CVMA-ACMV

Veterinary Dentistry - Position Statement

January 24, 2018

Position

The Canadian Veterinary Medical Association (CVMA) considers that all procedures comprising veterinary dentistry must be performed or delegated and directly supervised by a duly licensed veterinarian. The CVMA acknowledges that supra-gingival scaling and polishing and some other procedures in some species may be delegated by a veterinarian, however, such procedures must always be performed under veterinary supervision in accordance with regulations of the relevant jurisdiction. The CVMA does not support anesthesia-free dentistry.

Summary

  • Veterinary dentistry involves oral health care procedures in any animal species.
  • Veterinary dentistry demands extensive knowledge that is unique to a veterinarian's training.
  • A veterinarian should not delegate the examination of the teeth and/or oral cavity needed to make an assessment, develop a diagnosis and/or formulate a treatment plan, and should not delegate extraction procedures.
  • Where delegation of minor procedures occurs, such procedures must be performed under veterinary supervision and in accordance with the regulations of the relevant jurisdiction.
  • Supra gingival (above the gumline) and subgingival (under the gumline) scaling is the removal of plaque and calculus using specialized instruments. Supra gingival tartar removal without the concurrent subgingival cleaning is cosmetic only and does not offer any health benefits to the animal.
  • Anesthesia-free dentistry does not fulfill the veterinarian’s required standard of care for the animal (see Background 5).
  • The CVMA endorses the importance of a Veterinarian-Client-Patient-Relationship (VCPR) being in place.

Background

  1. Veterinary dentistry involves oral health care procedures in any animal species including all aspects of evaluation, diagnosis, prognosis, treatment, and prevention of any and all diseases of the teeth, oral cavity, mandible, and maxillofacial area and adjacent structures.

Procedures used are species-dependent and may include:

  • intra-oral radiography;
  • scaling (supra-gingival and sub-gingival);
  • adjustment, filing (floating), extraction or repair of teeth, and treatment of related structures, surgical procedures of the head (or oral cavity) whether or not it includes the administration of tranquilizers, sedatives, analgesics, and anesthetics;
  • invasive oral procedures including, but not limited to, in some species, removal of sharp enamel points, treatment of malocclusions of all teeth, reshaping of teeth, extraction of all teeth deciduous or permanent (including first premolars (“wolf teeth” in the case of horses);
  • treatment via restoration or endodontic procedures;
  • periodontal and orthodontic treatments.
  1. Veterinary dentistry is a component of veterinary practice that requires diagnosis and treatment of oral and sometimes maxillofacial pathology, and demands extensive knowledge of anatomy, anesthesiology, pharmacology, physiology, pathology, radiology, neurology, medicine, and surgery; all of which are part of a veterinarian's training (1,2).
  1. An understanding of the pathogenesis of oral diseases in animals is a requirement for making informed judgments regarding their prevention and treatment. A veterinarian should not delegate the examination of the teeth and/or oral cavity needed to make an assessment, develop a diagnosis, and/or formulate a treatment plan, and should not delegate extraction procedures. Where delegation occurs, procedures must be performed under veterinary supervision and in accordance with regulations of the relevant jurisdiction (3).
  1. In all species, knowledge of the etiological basis of oral disease is necessary in order to properly discuss prognosis(es) and preventive procedures with clients.
  1. A comprehensive oral examination is an integral part of the dental evaluation of an animal. In the majority of species, a complete oral examination can only be performed with the use of sedatives or anesthetic agents. In most cases, the evaluation should include dental radiography (4,5).
  1. Most veterinary dental procedures in animals require the appropriate use of sedatives and anesthetic agents, the selection of which is species-dependent. Anesthesia-free dentistry in small animals and sedation-free dentistry in some other species, does not allow for safe evaluation or treatment of the oral cavity, and as such does not fulfill the veterinarian’s required standard of care for the animal (2-6). Pharmaceuticals to manage pain and the judicious use of antimicrobials and other medications are necessary to maximize the comfort and safety of veterinary patients and the likelihood of a successful outcome. The removal of tartar below the gumline alone, without a proper assessment of the oral cavity and subsequent consideration of sub-gingival treatment option, does not protect the health and well-being of veterinary patients.
  1. The CVMA endorses the importance of a Veterinarian-Client-Patient-Relationship (VCPR) being in place, as defined by the veterinary statutory body, so that communications regarding necessary veterinary dental procedures can be enhanced, expectations defined, and the likelihood of a successful outcome maximized.
  1. Veterinarians are uniquely qualified to diagnose oral disease and address unexpected health conditions that may arise during oral examinations and procedures and to prescribe follow-up care. As such, the CVMA strongly supports that veterinary dentistry be a core part of the curriculum at veterinary colleges.
  1. 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) (7).

10. 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 (8).

References

  1. Canadian Veterinary Medical Association. CVMA Surgical Procedures Position Statement. Ottawa, Ontario. Revised July 2014. Available from: https://www.canadianveterinarians.net/documents/veterinary-surgical-procedures Last accessed August 30, 2016.
  1. American Association of Equine Practitioners, Position Statement on Equine Dentistry, 2012. Available from: https://aaep.org/guidelines/aaep-ethical-and-professional-guidelines/aaep-position-statements/veterinary-practice [contained within ‘Veterinary Practice’] Last accessed October 11, 2017.
  1. Equine Code of Practice. Available from: http://www.nfacc.ca/pdfs/codes/equine_code_of_practice.pdf Last accessed August 30, 2016.
  1. Anesthesia free dentistry. Know the facts. American Veterinary Dental College. Available from: http://avdc.org/AFD/ Last accessed August 30, 2016.
  1. A Statement on ‘anaesthesia-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.
  1. American Veterinary Medical Association. Policy on Veterinary Dentistry. Available from: https://www.avma.org/KB/Policies/Pages/AVMA-Position-on-Veterinary-Dentistry.aspx Last accessed October 11, 2017.
  1. American Veterinary Dental College. Available from: https://www.avdc.org/ Last accessed October 11, 2017.
  1. Academy of Veterinary Dental Technicians. Available from: http://avdt.us/ Last accessed October 11, 2017.

Text book references

Gorrel C. Veterinary Dentistry for the General Practitioner. 2nd ed. Philadelphia, Pennsylvania: Saunders, 2013.

Holmstrom SE. Veterinary Dentistry: A Team Approach. 2nd ed. New York, New York: Elsevier, 2012.

World Small Animal Veterinary Association Global Dental Guidelines. Available from: http://www.wsava.org/sites/default/files/Dental%20Guidleines%20for%20endorsement_0.pdf Last accessed October 11, 2017.

(Revised April 2017)