Dr. Amy Thomson joins us to explore non-anesthetic dentistry and client communication, tackling common fears about anesthesia and the importance of clear language in veterinary care. Learn from her expertise as she and Dr. Andy Roark discuss how to effectively manage cases like Nico, a Chihuahua with good teeth but bad breath on this week’s episode of the Cone of Shame Veterinary Podcast. Don’t miss these crucial insights that could transform your approach and elevate your practice. Let’s get started, gang!
You can also listen to this episode on Apple Podcasts, Google Podcasts, Amazon Music, Soundcloud, YouTube or wherever you get your podcasts!
LINKS
American Veterinary Dental College: https://avdc.org/
Veterinary Dental Forum: https://www.veterinarydentalforum.org/
Amy Thomson IG: https://www.instagram.com/toothy.thomson/
Referenced Obi Vet Course: https://obivet.com/product-category/certificates/
VetHive:https://www.vethive.com
Amy Thomson website: https://toothythomson.ca
ABOUT OUR GUEST
Dr. Amy Thomson, often known as “Toothy,” is passionate about teeth! However, it was not always this way—she started her career in small animal practice with very minimal dentistry knowledge. She was fortunate to have a great mentor in her first job, where she learned a lot and her desire to learn more grew. Once she attended her first Veterinary Dental Forum in 2013, she KNEW dentistry was her passion—and became affectionately known as “Toothy Thomson.”
With time and support from her family, friends, colleagues, and a big ‘shove’ from her mentor, she applied for a dentistry and oral surgery residency and was overjoyed when she matched at the University of Wisconsin-Madison. During her residency, her passion grew not only for dentistry but also for teaching. And because life is always full of surprises, Dr. Thomson found herself at a crossroads in 2020 in the early stages of the pandemic—so she started her own mobile dentistry practice!
In addition to working alongside small animal general practice teams, she also became very active online, sharing her knowledge. It has always been important for her to share as much as she can, given it took hundreds of hours and thousands of dollars to obtain the knowledge she did while in general practice. Knowledge she wants to see all veterinary teams have!
EPISODE TRANSCRIPT
Dr. Andy Roark: Welcome everybody to the Cone of Shame veterinary podcast. I am your host Dr. Andy Roark. Guys, I got it going for you today. I have got my friend Dr. Amy Thomson on. She is a boarded veterinary dentist. I am talking to her about a weird case of a little chihuahua whose teeth don’t look bad, but his breath is nasty.
He’s got gingivitis. Yep, we’re going to talk about some non anesthetic dentistry today and how we talk to pet owners about it. And also how do we deal with it when you’ve got this pet that’s got some nasty stuff lurking under the surface, but the teeth look good and the owners think that they’re that they’re golden.
Anyway, it’s a good case. Let’s get into it.
Kelsey Beth Carpenter: This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark.
Dr. Andy Roark: Welcome to the podcast, Dr. Amy Thomson. Thanks for being here.
Dr. Amy Thomson: Thanks for having me. I’m super excited to be here.
Dr. Andy Roark: It’s my pleasure. I, I’m so excited to have you here. For those who don’t know you, you are a boarded veterinary dentist. You and I met at the OVMA Convention in Ontario and you were speaking after me and we just started talking and I just I love your energy so much and like your passion for what you do just radiates through and so I really I wanted to spend more time with you and sort of talk with you and so I’m glad we were able to set this up.
Dr. Amy Thomson: It’s so, it’s so wonderful finding and getting to meet you in person and yeah, it was a, it was a great conference. I was super excited to be asked to be a part of it and then yeah, getting to connect with you and talk about teeth, which is my favorite thing to do. It’s pretty great.
Dr. Andy Roark: Yeah, see it’s I, I’ve got, I’ve got a tooth problem for you, actually, I want to, I want to bring up. So, I am looking at a five year old male neutered chihuahua named Nico. And so, Nico, Nico’s teeth, when I just looked in his mouth looked okay. But his breath stinks, and he’s got some gingivitis. And so, I started asking the owners about this, like, his breath, and what do you do for his dental health?
And they said, well, we’re very conscientious. Twice a year they do– they call it cosmetic dentistry. It’s anesthesia free dentistry and it sounds like they’ve been getting this service done for them. And now I’m, I’ve got Nico here and I’m, I’m looking at this dog and his, he’s got gingivitis and he’s got bad breath and I’m worried.
I’m going to, I’m going to, they’re going to let me do this. I’m really worried that it’s going to be a disaster when I get in there. And I’m hoping that you’ll talk, talk, you’d totally- don’t with me. Tell me I’m not, tell me I’m wrong. You’re supposed to “no it’s going to be fine.”
Dr. Amy Thomson: No, I think you’re right. I’m worried. I’m worried about Nico’s now, for sure.
Dr. Andy Roark: So, so, tell, how do you treat this, Amy? Talk, talk me through this a little bit, like, where’s your head at when I bring you this case, and just sort of, start at a high level and let’s get down to kind of how I approach this, and, and how do I set expectations with the owners so I don’t get in a lot of trouble if I do come back to them with something they’re really not going to want to hear?
Dr. Amy Thomson: Yeah, yeah. So yeah, so this is always a challenging case and so I guess like taking it sort of back I think it’s really important to like meet these owners where they’re at. So they really care about oral health, which makes me happy And so I always try and start with acknowledging that. That like I’m very glad that you’re taking Nico’s oral health seriously and, you know, being proactive and having these anesthesia free cleanings done
obviously shows that, you know, you care and that you’re wanting to keep his mouth healthy. Unfortunately, this is not a great way to do it. And I’ll, and honest We, I’ve had this conversation and owners are like, what? Like we thought this was the right thing and all I’ll validate them and say, absolutely.
Like if I were in your shoes, based on the information that I see on the internet these seem great. It’s, they seem great because you see the before and after pictures and there’s all this calculus and then it’s all gone. The concern or the issue is unlike you and I that will sit still. Our pets rarely sit still and certainly not in a way that will allow us to do a deep clean underneath the gums and so Bringing it back to what I’m seeing in Nico’s mouth is despite the teeth looking quite clean I’m getting this smell and I’m seeing the gums are inflamed and those are my What I call my red flags when I look in the mouth to say that there’s there’s problems underneath The surface.
And so that bad breath or, you know, I sometimes joke about we like fancy doctor terms or halitosis. That’s actually volatile sulfur compounds and that’s the breakdown of tissue. That we’re smelling. So that sort of not like smells like canned dog food or whatever. We fed them, but that sort of unmistakable foul odor or halitosis is evidence that there’s disease and then the fact that his gums are diseased or at least inflamed says we’ve got inflammation there and so I can’t say I’m entirely surprised because if he’s been getting cleanings on the surface that we can see, but not deep under the gum.
There could be, you know, significant disease that we’re just not able to see when he’s awake.
Dr. Andy Roark: Do you tell pet owners that smell, that distinctive smell, is the breakdown of tissue? Do you tell them that?
Dr. Amy Thomson: Sometimes.
Dr. Andy Roark: That’s pretty intense. Like I, you kind of like, you’re kind of grossing me out like I’m–
Dr. Amy Thomson: I know it’s gross, but, but I also think it’s important I don’t see it as much anymore, but there used to be that like I haven’t been in general practice for a long time. It’s been eight, nine years. So I’m a little bit removed now, but I do remember when I was in and I would hear like, Oh yeah, they’ve got a little bit of doggy breath.
And, and I just think like we talked about when we met, it was like, I’m a big stickler for language and nomenclature and I don’t know, doggy breath sounds cute, but like what we’re smelling is, is evidence of disease. So, it a bit depends on the conversation I’m having with the owner, but I will acknowledge that like that smell that we’re smelling is indicating that there’s deeper disease going on.
Mm hmm.
Dr. Andy Roark: You, you are a stickler for language. Talk to me real quick, we’re just gonna take a little, a little side tangent here. You don’t like, you don’t like the term dental disease. You like the term periodontal disease.
Dr. Amy Thomson: I don’t
Dr. Andy Roark: Tell, tell me why that is. I, because I, like, I always say like, ’cause I, I feel like the pet owners get it when I say dental disease, but put push back on it.
Tell me, help me, help me understand.
Dr. Amy Thomson: I’m happy to So I recently put together a lecture for the veterinary dental forum called dentistry dirty words And so that’s top of the like one of the top of the list of the the words that I think are bad dirty words we should stop using and the reason being is that for me if I’m trying to like Understand communicating with owners if I say it’s dental disease, that means there’s a problem with the tooth And you, hopefully you, well maybe not hopefully, but I’ve heard this a lot and I get a lot of nods when I lecture of like who here has heard, you’ve made a recommendation, the teeth are quite bad, we need to get in and clean and probably extract, and then maybe we get a call back from the owner and be like don’t worry doc, the tooth fell out, we’re all good.
Dr. Andy Roark: Yeah, sure.
Dr. Amy Thomson: Yeah, so when we call it dental disease, it’s not, I don’t think it’s unrealistic for the owner to say, Oh, the tooth is a problem. The tooth is gone. The problem’s gone. Um, And so I do think using the appropriate term of periodontal disease and discussing that it’s the root surface of the tooth, but it’s also the gum, the bone and the ligament that are diseased to help understand why it’s so important to do the exam under anesthesia, to do the x rays, and then to make sure that we remove the tooth debride that area and close it up.
I do find, personally, I get more reception from owners of understanding the importance of say x rays or doing this under anesthesia kind of thing
Dr. Andy Roark: Do you think that fear of anesthesia is the number one reason that we tend to see these cosmetic dentistries coming in where the tooth root below the gingival line has not been taken care of? Is that, is that, is that, in your opinion, is that what really drives it?
Dr. Amy Thomson: Absolutely that’s been my experience both when I was a general practitioner now as a dentist oral surgeon taking referrals, and then I do a lot of like online education. And so you have to be careful with things online, like social media. There’s lots of people that will kind of chime in. And yeah, there is a, there is a huge fear of anesthesia.
And I think being fearful of anesthesia is, you know, important. I don’t, I’m not, I’m not here to say we shouldn’t be worried. I mean, I, I, I tell all of my owners, anesthesia is not a benign treatment. So there is always going to be a risk, albeit for most healthy patients, it’s, you know, less than 1%. And those that have comorbidities there’s lots of things that we can do as far as working up heart disease, kidney disease to make it as safe as possible.
And then we have. The wonderful people who are board certified anesthesiologists who can manage the higher risk anesthesia. So, I would say at least half, if not two thirds of my patients have kidney disease, heart disease, or sometimes both, yeah, but, but it is, owners are afraid, and I think that fear, I don’t think anyone’s doing it on purpose, but it’s almost like this fear mongering of like, you want clean teeth, which we talk about the importance of oral health, but you don’t want your pet to die, so here’s the solution.
The problem is that while we’re avoiding anesthesia, we’re not actually treating disease in their oral cavity and potentially we’re making it worse because the teeth look clean and so we’re not clued into the fact that actually below the gum line there’s problems.
Dr. Andy Roark: Hey guys, do you wish that your team was better at handling conflict management? Are you a leader, a medical director, a practice manager, a practice owner and associate vet that wants to not only be able to handle conflict really well in your team, but also to have the tools to train your people so that they have these conversations more gracefully with each other.
Would you like to work at a place where we’re. We’re not sniping at each other. We’re getting along and communicating effectively. Guys, we can make that happen for you. I and the uncharted team will be at the hive event in Minneapolis is June 15th and 16th. We are having one day. Conflict management training program.
So it will be, my team will be there is through uncharted. And so it is going to be one day of working with me and Stephanie Goss and Maria Pirita and we will be breaking down workshops on conflict management and you can drop in. You can get a day, you can spend the other day at the Hive conference.
It is going to be an absolutely fantastic time, guys. Ah, I’m going to put a link in the show notes, head over there, check it out, grab your spot. This is not sit and be lectured at. This is round table workshop discussion format where you get your hands dirty. You get down to the weeds. We talk about what these tactics look like in our teams, in our practices.
And we walk away at the end of the day with real skills to change the culture. In our practice guys, this is an investment in yourself is an investment in your team. It is an investment in your happiness and in your workplace. Do not miss the opportunity. It may not come around again. This is a great chance to work with us and to really stretch and expand your mind.
And I promise you’re gonna have a great time, gang. Again, June 15th and 16th in Minneapolis. Hope to see you there. Let’s get back into this episode.
Dr. Andy Roark: So, so, bringing this back to Nico. So, five years old seems young to me to have, especially, you know, when they’ve, they’ve, they have, they have been attentive in their way to his, to his oral health. I’m sort of surprised looking at this. Can you sort of lay down your approach to this case? So, I haven’t done any diagnostics here, but I’ve got Nico.
I’m trying to set expectations. How would, how would you approach this case from here? So walk me through kind of what your game plan would be, if you don’t mind.
Dr. Amy Thomson: Yeah, yeah, so again, I would acknowledge that, like, I think it’s great that they’re, like, taking an active approach and having his teeth cleaned. The concern is, is that despite the teeth looking clean and being free of plaque and calculus, there’s that, you know, bad breath, disease, I call it disease breath instead of doggy breath.
I don’t always maybe get as graphic as that.
Dr. Andy Roark: Yeah, exactly. Yeah
Dr. Amy Thomson: and, and the fact that his gums either look a little bit darker pink or red, maybe a bit swollen. Definitely those are my two indications that there’s a deeper disease going on. And so the bet, I would explain to the owner, the only way to know the extent of this disease, unfortunately, is to do a tooth by tooth exam, just like our dentist does in our mouth, and take those x rays.
And then I’ll often joke around like, I wish we could do that awake, and he would just sit and go, ah, but unfortunately that’s going to require anesthesia. So I’d really like to get him scheduled in so we can get to the bottom of this, you know, bad breath, diseased breath, inflamed gums and figure out if this is, you know, hopefully we’re at a point where we’ve got a lot of buildup underneath the gum tissue that needs to be cleaned, but we don’t have significant bone or ligament loss or loss of those periodontal tissue structures where a deep cleaning is enough.
However, given his age and his size and potentially, you know, the smell or, or what you’re seeing we may find that, unfortunately, despite on the surface being clean, there’s been debris and disease underneath, and, and he may actually require extractions, but the only way to know for sure is to get those diagnostics, which, which will require anesthesia.
Dr. Andy Roark: Gotcha. Okay. Do you have any concerns about whenever I have these small dogs and I’m working in their mouth and I’m concerned about sort of significant, periodontal disease, things like that do you have any concerns about tooth extraction in tiny dogs, things like that? I mean, just if, if this has been going on and we’ve got significant dental disease when we get in there, I’m, I’m worried about breaking these little dogs, you know what I mean?
Like, like I’ve, I’ve seen these little jaw bones that have been sort of deteriorated. I’ve, I’ve seen them just snap and
Dr. Amy Thomson: Yeah. And they’re just like, they’re so little.
Dr. Andy Roark: So little and I don’t know. Is that fear completely un I can’t be, no it’s not completely unfounded, but like, is there, is there anything that I should be particularly aware of or anything that you can do to help me kind of protect myself if I do get in there and I find that the, there’s just been terrible deterioration of, of, of the jawbone, things like that.
Any tips or tricks for me?
Dr. Amy Thomson: Not to get all nerdy, but there is publications to say that as our we bred dogs to get smaller and smaller, they don’t proportionally have smaller teeth. So smaller dogs actually have more of the volume in their jaw taken up by teeth. So that can create an issue when you have like a relatively big tooth.
I used to joke my little chichi, raisin nose. I used to joke. She was like the mask with the really big teeth, like the small little job, big teeth. And so it’s, it’s pretty common. So then if you imagine you have this really big tooth in this small jaw and then you start removing jaw, when you start to remove these teeth, you’re putting a fair amount of torque on the jaw to get this big tooth out.
And so, I think, And I will always say I said it a lot over OVMA is it’s important for you to be comfortable. So if you get into a mouth and you go this is way worse than what I thought Above all else do no harm like we take our oath is just let the owners know, you know, this is worse than what? We had thought and i’m concerned with the amount of bone loss and you know, the size of Nico. But there could be a risk that I could do some damage to his jaw.
And I just think it would be better in the hands of a colleague or, you know, perhaps we’ll do part of the work, but then come back because of course, depending on your clinic you may be scheduled for surgery and then in appointments. And the last thing you want to do with tooth extraction is try and rush.
Cause then I find when people rush, they get nervous. They use a bit more force. We’re more at risk to having problems happen. So I would just give everyone permission to say it’s okay to say like I’m not comfortable with this because you want to do what’s best for this pet. And then my little tip for that is I’m a huge huge fan of something called horizontal elevation.
So I find those that that had like a dentistry program in vet school or have gone to courses, I do find there’s a lot of what we call vertical elevation. So if this is like the tooth root, we put the instrument in down along it and we rotate which is, which is great. And one, technique in my toolbox.
The, so that’s vertical. It’s along the long axis. But horizontal, I find helpful in say like these big molars and these small dogs with the small jaw is if you actually say these are your two roots or two crown root segments, I put my winged elevator in between so perpendicular. And then when I rotate, I’m stretching the tooth against tooth and I’m putting less torque on the jaw while I support that jaw. And so, less likely not impossible but less likely to cause iatrogenic jaw fracture to that jaw because you’re not putting a ton of torque on that small jaw that’s potentially diseased.
Dr. Andy Roark: No, that totally makes sense. Okay, I feel like I got a plan here. I think I know how to approach this. Any last words of advice for me? Anything that you, that you could foresee that I would want to avoid as far as a pitfall or make sure that I do well?
Dr. Amy Thomson: I think you have a good plan. I just think like open communication and just like knowing that, you know, It’s very common for owners to feel like these anesthesia free cleanings are in their dog’s best interest because they’re scared of anesthesia And they know how important oral health is and probably at most of their pets visit The vet is talking about the importance of oral health So I think just letting them know that like we know they were doing what they felt was best and unfortunately There’s just not enough of us being able to be the voice out there to say that that these anesthesia free pains, while they avoid anesthesia very much limit in what we can do.
We can’t do diagnostics. We can’t do true, you know, therapeutic treatment. And so just talk to them about, you know, we may find that we have to extract multiple teeth from Nico, but he’s going to be healthier. And then when he comes back, I always tell owners, once he comes back at two weeks, I always see all my patients at two weeks, make sure they’re healing.
Then let’s talk about things that are going to be really helpful that you can be doing. So that we don’t kind of get into this situation in the future. There’s always a tooth brushing discussion and demo. And then we’ll talk about, you know, setting expectations for COHATs, or Comprehensive Oral Health Assessment and Treatment which is the cleaning the x rays under anesthesia.
And, and talk to them about what is realistic for them to feel comfortable doing, both from an anesthetic standpoint, overall pet health, cost and just sort of work together to make a plan. And, and let them know, you know, I’ll have recommendations, but this, this needs to be a team effort for Nico.
Dr. Andy Roark: Yeah, that totally makes sense. Thank you so much for being here. Amy, do you have any favorite resources for anybody if people are like man, this is my jam I love I love I love dental health. I mean you’re this is your passion. What are your favorite..
Dr. Amy Thomson: I love it.
Dr. Andy Roark: Resources?
Dr. Amy Thomson: Yeah,so, the veterinary dental forum that sort of like that was like Christmas for me and is every year I’ve been I don’t know. I think it’s like 11 years in a row now I’ve been, I’ve gone, or I’m coming up on my 11th forum. Lost track. But I went there early on in my career and it’s such an amazing weekend.
So it’s three full days of lectures. It’s broken up between sort of, beginner, intermediate, advanced. There’s practice management series. There’s technician series. And then there’s a bunch of wet labs and it’s just like a whole bunch of tooth nerds that are just real excited to talk about teeth.
And you can just really be immersed in that. And I always find like, even now I will, I will still learn things when I go. And, and it was interesting because when I was lecturing there last, last year I was also a moderator and, and hearing other diplomates talk about things that I talk about, you’re like, oh, it’s interesting they use that instrument a little bit differently.
So, it’s just like a huge wealth of knowledge. So if you’re available and can go, it’s normally in the fall, it moves around the continental U.S. It’s in Palm Springs this year at the end of September. So a pretty nice locale location. And, It’s a ton of CE. Definitely love that.
And then the AVDC website or the American Veteran Dental College has a lot of resources for ongoing CE and things like that. Which is really helpful if you’re looking for more. That’s sort of where I started many, many years ago, getting my education.
Dr. Andy Roark: That’s awesome. Well, thanks so much for sharing that. I’ll put links on the show notes guys. Thanks for being here. Amy. Thanks for being here. Take care of yourselves everybody. Yeah
And that’s what I got for you guys thanks for tuning in. I hope you enjoyed it. I hope you got something out of it. Thanks to Amy for being here and sharing her pearls of wisdom. Yeah, I really appreciate everybody’s time. I appreciate your time and her time and Dustin’s time who produces our episodes. It’s like don’t forget Dustin.
And so anyway, everyone is appreciated in the making of this episode. Anyway, guys, I’ve had enough. It’s been a day. I’m going home. Take care of yourselves, everybody.
