Episode 69: How can the healthcare team elevate the dental conversation to promote dental wellness in the clinic and at home?

Adam Christman, DVM, MBA: Hey, friends, welcome back to The Vet Blast Podcast. I'm so excited to talk about dentistry. The listeners are thinking, "Wait, we heard this before," we are going to talk about the teamwork approach to dental care because it's not just 1 person, there is a whole boatload of us that need to make sure we get that compliance in line. So, joining us today is Dr. Mary Berg. How are you, my friend?

Mary L. Berg, BS, RVT, RLATG, VTS (Dentistry): I am doing wonderful. Thank you for having me.

Adam Christman, DVM, MBA: My pleasure. We're really excited that we're going to be chatting with all things healthcare team and elevating the dental conversations to promote dental health. It's always such a huge and important topic, especially now so more than ever too. So, I just think that we're excited that you're here and we're going to be joining us and we're going to get all into it. So, we got to give a special shout out to our friends from Virbac for sponsoring today's podcast. Alright, so to our listeners that may or may not know about our friend Mary Berg, my goodness, where have you been?

Mary is a member of the Academy of Veterinary Dental Technicians. She earned a bachelor's degree in biology and microbiology at South Dakota State University, an Associate’s degree in laboratory animal science at Redlands Community College, and another Associate's degree in veterinary technology from St. Petersburg College. She received her veterinary technician specialty in dentistry in 2006. For nearly 3 decades, Mary worked in research where she specialized in products aimed at improving the oral health of companion animals.

She has also served as a practice manager and dental specialist at general practice. She teaches veterinary technology and she is president of Beyond The Crown Veterinary Education—a veterinary dental consulting service. Mary is actively involved in NAVTA, tAVDT, and KVTA and she has served on committees for the AVMA and AAVSB. She has authored or coauthored over 70 publications. So, I couldn't think of a better person to talk more about dental care than you, my friend. So, let's get into it. We know that dental care is so important to keep our pets healthy. We know it should be discussed with pet owners early and often which requires a teamwork approach. So, what are the roles of each team member? (And by role members, we're talking about the CSRs, the technicians, the assistants, [and] the veterinarians in the dental care discussion for pets.)

Mary L. Berg, BS, RVT, RLATG, VTS (Dentistry): I think everybody on the team has to be excited about it, because if 1 person has a kind of an 'eh' attitude towards dentistry, that's going to get to the client. So, let's start with the CSRs. I am really a big believer that we all know they're the first line— [they are] the first person the client sees when they walk into the practice and also the last person. So, [CSRs] really have to be on board with dentistry, and that means there are some great opportunities for them to get a little bit more knowledge about dentistry. [CSRs] don't have to be the one that knows everything, but they have to have a positive attitude towards it and they understand that good at-home care and regular dental cleanings is going to make for a healthier pet.

The next one in the line is probably going to be your veterinary assistants and technicians. They are really the pet advocate and client educators. So, they are going to be doing not only a lot of the procedure itself, but they're the ones who are going to be talking to the client and kind of getting them on board with doing the dental procedure. In addition to that, you know, a technician can really pretty much take ownership of dentistry within their practice, with the exception of diagnosing and performing oral surgeries. So, you know, they can be the "go-to" person in the veterinary hospital when it comes to dental procedures.

Then of course, we have the veterinarian, you know, they're the team leader, right? They're the ones who are going to be making sure that all of their team is educated gets the best education they can as far as dentistry, giving out quality and good information to the pet owners, and of course, they're going to be the bottom line for some of the questions that the client may have. So, it really becomes a true team effort. If you are a practice that may even still do some boarding, even your kennel assistants should have at least a working knowledge of dentistry and maybe lift that lip when the pet is dropped off for boarding and offered to either brush the teeth when the pet is there. Or to go ahead and you know mention "Hey, you know I see a lot of redness in his mouth a lot of tartar buildup. Are you okay? Would you like 1 of our technicians to look at him while he's here? Maybe we can clean him while he is boarding?" So, we have all these different things that everybody has to be excited about. They don't have to be the cheerleader dental diva that I am, but they still have to be excited about dentistry.

Adam Christman, DVM, MBA: Yeah, they really do. Nothing irks me more. Sometimes when I hear these stories where you know, the pet owner will be in the exam room—I'll leave and make my recommendation move on to the next appointment, and then they'll go to the veterinary technician and say, "Do I really need to get his teeth cleaned?" And then you could have a technician that may go, "Eh."

Mary L. Berg, BS, RVT, RLATG, VTS (Dentistry): Maybe, maybe not. Yeah, I mean, that happened with not only technicians but also even at the front desk, you know. So it's like, "Oh, I would never put my pet under anesthesia for this." So everybody has to understand the value, and I think it's always really good to have that story of the animal who 3 days after a dental procedure was suddenly acting like a puppy again. Even if it's the—especially if it would be one of the front desk people's pets, they could be really the real cheerleaders for the procedure.

Adam Christman, DVM, MBA: Yeah, they really are. So then switching gears. So from talking from the veterinary team, we also have to talk to the pet parents, of course, too. So what is your take on talking to them about dental care? More specifically, I'm sure that conversation is different when we talk about it with the new puppy, and even maybe the new rescue that might be older too. So you know, how do we have that kind of conversation with them?

Mary L. Berg, BS, RVT, RLATG, VTS (Dentistry): Well, I'm a big believer, and we start early, and that of course, starts with those puppy visits. Now, I used to say, let's start at that very first puppy visit, and then I, you know, kind of saw their eyes glaze over. We're talking all the vaccine protocols, crate training, potty training, diet, nutrition, all this, and pretty soon, they're just, you know, like, "Oh, my God, I can't absorb one more thing." So, let's bring [dental care] in at maybe the second or third puppy visit, and really start talking about how important it is to have that pet allow you to touch their teeth and to work with their mouth. Explain that it's a slow process, it's going to take a lot of time and a lot of reward for the pet to accept tooth brushing or whatever they might be using for that pet, but they need to be able to lift the lip and look.

When it comes to older pets or, you know newly adopted pets, you have to really kind of assess where their mouth is at, before we get too involved. I wouldn't want to take an older pet that has a pretty severe disease and start introducing a toothbrush, because it's going to be really painful and that pet is going to be kind of upset with you and probably will never let you touch their mouth again. So, we have to make sure we're having these conversations based on what the condition of the mouth is and really helping the pet owners understand that if we can keep that mouth cleaner—and I know it's anecdotal, there are no studies that prove this—but we can probably get 1 to 2, maybe 3 years more life for that pet because they do have a healthy oral cavity.

Adam Christman, DVM, MBA: Right? Yeah. And then with that, there's got to be some challenges that you have when communicating with pet owners about dental care—and this goes for both, you know, dog parents and cat parents. So, what are some of the challenges that you hear?

Mary L. Berg, BS, RVT, RLATG, VTS (Dentistry): Well, a lot of times, you know, we tend to do a lot of data dumping, you know, when we're in the exam rooms. I've seen you know, veterinarians do this, I've done it, and what happens is we tend to overwhelm pet owners. So, I think it's really important that we have a conversation with them more so than the data dumping of all the information we could give them. We really need to find out what [ owners] already know about dentistry, and if they're doing anything already. Have they ever had a pet's teeth clean? If they are concerned about dental cleaning, we have to kind of validate their fears, but then we want to educate them on how things are done now—what are we doing here at this practice so that we can get buy-in into our recommendations?

In addition to that, we want to realize that sometimes we as veterinary professionals get tired of saying the same thing day after day, hour after hour and we tend to kind of either sound like we're bored, or we assume our clients already know this stuff. We have to always keep in mind that this might be the first time this client has heard what we're talking about—and that goes for dentistry, that goes for flea and tick protection, [and] that goes for any kind of preventative thing that we're doing for their pets. So, it's really important we realize that they may not have heard it before. Another thing that really helps when it comes to communicating with the pet owner is, let's say you have recommended a dental procedure and put together that treatment plan estimate. You can't just hand it to the owner, they're going to look at it and kind of have a, you know, like "Oh my god, what is this?" Go through it, sit down with them, go through why every step is really important, and then they're going to be more likely to have buy-in to doing the dental procedure. So, it really is having that conversation. I think one of the other things we do quite a bit is we tend to use medical jargon or lingo that we've picked up and sometimes the owners don't understand what we're saying. Think about maybe that first time you were in vet school or vet tech school, and they were going through terminology courses, and you're like, "Oh my god, what is this language we're speaking," right? And we forget that the pet owner might not know that. So, a lot of times when it comes to any kind of really severe dental disease, I'm going to use the words 'pain' and 'infection' because clients understand those more so than periodontal disease. So, those are the kind of ways that I like to communicate with my pet owners.

Adam Christman, DVM, MBA: Yeah, no, that's great. I always feel to as a veterinarian, I find that the unknown is what's a little scary to pet owners. So, what we've learned to do is we've shown them. We actually take them to the back, and we show them the treatment from start to finish—what everything looks like. So, [we] show them with an endotracheal tube is [and] the reason why they may cough a little bit after the procedure because of the tube. Because when [owners] hear "anesthesia," they just think that [their pets] just get knocked out—they don't realize maybe there is a tube. Then we show them the technicians that [are] monitoring the dental radiography, we show them the "why" before we show them the price. We show them where they're recovering, we'll send you pictures when they're done, we're going to show you before and after pictures, because I'm sure to your point, that's probably going to be one of the biggest hiccups is the price at the bottom.

So, you know, what are some talking points that you see that express the value of a dental cleaning procedure?

Mary L. Berg, BS, RVT, RLATG, VTS (Dentistry): Actually, I think that's really kind of a misconception. We all think that because no matter how many lectures I do, the first thing when I say, "What's your roadblock to doing dental procedures?" cost is the first thing that comes up. But some studies that were done actually show that cost is a lot lower down on the list than we think it is. Part of that is because most of today's pet owners, [are] going to pay for premium dental care because they know what's important for their pet because that pet is no longer the dog in the backyard, it's become the heart of the family. So part of it is, they don't go forward with these procedures and we think it's on cost, but it's because they don't understand it. So, what you said, bringing them into the back, having that conversation, show them what happened, create a video that you can play in the exam room for them from the day of a dental procedure at your practice, so that unknown is kind of taken away a little bit. But we really need to explain why each step is so important and again, to using the right language when we are talking to them.

One of the things that make the hair on the back of my neck kind of stand up and crawl a little bit is when I hear the word "dental." "Now, you know your dog needs a dental," and I know that is what's been being used in the field since I started a long, long time ago, but it really doesn't explain what we're doing. You know, dental is an adjective, it's a dental instrument, it's a dental table, it's a dental machine, but it doesn't mean anything to the pet owner. So, using terms that really help the pet owner understand what we're going to do helps a great deal. So, my favorite term is COHAT, which is Comprehensive Oral Health Assessment and Treatment. Yeah, it's a mouthful, but it really tells the pet owner what we're doing, we're going to do a comprehensive oral exam, we're going to look at each and every tooth, we're going to take x-rays, we're going to assess what's happening, and then hopefully at that time treat that same disease at the same time. I also like to compare pretty much everything we do in animals related to dentistry, to something they may have done at the human dentist because a lot of the same stuff happens. So, when they're talking about, "Well, why do I need to have dental x-rays done?" Well, you know, your pet can't tell me where it hurts, and you get x-rays every year, and you can tell the dentist where it hurts. So, having those types of conversations with them can make a big difference.

Adam Christman, DVM, MBA: Yeah, I love that you said video. To the listeners out there, I do want to stress that, because you're right, Mary. When you're working a 13 hour day and you're talking about dental, just saying "dental"—and again the perceptions, I'm going to start using COHAT a lot—but when you talk about dental cleaning, you can actually defer [clients] to a video that you have too, because maybe your appointments are 20 to 30 minutes, and we know how busy you are, you can actually link that in your invoice item and it can be an emailed item to that you can show them a video from you—from your veterinary hospital that shows you the procedures. So you know, there was a practice in Florida that said that they said, "So, we heard that you're you were told that you needed a dental cleaning, here's what you can expect," and they show you the process. It's like a 2-minute video, but just enough to give them that information, peel back the curtain to get greater compliance. So, I love that you mentioned that. So that's fantastic. Thank you so much for sharing that.

Then the other thing that we hear a lot is so after [the pet's] teeth are clean professionally and they look great, you and I hear all the time, "Oh my gosh, what can I do to prevent us from seeing each other so often?" So, what are some of the most important things to communicate to help pet parents keep that preventative care going?

Mary L. Berg, BS, RVT, RLATG, VTS (Dentistry): Well, I think this is one of the places that I'm a huge believer in technician utilization. So, this is really one of the areas to that you can have tech appointments, and this can be the discharge the day of the dental procedure and then even a follow-up appointment in a week or 2 just to see how things are going. But go through everything that [the owner] can do for their pet, or find out what they're doing already and see what their interest level is, because if they have no interest in tooth brushing, why even discuss it, correct? You know, so what are they willing to do? What are they able to do physically for that pet? But then I want to go through and not only just you know if they are interested in tooth brushing—which only about 2% of Americans actually do—I'm not just going to hand them a paste and toothbrush, I'm going to explain how to do it. Again, this could be another place for a great video, but it's going to take a few weeks to really get that pet to accept it. Go through the different options and explain maybe why that bone that you're giving your dog to chew on isn't the best option, and it can cause fractures and it can cause more problems unnecessary. What's a good toy? What's a bad toy to play with? What's a good treat, or chew, you know, something to that effect to really help that pet owner understand.

I'm [also] a huge college basketball fan. So, I'm always going like, "Okay, now I'm going to put the ball in your court now. And we've done the procedure. Now it's your turn to really stay on top of this." So, we're going to have to clean them again. But maybe we can increase the length of time between that next dental cleaning.

Adam Christman, DVM, MBA: Right. And there's a difference, of course, as we know as veterinary professionals, but pet owners may not know the difference between saying "routine dental cleaning" vs having "a perio done." So, there were some extractions that are done, you know, how do you communicate some options because maybe the pet parent might feel scared knowing that they might be sore whatnot. So, what are some suggestions or soundbites that you would recommend?

Mary L. Berg, BS, RVT, RLATG, VTS (Dentistry): We want to make sure before they go home, initially after that COHAT is that, you know, they have had multiple extractions, you know, we have to stress the importance of no chewing on things, soft diets—all of those things that we have to make sure the pet owner really understands. But then we can go ahead and start talking about whether or not they feed a chew every single day, or what they're going to do for homecare to keep that pet’s teeth clean.

Yeah, you're right, they're scared. [Owners] are not going to lift that lip and look, "Oh, my gosh, what did they do these extractions?" They don't want to see it. So, I will actually put it on a discharge form that has a diagram of the mouth, and I'll put notes on there for which teeth were removed, so that they don't have to remember [whether it was] the left side the right side or what tooth it [was]. But I want them to be aware that I'm going to do what I can in the practice, so they don't have to worry about it for the first 2 weeks.

Adam Christman, DVM, MBA: Yeah, I love that. I know that they ask a lot about the types of toothpaste you know whether it be like an enzymatic toothpaste and things that are free from Xylitol. What are your thoughts on that, too? If they can brush your teeth, what are some recommendations that you would recommend?

Mary L. Berg, BS, RVT, RLATG, VTS (Dentistry): Well, a lot of times with the toothpaste, I really want them to have something the dog likes. So a flavor. That's why you know, our pet dog or cat pastes have these, you know, flavors that kind of make us cringe a little bit, you know, the beef, the chicken. But you know, we want to make it something that the pet enjoys. The enzymatic action is going to help some to kind of help break up some of that calculus in the mouth. But it's going to be mostly the action of the toothbrush and the abrasion that's removing the majority of that plaque off the teeth. It's so important to explain to our pet owners that plaque forms very quickly, and within you know, an hour or 2 we have plaque on our teeth after cleaning. But every 48 hours or so it's going to calcify into that tartar, the nasty stuff we see on the teeth, and the plaque is what causes the disease, so, it is important that we stay on top of keeping that plaque off. That's why it's so important that we brush every day. Brushing once a week, brushing once a month, or every 6 weeks when they go to the groomer is not going to be beneficial to their pet whatsoever.

Adam Christman, DVM, MBA: Right? Absolutely. Consistency, and frequent consistency, is key. So, what are some good resources that are out there that you would recommend to veterinary professionals to help communicate with clients about the options available and the value in dental care for their pets?

Mary L. Berg, BS, RVT, RLATG, VTS (Dentistry): Well, I'm working with Virbac to create what we call the C.E.T. Dental Authority Program. And what this is, is it's a resource that's there to help empower the entire healthcare team so that they can better educate their clients about the need for regular preventive dental care. There is a link for this at cetambassador.virbac.com, and it's basically a 4 session program that explains the importance of preventative care for your patients’ overall well-being. It's nice because it's at your pace. You don't have to go through it all at once. It's free of charge for veterinary team members, it's easy to digest and very short little segments, asynchronous so you can do it at your own time, start when you need to [and] finish when you need to, the Dental Ambassador Certificate, and there is going to be a lapel pin—everybody likes pins. That will help start that conversation with the pet owner. So, you know, it's also has a Dental Authority Clinic Kit that's going to be included. So there are a lot of good options and a lot of good material within that C.E.T. Ambassador Program.

Adam Christman, DVM, MBA: I love it that you're going to get a certificate too, how cool is that?

Mary L. Berg, BS, RVT, RLATG, VTS (Dentistry): Yes.

Adam Christman, DVM, MBA: Excellent. Well, this has been so much fun. Thank you so much, Mary, for tuning in with us. And thank you to our friends at Virbac for sponsoring this session and for all they do for us in the veterinary profession. This has been great.

Mary L. Berg, BS, RVT, RLATG, VTS (Dentistry): Thank you.

Adam Christman, DVM, MBA: If [the listeners] are interested in learning more about you, is there an area where we can find more information about you?

Mary L. Berg, BS, RVT, RLATG, VTS (Dentistry): Yes, I have a Facebook page on Beyond The Crown Veterinary Education—is my Facebook page. You can also go to my website, which is btcveted.com, but make sure on that Facebook page you put in Beyond The Crown Veterinary Education because otherwise you just get a whole lot of beauty pageant stuff, which I didn't think about when I came up with the name.

Adam Christman, DVM, MBA: I mean, yeah, you know, if I want to know about the origin of some of the crowns, I think we can do that too. That's great. Well, Mary Berg, thank you so much for joining us today, this has been so helpful.

Mary L. Berg, BS, RVT, RLATG, VTS (Dentistry): Alright, well thank you very much. I appreciate it.

Adam Christman, DVM, MBA: You're welcome and thank you to our listeners for always tuning in. We always appreciate your time for this and please stay safe out there my friends. Thank you for all your hard work and continue to stay pawesome everybody, take care.

Transcribed by https://otter.ai