Let technicians polish dental practice success

Behind every flourishing dental practice is a great veterinary staff. If you want to move forward with your veterinary dental practice, it's time to get your technicians on board.

Recently, there was an interesting discussion on the Veterinary Information Network concerning a veterinarian who wanted to "get into dentistry." This doctor purchased a dental X-ray unit, and he expected the dental segment of his practice would just grow. The reality: Nothing happened.

Photo 1: Properly attired technician examining a patient's mouth.

His next move was to urge his technicians to obtain proper dental radiology continuing education. Still, the team didn't bite. Out of frustration, he delivered a hard-line ultimatum. Unless his technicians became proficient in their role with dental radiology within three months, they would be fired.

The threats were in vain. He sought advice on what to do next. The answers from fellow VINers focused on training, compassion and reiterating the philosophy that learning is a journey, not a destination.

So what is the answer to this veterinarian's dilemma? How does a veterinarian motivate his or her technicians so they can improve the medical delivery of dentistry to patients?

Table 1 Technician tasks

Jim Collins, in his book "Good to Great," analogized that successful company leaders acted as bus drivers steering their company in the right direction. The "bus" needs to be loaded with the right people, and they need to be in the correct seats. This analogy is very appropriate for our practice team as they work to deliver oral assessment, treatment and prevention of veterinary dentistry. The practice owner needs to decide the extent of dental services to offer — oral assessment, cleaning and prevention with non-surgical extractions; endodontics, orthodontics and/or oral surgery. This first (of three) articles will focus on the technicians' critical role, followed by the veterinarian's connection and finally address client responsibilities.

Who's driving anyway?

You would think that the veterinarian acts as the driver for veterinary dentistry: not true. In most practices, veterinary technicians often determine the success or failure of this important veterinary discipline. Without trained, capable and eager technicians, the "bus" and journey can only go so far.

Photo 2: Sterile examination pack.

Roles delineated

When it comes to organizing veterinary dentistry delivery within a practice, the veterinary technician should be assigned important duties from equipment and material procurement, maintenance, sterilization, procedure preparation, information gathering (probing, charting, X-rays), teeth cleaning, polishing, barrier gel application as well as client education before, during and after these procedures (Photo 1).

Equipment and material management

Here are some duties to consider for your technicians:

• Preparation of dental packs.

• Sterilization of dental instruments.

Technicians are responsible for preparation and sterilization of ovariohysterectomy, and orthopedic instrument packs which group instruments and materials for a specific purpose together. The technician should also prepare and sterilize dental specific "trays" for examination, non-surgical extraction, surgical extraction as well as advanced endodontic and periodontal surgery. In some practices, this will necessitate purchasing additional instruments. Fees for "sterile extraction surgical pack", or "sterile oral examination pack" are well accepted by clients (Photo 2).

Table 2 Skills that candidates of the Academy of Veterinary Dental Technicians are expected to master

As with human dentistry, sterility of instruments that enter patient's mouths is important to prevent infection as well as cross contamination. Individual see-through packets are available from veterinary distributors for instrument sterilization.

• Technician maintains dental equipment.

• Technician keeps hand tools sharp.

Equipment maintenance is critical to the successful dental practice. Many of the hand instruments (scalers, curettes, luxators, periosteal elevators) must be sharp to work correctly. A human dental hygienist can easily teach sharpening techniques. Ultrasonic scaler tips should be inspected before each teeth cleaning to make sure they are not broken (Photo 3). High-speed, water-cooled dental delivery systems must be maintained according to the manufacturer's instructions (Table 1 and Photo 4).

Procedure set up

Technicians must understand the steps involved in different dental procedures in order to predict what equipment and material the veterinarian plans to use.

It is the technician's responsibility to gather equipment and materials for the procedure at hand before the patient is anesthetized. If oral surgery is planned, placing all the equipment, instruments and materials within reach saves countless minutes and wasted time.

Anesthesia

• The technician is involved in anesthesia from induction to arousal.

• Keep the monitoring equipment in working order (can be challenging).

In many offices, the trained veterinary technician administers medication to anesthetize the patient under the veterinarian's direction. Monitoring equipment is connected to evaluate the patient's vital signs. It is up to the technician to make sure the monitor's cuffs and wires are in working order before anesthesia begins and that the connections transmit correct information during the entire procedure. Dental procedures can be lengthy leading to hypothermia. The technician shares responsibility for proper temperature maintenance. The technician's anesthesia responsibility does not end until the patient is in sternal recumbency (Photo 5).

Let technicians be the guide: key duties

Dental information

• The technician spends more tooth-by-tooth time with patients, so access to quality information, including X-rays, is imperative to create a sound dental treatment plan. Remember X-rays should be properly exposed and processed, and they provide an essential piece to the dental puzzle.

The technician provides information to the doctor on a dental chart. The difference between information and diagnosis is important for all parties to understand. Gross findings (probing depths, mobility scores, missing teeth), diagnosis and development of a treatment plan is left to the veterinarian once information is delivered and reviewed.

Generally, the technician performs coronal scaling, compiles information on the dental chart after a tooth-by-tooth evaluation, exposes and processes oral survey radiographs for review. After dental treatment, the technician performs fine coronal and sulcar scaling, polishing, sulcar lavage and application of the plaque barrier gel if indicated (Photo 6).

Client communication

Dental disease prevention is as important as the other dental disciplines. Here, the technician acts as an extension of the veterinarian counseling clients on how to keep their pet's teeth and gingiva healthy.

The technician also acts as the practice's voice on dental subjects — from fielding intake questions to demonstrating brushing techniques. Many practices appoint the technician most knowledgeable in dental care to make dental appointments. This works very well preparing the client what to expect during the oral assessment, treatment and prevention visit.

Getting results

Where can the practice owner send their interested technicians to get the necessary dental knowledge?

I could feel the frustration of the veterinarian featured at the beginning of this article. All he wanted to do was expand his practice's capabilities and service with diagnostic radiographs in dentistry. To date, there are no full or part-time veterinary dental hygiene schools. The more you can read, see, hear and practice, the better.

Continuing education courses including hands-on wet labs on dentistry are listed on www.veterinarydentalforum.com/calendar.cfm.

The annual Veterinary Dental Forum contains three days of high-quality programming with presentations in several tracks to suit anyone from the beginner to the expert, plus hands-on laboratory sessions and reports on the latest research in veterinary dentistry. The upcoming Veterinary Dental Forum is Sept. 21-24, 2006 in Portland Oregon.

Dental textbooks concentrating on dental technician education:

• Veterinary Dentistry for Technician & Office Staff-Holmstrom, 2000, Elsevier

• Atlas of Veterinary Dental Radiology, An-DeForge,III, 2000, Blackwell Publishing

• Small Animal Dentistry, Mitchell, 2002, Elsevier

• Veterinary Dentistry for the Nurse and Technician – Gorrel, Derbyshire – 2005

• Veterinary Dentistry for Small Animal Technician-Kesel, 2000, Blackwell Publishing.

Aim for the stars

The Academy of Veterinary Dental Technicians (AVDT) received approval as a technician specialty organization by the National Association of Veterinary Technicians in America (NAVTA). Since 2000, charter academy members have worked with NAVTA and the American Veterinary Dental College to prepare credential requirements and a certification examination. On June 17, the first examination was administered in Baltimore.

The AVDT is in the process of setting up the appropriate continuing education lectures and wet laboratories, and other support for staff interested in the field of veterinary dentistry. Anyone interested in further information on the academy should log on to its Web site at www.avdt.us.

Our next article will explain how to make dental decisions based on the information the your dental technician provides.

Dr. Bellows owns Hometown Animal Hospital and Dental Clinic in Weston, Florida. He is a diplomate of the American Veterinary Dental College and the American Board of Veterinary Practitioners. He can be reached at (954) 349-5800; e-mail: dentalvet@aol.com.