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Teamwork for holistic dental health

  • Stephanie Goldschmidt, Chopper, and Jessica Lawrence

    Teamwork for holistic dental health

    The Veterinary Medical Center's dentistry and oral surgery service builds momentum

    (From left to right) Stephanie Goldschmidt, Chopper, and Jessica Lawrence

Veterinary dentist and oral surgeon Stephanie Goldschmidt came to the University of Minnesota College of Veterinary Medicine (CVM) in the fall of 2017 to help lead the dental surgery services at the Veterinary Medical Center (VMC). Since then, the assistant professor has shown a knack for providing top-notch care by collaborating closely with colleagues in the VMC’s surgery, anesthesia, and radiation oncology teams to put the U of M on the map for team-based veterinary dental care.

Illustration of healthy canine teeth and jaw

Goldschmidt, BVM&S, DAVDC, who won the American Veterinary Dental College Outstanding Resident of the Year Award in 2017, says she is passionate about dentistry because of the drastic change in quality of life it provides patients. “I get to see a patient that is experiencing a lot of pain become such a happy animal,” she says. “Dogs don't look in the mirror, so despite what they look like at the end of the day, when their pain is gone because we treated painful teeth or removed a tumor, their quality of life is vastly improved. I know a lot of dogs that lost half their jaw and play frisbee, carry around balls, and even hunt!” 

Goldschmidt is drawn to the varied caseload dentistry and oral surgery garners. It usually means she gets to cross-pollinate with colleagues all over the VMC. “We tackle things like periodontal disease, large tumors, root canals, and orthodontics,” she says.

She often works closely with small animal oncology surgeon Pierre Amsellem, DVM, DACVS, associate professor in the Department of Veterinary Clinical Sciences (VCS), and small animal surgeon Betty Kramek, DVM, MS, DACVS, professor in VCS, for more intensive surgeries. For cancer cases, Goldschmidt also collaborates with radiation oncologist Jessica Lawrence, DVM, DACVIM, DACVR, DECVDI, associate professor of radiation oncology in VCS, and Amber Wolf-Ringwall, DVM, PhD, assistant professor of oncology in VCS.

When Goldschmidt's patients come in through the emergency room at the VMC, she works with various faculty and staff from the Emergency and Critical Care team. And many of Goldschmidt’s patients are older or have additional medical issues, so her collaboration with VMC’s board-certified anesthesiologists is also crucial.

A joint effort

3D print of Chopper
Goldschmidt and Lawrence created a 3-D print of Chopper's tumor (lower left) with the UMN Earl E. Bakken Medical Devices Center.

Chopper, an 8-year-old black Labrador retriever, benefitted from the VMC’s specialty, team-based dental and oral surgery care. His owners brought him in to his primary care veterinarian for making strange sounds and experiencing labored breathing. During a thorough oral exam, the vet found a mass in the back of Chopper’s throat toward the bottom of his mouth. Chopper was then referred to the VMC.

Samantha Bilko, DVM, an emergency and critical care specialty intern, and Jeffrey Todd, DVM, DACVECC, an emergency and critical care clinician, performed a preliminary exam on Chopper. They saw a potential need for a CT scan to see the exact shape of the mass to decipher how best to remove it, so they referred him to dentistry and oral surgery.

Goldschmidt saw in a CT scan that the mass was extending from the right side of Chopper’s mouth to the right side of his ear. She performed a biopsy of the mass—which proved that the tumor was malignant—and removed the tumor shortly thereafter.

But five months later, the tumor returned. Goldschmidt collaborated with Lawrence to utilize the Earl E. Bakken Medical Devices Center and create a 3-D print of Chopper’s tumor. Through the print, they saw that this time, the tumor was embedded in Chopper’s jawbone. Goldschmidt and Kramek removed the tumor and the afflicted portion of Chopper’s jaw. Goldschmidt fitted Chopper with an orthodontic device to prevent the remaining parts of his jaw from shifting.

“What sets us apart from other specialty hospitals is that we have group-based care and we have all the facilities here to work together to do complicated surgeries.”

Stephanie Goldschmidt, BVM&S, DAVDC

Chopper investigates his 3D print
Chopper investigates the 3-D print of his jaw.

Despite bouncing back after surgery, Chopper developed an air bubble—bullous emphysema—in his lung tissue a few weeks later. The bullous emphysema was likely a holdover symptom of having the tumor—the severe blockage to his trachea may have resulted in the dilation of his small airways. “Luckily, we were able to work well with the emergency team to stabilize Chopper,” Goldschmidt says, “and then the surgery team removed the abnormal bulla.” Emergency clinicians Austin Luskin, VMD, and Chiahsin Sandy Young, DVM, managed Chopper in the ICU pre- and post-operatively. Since then, Chopper has recovered fully.

“Today, Chopper is doing great!” Goldschmidt says. His owners say his tail is wagging from the minute he wakes up in the morning until he falls asleep at night. He is also back to routinely playing fetch with anyone willing to throw a ball for him and stealing food scraps whenever possible.

The right people in the right place

"The most important thing in undertaking these large oral surgeries is having the right resources,” says Goldschmidt. “You need a great anesthesia team to keep patients stable during the surgery, a blood bank, and an overnight critical care team to watch for any complications after the surgery since we come into contact with many large vessels in the oral cavity." She says the VMC at the University of Minnesota stands out due to its state-of-the-art facilities as well as the multitude of specialists who work together to offer collaborative team-based care.

What’s also rare about the dental and oral surgery services at the VMC is that Goldschmidt performs veterinary dental work and oral surgery exclusively and regularly. She can anticipate—from every angle—how a dental surgery will affect a patient. “Since I only perform surgery in the head and neck, I am attuned to the anatomy in the oral cavity, which can help me anticipate how a surgery will affect dental health and the overall cosmetics of the patient,” she says. “Often, long-term tooth health is overlooked when a large oncologic surgery is performed. However, ignoring that in surgery may lead to nonvitality of a tooth and can give a patient long-term discomfort that could have been prevented.”

Goldschmidt says the U of M sets the dentistry and oral surgery service up for success in a number of ways. For one thing, the varied caseload helps keep skills sharp. “What sets us apart from other specialty hospitals,” says Goldschmidt, “is that we have group-based care and we have all the facilities here to work together to do complicated surgeries.”

Goldschmidt also gets to teach the dental course for second year veterinary students as well as the refresher dentistry lab in the third year. She also gets to host students on rotation. “I love the opportunity to teach the students in a progressive manner,” she says. “We teach them about common oral problems they will encounter in dogs and cats and how best to treat them. Their education culminates with clinical rotation, where they see more advanced cases compared to what we teach them in their preclinical years.”

As cases continue to flow into the VMC for Goldschmidt, her collaborators, and her students, a new team-based standard of care will emerge across the veterinary profession. It's an approach that Goldschmidt thinks will stand the test of time.


Illustrations by Hairun Li

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