I am against allowing LVT’s to close gingival flaps for multiple reasons:

1. LVTs have two years of general training to be assistants to veterinarians.Beyond a secondary education, this would be considered a generalized entry level education into anything.It is far from the criteria necessary to perform the practice of veterinary medicine and surgery.The licensing of veterinarians and veterinary practices has evolved out of necessity to protect the public.Any instrument applied to a tooth or the surrounding structures is unquestionably oral surgery and falls under the practice of veterinary medicine.Just as the pathway of human dentistry has lagged behind advancement in other areas of human health (but is catching up), the value of oral health care for animals and veterinary dentistry has lagged behind in our profession.As could easily be considered progressive many States and Provinces of Canada, have recognized the importance of dentistry and restricted the practice to licensed veterinarians.LVTs are restricted to assisting and not performing extractions and suturing.In the State of Virginia, LVTs are currently allowed to extract single rooted teeth.This aspect of the practice act is already abused.It is common knowledge that veterinarians regularly section multi-rooted teeth, refer to them as “single rooted teeth”, and then allow assistants to extract.The public is uninformed and unaware of this practice.Informed consent for LVTs performing even single root extractions is not provided in most practices.Allowing LVTs to suture will open additional abuse potential. Allowing assistants (LVTs) to perform dental surgery (extractions, suturing, etc.) is allowing the practice of veterinary medicine. Owners are usually uninformed when this does occur.

2. Oral cavity is part of the alimentary tract. Like other parts of our anatomy, the oral cavity has specialized, unique anatomy and properties.The anatomy of the gingiva is unlike skin, in that it is tightly bound down to bone. Because of this characteristic, it requires a distinctly different technique to release uninjured gingival tissue.It is VERY easy to tear the gingiva if this difference is not appreciated, or if insufficient effort is made to undermine the full height of the gingiva to allow the gingival tissue to be advanced over the alveolus following extraction.Insufficient releasing of the gingiva requires placing sutures under tension to obtain closure across the alveolus. The result is a guarantee of dehiscence a few days following surgery, with oral pain and bleeding.Sometimes there is sufficient gingival tissue undermined that the gingiva on the opposite side of the tooth does not need to be released. However, the usual techniques of placing a suture needle through skin will not work on this unreleased gingiva, and an individual not trained in oral surgery will very likely tear the gingiva and eliminate any possibility of satisfactory closure of the extraction site with uninjured gingiva.The mouth of a patient who has had extraction sites ‘closed’ by a veterinary technician who does not understand these nuances often looks like it has been butchered. These techniques specific to gingiva are not taught in veterinary technician school, and learning on the job is not satisfactory.

3. Just because the oral cavity is not in one’s normal view, and animals are able to endure significant levels of discomfort and pain, does not mean that conscious veterinary professional stewardship is not necessary.Handling of invaded dental and oral structures is the practice of veterinary medicine/surgery.Oversimplification of the facts is easy if one isn’t conscious of them and doesn’t have working knowledge of them.

4. The proper handling of each extraction site usually includes the necessity for alveoloplasty, osteoplasty, debridement of inflamed tissues, trimming of flap margins, proper subgingival curettage, proper lavaging, creation of mucogingival flaps using surgical instruments, proper release of tissue tension, selection of suture material type and proper suture placement.Each tooth is unique in this regard.Each closure site requires proper assessment and technique.Proper planning and technique factors play a major role in the reduction of complication rates, patient comfort and rate of return to normal functioning. There are several complications that may be associated with improper closure of extraction sites.Complications include: A) many extractions sites are not sutured closed.B) Unhealthy and compromised tissues may be present.C) Poor selection of suture needles and suture material may promote tearing of flaps, excessive inflammation, infection, sutures dissolving too soon, sutures dissolving too late. E) Strategic suture placement, positioning of sutures (spacing) and knot tying techniques are extremely important to optimum healing.

5. AVDT- LVTs do have additional training in veterinary dentistry, however, their more specific training is directed towards a more in depth understanding and proficiency in assisting the dentist…not performing procedures. At this point in time, AVDT trainees are not even allowed to be mentored by AVMA sanctioned board certified veterinary dentists.Adequate training for allowing procedures to be performed on someone’s pet would require a substantial increase in supervised, accredited and certified training.Again, learning on the job is not satisfactory.