Bio
Interview with Tom Rampton - a Veterinary Dentist.
Name: Tom Rampton
Post Nominals: BSc (Zool), BVSc (Hons), MANZCVS (Small Animal Dentistry and Oral Surgery)
"I graduated in 2004, and slowly formed an interest in the misunderstood (and often disliked!) and poorly taught field of dentistry. It appeared that the veterinary world had a lot to learn in this field compared to most others, so I was keen to contribute. In the last 10 years now I have practiced almost solely in the field of dentistry and oral surgery.
Tell us about a new dental development or technique that you are excited about.
One horrible disease that we really struggle with is Feline Chronic Stomatitis. At the moment, the go-to approach is extensive (sometimes complete) surgical extractions. In the pipeline, there is research into stem cell therapy that is having some very good results. We will need to wait and see, but I would love to see a successful and reliable treatment for these cats.
What are the top 3 most common issues you are seeing in practice?
- Periodontitis – Every day without fail you will see this disease (70% over 3 years old, and 80% over 1-year-old in less than 5kg dogs) – get them in early and regularly, don’t wait until you can see extractions.
- Broken teeth – dogs either find or are given inappropriate things to chew! (Remember: if you can't break it or mark it with a nail, it's too hard for your dog's teeth – NO BONES/ANTLERS/NYLA BONES etc).
- Malocclusions (incorrect jaw lengths/tooth positions) – we have seen a massive increase in debilitating malocclusions in puppies in the last few years, often with a genetic background. Beware the puppy that won't let you into its mouth.... sedation and checking are perfectly valid and often these dogs are the problem ones.
What are your top tips for :
- Taking x-rays: PRACTICE!! Keep practicing. Get radiographs of everything. Every cat needs full mouth radiographs every time. Every dog should have full mouth radiographs the first time you see it under anaesthetic
- Local anaesthesia: So important. Get a skull and have it beside the dental table so you can see where the foramen are. Look at all stages to provide good pain relief. Post-op pain relief is important.
- Extractions: Patience. Don’t rush it. Don’t book a dental for a 30-minute slot between consults. A good dentist will often take longer than a bad one, as they will find more problems! Look at the whole mouth, not just the obvious broken tooth. Oh and big gingival flaps!
What are your top 3 pieces of dental equipment that you would love to see in every general practice (excluding the dental machine)?
- RADIOGRAPHS – 100% vital. No practice should be performing dentistry without one nowadays
- Elevators and luxators that are well looked after. They aren’t expensive to replace, but a good set that is sharpened daily will save you a lot of time and stress.
- A spare table – a highly complex piece of equipment, but give yourselves space. There is nothing more frustrating than having to pile your kit on top of the cat or losing your periosteal elevator under the dog.
What is the most unusual case you have ever seen?
A 3-month-old big mastiff-type dog with an odontoma involving the whole left side of its face (12-15cm lengthx7-8cm wide), pushing the orbit dorsally and compressing that side of the nasal cavity. We removed around 300 mini teeth. 6 months later, the dog looked largely normal, the eye and nose were back to a fairly normal position, and the deficit had settled. It was fun pulling out the million little teeth!!
Words of wisdom - what do you wish someone had told you about dentistry when you were in general practice?
Take your time, and give yourself time. This is something I try to instill in all the clinics I work in. A dental is not a procedure that takes 30 minutes between consults, and it is not a procedure to give the new graduate because the older vets don’t want to do it. You are often working with big hands in small areas, soft tissue, bone, and teeth. It is complex and you can leave them in a lot of pain if done badly. If you are not confident then refer or at least talk to someone with more experience.
What dental CPD or resources would you recommend to vets that are interested in upskilling?
There are lots of courses now available through a variety of sources. Conferences, wet labs, and even youtube videos can help. But if you are anything like me, the best teaching you will receive is in-house (using your own equipment ideally), and small numbers with hands-on. But the more you do the less stressful it will be. It is actually fun, honestly!
What aspects of your job do you find most rewarding?
Seeing the improvements in the animals 2-3 weeks later is immensely satisfying. Knowing you have improved that animal's life, often after years of chronic pain.
What types of dental cases would you recommend for general practitioners to refer?
Lots of the malocclusions at the moment require advanced techniques, but bad stomatitis cases, awkward extractions in the 3kg dog, or the broken canine in a 30kg staffi. Really if you aren’t feeling confident to deal with it look at a referral. Dentals have traditionally been done in-house, often by people who aren’t happy doing them, it's perfectly okay to refer or at least talk to someone with more experience if you are anxious.
What aspects of client education are essential when talking about pet dental health?
Time. Don't try and squeeze the chat in with vaccination in a lame dog with skin complaints in 15 minutes. I like to have a nurse/front desk person who can start (or often give a very comprehensive talk), then have a consult purely for the teeth. SHOW the client the dog's mouth. Explain they will not go off food just because they are sore. Relate it to human pain.... Oral pain is among the worst humans suffer.
Is there anything else you would like to share with our Vetcheck users?
If you have a vet or nurse in the clinic with an interest in dentistry, then ENCOURAGE IT! Send them on courses, and give them time to get better. One good vet and nurse team will make a world of difference to everyone in the clinic, as well as the welfare of the animals.
