Avoid surprising clients after dental procedures

For many clients, a surprise tooth extraction-even when performed with the patient's best interest in mind-is nothing to toot a horn about. (Shutterstock.com)Editor's note: We recently received an email from an unhappy pet owner whose veterinarian had removed her dog's canines while the pet was under anesthesia for the extraction of an abscessed tooth. The pet owner was unable to take the veterinarian's phone call while at work, and though she was later told that gum recession was the impetus for the extra procedures, she believed that the removal of her dog's canines was unethical and cruel. Instead of passing judgment on a situation about which we know few details, we asked Dr. Greenfield to comment on steps veterinarians can take to avoid such situations altogether.

Many veterinarians take it upon themselves to make unilateral decisions regarding what to perform in an anesthetized pet's mouth without owner consent. From a legal standpoint, these veterinarians are treading dangerous waters. But before we cast a colleague into the dungeon, let's look at ways that would allow for better veterinarian-client communication with a goal of avoiding surprised and upset clients.

There's a colossal difference between the treatment plan for an oral procedure and one for a spay or neuter. The latter are defined procedures with little chance of deviation from the original plan. But because 80 percent of all dogs and cats over the age of 3 years have some form of periodontal disease, the initial treatment plan (avoid calling it a “quote”) for an oral procedure is much more subject to change-a fact that should be made explicitly clear to your clients to allow you some latitude.

Before a pet is transferred to your hospital's care for a planned dental procedure, a trained person (most reliably a veterinarian) should examine the patient's oral cavity for any obvious pathology requiring treatment beyond the original plan so any changes can be discussed with the client in person before the pet is anesthetized. However, you'll still need to explain to the client that once the patient undergoes anesthesia and further assessment via probing and dental radiography, you may detect hidden pathology that will need to be addressed. 

The consent form should reflect the base treatment plan and possible additions. If the client says that he or she will be unavailable to talk during the procedure, you'll need to discuss possible additions and whether or not the client is comfortable with having them performed. But even with this information, I would never recommend unilaterally extracting any extra teeth without the client's consent unless it was pre-arranged with the signing of the consent form.

Don't remove a strategic tooth (e.g. canine tooth, maxillary fourth premolar, mandibular first molar) unless you're able to discuss it with the client first. If you later learn that the owner is against the procedure, you will have placed yourself in legal jeopardy.

Let the client know via the consent form that if they do not respond to your texts or calls, you will awaken the pet and create a new plan for any additional treatment that needs to be done. Is there wiggle room for minor procedures? Yes, but proceed with caution, as some clients resist having even an incisor extracted without direct consent.

I tell clients to keep their cell phone by their side during the day with a possible second number to call. My team texts the clients to let them know when we are starting the anesthetic procedure, and once we clean, chart, probe and radiograph the patient, my team calls or texts again to discuss treatment recommendations. If the owner does not respond within 10 to 15 minutes, we simply wake the pet up, and the recommended additional procedures are staged with a new treatment plan. (The owner will need to know that startup fees will be incurred, but that's the price they must pay for delaying treatment.)

Your client consent form should be your friend, and your team should know that there's no such thing as a universal periodontal procedure fee. Pets receiving thorough dental care are healthier pets, and their owners are happy knowing they got what they agreed to-it's a win-win situation for retaining valuable clients for the lifetime of the pet.

Dr. Barden Greenfield is the owner of Your Pet Dentist of Memphis and Little Rock.