should be considered for all patients except routine cleaning •Cats –Buprenorphine - OTM –Onsior (robenacoxib; NSAID) •Dogs - so many choices: NSAIDS, gabapentin

Answer 23

Instructions pertinent to individual ■Limitations on starting home care ■Appropriate home care recommendations ●Brushing ○When to start ●Rinses ●Chews ●Diets ■Next appointment ●This might be a re-check appointment or a forward-booking appointment (notice how you never leave your dentist without a next appointment?)+

Answer 24

- Oral rinses •Water additives •VOHC***** Product testing - Diets •Hills T/D •Royal Canin •Eukanuba - Chew toys - Powders

Answer 25

Veterinary Oral Health Council: VOHC authorizes the use of the VOHC Registered Seal on products intended to help retard plaque and tartar on the teeth of animals. Any chew toy or treat should be monitored under close supervision* •Anything that you can bend, break in half, crumble, imprint your nail is appropriate ▫Rubber balls, Kongs, and rope toys (cotton not nylon) are appropriate toys •No •hooves, bones, pig ears, antlers •nylabones •Tennis balls are too abrasive --->

Answer 26

Has much to do with making home care accessible/reasonable •Client’s physical ability •Patient tolerance –Can be trained/conditioned

Answer 27

the amount of air that moves in or out of the lungs with each respiratory cycle Considerations: ●The calculation is based on weight ●Wt (kg) x 15ml x 6 / 1000 = x (L) ●So if the weight is increased is the TV increased?

Answer 28

Implementing: Complete PE Individualized ax protocols Venous access with IV fluid support (preferably warm) Airway management Monitoring Warming Supportive care until complete recovery

Answer 29

•Least effective •The block is limited to one localized area of the body •Performed when the animal is under general anesthesia •Ease of administration •Technique •Inject medication into tissues surrounding area needing local anesthesia

Answer 30

•State law regulates if a technician able to perform* •Advantages •Blocks the entire quadrant of the mouth = effective •Great for oral surgery; tumor/jaw removal, major extractions •Can be repeated if the amount given is under the maximum dose 2mg/kg in dogs and cats •Ease of administration •Don’t need a lot of supplies/inexpensive •Disadvantages •Loss of feeling and function to the blocked area could lead to self trauma •Anaphylactic reactions •Permanent nerve damage •Toxicity to the skeletal muscle •Cardiac side-effects •Difficult to assess efficacy

Answer 31

•Caudal Maxillary “Infraorbital” entering foramen •Similar to the rostral approach, only advance the needle more caudal into the infraorbital canal

Answer 32

•Along the gum tissue dorsal to the distal root of 107, 207 (3rd premolar) •Infraorbital foramen *Careful not to inject into/thru neuromuscular bundle

Answer 33

•Infiltrates the inferior alveolar nerve, distal to the mandibular labial frenulum, ventral to the mesial root of the 306, 406 (2nd premolar) *Very difficult to access d/t labial frenulum - “Don’t bother”

Answer 34

•Advance the needle bevel up intraorally along the mandible caudal to 311, 411 in the dog (3rd molar) or 310, 410 & in the cat (1st molar) 309, into the extraoral notch ventral to the condylar process •Extraoral technique also possible •Draw an imaginary line from lateral canthus of eye as a landmark