Dr. Amy Thomson joins us to discover non-anesthetic dentistry and consumer communication, tackling frequent fears about anesthesia and the significance of clear language in veterinary care. Be taught from her experience as she and Dr. Andy Roark talk about how you can successfully handle instances like Nico, a Chihuahua with good enamel however unhealthy breath on this week’s episode of the Cone of Disgrace Veterinary Podcast. Don’t miss these essential insights that would remodel your method and elevate your observe. Let’s get began, gang!
https://www.youtube.com/watch?v=IZsV40DC3gk
You may as well take heed to this episode on Apple Podcasts, Google Podcasts, Amazon Music, Soundcloud, YouTube or wherever you get your podcasts!
LINKS
American Veterinary Dental School: https://avdc.org/
Veterinary Dental Discussion board: https://www.veterinarydentalforum.org/
Amy Thomson IG: https://www.instagram.com/toothy.thomson/
Referenced Obi Vet Course: https://obivet.com/product-category/certificates/
VetHive:https://www.vethive.com
Amy Thomson web site: https://toothythomson.ca
ABOUT OUR GUEST
Dr. Amy Thomson, typically referred to as “Toothy,” is keen about enamel! Nevertheless, it was not at all times this fashion—she began her profession in small animal observe with very minimal dentistry information. She was lucky to have a terrific mentor in her first job, the place she discovered rather a lot and her need to study extra grew. As soon as she attended her first Veterinary Dental Discussion board in 2013, she KNEW dentistry was her ardour—and have become affectionately referred to as “Toothy Thomson.”
With time and help from her household, pals, colleagues, and a giant ‘shove’ from her mentor, she utilized for a dentistry and oral surgical procedure residency and was overjoyed when she matched on the College of Wisconsin-Madison. Throughout her residency, her ardour grew not just for dentistry but in addition for instructing. And since life is at all times filled with surprises, Dr. Thomson discovered herself at a crossroads in 2020 within the early levels of the pandemic—so she began her personal cell dentistry observe!
Along with working alongside small animal normal observe groups, she additionally turned very lively on-line, sharing her information. It has at all times been necessary for her to share as a lot as she will be able to, given it took lots of of hours and hundreds of {dollars} to acquire the information she did whereas normally observe. Data she desires to see all veterinary groups have!
EPISODE TRANSCRIPT
Dr. Andy Roark: Welcome everyone to the Cone of Disgrace veterinary podcast. I’m your host Dr. Andy Roark. Guys, I acquired it going for you as we speak. I’ve acquired my pal Dr. Amy Thomson on. She is a boarded veterinary dentist. I’m speaking to her a few bizarre case of a bit of chihuahua whose enamel don’t look unhealthy, however his breath is nasty.
He’s acquired gingivitis. Yep, we’re going to speak about some non anesthetic dentistry as we speak and the way we speak to pet house owners about it. And likewise how can we take care of it whenever you’ve acquired this pet that’s acquired some nasty stuff lurking beneath the floor, however the enamel look good and the house owners assume that they’re that they’re golden.
Anyway, it’s an excellent case. Let’s get into it.
Kelsey Beth Carpenter: That is your present. We’re glad you’re right here. We need to make it easier to in your veterinary profession. Welcome to the Cone of Disgrace with Dr. Andy Roark.
Dr. Andy Roark: Welcome to the podcast, Dr. Amy Thomson. Thanks for being right here.
Dr. Amy Thomson: Thanks for having me. I’m tremendous excited to be right here.
Dr. Andy Roark: It’s my pleasure. I, I’m so excited to have you ever right here. For many who don’t know you, you’re a boarded veterinary dentist. You and I met on the OVMA Conference in Ontario and also you had been talking after me and we simply began speaking and I simply I really like your vitality a lot and like your ardour for what you do exactly radiates by and so I actually I needed to spend extra time with you and type of speak with you and so I’m glad we had been capable of set this up.
Dr. Amy Thomson: It’s so, it’s so great discovering and getting to satisfy you in particular person and yeah, it was a, it was a terrific convention. I used to be tremendous excited to be requested to be part of it after which yeah, getting to attach with you and speak about enamel, which is my favourite factor to do. It’s fairly nice.
Dr. Andy Roark: Yeah, see it’s I, I’ve acquired, I’ve acquired a tooth downside for you, truly, I need to, I need to carry up. So, I’m a 5 12 months outdated male neutered chihuahua named Nico. And so, Nico, Nico’s enamel, after I simply regarded in his mouth regarded okay. However his breath stinks, and he’s acquired some gingivitis. And so, I began asking the house owners about this, like, his breath, and what do you do for his dental well being?
And so they mentioned, properly, we’re very conscientious. Twice a 12 months they do– they name it beauty dentistry. It’s anesthesia free dentistry and it seems like they’ve been getting this service executed for them. And now I’m, I’ve acquired Nico right here and I’m, I’m this canine and his, he’s acquired gingivitis and he’s acquired unhealthy breath and I’m fearful.
I’m going to, I’m going to, they’re going to let me do that. I’m actually fearful that it’s going to be a catastrophe after I get in there. And I’m hoping that you just’ll speak, speak, you’d totally- don’t with me. Inform me I’m not, inform me I’m incorrect. You’re purported to “no it’s going to be positive.”
Dr. Amy Thomson: No, I feel you’re proper. I’m fearful. I’m fearful about Nico’s now, for positive.
Dr. Andy Roark: So, so, inform, how do you deal with this, Amy? Discuss, speak me by this a bit of bit, like, the place’s your head at after I carry you this case, and simply type of, begin at a excessive degree and let’s get all the way down to sort of how I method this, and, and the way do I set expectations with the house owners so I don’t get in plenty of hassle if I do come again to them with one thing they’re actually not going to need to hear?
Dr. Amy Thomson: Yeah, yeah. So yeah, so that is at all times a difficult case and so I assume like taking it type of again I feel it’s actually necessary to love meet these house owners the place they’re at. In order that they actually care about oral well being, which makes me blissful And so I at all times try to begin with acknowledging that. That like I’m very glad that you just’re taking Nico’s oral well being significantly and, you realize, being proactive and having these anesthesia free cleanings executed
clearly exhibits that, you realize, you care and that you just’re wanting to maintain his mouth wholesome. Sadly, this isn’t a good way to do it. And I’ll, and sincere We, I’ve had this dialog and house owners are like, what? Like we thought this was the correct factor and all I’ll validate them and say, completely.
Like if I had been in your sneakers, based mostly on the data that I see on the web these appear nice. It’s, they appear nice since you see the earlier than and after footage and there’s all this calculus after which it’s all gone. The priority or the difficulty is not like you and I that may sit nonetheless. Our pets not often sit nonetheless and definitely not in a method that may enable us to do a deep clear beneath the gums and so Bringing it again to what I’m seeing in Nico’s mouth is regardless of the enamel wanting fairly clear I’m getting this scent and I’m seeing the gums are infected and people are my What I name my purple flags after I look within the mouth to say that there’s there’s issues beneath The floor.
And in order that unhealthy breath or, you realize, I typically joke about we like fancy physician phrases or halitosis. That’s truly risky sulfur compounds and that’s the breakdown of tissue. That we’re smelling. In order that type of not like smells like canned pet food or no matter. We fed them, however that type of unmistakable foul odor or halitosis is proof that there’s illness after which the truth that his gums are diseased or at the least infected says we’ve acquired irritation there and so I can’t say I’m totally shocked as a result of if he’s been getting cleanings on the floor that we are able to see, however not deep beneath the gum.
There might be, you realize, important illness that we’re simply not capable of see when he’s awake.
Dr. Andy Roark: Do you inform pet house owners that scent, that particular scent, is the breakdown of tissue? Do you inform them that?
Dr. Amy Thomson: Generally.
Dr. Andy Roark: That’s fairly intense. Like I, you sort of like, you’re sort of grossing me out like I’m–
Dr. Amy Thomson: I do know it’s gross, however, however I additionally assume it’s necessary I don’t see it as a lot anymore, however there was once that like I haven’t been normally observe for a very long time. It’s been eight, 9 years. So I’m a bit of bit eliminated now, however I do keep in mind after I was in and I’d hear like, Oh yeah, they’ve acquired a bit of little bit of doggy breath.
And, and I simply assume like we talked about once we met, it was like, I’m a giant stickler for language and nomenclature and I don’t know, doggy breath sounds cute, however like what we’re smelling is, is proof of illness. So, it a bit will depend on the dialog I’m having with the proprietor, however I’ll acknowledge that like that scent that we’re smelling is indicating that there’s deeper illness occurring.
Mm hmm.
Dr. Andy Roark: You, you’re a stickler for language. Discuss to me actual fast, we’re simply gonna take a bit of, a bit of aspect tangent right here. You don’t like, you don’t just like the time period dental illness. You just like the time period periodontal illness.
Dr. Amy Thomson: I don’t
Dr. Andy Roark: Inform, inform me why that’s. I, as a result of I, like, I at all times say like, ’trigger I, I really feel just like the pet house owners get it after I say dental illness, however put push again on it.
Inform me, assist me, assist me perceive.
Dr. Amy Thomson: I’m blissful to So I not too long ago put collectively a lecture for the veterinary dental discussion board known as dentistry soiled phrases And in order that’s prime of the like one of many prime of the record of the the phrases that I feel are unhealthy soiled phrases we should always cease utilizing and the reason is is that for me if I’m making an attempt to love Perceive speaking with house owners if I say it’s dental illness, meaning there’s an issue with the tooth And also you, hopefully you, properly possibly not hopefully, however I’ve heard this rather a lot and I get plenty of nods after I lecture of like who right here has heard, you’ve made a advice, the enamel are fairly unhealthy, we have to get in and clear and possibly extract, after which possibly we get a name again from the proprietor and be like don’t fear doc, the tooth fell out, we’re all good.
Dr. Andy Roark: Yeah, positive.
Dr. Amy Thomson: Yeah, so once we name it dental illness, it’s not, I don’t assume it’s unrealistic for the proprietor to say, Oh, the tooth is an issue. The tooth is gone. The issue’s gone. Um, And so I do assume utilizing the suitable time period of periodontal illness and discussing that it’s the basis floor of the tooth, nevertheless it’s additionally the gum, the bone and the ligament which are diseased to assist perceive why it’s so necessary to do the examination beneath anesthesia, to do the x rays, after which to ensure that we take away the tooth debride that space and shut it up.
I do discover, personally, I get extra reception from house owners of understanding the significance of say x rays or doing this beneath anesthesia sort of factor
Dr. Andy Roark: Do you assume that worry of anesthesia is the primary purpose that we are inclined to see these beauty dentistries coming in the place the tooth root under the gingival line has not been taken care of? Is that, is that, is that, in your opinion, is that what actually drives it?
Dr. Amy Thomson: Completely that’s been my expertise each after I was a normal practitioner now as a dentist oral surgeon taking referrals, after which I do plenty of like on-line training. And so you need to watch out with issues on-line, like social media. There’s a lot of folks that may sort of chime in. And yeah, there’s a, there’s a large worry of anesthesia.
And I feel being terrified of anesthesia is, you realize, necessary. I don’t, I’m not, I’m not right here to say we shouldn’t be fearful. I imply, I, I, I inform all of my house owners, anesthesia is just not a benign therapy. So there’s at all times going to be a threat, albeit for many wholesome sufferers, it’s, you realize, lower than 1%. And people who have comorbidities there’s a lot of issues that we are able to do so far as working up coronary heart illness, kidney illness to make it as protected as potential.
After which we now have. The great people who find themselves board licensed anesthesiologists who can handle the upper threat anesthesia. So, I’d say at the least half, if not two thirds of my sufferers have kidney illness, coronary heart illness, or typically each, yeah, however, however it’s, house owners are afraid, and I feel that worry, I don’t assume anybody’s doing it on goal, nevertheless it’s virtually like this worry mongering of like, you need clear enamel, which we speak concerning the significance of oral well being, however you don’t need your pet to die, so right here’s the answer.
The issue is that whereas we’re avoiding anesthesia, we’re not truly treating illness of their oral cavity and probably we’re making it worse as a result of the enamel look clear and so we’re not clued into the truth that truly under the gum line there’s issues.
Dr. Andy Roark: Hey guys, do you want that your staff was higher at dealing with battle administration? Are you a pacesetter, a medical director, a observe supervisor, a observe proprietor and affiliate vet that desires to not solely have the ability to deal with battle very well in your staff, but in addition to have the instruments to coach your folks in order that they’ve these conversations extra gracefully with one another.
Would you wish to work at a spot the place we’re. We’re not sniping at one another. We’re getting alongside and speaking successfully. Guys, we are able to make that occur for you. I and the uncharted staff can be on the hive occasion in Minneapolis is June fifteenth and sixteenth. We’re having in the future. Battle administration coaching program.
So will probably be, my staff can be there’s by uncharted. And so it’ll be in the future of working with me and Stephanie Goss and Maria Pirita and we can be breaking down workshops on battle administration and you’ll drop in. You will get a day, you possibly can spend the opposite day on the Hive convention.
It’ll be a fully improbable time, guys. Ah, I’m going to place a hyperlink within the present notes, head over there, test it out, seize your spot. This isn’t sit and be lectured at. That is spherical desk workshop dialogue format the place you get your fingers soiled. You get all the way down to the weeds. We speak about what these techniques seem like in our groups, in our practices.
And we stroll away on the finish of the day with actual abilities to vary the tradition. In our observe guys, that is an funding in your self is an funding in your staff. It’s an funding in your happiness and in your office. Don’t miss the chance. It could not come round once more. This can be a nice probability to work with us and to essentially stretch and increase your thoughts.
And I promise you’re gonna have a good time, gang. Once more, June fifteenth and sixteenth in Minneapolis. Hope to see you there. Let’s get again into this episode.
Dr. Andy Roark: So, so, bringing this again to Nico. So, 5 years outdated appears younger to me to have, particularly, you realize, once they’ve, they’ve, they’ve, they’ve been attentive of their option to his, to his oral well being. I’m type of shocked this. Are you able to type of lay down your method to this case? So, I haven’t executed any diagnostics right here, however I’ve acquired Nico.
I’m making an attempt to set expectations. How would, how would you method this case from right here? So stroll me by sort of what your sport plan could be, for those who don’t thoughts.
Dr. Amy Thomson: Yeah, yeah, so once more, I’d acknowledge that, like, I feel it’s nice that they’re, like, taking an lively method and having his enamel cleaned. The priority is, is that regardless of the enamel wanting clear and being freed from plaque and calculus, there’s that, you realize, unhealthy breath, illness, I name it illness breath as an alternative of doggy breath.
I don’t at all times possibly get as graphic as that.
Dr. Andy Roark: Yeah, precisely. Yeah
Dr. Amy Thomson: and, and the truth that his gums both look a bit of bit darker pink or purple, possibly a bit swollen. Positively these are my two indications that there’s a deeper illness occurring. And so the guess, I’d clarify to the proprietor, the one option to know the extent of this illness, sadly, is to do a tooth by tooth examination, identical to our dentist does in our mouth, and take these x rays.
After which I’ll typically joke round like, I want we may try this awake, and he would simply sit and go, ah, however sadly that’s going to require anesthesia. So I’d actually wish to get him scheduled in so we are able to unravel this, you realize, unhealthy breath, diseased breath, infected gums and work out if that is, you realize, hopefully we’re at a degree the place we’ve acquired plenty of buildup beneath the gum tissue that must be cleaned, however we don’t have important bone or ligament loss or lack of these periodontal tissue constructions the place a deep cleansing is sufficient.
Nevertheless, given his age and his measurement and probably, you realize, the scent or, or what you’re seeing we could discover that, sadly, regardless of on the floor being clear, there’s been particles and illness beneath, and, and he may very well require extractions, however the one option to know for positive is to get these diagnostics, which, which would require anesthesia.
Dr. Andy Roark: Gotcha. Okay. Do you’ve any considerations about every time I’ve these small canine and I’m working of their mouth and I’m involved about type of important, periodontal illness, issues like that do you’ve any considerations about tooth extraction in tiny canine, issues like that? I imply, simply if, if this has been occurring and we’ve acquired important dental illness once we get in there, I’m, I’m fearful about breaking these little canine, you realize what I imply?
Like, like I’ve, I’ve seen these little jaw bones which were type of deteriorated. I’ve, I’ve seen them simply snap and
Dr. Amy Thomson: Yeah. And so they’re identical to, they’re so little.
Dr. Andy Roark: So little and I don’t know. Is that worry fully un I can’t be, no it’s not fully unfounded, however like, is there, is there something that I ought to be notably conscious of or something that you are able to do to assist me sort of defend myself if I do get in there and I discover that the, there’s simply been horrible deterioration of, of, of the jawbone, issues like that.
Any ideas or methods for me?
Dr. Amy Thomson: To not get all nerdy, however there’s publications to say that as our we bred canine to get smaller and smaller, they don’t proportionally have smaller enamel. So smaller canine even have extra of the quantity of their jaw taken up by enamel. So that may create a difficulty when you’ve like a comparatively huge tooth.
I used to joke my little chichi, raisin nostril. I used to joke. She was just like the masks with the actually huge enamel, just like the small little job, huge enamel. And so it’s, it’s fairly frequent. So then for those who think about you’ve this actually huge tooth on this small jaw and then you definitely begin eradicating jaw, whenever you begin to take away these enamel, you’re placing a good quantity of torque on the jaw to get this huge tooth out.
And so, I feel, And I’ll at all times say I mentioned it rather a lot over OVMA is it’s necessary so that you can be comfy. So for those who get right into a mouth and also you go that is method worse than what I assumed Above all else do no hurt like we take our oath is simply let the house owners know, you realize, that is worse than what? We had thought and that i’m involved with the quantity of bone loss and you realize, the dimensions of Nico. However there might be a threat that I may do some injury to his jaw.
And I simply assume it could be higher within the fingers of a colleague or, you realize, maybe we’ll do a part of the work, however then come again due to course, relying in your clinic you might be scheduled for surgical procedure after which in appointments. And the very last thing you need to do with tooth extraction is try to rush.
Trigger then I discover when folks rush, they get nervous. They use a bit extra drive. We’re extra in danger to having issues occur. So I’d simply give everybody permission to say it’s okay to say like I’m not comfy with this since you need to do what’s greatest for this pet. After which my little tip for that’s I’m an enormous large fan of one thing known as horizontal elevation.
So I discover people who that had like a dentistry program in vet college or have gone to programs, I do discover there’s plenty of what we name vertical elevation. So if that is just like the tooth root, we put the instrument in down alongside it and we rotate which is, which is nice. And one, approach in my toolbox.
The, in order that’s vertical. It’s alongside the lengthy axis. However horizontal, I discover useful in say like these huge molars and these small canine with the small jaw is for those who truly say these are your two roots or two crown root segments, I put my winged elevator in between so perpendicular. After which after I rotate, I’m stretching the tooth in opposition to tooth and I’m placing much less torque on the jaw whereas I help that jaw. And so, much less possible not inconceivable however much less prone to trigger iatrogenic jaw fracture to that jaw since you’re not placing a ton of torque on that small jaw that’s probably diseased.
Dr. Andy Roark: No, that completely is sensible. Okay, I really feel like I acquired a plan right here. I feel I understand how to method this. Any final phrases of recommendation for me? Something that you just, that you could possibly foresee that I’d need to keep away from so far as a pitfall or ensure that I do properly?
Dr. Amy Thomson: I feel you’ve an excellent plan. I simply assume like open communication and identical to understanding that, you realize, It’s quite common for house owners to really feel like these anesthesia free cleanings are of their canine’s greatest curiosity as a result of they’re fearful of anesthesia And so they understand how necessary oral well being is and possibly at most of their pets go to The vet is speaking concerning the significance of oral well being So I feel simply letting them know that like we all know they had been doing what they felt was greatest and sadly There’s simply not sufficient of us having the ability to be the voice on the market to say that that these anesthesia free pains, whereas they keep away from anesthesia very a lot restrict in what we are able to do.
We will’t do diagnostics. We will’t do true, you realize, therapeutic therapy. And so simply speak to them about, you realize, we could discover that we now have to extract a number of enamel from Nico, however he’s going to be more healthy. After which when he comes again, I at all times inform house owners, as soon as he comes again at two weeks, I at all times see all my sufferers at two weeks, ensure that they’re therapeutic.
Then let’s speak about issues which are going to be actually useful that you may be doing. In order that we don’t sort of get into this example sooner or later. There’s at all times a tooth brushing dialogue and demo. After which we’ll speak about, you realize, setting expectations for COHATs, or Complete Oral Well being Evaluation and Remedy which is the cleansing the x rays beneath anesthesia.
And, and speak to them about what’s real looking for them to really feel comfy doing, each from an anesthetic standpoint, general pet well being, price and simply type of work collectively to make a plan. And, and allow them to know, you realize, I’ll have suggestions, however this, this must be a staff effort for Nico.
Dr. Andy Roark: Yeah, that completely is sensible. Thanks a lot for being right here. Amy, do you’ve any favourite sources for anyone if individuals are like man, that is my jam I really like I really like I really like dental well being. I imply you’re that is your ardour. What are your favourite..
Dr. Amy Thomson: I adore it.
Dr. Andy Roark: Sources?
Dr. Amy Thomson: Yeah,so, the veterinary dental discussion board that type of like that was like Christmas for me and is yearly I’ve been I don’t know. I feel it’s like 11 years in a row now I’ve been, I’ve gone, or I’m developing on my eleventh discussion board. Misplaced monitor. However I went there early on in my profession and it’s such a tremendous weekend.
So it’s three full days of lectures. It’s damaged up between type of, newbie, intermediate, superior. There’s observe administration collection. There’s technician collection. After which there’s a bunch of moist labs and it’s identical to a complete bunch of tooth nerds which are simply actual excited to speak about enamel.
And you may simply actually be immersed in that. And I at all times discover like, even now I’ll, I’ll nonetheless study issues after I go. And, and it was attention-grabbing as a result of after I was lecturing there final, final 12 months I used to be additionally a moderator and, and listening to different diplomates speak about issues that I speak about, you’re like, oh, it’s attention-grabbing they use that instrument a bit of bit in a different way.
So, it’s identical to an enormous wealth of data. So for those who’re accessible and might go, it’s usually within the fall, it strikes across the continental U.S. It’s in Palm Springs this 12 months on the finish of September. So a fairly good locale location. And, It’s a ton of CE. Positively love that.
After which the AVDC web site or the American Veteran Dental School has plenty of sources for ongoing CE and issues like that. Which is admittedly useful for those who’re in search of extra. That’s type of the place I began many, a few years in the past, getting my training.
Dr. Andy Roark: That’s superior. Properly, thanks a lot for sharing that. I’ll put hyperlinks on the present notes guys. Thanks for being right here. Amy. Thanks for being right here. Deal with yourselves everyone. Yeah
And that’s what I acquired for you guys thanks for tuning in. I hope you loved it. I hope you bought one thing out of it. Because of Amy for being right here and sharing her pearls of knowledge. Yeah, I actually respect everyone’s time. I respect your time and her time and Dustin’s time who produces our episodes. It’s like don’t overlook Dustin.
And so anyway, everyone seems to be appreciated within the making of this episode. Anyway, guys, I’ve had sufficient. It’s been a day. I’m going dwelling. Deal with yourselves, everyone.
