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Winter 2020, Dentistry

Dentistry Education for Patients and Practices

The need for dentistry must be integrated into the practice philosophy and should become as routine as vaccines and heartworm control.

Mary L. BergBS, RVT, RLATG, VTS (Dentistry)

Mary received her B.S. in Biology/Microbiology from South Dakota State University, A.S. in Laboratory Animal Science, and A.S. in Veterinary Technology from St. Petersburg College. She is a Charter member of the Academy of Veterinary Dental Technicians and received her VTS in Dentistry in June 2006. She serves as treasurer of the AVDT, president-elect of the KVTA, and Chair of the District Representative Committee for NAVTA. Mary has been published in various professional publications, and is a speaker/lab instructor at international, national, and state conferences. Mary and her husband have 2 sons and 3 grandchildren and live on a small farm near Lawrence, KS.

Dentistry Education for Patients and Practices
THE TOOTH OF THE MATTER Regular inspection of the patient’s mouth is important to catch dental disease in the early stages. Here’s how to communicate your findings to the pet owner. Ermolaev Alexander/shutterstock.com
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Oral disease is one of the most prevalent diseases in dogs and cats. 80% of adult dogs and 70% of adult cats have some form of oral disease.¹ Dental problems are a concern of pet owners in dogs and cats, especially if the pet has halitosis (i.e., bad breath). Calculus and gingivitis are the most common conditions diagnosed by veterinarians in animals of all ages. However, we know that 80% of companion animals do not receive dental care at the veterinary hospital.

Why is the incidence of dental disease so high? Is it due to lack of compliance or the lack of educating the client about the importance of oral health? Pets living longer lives may be one reason that oral disease is more prevalent. Current veterinary medicine improves many aspects of pets’ lives, but dental care is still behind.

WHY IS ORAL HEALTH IGNORED?

Unfortunately, veterinarians and veterinary nurses do not receive much training in dentistry while in school. Many practices don’t put enough emphasis on dentistry and the importance of a healthy oral cavity. In many small animal practices, dentistry accounts for less than 7% of the gross income.2 With 80% of veterinary patients having some level of oral disease,1 the percentage of revenue from dental procedures should be much higher.

Owners are often afraid of putting their pets under anesthesia, especially for something as routine as dental cleanings. The veterinary team must explain the need for an anesthetized examination, and explain that blood work and a complete exam is performed before the procedure. Veterinary nurses should also discuss the medications used and ensure that the pet will be monitored during the procedure to help alleviate fears.

In addition to the fear of anesthesia, the cost of the procedure is often thought to be an obstacle; however, many times, it is not an issue of cost but rather a lack of understanding of the value of the procedure. Offering some type of third party payment plans for the clients can also increase the initial and long-term compliance.

WHY ORAL HEALTH MATTERS

Companion animals are now viewed as members of the family and clients are more readily interested in seeking care for their pets. If periodontal disease is left unchecked it can end up negatively affecting other parts of the pet’s body. Talking to clients about the importance of oral care should become as routine as educating about other preventive care, such as vaccinations and heartworm prevention. In the author’s experience, about 25% of clients will accept a recommendation immediately; another 60% will take a little time to accept the recommendations; and the remaining 15% will not accept the recommendation.

As veterinary health professionals, it is our job not only to promote dentistry to clients but to also educate our team about the importance of good oral health. How can we do this? The team can attend webinars on the subject or the practice can host an in-clinic training session with a veterinary dentist or a Veterinary Technician Specialist (VTS) in Dentistry to help the team learn as much as possible about dentistry.

Having the entire team understand the importance of oral health and the treatment options the practice can provide means a consistent message will be communicated to clients. All members of the veterinary team must be excited and motivated about promoting oral care and dental treatments and project that enthusiasm to the client.

OPPORTUNITIES FOR COMMUNICATION

The receptionist must project a positive attitude regarding dentistry and home care. How your receptionist handles phone shoppers is essential. The receptionist should avoid quoting prices over the phone. Instead, develop a script that can be used by the receptionist for phone shoppers, such as, “We would like to provide an accurate estimate for proper dental care of your pet. Therefore, we would love to see your pet, perform a quick oral assessment, and together develop a treatment plan.”

In practices that board pets for clients, the kennel team should be trained to examine the teeth when the pet arrives. The team should show the owner the degree of oral disease and ask if they would like to have the pet’s teeth cleaned during its stay at the kennel. If the client hasn’t packed a toothbrush, offer to give one to them while the pet is boarding; later, the client can incorporate daily brushing of the pet’s teeth at home. This simple check-in procedure helps emphasize the importance of oral care to the client.

The veterinarian should be the oral health team leader. They must educate owners that proper dental health will help the pet live longer, healthier lives. The veterinarian should be comfortable recommending dental procedures to clients. They should also schedule dental education training and be supportive of continuing education opportunities for themselves and the rest of the team.

Veterinary nurses are essential members of the dental team. A successful dental practice must have a veterinary nurse whose focus is dentistry. This individual can concentrate on emphasizing home care, client education, and follow-up visits. The veterinary nurse’s examination, communication, and therapy skills are vital for a successful practice. Their responsibilities should include performing dental cleanings, oral radiography, charting, assisting in oral surgeries, giving post-operative instructions, maintenance of equipment, and keeping the dental operatory well stocked. They should also keep the veterinary team updated on oral hygiene products.

Veterinary nurses should be responsible for client education since they are usually the first and last ones to see the pet and client. Start this education process with your clients at the pet’s first visit. Talk with them about the importance of good oral care by expressing the fact that the mouth is a mirror to the body. Provide handouts explaining the relationship between oral disease and systemic health. Use photos to underscore to clients the repercussions of inconsistent oral care.


 

PICTURES ARE WORTH A THOUSAND WORDS
Use every tool at your disposal to encourage clients to invest in the oral health of their pets. Start the education process with clients at their first visit. Use easy-to-understand language, such as “the mouth is a mirror to the body,” to explain the relationship between oral disease and systemic health. Use photos to demonstrate the repercussions of inconsistent oral care. Make clear that dogs and cats are very good at hiding pain and their owners are often unaware that their pets have a serious dental problem until it’s advanced. Beatriz Vera/shutterstock.com


GOOD COMMUNICATION IS KEY

How we communicate with clients is just as important as what we communicate. Use a relationship-based approach that allows for two-way communication. Remember that both of you share a common goal—keeping the pet as healthy as possible. Use open-ended questions to evaluate and validate the owner’s knowledge and concerns. Ask the owner what they already know about dental disease, so that they are engaged in the conversation. Share additional information that can help them better protect their pet and deepen their understanding of the information being discussed. Ask if they have any questions to ensure they have a good understanding of the information that’s being shared.

After the oral exam, review the findings with the owner. In dentistry, treatment is usually completed while the animal is under anesthesia for the oral exam; however, taking the time to review the charts and radiographs after the procedure will be appreciated by clients. Explain the problem and treatments in terms that can be easily understood by your client. By changing your vocabulary, trust and client compliance can be gained. Highlighted below are a few terms that should never be used and words that can be substituted to gain compliance.

Dental (dentals): This term has no meaning in veterinary medicine. It is an adjective to describe something, not a noun. The client may not fully understand and may think it is only a tooth brushing. Replace this term with Professional Dental Cleaning, COHAT (Comprehensive Oral Health Assessment and Treatment), OAT (Oral Assessment and Treatment), ATP (Assessment and Treatment Plan) or Periodontal Therapy.

Prophy: Unfortunately, most dental procedures are not a prophylactic procedure but a treatment of the oral disease that is already present. Hopefully, some day we will truly perform dental prophylaxis on most of our patients.

Periodontal Disease: Many clients may not understand this term unless they have periodontal disease themselves. Use infection and pain as clients better understand these terms. Periodontal disease is an infection of the tissues surrounding the teeth and can be painful to pets.

Recommend: Don’t say, “The doctor recommends a professional dental cleaning.” A recommendation is just a suggestion. Say instead, “Your pet needs a professional dental cleaning.” Replace should with need and could with must: “Your pet needs to have a professional dental cleaning, and it must be scheduled soon to prevent the infection from getting worse and risking tooth loss and systemic health problems.”

MAKE THE CASE FOR COMPLIANCE

When presenting treatment plans to a client, explain each part of the procedure and why it is vital to the wellbeing of the pet. Focus on the procedure, not the price. Explain that it is difficult to determine the true extent of the oral disease until each tooth can be evaluated under anesthesia and radiographs have been evaluated before a treatment plan can be formulated and fees calculated. If the client has concerns due to cost, explain that periodontal disease is a progressive disease, and without treatment it will get worse. Clinics can also encourage clients to purchase pet insurance early in the pet’s life or offer a third-party payment plan such as Care Credit to help alleviate the sticker shock of any dental or emergency procedure.

A modified version of the dental chart can be on a dental report card for the client that will help them understand the problem areas and home care instructions for their pet. A section for diagnosis, treatment, home care, prescriptions, and follow-up visits should also be on this report card. Keep it simple and use bright, cheerful colors with clipart as well as before and after pictures on the take-home sheet.

TIPS FOR HOME CARE

Home care is a vital part of periodontal treatment. Treatments will be temporary and unsuccessful if the owner does not comply with home care instructions. For the owner to comply, they must understand the treatment and the recommendation being discussed. Daily tooth brushing is the gold standard, but not every individual can or is willing to brush their pet’s teeth every day. Demonstrate tooth brushing techniques to the client. Telling a client to brush their pet’s teeth without a demonstration is of no benefit to the patient. Demonstrate on one side and observe the client brushing the other side of the mouth. If you use the owner’s pet, you are also able to assess the pet’s temperament and acceptance of the tooth brushing. Investigate other, proven options for home care and follow up with clients on the success of the product.

Follow-up exams to evaluate healing and home care are a must. Many clinics include the cost of the follow-up visit in the initial service fees unless additional sedation or anesthesia is required.

When discussing home care products that retard plaque and tartar on the teeth of animals, we must also educate the client about label claims. Not all products that say “veterinarian recommended” are suitable for their pets. Always recommend oral health products with solid research to back those claims. The Veterinary Oral Health Council (VOHC) awards products a seal of acceptance if the companies that have applied for this seal have tested their products using strict protocols developed by the VOHC. Products that have this seal are known to have respectable science behind them and have demonstrated the product works. Additional information is available at vohc.org. There are many other chews and treats available that are efficacious but do not have the VOHC seal. Do your homework: ask the manufacturers of dental products specially formulated for dental disease to show you the research that proves the efficacy and safety of these products before recommending these products to your clients.

Finally, dental procedures must be done at the same level of perfection as all care in practice. Team members and the practice owner should commit to developing the team’s skills and training so the procedures can be performed properly. A dental cleaning procedure includes a thorough oral examination, radiographs, cleaning the crowns and below the gumline, and any treatments necessary. Refer patients for treatment if it is out of the scope of the training at your practice.

Remember, it is the veterinary team’s responsibility to educate, evaluate, demonstrate, and advise clients regarding oral home care. The need for dentistry must be integrated into the practice philosophy and should become as routine as vaccines and heartworm control. The need for routine dental cleanings prevents disease. An oral exam must be part of every checkup, regardless of the reason for the visit. Start early and set the stage for a lifetime of good dental health and an increased lifespan of the pet.

References

1. Logan EI, Boyce EN. Oral health assessment in dogs: parameters and methods. J Vet Dent 1994;11(2):58-63.

2. Benchmarks 2016: A Study of Well-Managed Practices. marketplace.dvm360.com/product/benchmarks-2016-study-well-managed-practices. Accessed September 11, 2019.

Recommended Reading

Holmstrom SE. Home-care instructions and products. In: Holmstrom SE, ed. Veterinary Dentistry: A Team Approach. 3rd ed. Elsevier; 2019:178-198.

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