Oral health: A multipronged approach

Companion animal practices offer a wide array of services to small animal clients. One of the most important services veterinarians provide is oral healthcare-and rightly so. After all, periodontal disease is the most common disease found in companion animals, and it affects animals' health in a myriad of ways.

Bill Gengler, DVM, DAVDC

Periodontal disease increases the potential for septicemia, which can affect the cardiovascular system, liver, and kidneys. Although most practices offer dental cleaning and polishing services, it's my belief that these services are often offered too late-after the bony substructure is already permanently damaged.

Unfortunately, there are many obstacles that contribute to low oral healthcare compliance among clients. When clients view professional care as an expense that takes time away from other obligations and requires anesthesia, it's easy for them to brush dental care aside. Additionally, home care requires a time commitment on the owner's part. We live in a busy world where time away from work is extremely precious. Owners must often prioritize family, social, and community obligations.

So how do general practitioners currently address the need for lifetime oral healthcare? In short, they use a multi-pronged approach that concentrates on wellness, in-house diagnostics, quality anesthesia, pain management, team training, and client communication. Before I address these areas, it's important to mention that the success or failure of oral healthcare services hinges first on the commitment and conviction of the veterinarian in charge. If the veterinarian strongly believes that a service benefits the patient, the service will cultivate compliance and succeed as a profit center.

1. Wellness programs. Today's practitioner knows that a total wellness plan isn't complete unless it incorporates preventive dentistry. Few patients that presently receive dental prophylaxis are free of oral pathology. Rather than continuing to just treat existing or advanced oral disease, team members promote the importance of preventive dentistry to clients when their pets are young.

Veterinary manufacturers are also helping in the effort to prevent periodontal disease by producing a myriad of professional and home care products, such as dentifrice, safe chew items, oral sealant gels, and diets with the mechanical and chemical ability to reduce plaque and calculus (see "New oral healthcare products").

2. In-house diagnostics. Today's quality dental programs include preanesthetic testing and diagnostic imaging. Preanesthetic testing gives veterinarians the ability to assess vital organ function in advance, which reduces the risk of complications for patients and helps allay clients' fears of anesthesia.

Diagnostic imaging is key to preventing periodontal disease. Periodontal disease causes bone loss, and dental radiography can detect the early signs that may not be visible at the tissue level. As with most diseases, early detection of periodontal disease helps ensure the best treatment outcome. Early intervention decreases patient discomfort and risk of disease, and owners don't have the added costs of treating advanced cases.

The advent of in-house diagnostic technology is a perfect fit for dental services and wellness medicine. In-house, automated dry chemistry profiles and blood counts allow practitioners to provide the wellness examination, blood work, and dental procedure in a same-day visit rather than scheduling them over multiple visits.

3. Quality anesthesia. The fear of anesthetizing pets-not cost-is the main reason for clients' adversity toward dental care. Many clients don't understand why their pets need anesthesia for prophylactic care when anesthesia isn't necessary for their own routine dental care.

Today's practitioner understands a client's uneasiness with anesthesia but does his or her best to allay those fears by:

• explaining that a thorough dental examination and treatment requires anesthesia,

• reminding clients that anesthesia will alleviate the pet's anxiety and discomfort,

• assuring clients that well-trained staff members will monitor the pet with the appropriate equipment and support the pet with intravenous fluid therapy, body heat sources or retainers, and cuffed endotracheal tubes,

• sharing historic hospital anesthesia information, and

• informing clients that other services, such as minor surgery, otic care, and therapeutic grooming, can be performed simultaneously.

Team members must also refrain from discharging the patient until it has recovered from anesthesia or sedation. These strategies help clients see the positives associated with dental anesthesia and increase their acceptance of future dental procedures.

4. Pain management. Some dental procedures will be painful. General practitioners today use regional anesthesia and nonsteroidal analgesia to provide excellent preoperative and long-term postoperative pain management without somnolent side effects. If stronger, narcotic-like pain medication is necessary to ensure proper pain management, practitioners give clients an oral form of the medication to administer at home with a small meal-before the regional anesthesia wears off. Accompanied by a restful night for the patient, this should ease the pet's transition from clinic to home.

5. Team training. Present-day practitioners realize that client compliance depends directly on the amount of dental education the client receives from the veterinary staff. To increase client acceptance, train every team member to deliver consistent information to clients through dialogue or visual aid enhancements, including dental models, graphics, and photographs. Focusing on education also prevents staff members from feeling like they are selling dentistry to clients.

Involve staff members in history taking and examinations. This allows them to directly receive the client's gratitude for the good care their pets recieve and to continue to be motivated to promote preventive oral healthcare.

6. Client communication. Giving clients accurate cost estimates for comprehensive dental care is difficult. Heavy layers of calculus can often mask unsuspected pathology, or the veterinarian may find periodontal pockets that were not apparent during the initial examination. In present-day clinics, clients receive estimates for the obvious recommended dental care, but the doctor emphasizes that additional care may be needed. To facilitate communication during and after the dental procedure, team members should record all possible phone numbers (home, work, and cell) in the file so they can notify the client if additional dental care is needed and update the client on the pet's condition. For the ultimate in communication, some clinics provide off-the-premises owners with pagers.

To maintain the highest level of dental services to patients, practice owners also seek out continuing education opportunities from organizations like the American Veterinary Dental Society (AVDS), which has developed excellent training programs and publishes the Journal of Veterinary Dentistry. Many veterinary organizations host Web sites, including the AVDS and the American Veterinary Dental College, where practitioners can find numerous continuing education opportunities. Online, interactive continuing education is also available through services such as the Veterinary Information Network.

In addition, many other associations, specialty groups, and national conferences offer excellent dental continuing education for doctors and technicians.

The importance of oral healthcare in today's small animal practices cannot be underestimated. Patients benefit from improved, long-lasting health; pet owners enjoy the company of healthier, happier companions; and healthcare teams help prevent periodontal disease in their patients while producing profits. In turn, part of those profits will be reinvested in the practice. As a result, pets of the present-and the future-will continue to receive the best in veterinary oral healthcare.

Dr. Bill Gengler, a Wisconsin native, received a bachelor of science degree from the University of Wisconsin in Platteville and master of science and doctor of veterinary medicine degrees from the University of Missouri in Columbia. He is a diplomate of the American Veterinary Dental College. Dr. Gengler has 32 years of small animal practice experience. He currently holds a dual appointment at the University of Wisconsin's School of Veterinary Medicine: associate dean of clinical affairs/director of the Veterinary Medical Teaching Hospital and director of the dental program, where he specializes in veterinary dentistry and oral surgery. He is also a consultant to The VetCor Group.