Keys to increasing dental compliance

Every day, pet owners across the country take their pets to local animal clinics, where veterinarians examine them carefully for signs of disease. One of the most common of those diseases is periodontal disease-a fact that has made oral healthcare an integral part of every pet's lifelong wellness plan. Yet according to AAHA's 2003 study, "The Path to High-Quality Care," 15.5 million dogs and cats with stage 2, 3, or 4 periodontal disease had not received dental prophylactic treatment. The study also found that, in the area of dental prophylaxis, the national noncompliance rate is an alarming 65%.

Dr. Mary Ann Vande Linde

What's behind these low treatment and compliance numbers? Not clients' unwillingness to pay. In fact, the AAHA study found that cost was not a significant factor in a client's decision to comply with a doctor's recommendation. As it turns out, clients aren't declining recommendations-they're often not receiving them. For example, "The Path to High-Quality Care" reported that 19% of the hospitals studied did not record dental stages in the medical records of pets that were given dental examinations. It also reported that 66% of the patients had stage 1 periodontal disease, but veterinarians and technicians had not recommended dental prophylaxes. In short, dental care noncompliance stems largely from the lack of clear, consistent recommendations by healthcare teams.

Fortunately, reversing low compliance rates for dental care is possible through a concerted effort by team members. Clients become, as I like to say, "adherent" to recommendations when they understand their importance and hear them regularly.

Steps to success

Are clients ready for dental recommendations for their pets? You bet! Just look at all the dental products for pets at your local grocery or pet store. Even

Consumer Reports

mentioned dental care in its list of "Top 20" things to do to keep your pet healthy and save on veterinary bills.

Now all you need is a plan to deliver clear and consistent recommendations, which will keep dental disease prevention and treatment a growing and successful part of your practice. The plan doesn't have to be complicated, as you'll see in the following steps. It's more about planting the seeds for success-and watching them grow.

1. Prepare your team. Some clients need to hear a message six to eight times before they respond or recognize its importance. To accomplish this, you'll need the help of your entire staff. Start by holding a staff meeting to explain the practice's dental program and stress its importance. Then create enthusiasm by acknowledging each person's role in improving pet health and client awareness. You'll also want to provide every team member with a uniform script that helps them stress the value of dental care to clients consistently.

Ask pet health industry representatives to help educate and motivate your team members. Often trained by experts, these representatives can conduct training seminars that are geared toward the support staff.

Finally, measure your team's success by tracking the number of exams that record dental disease stages and the number of dental prophylaxes (for stages 1 through 4) completed per month. Set future meeting dates so the team can modify or fine-tune the plan and, most important, celebrate your achievements.

2. Spread the news. Don't wait until clients are in the exam room to begin educating them about the importance of oral healthcare and the services you offer; not when you have a hospital reception area that's just waiting for you to:

• Place instructive pamphlets on tables and at the front desk.

• Play an educational video or DVD.

• Create a bulletin board that displays before-and-after pictures of a team member's pet that benefited from dental prophylaxis. Include the pet's response to the procedure and a list of your services.

It's also important to take advantage of office technology, which allows you to advertise services in your newsletter and on your Web site. In addition, change reminder messages and postcards to read, "Your pet is due for a yearly physical and dental exam."

Figure 1. A dental report card combines visual elements and educational information for a more effective handout.

Another way to spread the word: Call industry representatives and ask them to provide free product samples to clients at the clinic.

3. Establish a script-and stick to it. The idea is to create a pattern that reinforces itself with each visit. Here's an example of how the script might look:

Receptionist: Identifies the files of new puppies and kittens and all patients arriving at the clinic for routine physical and dental examinations.

Technician: Discusses the importance of oral healthcare with clients in the exam room before the doctor arrives.During puppy and kitten visits, he or she provides clients with tips on dental care (e.g., which treats and toys are good for teeth and gums) and reviews proper brushing techniques.

Veterinarian: Performs the examination. During the dental portion, he or she provides information that helps clients understand their pet's individual needs. For example, a Maltese with a small mouth might lose teeth at a younger age because of overcrowding and a breed predisposition to gum disease. Similarly, a Labrador retriever may break more teeth on bones and sticks while playing, which calls for safer toys and regular exams to check for damage.

Figure 2. A sample estimate.

After the examination, the doctor completes a dental report card (Figure 1). If the teeth are stage 1 or higher, he or she adds the appropriate code for the recommended dental treatment to the travel or charge sheet, prepares a long-term individualized treatment plan, and notifies the technician to prepare an estimate (Figure 2).

Technician: Reviews the report card and treatment plan with clients, reinforcing follow-up home care. He or she also reviews the estimate for the next recommended treatment. Owners of patients that have undergone teeth cleaning should receive full discharge instructions and a handout with their pets' before-and-after photos (Figure 3). The technician then escorts the client to the receptionist.

Receptionist: Asks the client to schedule an appointment for the recommended dental treatment. If clients decline, he or she inputs a computer code that will trigger a monthly letter (Figure 4), which includes photos of the pets' teeth, if possible. If clients don't respond, the receptionist adds their names to a targeted marketing list for February's Dental Health Month campaign.

4. Incorporate visual aids. Consider these statistics: People only retain 8% to 12% of what they hear when they listen to other people.1 On the other hand, 74% to 80% of people are visual learners.1 Therefore, the best way to educate clients is by combining dialogue with visual aids. In fact, the more visuals you use, the less time you'll spend giving explanations. Why? Because, as the cliché goes, a picture paints a thousand words.

Figure 3. Clients will value dental care even more if you include before-and-after pictures on a post-cleaning handout.

I've already mentioned some helpful visual aids in steps 2 and 3 (i.e., brochures, bulletin boards, and handouts). During examinations, you could also instruct your technician to:

• take digital photos of pets' teeth and then present printed copies to clients (if not included in a handout),

• shine a Wood's lamp on the pets' teeth to show calculus and bleeding gums, or

• use a disclosing solution to show stage 1 calculus.

In addition, doctors can reinforce the technician's initial discussion by using photos, models, or handouts to show the differences between healthy and diseased teeth and the progression of periodontal disease.

What's great about this combination approach? For starters, all team members play a role, and adding in the dental angle doesn't take much time. But more important, clients learn vital information. They learn what their pets' mouth and breath should look and smell like, what could happen if they dismiss oral healthcare, and what they need to do to prevent further damage and discomfort.

5. Keep the ball rolling. Part of selling dental services successfully depends on what you do after clients leave. If you skip this step, you're missing key opportunities to strengthen your bond with clients.

Clients appreciate it if a team member calls to check on pets the evening or the day after dental cleanings. And sending friendly reminders to clients who wish to return later for the procedure makes it easy for them to follow through.

Figure 4. A sample reminder letter. (Courtesy of VMC Inc.)

For those patients that receive prophylactic dental care, ask the client and pet to return two weeks later. (The recheck fee could be included in the original fee.) The doctor or technician should review the condition of the patient's teeth, the level of success with home care, and expectations for the future.

Next, enroll patients in a Healthy Smile Club that calls for six-month checkups by a technician. Club benefits could include anything you choose. For example, you could send each member a card that includes the pet's photo, clinic information, and future dental care due dates. You could also give free product samples from manufacturers and post clients' and pets' photos on your Web site or feature them on the reception area bulletin board.

Dental success can be yours-if you send your message clearly and consistently. All it takes is a simple plan that leverages your healthcare team, conveys the message repeatedly, educates with visuals, and reinforces a client's choice to prevent dental disease in their pets. Remember: Healthy pets with healthy teeth are only a recommendation away.

Reference

1. Bolton, R.:

People Skills.

Simon & Schuster, New York, N.Y., 1979

Dr. Mary Ann Vande Linde is a nationally recognized veterinary consultant and educator with VMC Inc., specializing in the areas of preventive care and client communications. She travels internationally, teaching at veterinary colleges, technician schools, and veterinary conferences, and she has been featured on radio and television. A graduate of the University of Georgia's College of Veterinary Medicine and a former private practitioner, Dr. Vande Linde lives in Atlanta with her beautiful cat, Hannah.