Questions from the dental trenches: The practical side of veterinary dentistry - DVM
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Questions from the dental trenches: The practical side of veterinary dentistry
Common inquiries from lectures about marketing, client compliance and much more.




Q. We have a technician who is good at taking radiographs, but the practice manager or owner is always trying to get us to hurry to finish one prophy so that we can get to the next one to meet the schedule for the day. How can we find the right balance?

A. If you have to ask that question, the entire dental service needs to be restructured and the entire staff (other than the technician who is taking the radiographs) needs proper continuing education. Complete evaluation of each and every patient for oral disease requires the production of a full-mouth radiographic survey, proper interpretation by a veterinarian, preemptive client education by technicians and veterinarians, timely estimate generation by the receptionist and proper treatment by a veterinarian trained in dental radiographic interpretation and surgical extractions. Surgical extractions should be the most commonly performed dental procedure if the veterinarian is properly trained in interpretation and therapy. Courses for veterinarians and technicians can be viewed at http://www.veterinarydentistry.net.

Q. We have four veterinarians in our practice, and three of them will see dentistry cases. One is very knowledgeable, but the other two miss many things that the knowledgeable one would correctly treat. How can we make sure all patients get top-notch care?


>>> Figure 2: This cat demonstrated no obvious signs of pain at home. The referring veterinarian noted the painful stomatitis and referred this cat for proper care to a veterinary dentist for full-mouth extractions.
A. This is an extremely popular question. The answer involves putting yourself in a client's shoes. Who would you rather have evaluating and treating your pet for oral disease? The practice must come to this realization and invest in further continuing education for the veterinarian who shows the most interest, knowledge and skill in dentistry. Deem that individual the sole curator of the dental suite, performing all radiographic interpretation and treatment. That person may become the busiest in the practice, significantly adding to the revenue per dental case by applying his or her superior knowledge and skill. Most importantly, the patients will be the ultimate winners.

Q. What do you say to a client who doesn't think a pet needs a dental cleaning and radiographic evaluation because it is not showing signs of pain?

A. This is a very common owner objection. Here are several suggestions:


>>> Figure 3: This mixed-breed dog presented for oral malodor, not pain. A spring had lodged between the teeth and had resulted in bone necrosis and the odor.
1. Do not allow owners to voice the objection in the first place. Preempt questions by telling clients that most dentistry patients do not present with signs of pain. Relay to the pet guardian that most of the time we only know that the patient was painful at the recheck examination. If a patient with periodontal disease that requires extractions has undergone appropriate surgical correction with flaps, diseased bone and tissue removal, extractions and closure, the owner will relay any number of positive behavioral changes that he or she has seen in the pet since the surgery. Only then do clients realize that their pets were in pain. Some pet guardians feel very guilty at this stage, thinking that their pets were just getting older and lamenting on how they let this go.


>>> Figure 4: This geriatric dog presented wagging its tail but was non-weightbearing on its limb. The owner's perception was that the dog was not in pain. However, it turns out that the patient had osteosarcoma, which is a severely painful condition.
2. Show them images of patients that came in for problems other than pain but had obviously painful oral conditions (Figures 2 and 3). Images of nonoral painful conditions are also effective (Figure 4).

3. As veterinarians and technicians, we often observe pain in our patients during oral examinations while probing painful regions and experiencing a pain reflex in the form of a sharp jaw movement upon contact. Relay this to the pet guardians verbally, or record the event and present it during the consultation.

4. Nonverbal patients cannot demonstrate pain easily and often mask it, continuing to eat, play, go for walks and so on. Pet guardians should be aware of this ability to mask pain.

Dr. Brett Beckman lectures internationally on veterinary dentistry and sees patients at Affiliated Veterinary Specialists, Orlando, Fla.; Florida Veterinary Dentistry and Oral Surgery, Punta Gorda, Fla.; Animal Emergency Center of Sandy Springs, Atlanta; and Dallas Veterinary Dentistry and Oral Surgery, Dallas. Find out more at http://www.veterinarydentistry.net.


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