The vet nurse’s role in dental procedures: Making the most of your RVN team

4 February 2025 -
A vet nurse undertaking a dental procedure in a beagle. Vet nurse dental care is important in practice!

With Pet Dental Health Month just around the corner, we thought we’d ask vet nurse Robyn Lowe RVN about vet nurses, dental care for pets, and the role an experienced RVN can play in practice. 

Periodontal disease is a highly prevalent and serious condition with significant implications for the overall health of dogs and cats. Periodontal disease is among the most frequently diagnosed conditions in companion animals, affecting up to 80% of dogs and 70% of cats by 2 years of age. Furthermore, if left untreated, dental disease can have numerous, severe local and systemic consequences, therefore encouraging prompt recognition and treatment is beneficial for patient welfare. Registered Veterinary Nurses (RVNs) play an integral role in all aspects of dental health management, from early education to dental health checks and more.  

Let’s look at how we RVNs can help our pet patients and the wider veterinary team with dental care. 

Role 1: Pet owner education 

Education of owners is essential. Owners who are educated on how to check for dental disease, and how to maintain oral health in their pets, may be more likely to present their pets earlier, and more likely to understand why treatment may be required to alleviate the issues. 

Toothbrushing 

Periodontal disease is a bacterial inflammation of the periodontium, or periodontal tissues. Periodontal disease is characterised by 2 stages: gingivitis (the early, reversible stage, characterised as inflammation of the gingiva) and periodontitis (the inflammatory condition affecting the supporting structures such as the periodontal ligament, cementum and alveolar bone). 

Periodontal disease begins when bacterial plaque accumulates on teeth, plaque attaches to clean teeth within 24 hours if left undisturbed. This is where education of owners can prove helpful. Effective tooth brushing is one of the most effective ways for owners to delay dental disease progression – but owners first need to understand why and how to achieve it. The aim is for the tooth surface to be cleaned frequently and thoroughly before plaque accumulation progresses to calculus formation (calculus is plaque that has become mineralized by salivary interaction and consists of a mixture of calcium carbonate and calcium phosphate). As plaque can accumulate within 24 hours, ideally, daily brushing is required. 

Educating puppies and kitten owners on how to introduce the concept of tooth brushing with positive reinforcement could set them up with the ability to easily clean their pet’s teeth throughout life, therefore maintaining a better level of oral health care. If periodontal disease has already been diagnosed and treated, then post-operative discussions on how to maintain good oral health going forward can be used as part of the operation aftercare visits.  

At-home monitoring of dental pain 

Clients should be taught to monitor for commons signs of oral pain including but not limited to: 

  • Halitosis 
  • Gingivitis 
  • Hypersalivation / drooling 
  • Bleeding gums – can happen after eating or play  
  • Pawing at mouth or rubbing face on the flooring 
  • Weight loss 
  • Behaviour changes (as with any form of chronic pain condition) 
  • Difficulty eating – manifesting as reduction in amount, favouring a certain side and dropping food  

Importantly, it is imperative that we educate owners that absence of clinical signs does not mean absence of periodontal disease. Periodontal disease can be extremely hard to spot, especially in food motivated animals, and commonly is accompanied by no or very subtle clinical signs.  

Role 2: Dental health checks 

Dental health checks should be conducted yearly as part of a general health check +/- vaccination of pets. However, there may be pets who need more regular checks, or who – for whatever reason – have not attended the practice in some time for a health check.  

We RVNs cannot make a medical diagnosis, but we are able to take a clinical history, and use validated tools or recognised scoring systems to monitor and screen pets overall, and dental health. Let’s take a look at how we can support the practice with dental check ups: 

How to perform a ‘dental check’ 

Dental disease can cause other systemic impacts on a pet, so it’s important to remember that a ‘dental check’ should be performed in a holistic manner, taking a history of the pets general health, diet, background (including importation status), Body Condition Score (BCS), weight and a ‘nose to tail’ exam, including heart and lung auscultation. This information is not only valuable to ongoing client education, but also an important factor when, or if, a General Anaesthetic (GA) is required to treat any periodontal disease.   

As part of the oral assessment an RVN can first examine externally, ensuring there are no facial swellings, or areas of particular discomfort. If the pet allows and it is safe to do so, then an oral examination can be carried out. This can be done with the aid of a canine or feline dental chart. First checking visually: 

  • The colour of the gingival mucous membrane 
  • Signs of inflammation or gingivitis 
  • Signs of infection such as purulent discharge or abscesses 
  • Gingival recession 
  • Slab fractures 
  • Indication on enamel damage 
  • Colour changes to the tooth 
  • Pulp exposure 
  • Teeth that are visibly mobile 
  • Missing teeth 
  • Dental malocclusion such as an ‘underbite’  
  • Any other signs of disease – masses, epulis and other  

You can also estimate the severity of the dental disease from 0-4 based on the ‘Periodontal Disease Index’: Can be generalised or localised Stage 0 – No disease Stage 1 (PD1) – Gingivitis – reversible, no attachment loss (AL*) Stage 2 (PD2) – AL < 25% or furcation 1 exposure Stage 3 (PD3) – AL 25%–50% or furcation 2 exposure Stage 4 (PD4) – AL > 50% or furcation 3 exposure *AL is usually best based on measurements with a periodontal probe and intraoral radiographs. 

There is also a plaque and gingival index that can be estimated, usually based on a 0-3 scale. These scores will need to be repeated by the RVN and Veterinary Surgeon (VS) under GA, as probing is required to check for Bleeding on Probing (POB). 

0 = No plaque 

1 = Thin film along gingival margin covering < 1/3 of buccal tooth surface 

2 = Moderate accumulation of plaque covering 1/3 to 2/3 of buccal tooth surface 

3 = Abundant soft plaque covering > 2/3 buccal tooth surface 

 

0 = Normal gingiva 

1 = Marginal gingivitis, mild swelling, some colour change, no BOP 

2 = Moderate swelling and inflammation of gingiva, BOP 

3 = Marked swelling and inflammation, spontaneous bleeding 

Role 3: Dental treatment and dental surgery  

Another area that the dental-keen RVN can assist their practice with is of course the dental itself. Let’s take a look at the RVN’s role in veterinary dental surgery: 

Pre-dental

To aid the clients’ understanding and ensure informed consent, a ‘preoperative dental handout’ can be formulated by the veterinary practice to hand out prior to the dental procedure. Ideally, this should be done in advance of the surgery day to avoid overwhelming clients. Veterinary practices can utilise email, apps and messenger services to send handouts as PDFs, as well as handing them out physically during RVN or VS dental checks or at the time of booking the treatment. To ensure the practice is accessible to all, a veterinary nurse may also be expected to call a client to relay this preoperative information, for example if a client is unable to read the handout.  

Admit appointment

Many patients will require dental treatment under GA. Once diagnosed and booked in, RVNs are often called upon to admit a patient. To ensure that there is informed consent, the RVN should explain the procedure again, and give a comprehensive estimate. Owners should always be contacted if the estimate or treatment plan changes, so they are informed of ongoing costs.  

General anaesthetic planning 

As with any GA, the clinical veterinary team needs to plan the protocol for the patient to ensure it covers the triad of anaesthesia (hypnosis/amnesia/unconscious, analgesia and muscle relaxation), and is safe for the individual patient.  If not doing so already, it may be helpful to use the ASA Physical Status Classification System.  

General anaesthetic maintenance and monitoring 

One area that RVNs are already well-utilised is in the delegation of anaesthetic maintenance and monitoring. Despite the exceptional skill of veterinary nurses, the veterinary surgeon must remember to provide the appropriate level of supervision and direction as specified and required by their country and state – e.g., in the UK we are obligated to follow the Veterinary Surgeons Act 1966 and the Royal College of Veterinary Surgeons (RCVS) Code of Professional Conduct (COPC). 

Section 18 ‘Delegation to veterinary nurses’ states: 

18.9  Veterinary nurses and student veterinary nurses may be directed to assist veterinary surgeons with the maintenance of anaesthesia and the monitoring of patients under anaesthesia.  

Dental exam, radiographs and cleaning 

While the patient is under GA, RVNs may also be able to: 

  • Undertake an initial oral exam 
  • Dictate charting 
  • Take dental radiographs 
  • Prepare the oral cavity for the procedure 
  • Perform dental cleaning procedures 
  • Place regional blocks (if indicated) 

Like maintenance and monitoring of anaesthesia, RVNs can only carry out this work under the direction of a veterinary surgeon, who does need to decide on the appropriate level of supervision. However, this can allow competent RVNs to do large portions of veterinary dental procedures. RVNs cannot, however, extract teeth using instruments. According to the RCVS “18.14  The extraction of teeth using instruments may readily become complicated and should only be carried out by veterinary surgeons. The RCVS considers that the extraction of teeth using instruments is not within the meaning of “minor surgery” in Schedule 3.” 

Conclusion 

RVNs are instrumental in numerous aspects of periodontal disease education and management. Appropriate delegation and collaboration of the veterinary team enables utilisation of RVNs time, skill and knowledge to offload tasks from the vet that RVNs are both competent and legally able to assist with. Not only will this increase efficiency, but it also gives the owner a more comprehensive service and provides career satisfaction for veterinary nurses.  

 

If you’ve been inspired by Robyn’s thoughts on vet nurse dental care, why not take some vet nurse dental CPD? Our veterinary nurse certificate in dentistry will give you the knowledge and skills you need to take on more of your practice’s dental work and improve the care of your dental patients. 

 

Other reading 

  • Stella JL, Bauer AE, Croney CC. A cross-sectional study to estimate prevalence of periodontal disease in a population of dogs (Canis familiaris) in commercial breeding facilities in Indiana and Illinois. PLoS One. 2018;13(1):e0191395. doi:10.1371/journal.pone.0191395 
  • Niemiec B, Gawor J, Nemec A, et al. World Small Animal Veterinary Association global dental guidelines. J Small Anim Pract. 2020;61(7):E36-E161. https://doi.org/10.1111/jsap.13132 

 


 

Author

Robyn Lowe BSc Hons, Dip AVN (Surgery, Medicine, Anaesthesia), Dip HE CVN is a small animal Registered Advanced Veterinary Nurse (RVN) who regularly writes articles for academic journals and publications for animal owners. Robyn has a passion for evidence-based medicine, has volunteered for Canine Arthritis Management to write owner literature, is Director of Veterinary Voices UK, runs the Veterinary Voices Public Page, and campaigns on mental health and animal welfare issues. To this end she also sits on the Board of Trustees of Vetlife, the first RVN to do so in the charity's history.