PREPARATION FOR ORAL AND DENTAL PROCEDURES
Dentistry procedures are often thought of as frustrating, but most frustrations can be avoided by adhering to the following recommendations.
2.1 Patient restraint
General anaesthesia is essential to perform a through oral examination and for any dental procedures.
Intubation (cuffed endotracheal tube) and maintenance on a gaseous anaesthetic is important to achieving an adequate depth of anaesthesia (this cannot be done using a mask alone) and to prevent aspiration of fluid and blood that may accumulate in the laryngopharynx.2.2 Patient positioning
There is no right or wrong way to do this. Some clinicians find the placement of patients in lateral recumbency to be most comfortable. However, the author prefers either dorsal or sternal recumbency for most cases (Fig. 13.2a, b). This typically grants access to the entire oral cavity without having to turn the patient. These positions also allow the clinician to maintain an ergonomic posture. For patients with a small gape (e.g. macropods, wombats, koala [Phascolarctos cinereus]), cheek retractors and a mouth gag are very helpful (Fig. 13.2c, d).
2.3 Appropriate light source
Appropriate lighting is essential for examining the oral cavity of any species; however, diprotodont marsupials in particular have long narrow oral cavities and a narrow gape, making visibility difficult. A good light source in the form of a headlamp (with or without magnification loupes) and a high-speed handpiece with fibre-optic lighting makes an enormous difference (Fig. 13.2a).
2.4 Dental radiography
Radiography not only plays a pivotal role in diagnosing dental and oral diseases but it is also crucial for treatment planning. The normal root structure in certain Australian mammals is described and radiographically illustrated in Fiani (2015). Although knowledge of the anatomy is critical, the clinician cannot predict changes to each individual patient’s root structure due to pathological processes or anatomical variation without the use of radiography.
Intraoral radiography provides superior visualisation of teeth by eliminating superimposition of
Fig. 13.2. (a) Swamp wallaby (Wallabia bicolor) in sternal recumbency undergoing an oral examination. The clinician is wearing a head lamp and magnification to improve visibility. (b) Tasmanian devil (Sarcophilusharrisii) in dorsal recumbency during an oral surgery procedure. Gauze swabs on a brightly coloured cord are used as a pharyngeal pack to prevent fluid accumulating in the laryngopharyngeal area. (c) Swamp wallaby in sternal recumbency with the mouth held open using an adjustable rabbit/rodent tabletop mouth-gag and long cheek dialators (iM3, Lane Cove, NSW). (d) Intraoral view of a common wombat (Vombatus ursinus) during oral examination. Photos: Taronga Zoo
structures; however, if it is not available, or difficult to use (e.g. patients with very narrow gape and long, narrow oral cavities or very small mouths), extraoral radiography using oblique projections is also useful (Vogelnest and Allan 2015).
2.5 Appropriate equipment
The use of correct and well-maintained equipment (e.g. sharp elevators) can dramatically reduce frustration. Some examples of helpful equipment include: rabbit incisor and premolar/molar luxators; surgical length burs in the high-speed handpiece for long, narrow mouths; adjustable rabbit/rodent or purpose-made tabletop mouth-gags and long cheek dilators (Fig. 13.2); and suction to remove fluids, which helps reduce the risk of aspiration and improves visibility.
3.