Friday, October 25, 2019

Compassion in Medicine 2019 Number #39

Compassion in Medicine 2019


Global Veterinary Ethics Congress
Compassion in Medicine
25October2019
Donald H DeForge, VMD
Fellow of the Academy of Veterinary Dentistry
Director: Silver Sands Veterinary
Director: Advanced Veterinary Dentistry
1-800-838-3368
DonDeForge100@gmail.com
www.SilverSandsVeterinary.com
AnimalDentistrySolutions.blogspot.com


The Global Veterinary Ethics Congress [GVEC]
The Human-Animal Bond
The Preservation of the Five Freedoms
Addressing connections between Ethics and the Human-Animal Bond:
Collaborative-Synergistic-Enlightening



Compassion in Medicine 2019  
One Medicine

The Global Veterinary Ethics Congress will be studying Compassion in Veterinary Medicine in the months ahead.  Look at the video below concerning our human brothers and sisters in medicine. Jennifer Dobner in the essay to follow describes where we have been and where we should begin again in a quest for compassion in medicine.  It will only take a few moments to view the video and read the essay.  It is a gift well worth experiencing.

Donald H DeForge, VMD
Acting Chair-The Global Veterinary Ethics Congress



"At the beginning of medicine, when our knowledge was frankly limited or absent, what is it that we were able to provide?" asks Dr. James Doty, a neurosurgeon, who has practiced medicine for more than 30 years. "It was not cure. It was not intervention. The only thing we could provide was care and comfort."
Compassion isn't entirely gone from health care -- those working in the profession are still driven by a desire to ease suffering -- but in practice, it's a tenet that seems to have been lost or pushed aside over time, says Doty, the director and founder of the Center for Compassion and Altruism Research and Education (CCARE) at Stanford University.
"We've become enamored with the technology and the power of science," he says. "Certainly, they've had a huge impact on health and health outcomes. But we also have seen the result of negating that and what we have learned is that there is immense power to demonstrating compassion and caring to individuals who are ill."
Working to put compassion back at the center of health care systems will be the focus of Compassion Week, a joint initiative of CCARE, the Charter for Compassion, and the Tenyin Gyatso Institute, which seeks to instill compassion into the arenas of business and public service.
Dignity Health is a lead sponsor of the week's events that include the 2nd Science of Compassion Conference, the 3rd Empathy and Compassion in Society Conference, the Charter for Compassion Day, a "Living Compassionately" Retreat, a youth gathering, and the inaugural Compassion and Healthcare Conference.
Research has produced ample empirical evidence for proving what should seem obvious: Feeling soothed or cared for through the experience of meaningful social or human connections produces a physiological state in the body that is optimum for healing, Doty says.
The immune system gets a boost. Cortisol levels drop. Blood pressure goes down. Stress and anxiety begin to melt away and a person's mental state improves.
"I always tell people that while science and technology have probably saved millions of lives, the fact of the matter is that kindness and compassion have probably saved more," says Doty.
But it can be hard to hang onto compassion in an industry that has become increasingly complicated and expensive, relies on payment models that reward procedures over wellness care, and moves cautiously around legal and regulatory concerns, Doty and Dignity Health's Heather Walker say.
A pediatric nurse who now runs the Learning Institute Simulation Center at Dignity Health's St. Joseph's Hospital and Medical Center in Phoenix, Walker says she's watched nursing become heavy with requirements for documentation and creates mounds of paperwork.
"What I see lately is that health care is just so task-oriented," says Walker, who chose a career in nursing because she wanted to make a healing connection with others. "Many of those tasks are important, but we are just so focused on the tasks that we sometimes forget the patient because we are busy checking off all the boxes."
Part of Walker's job is to teach compassion skills to health care workers across the spectrum, from nurses and respiratory technicians to medical students and others. To do that, Walker uses a team of hired actors and volunteers to serve as "patients" in simulated situations -- known as the standard patient program -- to measure a health care provider's performance.
What she's watching for: How is the health care worker interacting with the patient? Are they looking the patient in the eye? Are they really listening? Is the patient understanding the information about medications?
"Everybody calls them soft skills, but I think they are hard, harder than just learning the technical stuff," says Walker, who plans to show a video from a simulation during a conference panel discussion.
The simulations include providing students with immediate feedback from their "patients."
Many get heaps of praise, but some are also surprised at how poorly they score on the compassion scale, even when the perceived infractions might seem small in the overall scheme of things.
"Like moving the bedside table closer. It's not a huge thing, but when a patient can't get to it and you leave the room, they're saying, 'wow, that's really rude''," she says. "We have to practice these things every day. I tell my students, what if this was your mother in your bed? Your child? What would you want for them?"
From Walker's perspective restoring compassion -- a touch, a listening ear or an acknowledgment of a patient's frustration or sorrow -- is an important way in which hospitals and other care facilities can differentiate themselves from each other.
Today, patients can readily find satisfaction surveys on the internet and made choices about where to seek treatment.
"As consumers, patients are really looking at whether they feel like they are being listened to," says Walker, who is slated as a presenter on a Wednesday conference panel. "So we really need to put the patient back into the center of health care and make sure we are taking care of the whole patient."
Doty believes the health care system is at an important crossroads that make this the right time for conversation and action around the idea of compassionate care.
"I think a lot of people understand the prices we have paid for ignoring this aspect of health care," he says. "There's an understanding that compassion is not only what defines our humanity but it defines us physicians and health care providers."
It's why, he says, the future of medicine resides in understanding the past and the beginnings of medicine.
Doty hopes conference -- goers will leave the event with a deeper understanding of the power compassion and caring can have on medicine and health care.
"It is fundamentally at its core," he says. "I want them to have a sense of excitement in regaining this part of medical practice and to give them some tools to use within their own environments that will not only support them in terms of resilience but also allow them to better re-engage with those they are caring for."
Salt Lake City-based Jennifer Dobner is an independent award-winning journalist and writer and a regular contributor to Reuters, The New York Times, WebMD, and NBC’s Today Show. Her resume includes stints at newspapers large and small across the western United States, and for seven years she was the lead reporter in the Salt Lake City bureau of The Associated Press. She has written extensively about the Mormon church, criminal justice, politics and health care. Before working in journalism, Dobner worked in sporting event management and media relations for sponsors of professional golf events and for a professional soccer team. Raised in the San Francisco Bay Area, she studied journalism at Fresno State University.

Wednesday, August 14, 2019

Endodontic Competency Number #38


Tri-State Animal Dentistry Consultants
17 Seemans Lane
Milford, CT 06460
1-800-838-3368
DonDeForge100@gmail.com
DoctorDeForge@yahoo.com
             

Endodontic Competency
American Association of Endodontists

https://www.aae.org/specialty/wp-content/uploads/sites/2/2017/09/endo-competency-whitepaper.pdf


Donald H DeForge, VMD
Fellow of the Academy of Veterinary Dentistry
Practice Limited to Dentistry



Image result for Picture of an endodontic file in a dog's tooth


Please see the link above to the American Association of Endodontists

Root Canal therapy is non-invasive and the treatment of choice based on oral radiology in a patient presented with endodontic trauma or pulp pathology. 

A decision on endodontic care is complex. When appropriate, it returns a patient to a pain free active life with minimal recovery time.  Today, root canal therapy is being performed daily by veterinary dentists world-wide.

Recent articles in veterinary publications have eluded to general practitioners and their technicians performing root canal therapy on patients.

Only a veterinarian trained in root canal therapy should perform root canal therapy.  Technicians should not be performing endodontic procedures.  State practice acts determine which procedures technicians can perform.

Clients visiting their local doctor of veterinary medicine seeking endodontic procedures must be counseled in the benefit risks, treatment alternatives, and prognosis for the procedure[s] advised by the general practitioner.

Along with an endodontic work-up centered on dental radiology, the periodontal states of the patient must be determined before endodontic care.  

Before initiating any endodontic procedure, the general practitioner must demonstrate competence in endodontic care and provide a prognosis with an outcome assessment based on their clinical assessment.

Endodontic knowledge and skill is directly related to multiple hours of endodontic training.  It is always best to refer to an animal dentist.  

Root canal therapy; apexification; and new regenerative endodontic procedures must be completely understood before initiating care.  A decision on appropriate therapy is based upon the presence of normal pulp tissue; pulp death; an immature apex; open apex; or severely necrotic pulp tissue.  Animal dentists with years of training and continuing education allows the best treatment plan and outcome for the patient.











Endodontic Competency
American Association of Endodontistshttps://www.aae.org/specialty/wp-content/uploads/sites/2/2017/09/endo-competency-whitepaper.pdf

Monday, June 3, 2019

Increased Number of Iatrogenic Jaw Fractures in General Veterinary Practice~#37


Tri-State Consultations and Oral Surgery
Donald H DeForge, VMD
Fellow of the Academy of Veterinary Dentistry
Practice Limited to Dentistry
1-800-838-3368
DonDeForge100@gmail.com

The Global Veterinary Ethics Congress [GVEC]
The Human-Animal Bond and Preservation of the Five Freedoms
"Addressing connections between Ethics and the Human-Animal Bond"
Collaborative-Synergistic-Enlightening




Image result for X-ray of a mandibular jaw fracture in a dog



#37 Increased Number of Iatrogenic Jaw Fractues Reported in General Practice Animal Dentistry!

The Answer: Oral Radiology and Telemedicine Dental X-ray Interpretation and Referral to an
Animal Dentist

Small breed dogs and cats are prone to jaw fractures in advanced periodontitis during exodontia in general practice.

The question remains why are extractions being performed without pre-operative dental x-rays?

Commmon areas of fracture of the mandible are:

1] The Mandibular Symphysis
2] The Anterior Mandible
3] Distal Mandible Pre-Molar and Molar Extractions

What to looks for in your pre-operative dental x-rays:


 1] Roots of the pre-molars or molars are within millimeters of  the ventral cortex of the mandible
2] Vertical bony defects affecting the alveolar bony plates
3] Greater than 50% loss of the interdental septal bone
4] Apical osteolytic changes in close proximity to the vental cortex of the mandile
5] Non-separated pathologic fracture[s] from advanced periodontal disease~commonly these are bilateral nut just unilateral pathology
6] Decrease in bone dentisty
7] Sclerosing osteomyelitis with advanced corital bone resorption-especially in the anterior mandible
8] Neoplasia-over-looking extent of disease and need for a biopsy
9] Idiopathic Root Resorption
10] Root ankylosis

Advanced Periodontal Disease contributes to bone loss and increased risk of iatrogenic trauma~


How to Avoid Iatrogenic Fractures:
1] Pre-Oral X-ray of ALL dentition in ALL patients with advanced gingivitis/periodontitis before anticipated EXTRACTION!  Not all mobile teeth need exodontia. Exodontia is confirmed by oral radiology as well as intraoral examination. After oral radiology, absolutely no extractions without signed pet parent consent.
2] Detailed education of pet parent about oral pain and oral pathology after oral radiology.
3] Discussion with pet parent about REFERRAL to a veterinary dentist if there is a pathologic fracture already present from advanced periodontal disease
4] REFERRAL to an animal dentist if the general veterinarian's comfort zone in oral surgery has been surpassed based on oral x-rays
5] Send oral x-rays digitally to a Veterinary Dentist for interpretation prior to extractions; i.e. this mans re-scheduling extractions or referral to an animal dentist only after dental x-ray interpretation [E-Vet Diagnostics]
9] Veterinary telemedicine is an easy and inexpensive tool that helps veterinarians provide their patients with expert radiology service. You simply upload your cases to the radiology consultant servers and veterinary radiology consultants will read them and report back their diagnoses. [eVetDiagnostics.com is an example of a Telemedicine Radiology Service for general practitioners]




Monday, April 8, 2019

In Search of Compassionate Care #DrDonDeForge~No. 36


Donald H DeForge, VMD
17 Seemans Lane
Milford, CT 06460
P-203-877-3221

Tri-state Oral Consultant in Advanced Oral Medicine and Oral Surgery
E-Mail DoctorDeForge@yahoo.com
DonDeForge100@gmail.com
www.SilverSandsVeterinary.com
www.AnimalDentistrySolutions.com
Fellow of the Academy of Veterinary Dentistry
Practice Limited to Dentistry
Immediate Past President of the Society for Veterinary Medical Ethics
No.36-- www.AnimalDentistrySolutions.com



In Search of Compassionate Care
Donald H. DeForge, VMD




Image result for Picture of an animal doctor with a patient who is ill



 Human medicine, veterinary medicine, and other allied medical fields have reached epic levels of sophistication and specialization!

There is no upper limit! Top researchers and clinicians combine to find answers to cancer; diabetes; Alzheimer’s; Parkinson’s disease; and a plethora of painful conditions.  Organ transplants and cloning continue to advance to extend our years, on planet Earth, with quality of life.

With a plethora of specialists in veterinary medicine, our companion animal population continues to recover more quickly from serious disease; life expectancy continues to increase; and more pets have quality pain-free lives.  Surgical teams with criticalists in consultation with animal internists lighten the pathway to recovery.

What is lacking in the New Millennium in all areas of medicine is COMPASSION!

 Medicine is synonymous with multi-taskers.  Veterinarians are burdened by clinics; surgery; urgent care; critical care; and ER patients. They live in a framework of management bureaucracy.  Somewhere in the mass of this struggle the word COMPASSION has been forgotten.  This is not just a veterinary problem but also a major problem in human medicine.  Too many patients and not enough time leads to “impersonal” care.
The day of the human general practitioner visiting your home has decreased by 90%.  There are communities with local clinics and home visits but they are few and far between.  At one time, the human physician examined all systems and treated all problems.  With specialization, the orthopedist does not want to hear about a prostate problem.  The hand surgeon does not want to hear about your back pain…..etc. etc. etc.

Articles have been written on burnout, suicide, and compassion fatigue.  None have proven answers. The fact that we continue to write about these issues can hopefully encourage human physicians, human dentists, other health care professionals and veterinarians to seek help before it is too late.

We must not forget that COMPASSIONATE patient-care considerations are linked to treating others the way we would want to be treated. We owe it to our patients to never abandon them with a lack of COMPASSION.
When Doc visited my Dad who was a stroke victim, he sat and chatted and had a cup of coffee before leaving.  When the dentist came to our home to remove an abscessed tooth from my Dad, he did not just walk away but sat with my Dad and joked and told stories about what it was like “in the day” when they were growing up.  Compassion to the stroke victim isn’t as common today within the “sterility” of corporate practices.

Technical, biomedical, and financial issues are areas in which physicians and veterinarians find a comfort zone.  COMPASSION and other emotional care problems have become ”major discomfort areas”! They are intangible entities and take time to solve.  These issues decrease the amount of patients seen each day.  They are “not for profit” areas of care and that bothers medical facility management.

The intangible must become tangible.  Compassion does not belong on a multi-task list.  COMPASSION is a uni-task or a mono-task.   Years ago and even today, the veterinarian sought the multi-tasker and was the ultimate multi-tasker. In the New Millennium, the veterinarian must transition from a multi-tasker to a mono-tasker. Searching for COMPASSION is a mono-task.
Before anyone can mono-task, they must temporarily each day disconnect from the electronic world and initiate focus tasking:

1] First and foremost shut off the Smart Phone

2] Walk away from your desk-top and the other multi-problems sitting on your desk for completion

3] Put a pause on answering messages; writing E-Mails; consulting with your head technician or physician’s assistant; or meeting with your practice manager

4] Set COMPASSION goals.  Review these goals weekly with staff to see if any or all of the goals have been achieved.

All of this is to strengthen the meaning of the doctor-patient relationship. Separating oneself from an anxiety centered multi-tasking world and mono-tasking can lead to harmony and initiate feelings of compassion. Finding compassion in meditation has been found helpful.
A recent study by Northeastern University’s David DeSteno confirmed what Buddhist theologians have long believed---meditation can lead you to more compassion, love, and a commitment to end suffering for oneself and others. 

The concept is that the mono-task meditation exercise improves attention and the ability to focus one’s attention to specific areas of the work environment…..i.e. COMPASSIONATE CARE!  

In humans medicine, this is a reflection concerning ALL patients [i.e. the well insured and those without insurance] and in veterinary medicine to all members of the Animal Kingdom!

The ultimate question is:  Can compassion be trained and learned in adults?

One researcher compares it to flexing our “compassion muscles” every day.
We build up the “compassion muscle” and respond to our patient’s suffering with greater care and desire to help.  

Veterinarians find themselves holding their patients with loving care and talking to their patients after surgery or a medical test and not just returning them to the medical-surgical wards.

Veterinarians have to accept a TOTAL commitment to becoming “Voices of the Voiceless” and finding creative ways to help clients who love their pets but have financial difficulties.  This is not easy!  A team member can be assigned to this important task under the supervision of the hospital manager.

Human physicians MUST find ways to stop double and triple booking by adding new doctors and physician assistants to their group.  They MUST report abnormal lab tests compassionately with a personal phone call to their patients and not relegate this task to one of the nurse assistants at their practice.
Human physicians must take on a GREATER ROLE working with insurance companies to have testing approved that is relative to diagnosis and patient care.  This is time consuming but it is essential in returning COMPASSIONATE CARE to medicine.  Insurance obstacles should not become a problem in providing care.  Everyone is entitled to excellent diagnostic care and appropriate treatment without insurance restriction.

The positive extension of leadership compassion is that it grows!  It is embellished by all nurses, assistants; technicians; and client service representatives as it is exemplified by practice management.

This same model will be successful in any workplace.....not just human or veterinary medicine!  Consider bringing compassion to your workplace; to your school; to those that you meet and greet each day!

Leadership compassion originates from mono-tasking and focus-tasking in compassionate care.  It is the answer!  “Only when we give joyfully, without hesitation or thought of gain, can we truly know what love means.” Dr. Leo Buscaglia

Saturday, March 23, 2019

Let The Animal Dentist Come to You! #DrDonDeForge #MobileVetSilverSandsVeterinary~No.35



#DrDonDeForge
#AnimalDentistSilverSands
#SilverSandsVeterinaryNetwork
#MobileVetSilverSands
#MobileDentalServicesSilverSands
www.SilverSandsVeterinary.com
No. 35-www.AnimalDentistrySolutions.com


Dental Exams in your home!

Can't make a visit to a Veterinary Hospital?
Is your pet anxious?
#DrDonDeForge has you covered!

  • Physical Exam
  • Oral Exam

All in the comfort of your home!

Our unique medical/dental practice was among the first in the country established to care for patients who are unable to be treated in a traditional veterinary office setting. For over 40 years, we have been working to remove barriers to access to care by delivering premium dental care to patients with unique challenges at an affordable fee!!!  Is your dog stressed coming to the veterinary hospital?  Does your cat hate being put in a carrier?
Dr. DeForge administers a safe sedative for the inital oral check-up right in your home.  If your cat or small dog needs oral care there is a no fee to transport to #DrDonDeForge Dental Center at #SilverSandsVeterinary in Milford, CT.[find out more at www.SilverSandsVeterinary.com]
If your dog is medium; large; or extra large in size and has anxiety, Dr. DeForge administers at no charge a sedative for you to transport your dog to #SilverSandsVeterinary
Dental Operatory at Milford Veterinary Hospital which is part of the Silver Sands Veterinary Network.
Your pet is happy to come to our hospital without any stress or anxiety! 




Image result for Picture of a doctor with House Call Doctor printed on scrubs



#MOBILEVETSILVERSANDS 
House Calls for Pets
VMD Home Calls
Let the Doctor Come to You!
Dr. Don DeForge
1-800-838-3368
A Part of the Silver Sands Veterinary Network


House Calls

House Calls for Pets provide a unique perspective on patients' environment and health problems. The demand for house calls is expected to increase considerably in future decades as the U.S. pet population increases.
With early intervention, house calls involving multidisciplinary care may reduce in hospital admissions and long-term care can decrease
Dr. DeForge’s House Calls for Pets allows observation of the patient performing daily activities, reconciling medication discrepancies, and evaluating home care.
Dr. DeForge can offer house calls integrated into his general practice-Milford Veterinary Hospital at Silver Sands Veterinary in Milford, CT with careful planning, including clustering house calls by geographic location. 
Patients that need extensive imaging, urgent care, and specialist intervention must be seen at Milford Veterinary Hospital-Silver Sands Veterinary. [just across the street from Dan Perkins Subaru in Milford, CT at the intersection of Bridgeport Av. and the Boston Post Rd.] Find out more at www.SilverSandsVeterinary.com
Dr. DeForge offers at Milford Veterinary Hospital- Internal Medicine consults; Radiology-Special Imaging; Ultrasound Imaging; Echocardiograms; and specialized Surgery along with advanced oral care at Milford Veterinary Hospital-Silver Sands Veterinary.  www.SilverSandsVeterinary.com  Dr. DeForge is a Fellow of the Academy of Veterinary Dentistry.
House calls were standard practice for physicians in 1930, when approximately 40 percent of patient encounters occurred in the patient's home. By 1950, this had fallen to around 10 percent, and by 1980, only about 1 percent of patient encounters were house calls. 

House calls can provide a unique perspective on a patient's life that is not available in an office visit or during hospitalization. A house call can foster the physician-patient-client relationship, and enhance the veterinarians understanding of the patient's environment and support system

 

 

 

Dr. DeForge leads the way with compassionate animal house calls.  He will sit with you and review your pet’s health problems and set up a plan of health care just as the physicians did in the 1950’s in the United States. No anxiousness......just tender loving care with mobile animal nurses that want to bring love and compassionate care to your home!
Call 203-877-3221 with questions or write to #DrDonDeForge at DonDeForge100@gmail.com
Do it today for the pet you love!
You can schedule on-line at www.SilverSandsVeterinary.com

Just state you want a house call-mobile visit!

Monday, February 25, 2019

Vital Pulpotomy in the Dog and Cat~ No.34


DrDonDeForge
Advanced Veterinary Dentistry
1-800-838-3368
DonDeForge100@gmail.com

DH DeForge, VMD
Fellow of the Academy of Veterinary Dentistry
[Practice Limited to Dentistry]

Treatment of the Recent Fracture
Vital Pulpotomy

Image result for Picture of a dog with an open pulp canal


Vital Pulpotomy-Saving Teeth!
The vital pulpotomy is a  procedure used most often in immature teeth in young dogs with a  recent fracture. It can be used in older dogs, with recent crown fractures, if dental x-rays show no radicular [root] pathology. 
The client must be told that all dogs undergoing Vital Pulpotomy treatment must have a post-treatment endodontic x-ray in 12  months post-care. 
If the apex of the tooth is abnormal, the patient will need a conventional root canal at that time.  The pulpotomy, in young patients, is recommended because it keeps the tooth vital allowing for tooth maturation.
If there is radicular [root] pathology, then the patient must undergo conventional root canal therapy. 
Besides vital pulpotomy and or root canal therapy the only other option for a tooth with an open pulp canal is extraction.  A patient should never be left with an open pulp canal.  It is painful and can lead to a very poor quality of life.
 For the large canine teeth in dogs and cats, and the large chewing (carnassial) teeth in dogs, the extraction procedure can be traumatic and painful due to the size of the roots in our animal patients. The root of the canine tooth is longer and wider than the crown (the part of the tooth you can see above the gums). Extraction of these teeth involves major oral surgery, comparable to removing impacted wisdom teeth in human patients. The patient also loses the function of the tooth, which can be very important in working dogs.
Dr. DeForge tries to avoid extraction of fractured but otherwise healthy teeth.
After any endodontic procedure a restoration is utilized to close the treatment site.
There are exceptionally strong enamel shaded restoratives available to animal dentists from human dentistry. Amalgam is another very safe alternative in restorative dentistry.  No restoration is permanent in the dog.
Dog's can dislodge restorations quite easily if chew behavior is not modified.
The restoration that has the least chance of being dislodged by our animal patients is a full jacket crown.

Comments from Dr. DeForge:
The most important single aspect of successful vital pulp treatment is a correct diagnosis.  The clinician must ascertain the tooth to be vital! This determination is made through a thorough workup  including the clinical examination and radiographic appearance of the tooth.--all performed under general inhalation anesthesia. 

Vital Pulpotomry is only performed on recently fractured teeth.
It is commonly performed in young patients.  It can be used in any age patient as long as the clinician is sure that the tooth in question was recently traumatized and endodontic x-rays are within normal limits.

Subjective and objective pain determination is quite difficult to determine in the dog an cat. Clinically, the tooth must be free of soft-tissue symptoms of gingival swelling and pathologic mobility. Radiographs should not show any periapical radiolucency. There should be no radiographically demonstrable external or internal resorption.

 

Pulpotomy:

Following the induction and maintenance of the patient with gas inhalation anesthesia the technique of pulpotomy, regardless of agent used, is exactly the same up to the application of the pulpal medicaments.  

MTA and Calcium Hydroxide are the most common medicants for the pulpotomy in the dog. Either is applied as a paste that remains over the pulp. Dr. DeForge uses the most up-to-date materials to assure a successful pain-free outcome.

The second most important aspect of pulpotomy assuring a successful outcome is the placement of a start of the art  base; primer-resin adhesive and a composite restoration. 

There is no guarantee that Vital Pulpotomy will be successful. If bacteria have reached a point below the treatment site, infection can continue into the pulp necessitating a root canal.  

The Vital Pulpotomy is an important first step in care that may need no further treatment. It decreases anesthesia time; removes pain; and allows maturation of the tooth.  

The root canal is reserved as a last resort.  Once a root canal is performed the tooth is now non-vital.  The advantage of the root canal is that it is also non-invasive and the patient has a remarkable return to normalcy without pain.

Extraction is invasive and requires surgical cutting of mucosa and bone and is never recommended by Dr. DeForge as first choice of care in recently traumatized teeth.

Post treatment x-rays in 12 months is the key! If these x-rays show an abnormal apex after Vital Pulpotomy, root canal therapy is then advised.

Follow-up oral radiology in 6-12 months is imperative.




Questions?
E-Mail DonDeForge100@gmail.com

Friday, February 15, 2019

INTRODUCING STOMASURG No. 33



Donald H. DeForge, VMD
Fellow of the Academy of Veterinary Dentistry
Practice Limited to Dentistry
www.SilverSandsVeterinary.com
1-800-838-3368
Milford Veterinary Hospital at Silver Sands
House Calls for Pets Silver Sands

#DrDonDeForge

Introducing: StomaSurg➽ No. 33
Removing Oral Pain One Patient at a Time!


Image result for Picture of a cat in pain



Gingivostomatitis in the Cat

The pathology of gingivostomatitis can affect gingiva, mucosa, tongue, palate, and the pharyngeal area. The salient clinical signs of gingivostomatitis are: swollen, ulcerated, and bleeding gums; lack of appetite or the inability to eat; consequent weight loss; cachexia; excessive salivation; blood in the saliva; halitosis; pawing at the mouth and SEVERE ORAL PAIN! 



Introducing StomaSurg➽
A Surgery for Gingivostomatitis in the Cat using
Guided Bone Regeneration

StomaSurg➽ is the first oral surgery that completely removes Gingivostomatitis in CATS. It is now available in CT and NY.

CT Location-Milford Veterinary Hospital at Silver Sands-17 Seemans Lane, Milford, CT 06460

NY Location-Gold Coast Center for Veterinary Care
770 W. Jericho Tpke-Huntington, NY 11743

For appointments at either location:

E-Mail DonDeForge100@gmail.com or call
1-800-838-3368
Dr. DeForge will come directly to the phone, if you call, to discuss this breakthrough surgery, StomaSurg➽, the only oral surgery treatment to date that COMPLETELY removes Gingivostomatits in the cat.


What is StomaSurg➽?
Dr. DeForge's breakthrough surgery has three components:

1] Biopsy to confirm Gingivostomatitis is present


2] Intraoral Radiology to review bone pathology present


3] Radiosurgery, Osteoplasty, and Guided Bone Regeneration Treatment of pathological bone sites


Gingivostomatis is THE MOST Painful Oral Disease in Cats

Gingivostomatitis is NOT a dental disease it is a bone centered pathology!

Dr. DeForge can treat any cat that has all of the teeth removed, i.e. edentulous, with no successful resolution of the stomatitis state........ and completely return the patient to a pain free quality of life with StomaSurg➽

Radiosurgery is utilized to create full thickness mucoperiosteal surgical flaps and to expose the diseased bone
  • Oral radiology identifies the osseous pathology
  • Osteoplasty is aggressive and is utilized to remove all diseased osseous tissue after PDL Nerve blocks
  • Guided Bone Regeneration with bone alloplast is utilized to create a bone matrix that allows osteoblasts to reconstruct the alveolar ridge and reconstitute the bone


Pre-Anesthesia testing and Clearance for Anesthesia is
completed by the referring FDVM; LDVM; or RDVM

Some patients will need esophagostomy tubes for alimentation if presented in the advanced cachexia state

All cats return to a pain free quality of life after StomaSurg➽


Pre-Surigcal Consultation is fully credited to StomaSurg➽ surgical fees if you decide to have your cat treated with StomaSurg➽ after consultation with Dr. DeForge

Feline Orofacial Pain-Cat Stomatitis Syndrome

  Feline Orofacial Pain  Cat Stomatitis Syndrome  Guided Bone Regeneration  An Innovative Treatment Donald H DeForge, VMD Fellow of the Acad...