February 11, 2019
This month, veterinarians are being encouraged to raise awareness of oral care as a component of general health for animals and increase routine dental checkups.
In honor of Pet Dental Health Month, Sharon Campbell, DVM, MS, DACVIM, of Zoetis, offers three tips to help veterinarians improve client compliance with dental procedures.
According to Dr. Campbell, even though February is designated dental month, every patient every day is an opportunity to talk about oral health with a client.
“We know the vast majority of dogs and cats have dental disease by the time they’re four years old; it is the most common infectious disease for these species,” Campbell said.
“Anytime you can have a conversation to increase awareness is important. When you get to a situation where it’s time for a dog or cat to have a dental procedure, having a conversation can be tricky. There are ways to get to it.”
1) Identify the why
It is critical to have an open conversation about why the pet actually needs to have a procedure done—talk about the benefits of good dental care and help the pet owner understand the possible health risks to ensure you intervene early. The most obvious point to address is the impact on the human-animal bond. If you think about getting kisses from a dog or snuggling with a cat who has bad breath, it can be off-putting. From a medical standpoint, periodontal disease is insidious and progresses if it is not treated. The different things you see—plaque, gingivitis, tooth loss, and abscesses—are all complications of periodontal disease. Another area to mention, which is often overlooked, is the pain associated with those conditions. Plaque and gingivitis can be irritating, and certainly a broken or abscessed tooth can be painful. Let pet owners know about other possible health problems that can arise. Studies have shown complications in organs, such as the heart, kidneys, and liver, have been associated with dental disease.
2) Address concerns
Owners can be reluctant to have pets undergo a dental procedure, so be mindful of what their concerns are. Ask them open-ended questions about their worries. Usually it is one or a combination of three areas of worry. First, there may be some concerns about general anesthesia. Reassure them a qualified team member will be monitoring the pet throughout the procedure making sure they are pain free and keeping them stable. Postoperative complications are another concern. To address this, have a conversation about what you are going to do during the procedure to minimize any complications. Cost is typically the third concern for pet owners. Let them know intervening early in the dental disease is going to be more economical for them. If a pet owner waits until the dental disease gets to a more severe stage, procedures become more expensive. Make sure to also highlight the value of what you are doing. Explain to pet owners beforehand all the different things you will do during the procedure. You can even take them to the area you have designated for the procedure in your clinic and show them the equipment involved. After the procedure, show them the dental chart, radiographs you’ve taken, and before and after photos of the mouth so they have a good understanding of all that was done. Good communication leads to good compliance and satisfaction of the customer.
3) Don’t just recommend it
Another way to get pet owners to agree to have the procedure is to avoid phrasing the dental procedures as a recommendation. “This is an error I made early in my career,” Campbell said. “Instead of saying, ‘Your dog has some gingivitis and tartar, I think it is time you should do this,’ I should have said, ‘Your dog needs to have a dental procedure because of XYZ.’” It would be very similar to having a diabetic patient—you wouldn’t recommend insulin therapy, you would say he or she needs insulin and routine monitoring. With dental disease, there is a little bit more leeway and the procedure doesn’t necessarily need to be done the same day, but you don’t want to let it go on year after year until it becomes a severe condition.
Since Pet Dental Health Month started nearly 20 years ago, there has been much improvement in veterinary dentistry. From specialized educational programs to wet labs and didactic sessions at conferences, there are many ways to grow a strong dental program in your clinic.
Although things are looking up, Campbell said there are still a few issues that are important to address, such as the need for general anesthesia.
“In human dentistry there is a procedure called sedation dentistry,” Campbell said.
“People who are afraid of dental procedures are given a sedative. There is no parallel to that in veterinary medicine.”
According to Campbell, animals should be put under general anesthesia when having a dental procedure. She says the American Veterinary Medical Association (AVMA), American Animal Hospital Association (AAHA), and the American Dental Veterinary College (ADVC) have all endorsed it.
“It is for the safety of the patient and the staff, as it reduces anxiety, addresses pain, and allows for comprehensive examination of oral cavity, including radiographs and a thorough procedure. You can’t do that if the animal is only sedated,” she said.
“It is crucial to intubate these animals; insert an endotracheal tube into the trachea to protect the airway from any of the bacteria or dental debris from the procedure.”
Campbell said it is also important to address the controversy surrounding the use of antibiotics with dental procedures.
“The bacteria are enveloped in the plaque, which is a biofilm that walls the bacteria off, so that systemically administered antibiotics cannot reach the bacteria,” Campbell continues.
“Therefore, if you try to treat it with antibiotics, you’re not going to be successful.”
According to Campbell, plaque needs to be removed through scaling.
“Where you would use antibiotics is when a patient has severe periodontal disease, such as stage 3 or 4, is immunocompromised, has multiple systemic diseases, is an uncontrolled diabetic, or if you’re treating an abscess. When you choose the antibiotics, you need to consider the different bacteria that are inside the mouth.”
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