Concern with anesthesia-free dental cleanings

I read with interest the JAVMA News story by Katie Burns entitled “Below the surface of anesthesia-free dentistry.”¹ I was particularly happy to see that the AVMA policy on anesthesia in veterinary dentistry was quoted, which states that “When procedures such as periodontal probing, intraoral radiography, dental scaling, and dental extractions are justified by the oral examination, they should be performed under anesthesia.”

However, I was surprised to read that Dr. John de Jong, chair of the AVMA Board of Directors, offers anesthesia-free dental cleanings for dogs and cats in his practice under contract with Animal Dental Care Inc. As a veterinary dental specialist, I have spent a great deal of time and effort educating the veterinary community about professional veterinary dental treatment, and I believe that anesthesia-free cleanings provide no benefit to the health of our patients. My advice is to follow the guidelines of the AVMA, American Animal Hospital Association, and American Veterinary Dental College, which all advocate that professional dental treatments, including dental cleanings, be performed by veterinarians with the animals under general anesthesia.

Daniel T. Carmichael, dvm

Veterinary Medical Center of Long Island

West Islip, NY

More on anesthesia-free dental cleanings

I wanted to respond to those who were surprised to read that my hospital offers anesthesia-free cleanings for dogs under contract with Animal Dental Care¹ and who were concerned that, as chair of the AVMA Board of Directors, I might be speaking for the AVMA in sanctioning this practice or am opposed to the current AVMA policy. I can appreciate that sensitivities were touched and want to emphasize that, in this instance, I was speaking entirely on my own behalf.

The AVMA has many policies on a wide range of topics, and members may not necessarily agree with any given AVMA policy. In this instance, I asked members of the AVMA Council on Veterinary Service for their interpretation of the AVMA's veterinary dentistry policy and was informed that while the policy was suggestive, it was not prohibitive.

As is the case for many others, I was initially highly skeptical that conscious dental cleanings had a place in veterinary medicine. When I saw the procedure firsthand, however, I was impressed by the professionalism, thoroughness, and skill of the technicians who performed it. These technicians work only with and under the direct supervision of veterinarians and promote regular dental treatment under general anesthesia with full-mouth radiography. They are well trained and able to achieve thorough charting and cleaning in those patients amenable to the procedure. Note that I do not approve whatsoever of this type of work being done by less-qualified individuals or absent the supervision of veterinarians.

The major question, of course, is whether conscious dental cleanings can improve the oral hygiene of patients, without causing any harm. Given my experience, I believe they can. Importantly, at my practice, we use conscious dental cleaning as an adjunct and intermediary option. We typically offer this procedure for young, healthy pets without overt signs of progressive dental or gingival disease, and we always offer and encourage dental cleaning under anesthesia first. More often than not, conscious cleanings help build awareness of the importance of dental health and act as a gateway to anesthetized dentistry later. Not infrequently, a conscious cleaning is stopped and anesthetic dentistry is scheduled because of identification of previously unrecognized dental problems. I can imagine performing conscious cleanings once or twice a year, starting at 1 year of age, and through a pet's early life. Might that early intervention, by engaging clients at the outset, make a huge difference in preventing decay, extractions, and more? I believe our patients and the profession deserve to find out.

At this year's North American Veterinary Community meeting, the AVMA convened leaders, pro and con, who agreed that we need to study this issue more thoroughly and develop sound science to determine whether there is a place for conscious dental care in veterinary medicine. If so, there needs to be a standard of care based on defensible evidence. Soon, colleges of veterinary medicine will be asked to undertake studies of this procedure. We are also planning a roundtable at the AVMA convention this summer to discuss the matter further.

I want to thank those individuals who have reached out to me on this issue and encourage others to contact me so that we can continue this important discussion.

John de Jong, DVM

Newton, Mass

Urging AVMA BOD support of the Equality Act of 2015

We wish to bring attention to a bill currently before Congress that we believe directly affects the AVMA membership. The Equality Act of 2015 (H.R. 3185/S. 1858)¹ was introduced in the House and Senate on July 23, 2015, and would amend the Civil Rights Act of 1964 to prohibit discrimination on the basis of sexual orientation and gender identity in education, employment, housing, credit, and Federal jury service and prohibit discrimination in public accommodations and federal funding on the basis of sex, sexual orientation, and gender identity. The AVMA Board of Directors approved a recommendation of support during its November 2015 meeting.

In keeping with its strategic goals, the Lesbian and Gay Veterinary Medical Association (LGVMA) hopes to raise support for this bill within the veterinary profession. Members of the AVMA should understand that, despite last year's Supreme Court ruling legalizing same-sex marriage in all 50 states, 31 states still lack clear, fully inclusive, nondiscrimination protections for lesbian, gay, bisexual, and transgender (LGBT) people, including LGBT veterinarians and staff members. This means, for example, that in many states, lesbian or gay veterinarians or veterinary technicians who get legally married risk being fired from their jobs or evicted from their homes simply for posting their wedding photographs online. Unfortunately, this is not simply a hypothetical concern, in that we personally know individuals within our profession who have faced this type of discrimination.

The Equality Act of 2015 would not only protect LGBT veterinarians and staff members from discrimination in hiring and firing, it would also protect LGBT students hoping for job security as they enter the work force and prevent LGBT clients from having their animals refused service simply because those clients are open about their identity.

We encourage the AVMA Board of Directors to consider taking a position of “active pursuit of passage” for the bill, which would make its passage a high priority for the Association and direct the AVMA's Governmental Relations Division to expend greater resources toward that end. We believe this is fitting for a bill guaranteeing equal rights for all colleagues in the veterinary profession. We also believe that passage of the Equality Act of 2015 ties directly to the AVMA's 2015–2017 Strategic Plan.² Two of the Association's core values identified in the plan are inclusivity and member-centricity, and the plan identifies diversity and retention as a key result area by which the Association will assess its efforts to enhance member value. Thus, we believe that the AVMA should fully embrace its LGBT members by supporting “active pursuit of passage” of the Equality Act of 2015.

Sandy Hazanow, dvm

Michael Chaddock, dvm, eml

Michael McGuill, dvm, mph

Paige Carmichael, dvm, PhD

Advocacy Team

Lesbian and Gay Veterinary Medical Association

Incentive to improve dog behavior

During my more than 50 years as a veterinarian, I observed that many dog owners didn't spend the time or effort needed to train their pets in basic obedience. A novel idea I would consider implementing—were I to return to clinical practice—would be to post a sign in the waiting room stating that any dog first seen at our clinic as a puppy that subsequently earned the Utility Dog obedience title from the American Kennel Club would receive free service for the remainder of its life. The number of dogs that achieve the Utility Dog title is small, but think of the incentive for clients. And think of how nice those dogs (even the ones with limited training) will be for their veterinarian, their owners, and society. One or two animals receiving free service will not hurt financially, and you might get some good publicity.

Lawrence F. Fisher, dvm, PhD

Noblesville, Ind

The importance of puppy socialization

I am writing this letter to call to my colleagues' attention the fact that the AVMA has recently made available valuable new resources regarding the importance of early puppy and kitten socialization.¹

In addition to a podcast and video, included on this web page is a literature review on socialization of puppies and kittens that provides not only an excellent description of the benefits of puppy and kitten socialization to the animals themselves but also detailed instructions on how to properly perform socialization. This letter is to call attention to the less frequently discussed benefits of early puppy and kitten socialization: those to veterinarians and the veterinary profession.

Intuitively, anything that reduces the number of pets relinquished and subsequently euthanized improves the overall economics of the veterinary profession. In this vein, a study² of adult dogs adopted as puppies from a humane society reported higher retention in the adoptive home for dogs that had participated in puppy socialization classes than for those that had not. Even for dogs retained in their homes, fear of veterinary service may cause owners to delay or avoid veterinary visits, resulting in economic loss to the practice in addition to poorer quality of life for the pets.

For some veterinary practices, offering in-clinic puppy socialization classes represents not only a new profit center, but a way to ensure that puppies receive appropriate socialization and that pet owners become bonded to the practice. Those practices without the resources to hold their own classes should consider developing relationships with local professional dog trainers who provide puppy socialization classes and reward-based dog training, as these relationships can be a source of mutual client referrals.

Well-socialized pets are generally less fearful and less aggressive than pets that were not appropriately socialized and therefore less likely to cause injuries to veterinarians and their staff members. According to a study³ of veterinary practices in Minnesota, approximately a third of all veterinarians and veterinary technicians have sustained an animal-related injury at some point during their career. It seems likely that at least some of these injuries were inflicted by pets because of fear resulting from suboptimal socialization. Well-socialized pets tend to be friendly to veterinary staff and easy to handle, thus increasing clinical safety and efficiency.

No owner seeks to live with a pet that is aggressive or has other behavior problems. Socialization is sometimes referred to as psychological vaccination because it represents one of the best ways to prevent veterinary injury and pet behavior euthanasia.

Rolan Tripp, dvm

Vancouver, Wash

Exposure of dogs to electronic cigarettes

Electronic cigarettes (also known as e-cigarettes, e-cigs, personal vaporizers, and electronic nicotine delivery systems) are battery-powered devices that contain a solution of nicotine, flavorings, and other chemicals (eg, propylene glycol and glycerol) that is heated to produce a vapor that users then inhale.^1–3 Refill containers are available in a variety of sizes and concentrations.²

Since at least 2009, US poison control centers have been receiving reports about potentially serious exposures to electronic cigarettes and the refills, with the number of exposures increasing since that time.^4,5 Most of the affected individuals have been young children, and the most frequently reported clinical effect was vomiting.^2,4,5

Pets may also be exposed to electronic cigarettes or their refills. The Veterinary Poisons Information Service in the United Kingdom has reported on 20 ingestions by dogs.⁶ The most common clinical effects were vomiting, hypersalivation, lethargy, diarrhea, hyperthermia, and ataxia.

Although its primary activity is to manage human exposures, the Texas Poison Center Network received 11 calls about pet exposures (all related to ingestion by dogs) involving electronic cigarettes or their refills from 2009 through 2015. By comparison, there were at least 902 reported human exposures during the same time period. All of the calls related to pet exposures appear to have come from the dog's owner or caregiver, and all of the exposures appear to have occurred at home. The only initial clinical sign reported was vomiting, which was reported in 3 of the 11 dogs.

Texas Poison Center Network staff generally do not manage animal exposures but may refer callers to others who do. For these exposures, 5 (45%) of the callers were referred to a veterinarian, 2 (18%) were referred to an animal poison control center, 3 (27%) were referred to both, and 1 (9%) was not referred for further information because the dog did not have any clinical signs.

The Texas Poison Center Network's experiences suggest that, as is the case for young children, electronic cigarettes and refills should be kept out of the reach of pets. Until there is more information on the effects of ingestion in animals, especially dogs, owners of animals that have been exposed should probably be referred to an animal poison control center or veterinarian for management.

Mathias B. Forrester, bs

Epidemiology and Disease Surveillance Unit

Texas Department of State Health Services Austin, Tex

The harm of recruiting in veterinary medicine

I recently learned that two of my staff members—a veterinarian and a veterinary technician—have been contacted by a recruiter for a nearby emergency and specialty center that is expanding. I understand recruiting employees from competitors is common in the business world, but this comes at the same time when all of the emergency and specialty centers in our area have been making efforts to build and nurture relationships with the primary-care hospitals that refer patients to them. Our metropolitan area has a large number of high-quality primary-care hospitals and specialty centers all vying for what appears to be a shrinking pool of qualified employees. Attempts to recruit employees from nearby practices threaten to harm the relationship between primary-care hospitals and specialty centers.

A few years ago, Milton Wyman, a veterinary ophthalmologist, called on veterinary specialists to scrutinize their own behavior within this collaborative relationship and recognize that general practitioners justifiably worry they will lose their clients to a specialty center once a referral has been made. More recently, the suggestion has been made that because of the growing number of specialists, specialty boards should work with state veterinary boards to encourage the use of specialists.

Both parties need each other and should work for a collaborative relationship. As the numbers of general practitioners and specialists grow, it will be fascinating to see what developments arise. From the general practitioners' side of the equation, a growing number of specialists means more options for referral. Then it all comes down to how each of us treats our patients, our clients, our staff members, and our collaborative partners in the delivery of veterinary care.

Bruce Silverman, vmd, mba

Village West Veterinary Chicago, Ill