Saving Smiles

Dental issues often serve as a catalyst for various health problems in pets, according to the American Veterinary Medical Association, as dental health is a key component in a pet’s well-being. By the age of three, most dogs and cats are afflicted with the most common issue, periodontal disease, which is often associated with other health issues such as kidney, liver, and heart muscle changes.

Like humans, preventative dental maintenance is crucial to avoid painful and costly procedures in the future.

In the past, veterinary students have been inefficiently educated and trained about dentistry to address this need. “Within veterinary medicine, I’ve found that most of the training in dentistry is received after veterinary school, to supplement the curriculum. Over the past 20 years, most of our graduates have gotten a few hours of courses in dentistry,” says Greg Wolfus, V98 (he/him), director of Tufts at Tech Community Veterinary Clinic and one of the founding course directors of Dentistry Week.

“After I graduated, I realized the deficiencies,” he explains, as new graduates were generally unable to fulfill the emerging need to perform dental extractions, due to a lack of training and experience.

“Dental surgery has become the dominant surgical procedure in small animal hospitals as shelters have performed most spaying/neutering procedures before releasing animals to adopting owners,” says Wolfus.

In response, Cummings School of Veterinary Medicine has enhanced its students’ dental instruction and training through innovative collaboration and practice. 

Each year since 2019, up to 20 veterinary clinicians and technicians from various practices and specialty hospitals have visited Cummings School to teach 100 veterinary students about dental care.

Held each spring, Dentistry Week enables third-year D.V.M. candidates to practice the components of a comprehensive dental procedure. In addition to working with students as they learn how to perform oral exams and prophylactically clean teeth, clinical instructors teach students how to take dental radiographs, perform nerve blocks, and extract teeth. Students also work through interactive case-based activities and online modules to learn about oral diseases, interpretation of dental radiographs, indications for referral, and client communication skills. 

Dentistry Week is based upon an annual conference hosted by the North American Veterinary Community, where Wolfus was educated and trained in dentistry by board-certified dentists. “In addition to learning procedures I made connections and discovered who the veterinary dental experts were in the area,” he says.

To help develop the Week’s learning objectives and participate in the sessions, Wolfus reached out to Bill Rosenblad, V95, past president of the Tufts Veterinary Alumni Association, and Rich Levine, regional medical director at VCA Animal Hospitals. He then collaborated with Tufts at Tech colleague, certified veterinary technician Kate Zukowski (she/her), one of few New England technicians board-certified in dentistry, to host the inaugural event.

Zukowski and Yuki Nakayama, V14 (she/her), another Tufts at Tech colleague, now coordinate Dentistry Week. As a general practitioner, Nakayama has received extensive continuing education in dentistry and has been mentored by Brett Beckman, D.V.M., FAVD, DAVDC, DAAP. 

Furthermore, Nakayama recently welcomed Dr. Jordan Peters, a dental resident, as a specialist consultant for course content. He also teaches in the Week’s extraction laboratories. Seven of this year’s 18 guest instructors were from specialty dentistry services. Although Cummings School does not have a dental service, Dentistry Week’s low student-to-instructor ratio (3- or 4-to-1) enables students to get a more personalized experience.

Cummings School and its students benefit from the commitment of its guest instructors, which include several alumni. Patricia Dettlinger, V99 (she/her), regional medical director of VCA Animal Hospitals, shares “It is paramount to have the proper knowledge base, skill set and instrumentation for veterinary dentistry. Yet, until recently, this training was lacking at veterinary schools, and in the profession at large. Teaching these skills fosters an increased passion for dentistry and allows for improved patient outcomes and caliber of care.”

“Dentistry Week helps us to simulate a full dental procedure and to show students what’s involved in each step,” says Nakayama. “Students must interpret radiographs and determine a treatment plan. In practice, this is something that needs to be done in minutes to maximize the time available for treatment.”

The level of veterinary dental care has elevated, according to Nakayama. “The majority of small animal dentistry is performed by general practitioners, with the goal of maintaining a comfortable mouth. Often, that means extracting painful diseased teeth. By taking full mouth radiographs, we can identify all these diseased teeth,” she contends.  “In the rare mouth that looks perfectly normal on exam, 30% of dogs and over 40% of cats have significant dental disease that needs to be addressed if you take x-rays and look under the surface.”

Angell at Nashoba, a collaborative effort of Angell Animal Medical Center and Nashoba Valley Technical High School, cannot keep up with demand for dental procedures, according to Medical Director Laurence Sawyer, V99 (she/her). Using Tufts at Tech as a model Sawyer created a similar clinic in Westford, Massachusetts. She has served as a regular Dentistry Week guest instructor. 

“I especially enjoy teaching veterinary students a skill set that will be used so frequently in private practice,” says Sawyer. “By removing infected or fractured teeth, we are definitively and measurably improving the patient’s quality of life.”

Sawyer has noticed a significant difference in the dental knowledge and competency of recent Cummings School graduates, whom she has welcomed as interns and/or staff members, including Carly Nangle, V22, and Mary Kate O’Toole, V21.

“The externs and interns come to us with more dental knowledge and, more importantly, a stronger interest in learning more about how to be a competent veterinary dental surgeon,” she shares. “Before this course, they were scared of dentistry and let their fear help them avoid it.”

Nangle, V22 (she/her), a current Angell at Nashoba intern, believes that Dentistry Week greatly enhanced her education. “Being able to provide high quality and efficient dental procedures has an enormous impact on the quality of life of many animals,” she shares. 

“I used the skills I learned in Dentistry Week to jump into dental procedures when I started working. I believe dentistry has been a historically under-taught skill for many vet schools and I am proud to see that Cummings School is addressing this to provide future vets with this valuable training and knowledge.”

Cummings School aims to build upon the unique aspects of this instruction for future veterinary professionals. “Although we cover the same dental objectives as other veterinary schools, I think the unique aspects are the one-week intensive experience, the involvement of outside veterinarians in the teaching, and the emphasis on acquiring hands-on skills just before clinics,” says Nicholas Frank, associate dean for academic affairs. 

“The outside veterinarians teaching in the course and support from manufacturers of the dental equipment (through their generous lending) makes this a group effort. We look forward to including improved dental instruction to the new curriculum currently in development.”

In the future, Wolfus hopes to provide students with an interest in dentistry to progress to a high-level training opportunity, and to eventually create a week-long dental clinical rotation at Tufts at Tech.