Dental compliance: getting those dentistry cases to the table!
By Vickie Byard, CVT, VTS (Dentistry), CVJ
While 70-80% of all companion animals over the age of three have some level of periodontal disease, it is among the most ignored disease in dogs and cats. With “wellness” the forefront of most practices, and evidence linking periodontal disease to conditions including liver and heart disease, it is surprising how few practices actually recommend dentistry services and care.
A 2003 AAHA client-compliance survey revealed that the responsibility for the failure of owners to provide dental services for their pets was the person responsible for giving the recommendation. Most veterinarians felt that cost was the deciding factor against dentistry; however the survey showed only 7% responded that cost was a factor. The client either did not receive a recommendation for dentistry, they did not understand the importance of the recommendation, or they either forgot the recommendation or their vet failed to follow up. Therefore, each of these concerns must be managed before compliance will be gained.
The same survey reported that dental prophylaxis treatment would increase if the practice simply recommended it. In a 2009 follow-up study, recommendations had increased, as had the percentage of pets having dental prophylaxis done when the recommendation was made. However, there is still a recommendation gap: for 15% of pets with a diagnosis of dental disease (grades 2-4), no recommendation was recorded.
Staff training
Training begins at the practice level. All staff members need to be on the same page as far as dentistry is concerned. This means that everyone from the receptionist to the practice administrator must understand their role, and “buy in” to the importance of dental care.
Firstly, it is important that everyone understand the impact of dental disease on the patient. Recent research demonstrates the association between inflammatory periodontal disease and cardiovascular disease, respiratory disease, liver disease, kidney disease, and joint disease.
What about patient comfort? Animals live with fractured teeth, multiple tooth root abscesses, oral ulcerations, and more. But, because in many cases they continue to eat, and appear well, many clients perceive that the pets are not uncomfortable. On the contrary, experience shows that most clients notice significant positive change in behaviour after dentistry is provided.
Technicians should be trained to “flip the lip” every time they examine a pet. The veterinarians should be trained to discuss the oral status and make appropriate notations in the permanent medical record every time they perform a physical exam.
Also, when a veterinarian makes a dentistry recommendation, a reminder card, which can be generated by most veterinary software packages, should be sent out.
Along with the staff, the clients have to begin to expect reports about their pet’s oral health as they expect to hear about vaccinations. It may take a client 10 times of hearing that their pet needs to have dentistry before they value the information enough to jump over the barriers to that care. There are also some simple things that you can do around the clinic to help remind clients of the importance of dental care:
- Put up posters around the practice – many drug companies provide professional posters highlighting oral disease
- Create photo albums filled with before and after photographs
- Post articles and case presentations on the company website stressing the positive outcomes of dental care
- Use simple computer software to create brochures and have them on display around the practice
- Provide monthly dentistry seminars for the clients – this can be provided by a veterinarian or a technician well-educated and passionate about the subject
Practice resources
Some clients will be hesitant to have their pet treated because of the potential medical risks associated with anesthetic. To help deal with this, create a PowerPoint presentation or a brochure explaining how your practice minimizes the risk to the patient. For example, each pet will receive:
- A complete physical examination
- Heart auscultation
- Lab work, provided prior to the procedure to ensure that the kidneys and liver are functioning properly
- Tailored anesthetic drug protocols for each patient
- Elegant monitoring (show photos of pulse oximeter, ECG, blood pressure monitor, Bare Hugger, IV fluids, IV fluid pump)
As well, reassure them that certified veterinary technicians are responsible for monitoring their pet.
The presentation can also show a few interesting clinical cases, which can provide the opportunity to discuss:
- Different grades of dental disease
- Resorptive lesions
- Periodontal disease
- Fractured teeth
- Malocclusions
- Tooth crowding
- Retained deciduous teeth
- Dentigerous cysts
- Gingival hyperplasia
- Chronic ulcerative paradental syndrome
- Lymphocytic plasmacytic stomatitis
You can also discuss:
- Tooth brushing
- Dental diets
- Veterinary Oral Health Council acceptance
- OraVet Dental Chews
- Sealants
- Water additives
- Appropriate chew toys
Not only will the client learn more about the importance of dental care, but also they will feel that their veterinary team has the best interests of their pet at heart. This is key when building a relationship with the client, and encouraging treatment compliance.
To simplify the client education process, PetED Veterinary Education and Training Resources (www.PetED4VetCE.co) has created a series of client-focussed educational videos discussing all of the above information. Subscription to these videos allows the practice to consistently provide the same information to every client, decrease the time spent discussing these issues in that tight 20-minute office visit, and supports the growth of dentistry in every practice.
Conclusion
Education is critical. There are countless examples in human medicine where patient outcomes improve dramatically when the caretaker fully understands the cost of neglect versus the benefits of proper care.
The payback to the practice is multifold. When we effectively educate the client, compliance increases. This benefits the practice in terms of increased revenue, more routine care, and clients that are more apt to ask their veterinary team for advice rather than, for example, the clerk at the pet food store. Clients, in turn, feel they are involved in their pet’s healthcare, and are better educated on how to keep their pet happy and healthy. It truly gives the veterinary profession the opportunity to provide excellent wellness care for their patients.
Vickie Byard practices at Rau Animal Hospital in Glenside, Pennsylvania. She is the founder of and dentistry consultant/trainer for PetED Veterinary Education and Training Resources. She shares her home with her special needs kitty, Margo.
This article is based on Ms. Byard’s presentation at the North American Veterinary Community Conference in Orlando, FL.CVT
