Developing a thriving veterinary dentistry department (Proceedings)

It always amazes me that so many veterinary practices ignore or do not pay adequate attention to one of the most prevalent diseases that pets suffer from every day. The statistic is that 70-80% of all companion animals over the age of three have some level of periodontal disease. Yet, it is probably the most ignored disease in dogs and cats.

Before we ever entered a veterinary technician school, we were already trained by the veterinary practices we took our own pets to, how very important vaccines are. We have come to expect that a wellness visit to the vet may very well include vaccines. These are vaccines that our pets will most likely never be exposed to. But, we have been successfully trained to provide this care.

Now, I'm not advocating not vaccinating our pets, nor am I suggesting that we shouldn't be vaccinating client's pets. What I am trying to illustrating is the importance of training.

Interesting to know, a 2002 AAHA client-compliance survey revealed that the responsibility for the failure of owners to provide dental services for their pets was the person responsible for giving the recommendation. Most veterinarians felt that cost was the deciding factor against dentistry. The survey showed only 7% responded that cost was a factor. The survey showed that they actually either did not receive a recommendation for dentistry, they didn't understand the importance, they forgot the recommendation or their vet didn't follow up. So, that means that we have to manage each of these concerns.

Training begins at the practice level. All staff members need to be on the same page as far as dentistry is concerned. This means that everyone from the receptionist to the practice administrator must understand their role and "buy in" to the importance of this care.

First, what is the impact of dental disease on the patient? The result of recent research demonstrates the association between inflammatory periodontal disease and cardiovascular disease, respiratory disease, liver disease, kidney disease, and joint disease. So, when we take care of the mouth, we are in turn, taking care of the rest of the vital organs.

What about patient comfort? Animals live with fractured teeth, multiple tooth root abscesses, oral ulcerations and more. But, because they do not stop eating, or become noticeably lethargic, many clients perceive that the pets are not uncomfortable. On the contrary, my experience is that most clients notice the positive change in behavior after the dentistry is provided.

So, how can we train everyone on staff? I am a strong advocate for staff meetings and staff education. Close the practice down for 2-3 hours and provide the staff with that training. Receptionists should understand dentistry services, terminology and products dispensed.

Technicians should be trained to "flip the lip" every time they examine a pet. The veterinarians should be trained to discuss the oral status and make appropriate notations in the permanent medical record every time they perform a physical exam.

Also, when a recommendation is made by the veterinarian that dentistry should be provided, reminder cards can be generated by most veterinary software packages.

Along with the staff, the clients have to begin to expect a report about their pet's mouth as much as they expect vaccines. The clients will come to expect this when the practice is consistently saying the same message time and time again. It is no coincidence that large companies spend millions of dollars interrupting programming on television repetitively. It may take a client 10 times of hearing that their pet needs to have dentistry before they value the information enough to jump over the barriers to that care.

Many drug companies provide professional posters highlighting oral disease. These can be placed around the practice. Some practices have photo albums filled with before and after photographs. The practice websites can have articles and case presentations stressing positive outcomes. Computer software makes it possible for the practice to produce brochures informing clients of the importance of good oral care.

Having provided dentistry services for companion animals full time for nearly 20 years now, I have heard too many clients lamenting that, if they had only known, they would never have let their beloved pet's mouth get so bad. In an attempt to give them the critical information required to maintain their pet's oral health, I have even been providing monthly seminars for the clients on dentistry. Recently, I gave this same presentation at our local library.

I understand that cost is one barrier, but the most common barrier is the fear of anesthesia. In my seminar, I have a PowerPoint presentation explaining that we minimize the risk to their patient and how we do that:

• Complete physical examination

• Heart auscultation

• Lab work is provided prior to the procedure to ensure that the kidneys and liver are functioning properly.

• Tailored anesthetic drug protocols for each patient

     o Elegant monitoring (show photos of pulse oximeter, capnograph, ECG, blood pressure monitor, Bare Hugger, IV fluids, IV fluid pump)

• Certified veterinary technicians are responsible for monitoring their pet.

I also inform them that if we encounter any changes on any of these monitors that concern us, we will take steps to correct it. If we can not affect the necessary change, we will wake the patient up and will reschedule using a different anesthetic protocol. I treat every pet as if it were my own.

The presentation also walks the client through some clinical cases. There are clinical photos that look normal but I show the radiographs that prove otherwise. These cases give me the opportunity to discuss:

• Different grades of dental disease

• Resorptive lesions

• Periodontal disease

• Fractured teeth

• Malocclusions

• Tooth crowding

• Retained deciduous teeth

• Dentigerous cysts

• Gingival hyperplasia

• Chronic ulcerative paradental syndrome

• Lymphocytic Plasmacytic Stomatitis

• Others

We also discuss:

• Tooth brushing (I have a video of my cat having her teeth brushed)

• Dental diets

• Veterinary Oral Health Counsil acceptance

• OraVet

• Water additives

• Appropriate chew toys

I also bring up the discussion of the new periodontal vaccine produced by Pfizer. This is a bacterrin that can be administered to dogs only. It targets the anaerobic bacteria responsible for destroying the bone that supports the teeth.

These are some ideas of how to incorporate dental services into your practice in order to treat the most prevalent disease we come across. The benefit to the patient is better overall health and a dramatic decrease in undisclosed pain.

The benefit to the practice is multifold. It creates a very lucrative profit center that can increase revenue to the practice, which ultimately should translate to the ability to provide better staff salaries.