There is evidence to suggest that 80 percent of cats and dogs over the age of three need dental treatment. And there is a whole host of systemic problems that accompany dental disease, from cardiovascular disease to brain abscesses and chronic conjunctivitis. Why, then, is the condition so undertreated?
On 7 February, dental expert Bob Partridge spoke to VetsSouth delegates about ways they could bring clients on board with dental care. Importantly, he believes you must involve the whole team in the process – including veterinarians, veterinary nurses and receptionists.
Bob explained that it is important to have a dental ethics practice policy. “The full extent of dental problems is often only evident once we have the animal anaesthetised. Because of that, we need to have systems in place so we can communicate to clients and say, ‘We thought we needed to take out two teeth, but we’ve taken out six’.”
He also advises that every practice allocates a lead veterinary dental surgeon – somebody who has undergone extra training and can advise on advanced treatment and when to refer to a specialist.
Compliance issues
Only about 50 percent of clients are likely to book their pet in for a dental on the advice of a veterinarian, Bob said. Based on 80 percent over the age of three having dental problems and a 50 percent compliance rate, he calculated that the expected number of dental assessment and structured healthcares per week, per vet in his practice is 5.2 dogs and 4.2 cats. “Is anyone doing that number in practice?” he asked. “No” was the answer. “That’s assuming only 50 percent of people are complying. It’s also only talking about those animals aged over three. We are woefully undertreating dental disease.”
Every opportunity to bring up the subject of dental disease with clients should be grasped. To get a lifelong commitment to caring for dental disease, sow the seed early, Bob advised. “Ensure that clients are used to the idea of lifting the lip and examining the mouth. For every single dog and cat having its first examinations, examine the mouth and talk about toothbrushing and preventative care… If clients are used to talking about dental disease and they get it every time they come into the practice, they will be more likely to comply,” he explained.
Pre-operative care
Bob noted that reducing the bacterial loading inside the mouth during pre-operative home care will increase safety for the staff and patient. The use of oral mouthwashes should be considered and in some cases, tooth brushing as well – even before the teeth are scaled.
Getting some pain relief on board before the dental is important. “Our client message with that is that we are decreasing the anaesthetic risk during the procedure. For a lot of our dental cases, we’re looking at elderly patients – higher-risk patients. Anything we can do to decrease the anaesthetic risk has got to be of benefit. Often when I’m examining mouths, I show things that must be causing pain. Get the owners to empathise with that. By reducing bacterial load, we’re trying to improve our chance of success, too.”
It’s also a good time to talk about some innovative products. Bob regularly uses Sanos – a product that can be painted into the sulcus between the gum and tooth once the teeth have been cleaned to prevent plaque build-up. “I use my pre-operative consultation to talk about this and try to get clients to buy into the use of Sanos there and then.”
Post-operative care
Pain relief, mouth washes, using soft food for a couple of days and tooth brushing are some key components of post-operative care, said Bob. “Again, pain control is the feature of client messages, and trying to increase our chance of success. The client has spent a lot of money on dental work, so try to get them to realise they’re investing in this procedure.”
This investment will involve ongoing care, such as tooth brushing, prescription diets and regular checks. “For tooth brushing, I always say to clients that they’re looking at a two-month project. Pick a set time of day and every day, at that time, play with the toothbrush. Start off presenting it with the toothpaste on, and build up to brushing teeth properly. Giving them permission to know that it won’t be perfect on day one can be useful. The routine is important.”
He emphasised that the most effective component is the brush. “Microfibre toothbrushes are great for training but they won’t get into that key space between the gum and the tooth,” he advised. The taste of toothpaste can aid compliance, he said, but avoid human toothpastes and look for VOHC approval. He recommends mouthwash after extractions and for patients with gingivitis.
Marketing dentistry to clients
Bob’s key message was to engage the whole team. The process of marketing can involve training, using newsletters and waiting room displays – Bob has a display in his waiting room that takes clients through the journey of dental care using a video. Video allows you to talk about the technologies you have and why you do things the way you do; he recommended asking local college students to help put it together.
“Try and get clients talking to each other,” he urged, suggesting using the practice website to share positive feedback from clients following dental work. “Just ask them to say it again to the iPhone, because clients will believe other clients.”
Overcoming barriers
Bob argued that the biggest barrier to dentistry is not client acceptance – it is vets. “Dentistry is not regarded as sexy by the universities; there are no dentistry specialists employed by the UK veterinary schools today. We know how common dental disease is, yet we’re not teaching vets how to treat it properly. A-type personalities don’t like doing a bad job so they’d rather not do it at all – saying ‘We’ll monitor it’, ‘We’ll check it at the next vaccination’… [But] we know what’s going to happen. It’s going to get worse, so why leave it?”
Dental work also tends to be done at the end of the day, when everyone is rushed, pressured and running on low glucose levels. Having good equipment is important, Bob said, and it’s worth investing in: “The item of equipment that is going to give you the greatest return is your dental machine. It will pay for itself within a year.” To finish his talk, Bob summarised the key considerations: putting the patients’ needs first; investing in training and equipment; considering innovative products; and, finally, getting everybody in the practice involved.
