The magnitude of the role of veterinary dental technicians in the 21st century of oral medicine, oral surgery and dentistry has been largely ignored.
The licensed, registered, and certified technicians with associate and/or bachelor's degrees need to be recognized for their outstanding contributions to patient care, pain management and quality of life.
For years, dental technicians have been relegated to the role of "oral cleaning machine," with little respect for the total patient care they provide.
Many non-licensed or certified technicians have taken continuing education to improve their skills in periodontal care and oral radiology. They are to be congratulated. Veterinary technology programs in the university setting are now beginning to address the need for these added skills with advanced oral care training programs.
The dental specialist practicing "four-handed" dentistry relies on the veterinary dental technician in advanced oral pathology, endodontics, prosthodontics, oral oncology surgery and oral orthopedics. These highly skilled technicians can decrease patient anesthesia time by one third by anticipating the needs of the dentist or oral surgeon and providing an efficient material and instrument pathway in a logical sequence.
Beyond all of these very important skills, the veterinary dental technician in both general and specialty practices is a partner in anesthesia induction, anesthesia maintenance, anesthesia recovery and pain management.
Pain Assessment History
Pain assessment is difficult in veterinary medicine because animals lack the subjective ability to communicate.
Also, technicians work with different species, each with different pain thresholds to evaluate. Vocalizing is not common with oral pain in dogs and infrequent in the feline.
Technicians must take detailed histories and observe the patient for signs of pain that are oral related.
Pain Management
The veterinarian and the dental technician must review the patient's anesthesia protocol based on multiple factors. Age, pre-existing medical problems and adverse reactions to anesthetic induction or maintenance systems in the past, must be considered.
The technician records any medical alerts on the anesthesia chart that will be used during the procedure for system monitoring. These same technicians review pre-anesthetic testing to be sure that all tests are completed in consultation with the doctor in charge.
During anesthesia, the dental-anesthesia technician monitors the patient's ECG, Pa02, end-stage expired CO2 and blood pressure. While doing this charting, the technician uses non-mechanical monitoring to verify respiratory rates, cardiac rates and pulse determination.
The patient under anesthesia is under constant pain management-assessment. Changes in physiologic monitoring patterns such as blood pressure, cardiac rate and respiratory rate can change in direct relationship to pain.
The key word for the technician is anticipation. The technician-anesthetist anticipates and adjusts for pain as the procedure dictates.
The adjustment may simply be in the percent of gas inhalant or it may require doctor intervention with a local anesthetic. It is critical that the doctor fully understand the potential systemic effects on the anesthetized patient when altering a preoperative pain control system.
Post-Operative Management
The veterinary dental technician's responsibility in patient pain management only begins in the operatory. The post-operative journey must have an hourly reassessment of the pain control program.
There is not a bid or tid dosage of pain medicine. There is constant monitoring and altering of the drug or drugs chosen to bring the patient from severe to moderate to mild to no pain. Their task is unending and patient-specific.
In conference with the doctor or doctors on duty, these pain protocols are changed, hour by hour, until zero pain is achieved.
Without the technician, the correct pain management assessment and reassessment programs are not going to be established. The technician/nurse anesthetist/critical care provider is the true hero of veterinary medicine and veterinary oral care.
This article has concentrated on the dental or oral technician. It could easily apply to the medical technician, the surgical technician, the critical care technician, the treatment technician, the ER technician, the overnight technician.
All About Teamwork
The doctor has the medical and surgical skills to reach a diagnosis and to perform a specialized medical test or surgical achievement.
But the technician/nurse/care provider is the true patient advocate and pain management member of the team. With all the advanced specialist designations that doctors carry after their names, their significance is minimal compared to the hard work and skills of the technician providers.
These technician providers live in the pits of the hospital, center, or university setting, doing the impossible and bringing each and every patient to a life of quality without pain.
These technicians will cherish their victories but they, also, deeply suffer each and every loss.
Take a moment today to thank those hard working technical team members in your individual setting that provide, to you, all that has been reviewed in this discussion.
Dr. DeForge is a fellow of the Academy of Veterinary Dentistry and adjunct instructor at Northwestern Connecticut Community College in oral radiology and periodontology. His website is www.vetdent.com, and he may be reached at DonDeForge@aol.com.
