7 steps to better veterinary dental recommendations

Mitsy is a 6-year-old Shih Tzu visiting your clinic for her annual wellness exam and vaccinations. On her physical exam, you note halitosis, dental calculus, gingivitis, and mandibular incisor mobility. You launch into your spiel about scheduling a professional dental cleaning, oral assessment, and treatment, and you ask your technician to prepare an estimate. How do Mitsy's owners respond?

Laura McLain

A. "But last time she had her teeth cleaned at El Cheapo Animal Clinic, they only charged $80."

B. "I've had dogs all my life. They've never had their teeth cleaned, and they did just fine."

C. "My neighbor took her cat in for a dental procedure, and it died from the anesthetic."

D. "No, thanks. My groomer brushes Mitsy's teeth when she gets a haircut."

E. "OK, when should we schedule that?"

In a perfect world, clients would respond with E, but you most likely get answers A through D. After all, we as veterinarians understand the importance of comprehensive dental care for our patients, but how well do we convey that to clients?

Whether we call it a "dental," a "comprehensive oral health assessment and treatment" (COHAT), or an "oral assessment, treatment, and prevention" (ATP), we understand that the majority of pets need more than just a prophy. Quickly polishing patients' teeth can miss a multitude of hidden pathologies, from apical abscesses and resorptive lesions to dentigerous cysts and fractured roots. But when clients are bombarded with advertisements for "anesthesia-free" dentals and quoted $75 at the clinic down the street, they're understandably suspicious of our much-higher estimates for comprehensive care. Here are seven ways to explain the cost and importance of dental care to clients.

1 DON'T COMPARE APPLES TO ORANGES

To a veterinarian it's obvious that a scaling under sedation is in no way comparable to a complete oral exam with radiographs performed under general anesthesia. However, a client may not appreciate the difference. When your technician presents an estimate for $600—including a preanesthetic blood panel, intravenous fluids, general anesthesia, supragingival and subgingival scaling and polishing, periodontal probing, and dental radiographs—many clients look at just the bottom line. We need to help clients understand that they're looking at apples, not oranges. Here are some ideas on how to do that:

Don't sugarcoat the facts. "Dentistry is the most variable procedure you can get at any clinic," says Dr. Ian Giebelhaus, co-owner of Rimbey Veterinary Clinic in Rimbey, Alberta, Canada. "With neutering, you can take 10 male cats into 10 different clinics with different surgeons, pre-op exams, and premeds, but at the end of the day all 10 cats will have two fewer testicles. Dentals aren't like that—procedures vary widely; therefore, so does the cost."

When helping veterinary clients understand the difference in levels of care, Dr. Giebelhaus uses an analogy: "I have two red 1968 Mustangs for sale at my house," he tells them. "One costs $3,000 and the other costs $15,000. Do you think they're the same?"

Divulge dirty details. One of the most important things clients must understand is that a surface cleaning doesn't detect or address potential hidden pathology—in fact, it does patients a disservice. Dr. Fraser Hale, FAVD, DAVDC, owner of Hale Veterinary Clinic in Guelph, Ontario, Canada, uses this comparison with clients: "A bridge that collapses after standing solidly for decades didn't rot overnight," he says. "It underwent gradual and hidden decay over many years, which eventually reached a critical threshold. Then the problem became obvious."

Define the difference. Dr. Dale Kressin, FAVD, DAVDC, owner of Animal Dentistry and Oral Surgery Specialists in Oshkosh, Wis., explains the difference in terms of the pet's well-being. He compares a simple teeth scaling to grooming, which makes the pet look better, as opposed to a comprehensive oral treatment, which makes the pet feel better.

Picture this. Dr. Janice Niedermeier, owner of Healthy Companions Veterinary Clinic in Janesville, Wis., takes the show-and-tell approach. She keeps a photo of a tooth and its corresponding radiograph in her exam room. The photo shows what appears to be a relatively healthy tooth, but the radiograph shows severe bone lysis and resorptive changes—obvious even to pet owners. After showing the photos and radiographs to clients, she says, "I'd be disappointed in myself if I charged you to care for Muffy's mouth and teeth and missed something as damaging and painful as this."

2 EDUCATE, EDUCATE, EDUCATE

Even dental specialists are susceptible to client pushback against recommendations. "At my hospital we often end up finding even more severe problems than what the referring veterinarian noted," Dr. Kressin says. "So we must continually educate the owners on the value of our services." His guiding principle? Value = perception ÷ price. So if the price is high, then perception of value must also be high. "I educate clients to elevate their perception of the need for the services and to explain the procedures," Dr. Kressin says. "The more I educate, the higher the value rises for the client."

Veterinary client education can be facilitated by the use of anatomic models, photos, and written handouts. Dr. Lisa Bennett, owner of Beaver Lake Animal Hospital in Issaquah, Wash., relies on handouts to explain the differences between dental prophylaxis and dental treatment, to outline her anesthetic protocols, and to detail the procedures that will be performed, from preanesthetic blood testing to local nerve blocks. Turn to page 20 for a dental client handout you can use at your practice.

Dr. Bennett also likes to use an automotive analogy with clients: "If you take good care of your car with regular oil and filter changes, the cost is minimal compared to having to rebuild the engine or transmission."

This means it's best to start educating clients early—while the pet is still a puppy or kitten—about preventive dental home care and the likely need for dentistry when the pet gets older.

3 DON'T PLAY THE BLAME GAME

Dr. Ginny Kunch, an associate at Diamond Animal Hospital and Emergency Services in Anchorage, Alaska, takes a nonconfrontational approach when discussing dentistry. "I tell clients it's not their fault," she says. "I explain that some pets just have bad enamel and make the correlation that my dad has great teeth and my mom had terrible teeth. I had a cavity by the time I was 5 years old—not because I didn't brush but because of genetics." By reassuring her clients that they didn't cause their pet's dental disease, Dr. Kunch is able to get her clients to focus on what's important—the necessary treatment.

4 APPEAL TO THE CLIENT'S SOFT SIDE

A rotten tooth hurts. Clients know this, but it's hard for many of them to tell if their pet is in pain. Make sure they understand that animals feel pain the same as people do, even if they don't show it. I often ask my clients, "Have you ever had a root canal?" They usually wince or groan as they nod. Then I'll say, "Then you know how much it hurts. Buster can't tell us his tooth hurts, but you know it's painful."

5 SHOW AND SMELL THE DIFFERENCE

Some clients assume that halitosis is just doggy breath. Dr. Bennett reports that when clients seem oblivious to the severity of the disease, she'll gag in front of them or give a little shudder upon catching a whiff. One trick I often use in the exam room is to quickly find the worst example of pathology I can and have the owner bend down for a close look (and sniff) while I explain what they're looking at (and smelling).

6 ANTICIPATE OBJECTIONS

If you recommend dentistry to a newer client, bring up potential anesthesia objections before the client even mentions it. Explain that you'll have a dedicated veterinary technician monitoring the pet every minute under anesthesia, or offer a tour of the dental area to highlight your anesthetic equipment and monitors.

7 OFFER INCENTIVES

Dr. Bennett has successfully implemented a "compliance discount card" program in her practice. When she first diagnoses dental disease and recommends that the client schedule a dental procedure, her staff mails a $40 discount card to the client. The card gives the client $40 off the final bill—but only if the client has the procedure performed within six weeks of the recommendation. The time limit prompts many of her clients to jump on her recommendation.

Of course, there will still be many clients who decide not to pursue treatment. But if we've educated them, at least we will have raised awareness. As Dr. Niedermeier says, "I don't succeed in booking all of these pets for services, but my approach has helped make believers out of more clients than would otherwise opt for this level of care."

Dr. Laura McLain is an associate at Central Valley Veterinary Hospital in Salt Lake City, Utah. Send questions and comments to ve@advanstar.com or post them online at dvm360.com/comment.