Preventative Teeth Cleaning & Oral Agreement Form

Preventative Teeth Cleaning and Oral Assessment (PTCA) Consent Form

A PTCA involves a non-anesthetic procedure performed by a dental hygienist (veterinary nurse) that works for Animal Dental Care Co. Mountain View Animal Hospital and Holistic Pet Care employs Animal Dental Care Services and is not affiliated with company.

A PTCA is to help pets improve their oral hygiene in a non-invasive manner. Although we believe this is a powerful method to prevent anesthesia when not necessary in our patients, a PTCA has significant limitations. 

Limitations of a Non-Anesthetic PTCA:

1. In our pets, unlike adult humans, radiographs can not be taken without anesthesia. Radiographs are the only way to evaluate for tooth root disease such as tooth root abscesses, tooth root fractures, tooth root cavities or other tooth root disease. Because pets often hide their dental pain until severe, without radiographs, we may miss severe dental disease and/or pain that your pet is silently harboring. Anesthesia allows relaxation for the pet and jaw for proper radiographs to be taken.

2. Causes of dental pain can not be fixed, only evaluated through a PTCA. Dental pain can come from fractured teeth, mobile teeth, cavities, tooth root abscesses, etc. If a tooth needs root cleaning, specific treatment and/or extraction, this can only be done under anesthesia. The veterinary hygienist will make any recommendations for anesthesia if felt necessary once the mouth is evaluated.

3. A PTCA can only clean so far into the gingival gumline. When large / deep pockets are noted, the infection may be difficult to remove with an awake or even sedated patient.

PTCA's are highly controversial in the world of veterinary medicine. Many average veterinary hospitals do not see the benefit of this procedure as it does not include radiographs. Because of this, the medical board has tight regulations on veterinary hospitals that offer this service. There are several regulations that we are responsible to tell you.

American Association and Medical Board Requirements for a PTCA:

1. The American Veterinary Medical Board and American Dental Association recommends every pet to undergo anesthesia once yearly to perform dental radiographs and deep gingival cleaning.

2. Nevada Veterinary Medical Board requires an annual exam to be performed with a Mountain View Animal Hospital and Holistic Pet Care doctor to receive any services, treatments or products/medicines including a PTCA at our hospital.

3. The annual exam establishes a relationship, evaluates health status and ensures there is no gross observations that would prohibit a patient from receiving a PTCA. In addition, medications to help sedate / relax patient during the procedure can be discussed. If the pet is found able to proceed safely with the PTCA procedure, during the PTCA procedure additional teeth / gum disease may prohibit the veterinary nurse from completing the PTCA as it may be painful for the pet.

4. If the pet is showing signs of pain, anxiety or distress, the veterinary nurse will stop. At that time the significance of dental / gum disease may be discussed with the owner and recommendations to proceeds with a anesthetized dental may be recommended or request or sedation may be desired. In the case the veterinary nurse can not clean the mouth fully, only the sedation should be charged.

5. You will receive a reminder yearly based upon regulations and recommendations by the American Veterinary Association to perform anesthetized dental cleanings. You may discuss the risk and benefits of anesthesia in your individual pet on your annual exams or sooner if necessary.

You may request an estimate for a dental cleaning with appropriate treatment options if your pet is found to have one of the dental health concerns above that limit him/her from completing a PTCA treatment and/or for your pets annual anesthetized dental cleaning. If you have a preferred doctor at Mountain View, you may request the dental be scheduled with them.

Risks of this procedure may include soreness of the gums, respiratory infections or unidentified tooth root disease that is only visible with radiography (X-Rays). Please contact us immediately if you notice lethargy, coughing, decreased appetite or a painful mouth after your procedure. 

Authorization for Sedation

I have elected conscious sedation for your pet's procedure today. This sedation will be "light conscious sedation" where my pet will maintain protective reflexes, however, they will be less aware of their environment. I certify that I am the owner, or authorized agent of the owner, of the animal above and have full authority to execute this agreement. I also certify that I am 18 years of age or older. I authorize Mountain View Animal Hospital and Holistic Pet Care (MVAH & HPC), its veterinarians and employees under veterinary supervision, to perform the procedure(s) identified above. I understand that some risk always exists with sedative administration and invasive procedures and that during performance of these/this procedure(s), conditions may be encountered that necessitate an extension of, or variance from, the procedure(s) set forth above. I have discussed the recommended procedure(s), associated risks and anticipated recovery with an attending veterinarian. All questions and concerns I have about sedation, procedures and associated risks have been answered to my satisfaction. I understand that a reasonable attempt will be made to contact me if expected fees will exceed the estimate by 15% or more. I agree to assume financial responsibility for all fees associated with the care of my pet and agree to provide payment in full, in accordance with the payment policy, at the time my pet is discharged. This consent will cover the next 12 months for any elective sedation procedures. I will notify the doctor if there are any changes in my pets health since the last sedation procedure.

CPR CONSENT AND RELEASE OF LEGAL LIABILITY

Based on the medical judgement of MVAH & HPC's veterinarian(s), should my pet require CPR, including cardiac compression, positive pressure respiration, emergency drugs, or other interventions, I request or decline that the doctor(s) at MVAH & HPC pursue such medical care as indicated below. Furthermore, I have been informed by the team at MVAH & HPC that less than 5% of animals that require CPR will survive to be discharged from the hospital. I understand that despite the best efforts of the veterinarians and the team members at MVAH & HPC, CPR may not allow my pet to regain his/her normal mental or physical capacity. Priced from $75-$150, charges are due in full upon pick up if CPR is performed. Regardless of whether I consent or decline to have CPR performed on my pet, in consideration for following my directive, I hereby waive, release and discharge any and all claims for damages, including, but not limited to, claims for death, injury or property damage, whether or not resulting from the negligence, gross negligence or other acts of MVAH & HPC, its veterinarians and staff. I declare that any such veterinarian, staff, and MVAH & HPC is acting in accordance with my directions. This is intended to be an advance release of legal liability.

By signing this document, you are consenting for your pet to receive a PTCA, are stating that you understand the difference between an anesthetized dental versus a PTCA, the benefits and risks of the procedure and current Nevada State Laws. You have been given the opportunity to ask additional questions regarding the procedure.

Mountain View Animal Hospital and Holistic Pet Care

6474 Bonde Lane Reno, NV 89511

775-853-6900 (phone); 775-853-6966 (fax)

What is an Oral Healthcare Screening & Preventative Cleaning?

We offer a routine oral healthcare procedure designed to provide early detection of disease in the oral cavity and preventative cleanings. This allows pet parents the the opportunity to have painful conditions identified earlier and to ultimately prevent further future disease. The ability to provide this procedure awake with a cooperative patient allows for the necessary frequent care in maintaining oral health.

This procedure has limitations and requires individualization. 

A number of factors contribute to whether or not this procedure is appropriate for your pet and are evaluated under the Veterinary Client Patient Relationship. A behavior screening is performed to provide a safe and comfortable experience. A review of your pet's oral history along with an oral cavity screening is provided to optimize the effectiveness of this procedure. This procedure is preventive and is only effective when candidacy criteria is fully met. Remember, Dental Disease progresses differently in each dog or cat which requires individualized methods for treatment. 

Your pet requires a complete oral healthcare program!

A Preventive Oral Healthcare Screening and Cleaning is just one approach utilized in the dental disease fight, it's goal is prevention. It is not the same as other forms of necessary oral care. Complete care also involves, but is not limited to, routine full-mouth dental x-rays to help discover pathology, oral surgery (anesthetized procedures) to address any found pathology and home care brushing to disrupt the bacteria that forms in the mouth every day. Speak with your veterinarian about all the ways in which we can fight dental disease and begin forming a treatment plan for your pet.

Please fill out form

By signing this form I understand the information provided to me about treatment, I want to proceed with treatment and verify that the information I have provided is accurate.

Thanks!

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