by samantha_ashenhurst | March 15, 2023 10:03 am
While Colleen O’Morrow, DVM, FAVD, DAVDC, came from a family that valued formal education, she acknowledges it took time to find her niche.
While attending the University of Manitoba, Dr. O’Morrow debated several professional avenues, including nursing and social work. Ultimately, a summer job on the production line of a Winnipeg meat-packing plant led to her to the field of veterinary medicine.
“I found I was quite worried about the humane handling of cattle and pigs on the killing floor,” she says. “I knew they were frightened, and I wondered if they were feeling pain.” These thoughts on animal care, husbandry, food production, and, ultimately, pet ownership and care led to wanting to investigate further animal health, disease, and treatments.
O’Morrow attended the Western College of Veterinary Medicine (WCVM), where she obtained her DVM in 1977. From there, she entered general practice Winnipeg and eventually opened a solo practice for several years—but continuing education (CE) ultimately turned her attention to a dental specialty.
“In the early ‘90s, I took a couple of endodontic courses,” O’Morrow says. “In retrospect, they were quite inappropriate to give to general practitioners, but, nonetheless, they opened my eyes to something I had always been interested in, which was dentistry—not for humans, because I always thought that would be pretty gross, but animal teeth and animal dental disease.”
After becoming a diplomate with the American Veterinary Dental College (AVDC), O’Morrow started offering dental services in Winnipeg. These days, she regularly treats patients while working out of an animal hospital in Winnipeg, where she offers cleanings, extractions, other oral surgeries, oral disease medical management, endodontic procedures to include root canals, and even applies orthodontics appliances.
Veterinary Practice News Canada recently spoke to O’Morrow to discover how the speciality of veterinary dentistry has evolved throughout her career and find out why animal health professionals should always investigate what’s causing a canine patient’s bad breath.
When I was at WCVM in the ‘70s, we had a surgery lab on dentistry, which was removing a canine tooth on a fairly large dog. We basically took the tooth out with brute force—there was no surgical flap technique, no proper veterinary dental instruments, and such. That was really the extent of dentistry we had.
In practice at that time, you may do a scaling or chip off calculus with your finger in the exam room, but veterinary dentistry wasn’t widely done. If you had an animal that came in with all of its teeth ready to fall out, you would just pluck them out under anesthesia—and anesthesia was quite different in those days! We didn’t have any of the monitoring we have today for things like blood pressure, spO2, or CO2. We didn’t have thermal support. Anesthesia was often just given by injectable, like sodium pentothal, or gas anesthesia of methoxyflurane. In my early days of practice, this was quite touchy. It wasn’t uncommon to have an anesthetic death. It was very common for animals to feel pain. We didn’t have the education on pain management or the drugs available that, thankfully, exists today.
I certainly wanted to learn more about veterinary dentistry, so I entered the tracking program with the American Veterinary Dental College (AVDC). This was an alternate pathways program—not a formal two-year residency program—and it allowed you to stay in your own practice. This was necessary for me because, at the time, I had my own solo practice. With the program, I needed to put in a certain number of hours with an anesthesia specialist, a surgical specialist, and a radiology specialist. I had to log all my cases in and spend a certain amount of time with different diplomates of the college. I also needed to have a mentor to oversee all of my progress. There was a lot of travelling involved and significant expense on my part. My solo general practice suffered quite a bit because I was away so often.
Nonetheless, I entered the program. Six years later, I was eligible to sit and take the exams, which were quite brutal. It was a multi-day process, with one day of a written and bench exam, and then two days of a timed practical exam where all the different aspects of veterinary dentistry were examined on—orthodontics, oral surgery, endodontics, prosthodontics, and all the different disciplines.
It was a lot of work. I took the exam three times to pass the practical. I remember the last time I took the exam, I worked on about 80 cadaver heads to prepare, practicing different techniques over and over and over. The exams were all timed and my technique needed to be refined.
My exams were held at the dental college in Houston, Texas. Every examinee had to bring all their own equipment—everything that you wanted to use (except for the high speed/low speed torque), you had to bring ourselves. So, we all arrived with huge cases of equipment and instruments, then we set everything up and completed our practical exams in an unfamiliar environment. There was a lot of pressure. It’s something I’m glad is behind me now.
Once I became credentialed, I sold my general practice because I just couldn’t see how I could maintain a single-person general practice and only offer dentistry, which was all I wanted to practice.
I was offered a position in Arizona, which ended up falling through at the last minute. I opted to stay in Winnipeg and start a mobile dental practice, whereby I would bring my equipment into individual clinics. I soon learned this wasn’t satisfactory. Working in different places was a bit inconsistent—some hospitals didn’t have dental X-ray at that time, which was something I needed. Carrying my own equipment everywhere was difficult due to back issues I had developed.
For the past six or seven years, I have been practicing out of one veterinary hospital in Winnipeg. I have a great working relationship with the veterinarians and staff members. It is like a big family. The staff follow the anesthetic protocols I lay out and the hospital has all the monitoring equipment, thermal support, and other supports to provide a good anesthetic experience for the patients.
Our goal in veterinary dentistry is always for a functional, pain-free occlusion. When we put an appliance on a patient to move a tooth or teeth that might be making contact with other teeth or hitting soft tissue in an abnormal fashion, the goal is to make a pain free and functional occlusion for the patient. This end-goal can be achieved in several ways, including extracting the tooth, amputating the coronal portion of the crown and endodontically treating the tooth, or orthodontically moving it.
Alleviating pain in the mouth doesn’t necessarily mean the occlusion will be normal or cosmetic. Again, anything that is done—whether its extracting diseased teeth, applying orthodontics, performing root canals on teeth with pulpal exposure, or just doing a basic cleaning—the goal is to achieve a pain-free, functional, and healthy mouth for the patient. Cosmetics are of minimal importance. Our patients aren’t in fashion shows.
The first patient I assisted the attending veterinarians on was a wolverine, and I believe we did a root canal or two. I’ve also worked on a red panda, as well as two polar bears.
The techniques of everything I do with these species is the same as it would be for dogs and cats—though the instruments may be a bit different. For the polar bears, for example, the files have to be about twice as long as what would be used on a large dog. Some of the instruments have to be obtained specifically for the species we are working on. For the most part, though, the techniques are the same.
The tricky part is the anesthesia, which is managed by the zoo veterinarians and staff. They deserve so much credit. While dogs and cats are anesthetized for procedures multiple times a day, for exotic species, this is not the case—a wolverine, for instance, might only have been anesthetized once or twice in its life. In practice, you try to create a standard as you go along, but it’s hard to achieve this if you are not doing something regularly. The zoo veterinarians also have to ensure they have the right monitoring equipment for anything that might come up for species ranging from a 1,500-lb polar bear to a bird.
So, what I do with wild animals is pretty much the same as what I do with dogs and cats. It’s a privilege to work on those animals, there’s no doubt about it. I love doing what I can to help them to be pain free and have a functional occlusion, but I think the real kudos go out to the zoo veterinarians who handle the anesthesia.
It’s crucial to begin relationships with clients by educating them on the importance of oral health. If a pet’s mouth isn’t healthy, its body won’t be healthy. In humans, periodontal disease has been linked to conditions such as heart disease, low birth weight pre-term babies, dementia, diabetes, and more. What’s more, in animals, there is research showing the targeted organs for periodontal disease are the heart, liver, and kidneys.
It’s best to start from the get-go with every single patient and educate them on oral home care, including twice-daily tooth brushing, as well as feeding healthy food and having pets chew on the right chew toys. Clients also need to be supported. We need to show them how to properly brush their pets’ teeth and offer continued help as needed. This all is time consuming, of course, which is why it needs to be a group effort by the hospital’s entire veterinary team.
Education is key. Pet owners need to understand the importance of oral health and the ways in which oral disease can affect the whole body—how it causes pain and how it can impact function and long-term health.
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