Position Statements

Veterinary Dentistry

October 21, 2022

Background

1. The CVMA supports the definition of veterinary dentistry provided by the American Veterinary Dental College (AVDC) as being: “...a discipline within the scope of veterinary practice that involves the professional consultation, evaluation, diagnosis, prevention, treatment (nonsurgical, surgical or related procedures) of conditions, diseases, and disorders of the oral cavity and maxillofacial area and their adjacent and associated structures; it is provided by a licensed veterinarian, within the scope of his/her education, training and experience, in accordance with the ethics of the profession and applicable law.” (1)
2. Veterinary dentistry demands extensive knowledge of anatomy, anesthesiology, pharmacology, physiology, pathology, radiology, neurology, medicine, and surgery; all of which are unique to a veterinarian's professional expertise and training. In addition, in all species, knowledge of the etiological basis of oral disease is necessary in order to properly discuss with a client the prognosis, treatment, and preventative procedures (2,3).
3. A professional dental cleaning, also known as COHAT (comprehensive oral health assessment and treatment) (6) requires expert knowledge of normal veterinary anatomy and an understanding of oral pathology in animals in order to conduct a proper assessment, formulate a diagnosis and develop a treatment plan. As such, a veterinarian should perform the examination of the teeth and/or oral cavity. In no circumstances should a veterinarian delegate a dental procedure unless permitted under the regulations of the jurisdiction in which they are licensed to practice.
4. With respect to equine dentistry, the CVMA supports the position of the American Association of Equine Practitioners (4) which states that the following are considered to be veterinary dental procedures and as such should be performed by a licensed veterinarian: " Procedures which are invasive of the tissues to the oral cavity including, but not limited to, • Removal of sharp enamel points, • Treatment of malocclusions of premolars, molars, and incisors, • Odontoplasty, • The extraction of first premolars and deciduous premolars and incisors, • Extraction of damaged or diseased teeth, • Treatment of diseased teeth via restorations and endodontic procedures, • Periodontal and orthodontic treatments, • Dental radiography, • Endoscopy of the oral cavity.”
5. With respect to equine dentistry only licensed veterinarians have the knowledge, training, equipment, and access to tools such as pharmaceuticals (sedatives, anesthetics, antimicrobials, and analgesics) to properly perform dental procedures in a safe and humane manner. Therefore, CVMA holds that all equine dentistry should be performed by a licensed veterinarian within the scope of their education, training, and experience or as defined by the relevant jurisdiction, delegated by them to an appropriately trained individual.
6. As part of the patient assessment a complete physical exam is required. Further diagnostic testing may be indicated prior to sedation, anesthesia, and dental procedures being performed.
7. Dental procedures performed on animals vary by species depending on associated dentition and other species-specific factors (5) but may include: • Oral exam including probing depths and charting of oral findings and treatments. • Intraoral radiography. • Scaling: supra and sub gingival (above and below the gumline), curettage, and polishing of teeth. • Invasive oral procedures including but not limited to extractions of deciduous or permanent adult teeth (including “wolf teeth” in the case of horses), removal of sharp enamel points, treatment and or repair of teeth or malocclusions, surgical procedures of the oral cavity. • Treatments requiring endodontic, orthodontic, periodontal, or restorative procedures. • Biopsy of abnormal tissue.
8. In order to conduct a proper and comprehensive oral examination in any animal species, sedatives or anesthetic agents up to and including a general anesthesia with intubation should be employed. In the case of companion animals, a professional dental cleaning (COHAT) should utilize intraoral radiographs and a general anesthetic with intubation. In equines, a comprehensive oral exam is only possible with the use of sedatives, a thorough oral rinse (to remove foodstuffs retained in the oral cavity), a properly fitted mouth-gag, and sufficient auxiliary artificial lighting directed into the oral cavity. (6).
9. Dental procedures performed on animals often involve the use of sharp instruments and the possibility of oral trauma and or discomfort if the patient is not cooperative and does not remain still for these procedures. The use of physical restraint alone leads to high patient stress and failure of that restraint can lead to either patient or human injury. (7, 8, 9,10). As in the case of oral examinations, dental procedures performed on animals require the use of sedatives and anesthetic agents (in the case of companion animals) to properly assess and treat the patient as well as to support animal welfare.
10. In addition to sedatives/anesthetics, other prescription pharmaceutical drugs are required in veterinary dentistry. The prudent use of such drugs including antibiotics (11) and analgesics allow veterinarians to address animal welfare needs, and to maximize the comfort and safety of veterinary patients as well as likelihood of a successful outcome.
11. The removal of tartar above and below the gumline alone, without a proper assessment of the oral cavity and subsequent consideration of sub-gingival pathology and associated treatment options, does not improve or protect the health and well-being of veterinary patients and presents a risk to animal welfare. The CVMA does not condone anesthesia-free or sedation-free dentistry, including non-professional dental scaling in any animal species.
12. The CVMA endorses the importance of a Veterinarian-Client-Patient-Relationship (VCPR) being in place, as defined by the veterinary licensing body so that communications regarding necessary veterinary dental procedures can be enhanced, expectations defined, and the likelihood of a successful outcome maximized.
13. CVMA strongly recommends that veterinary dentistry be a core part of the curriculum at veterinary colleges and that continuing education opportunities be made available to enable veterinarians to enhance their skills, knowledge, and training in the area of veterinary dentistry (12).
14.  The CVMA encourages veterinarians to refer cases as indicated to a veterinary dental specialist who is a Diplomate of the American Veterinary Dental College (AVDC) (13) or the European Veterinary Dental College (EVDC) (14).
15. The CVMA encourages the continuing development of veterinary technical expertise such as that offered to veterinary technicians through certification by the Academy of Veterinary Dental Technicians (15).
16.  Veterinarians providing dental care and appropriately trained individuals delegated such responsibilities, should regularly update their knowledge, skills, equipment, and instrumentation in the field of veterinary dentistry for the species under their care in order to improve the diagnosis and health management of their patient given changing information and technologies.
17.  In the interest of the public and to protect animal welfare the CVMA strongly encourages veterinary licensing bodies to regulate dental procedures performed on animals within their jurisdictions. Regulations should ensure that such procedures are only performed by a licensed veterinarian within the scope of their education, training, and experience, or delegated by them to appropriately trained individuals, as defined by the jurisdiction.
18. The CVMA recommends that veterinarians address preventive dental care as part of maintaining patient wellness by focusing on educating owners on homecare as well as regular dental maintenance procedures that will be performed by their veterinarian during the life of the animal. Where possible, preventive care and education should be initiated when the animal is young. Such efforts may reduce the need for extensive dental veterinary care as the animal ages and thus improved health and wellness of the animal and reduce patient healthcare costs for the owner. (16, 17).

References

1. American Veterinary Dental College. Available from: https://avdc.org/avdc-nomenclature/.
2. Canadian Veterinary Medical Association. CVMA Surgical Procedures Performed on Animals. Ottawa, Ontario. Revised 2021. Available from: https://www.canadianveterinarians.net/policy-and-outreach/position-statements/statements/surgical-procedures-performed-on-animals/.
3. American Veterinary Medical Association. Policy on Veterinary Dentistry.
   Available from: Veterinary dentistry | American Veterinary Medical Association (avma.org).
4. American Association of Equine Practitioners, Position Statement on Equine Dentistry, 2019. Available from: https://aaep.org/guidelines/aaep-ethical-and-professional-guidelines/aaep-position-statements/veterinary-practice [contained within ‘Veterinary Practice’].
5. Merck Veterinary Manual. Available from: https://www.merckvetmanual.com/digestive-system/dental-development-and-anatomy/dentition-and-dental-nomenclature-of-animals.
6. 2019 AAHA Dental Care Guidelines for Dogs and Cats. Available from: https://www.aaha.org/globalassets/02-guidelines/dental/aaha_dental_guidelines.pdf.
7. World Small Animal Veterinary Association Global Dental Guidelines 2020. Available from: https://onlinelibrary.wiley.com/doi/epdf/10.1111/jsap.13132.
8.  Anesthesia free dentistry. Know the facts. American Veterinary Dental College. Available from: http://avdc.org/AFD/. Last accessed August 30, 2016.
9. Companion Animal Dental Scaling Without Anesthesia, American Veterinary Dental College. 2004. Available from: https://avdc.org/PDF/Dental_Scaling_Without_Anesthesia.pdf.
10.  A Statement on ‘anesthesia-free dental procedures’ for cats and dogs. Available from: https://www.rcvs.org.uk/document-library/a-statement-on-anaesthesia-free-dental-procedures-for-cats-dogs/. Last accessed August 30, 2016.
11. Canadian Veterinary Medical Association. 2021. Antimicrobial Stewardship in Veterinary Medicine. Available from: Antimicrobial Stewardship in Veterinary Medicine | Canadian Veterinary Medical Association (canadianveterinarians.net).
12.  Anderson JG. The State of Veterinary Dental Education in North America, Canada, and the Caribbean: A Descriptive Study. Journal of Veterinary Medical Education 2017;44(2):358-363. Available from: https://doi.org/10.3138/jvme.1215-204R.
13.  The American Veterinary Dental College. Available from: https://avdc.org/.
14.  The European Veterinary Dental College. Available from: https://www.evdc.org/.
15. Academy of Veterinary Dental Technicians. Available from: http://avdt.us/.
16.  Veterinary Oral Health Council. Available from: www.vohc.org.
17.  Foundation for Veterinary Dentistry. Available from: https://www.veterinarydentistry.org/

Additional References

Gorrel C. Veterinary Dentistry for the General Practitioner. 2nd ed. Philadelphia, Pennsylvania: Saunders, 2013.
Reiter, A. Veterinary Clinics of North America (Small Animal Practice), Veterinary Dentistry and Oral Surgery Volume 52, Issue 1, January 2022. Available from:
Veterinary Clinics of North America: Small Animal Practice | Journal | ScienceDirect.com by Elsevier
Holmstrom, Steven E. Veterinary Dentistry: A Team Approach, Third Edition. Saunders, 2018.
Perrone, Jeanne R. Small Animal Dental Procedures for Veterinary Technicians and Nurses Second Edition. Wiley-Blackwell, 2020.
Berg, Mary. Companion Animal Dentistry for Veterinary Technicians 1st Edition. Bluedoor, 2021.
Definitions that pertain to dental care guidelines. Available from: https://www.aaha.org/aaha-guidelines/dental-care/anatomy--pathology/definitions/