This is part two of an exclusive three-part series on how to grow your practice through dental services. To read part one, click here.
Imagine going to your family physician and they offer to do your annual dental exam? While it would be convenient to have all things wellness taken care of in one visit, would you feel comfortable having a GP perform oral surgery on you? Wouldn’t your doctor and his or her team need to have specialized training in dentistry? This is exactly what veterinarians and supporting staff are expected to do every day under one roof. Yet, very few have specialized training in this common area of pet health.
“Veterinary dentistry is the largest opportunity for patient care and practice growth in most companion animal practices,” says Cindy Charlier, DVM, DAVDC. She holds this view because while about half of patients have some degree of periodontal disease, many practices are treating less than 10 percent of those who do. Why? It all comes down to a lack of effective dentistry training, not just for veterinarians, but for the entire practice team.
A look at traditional dentistry training
Many veterinary schools are modeled after medical schools, which means they simply do not adequately prepare graduates to identify and treat oral disease. A 2017 study demonstrated most students graduate from veterinary school with less than four hours of dentistry training in their first three years. In essence, there is no “dental school” for veterinarians. Thus, dental training has been acquired on the job or by attending weekend dental wet labs, and is almost entirely focused on closing the clinical skills gap among veterinarians and technicians at an individual level. Acquiring clinical skills in dentistry is certainly an important and foundational step. However, this is not enough to create a lasting dental program offering sustained success.
Comprehensive team training
Have you ever attended a CE event, got excited, and then couldn’t wait to get back to work and make a commitment to improve the way you were doing things? Have you then tried encouraging the rest of your teammates to get on board with your new ideas only to have the excitement fizzle and everyone revert to old routines? What if your entire team was a part of the same CE event you attended? Imagine how everyone’s excitement and commitment to change would impact team synergy, practice growth, your client’s perception, and, most importantly, the care you provide to patients coming through your doors every day.
In many clinics, there is a dedicated technician or doctor who is comfortable with or does most dentistry procedures. What if that person calls in sick, or worse, what if that teammate leaves the practice? Having everyone trained in proper dentistry skills ensures another teammate can step right in, perform the necessary tasks, and avoid having to reschedule or sacrifice the quality of care provided to patients. Plus, building an educated team that takes ownership and pride in their roles can help reduce staff turnover.
In-clinic, team training is a paradigm shift from traditional continuing education offerings. Trade shows, local veterinary medical association (VMA) meetings, and regional events offer a wide range of training for clinical staff and practice managers, but what about the rest of the team? Client care and receptionists, veterinary assistants, kennel staff, and groomers are all important members of the team that can significantly impact a practice, but are often left out of training. When team members attend different training events on dentistry, they hear a variety of opinions and learn different techniques, which can result in inconsistent recommendations that can potentially undermine client trust.
Having the entire team trained at the same time can ensure everyone is learning and performing clinical procedures the same way and delivering consistent client education messages. Team synergy makes an impact on the confidence your clients have in your hospital and likely increases compliance for recommended procedures and home care regimens. The entire team learns together, understands the standards of care, and each
of its members has a role in making a difference.
Your client care and reception team
Let’s start with who answers the majority of questions in the clinic. Your front-office staff has the most face time and contact with your clients. It is important they know and understand the standard of care at your practice so they can effectively communicate the importance of oral health care to clients. If your front-office team has never seen a dentistry procedure from start to finish, how can staff communicate value to a client who may be on the fence deciding to follow a recommendation or calling in for a price comparison? If they have never had a dentistry procedure performed on their own pet, they will not have a personal story about how much better he or she felt after it was done.
Your front-office team should have basic knowledge of what happens during a dental procedure, what home care products to recommend, and basic anatomy, such as how many teeth a dog and cat have. Imagine this scenario: a client is distraught over their dog having 22 teeth removed. Rather than simply expressing empathy for their anxiety, what if the client service representative informs them there are 20 more teeth in their pets’ mouth, and they will be much more comfortable once all the pain and infection has been removed. Think about the impact that would have on the client. What about other pet owners in the reception area who may overhear that discussion? It also is important they know how and when to schedule procedures for patients with different stages of disease to help with the flow of the day. It is common to hear someone say, “I’m just a receptionist.” Yet, these teammates usually become the most enthusiastic and motivated to carry out the new ideas as a result of being part of team training.
Bringing in a boarded veterinary dentist
Considering the high percentage of patients over the age of three with periodontal disease, very few students graduate veterinary school with enough education to feel comfortable performing dentistry. A dental education study1 found that while 97 percent of veterinarians extracted a tooth and 95 percent scaled teeth in their first year in practice, only three percent extracted a tooth and only 19 percent scaled teeth as university students. Most veterinarians either learn on the job or have had to find CE events locally to get their dentistry education. As a result, many are inclined to avoid dentistry or have one person in the clinic who likes dentistry to perform the procedures.
It is beneficial for all veterinarians in a clinic to be level set with the same foundational information and proceed together in a course delivered by a board-certified veterinary dentist. There is no comparison to having a boarded veterinary dentist in your practice, looking over your shoulder to help you with oral surgery techniques and instrument handling. It is far better than any video, textbook, or periodic CE course you may take throughout the year. Although all are adequate for supplemental training, there is no substitute for hands-on dentistry training by an expert in your own practice.
There may be varying levels of comfort and knowledge with dentistry, but it is important everyone seeing patients during wellness visits be trained to perform an oral exam. It’s easy to direct the limping patient to the orthopedic enthusiast or the itchy-scratchy dog to the dermatologist. However, animals are expert at hiding their painful mouths, so everyone must be level set on recognizing and staging disease in the exam room and recommending a comprehensive oral and radiographic exam (CORE). The entire doctor team should be adequately trained to interpret dental radiographs, perform oral surgery, and understand best practices in pain management so everyone can agree on a standard of care. This also allows those performing CORE to follow the same steps and techniques so they can deliver consistent quality care.
Technicians are the primary anesthetists during any procedure, and an oral surgery case could last more than an hour. Fear of anesthesia is the number one objection your team probably receives from clients considering dentistry, especially since the patients are often older when the owner finally recognizes there is a problem in their pet’s mouth. Seeking training by an anesthesiologist or technician specialist (VTS-anesthesia/analgesia) is one of the most valuable decisions you can make. Whether the staff is comprised of seasoned veterans, credentialed technicians, or veterinary assistants, everyone will benefit learning best practices together and putting them into practice. Anesthesia training helps the team operate efficiently with less stress and will pay off with higher compliance to their more confident dentistry recommendations.
Fully utilizing your technician team can make dentistry thrive in the practice. Training all technicians together will have a major impact on the efficiency of the procedures to allow the veterinarian to be more productive and empower the team to perform all the tasks their role encompasses. For this to occur, the technician team needs to know the steps in a complete oral assessment, which are:
- supragingival and subgingival scaling and polishing;
- probing and charting every tooth;
- proficiency in taking diagnostic quality canine and feline full-mouth X-rays;
- properly caring for equipment and instruments; and
- how to make home care recommendations.
Deciding to invest in team training starts with the practice owner believing in the importance of treatment and prevention of periodontal disease, and committing to implement and continuously follow through on dentistry standards of care. Investing in whole-team dentistry training can provide returns for as long as you own your practice, but if you want sustained success, you must establish a culture of continuous learning and a year-round dentistry training program.
As your dentistry program grows, a whole new set of questions and challenges will emerge. Plus, you may have new teammates in the form of veterinarians, technicians, and staff who will need to ramp up knowledge and skills in dentistry. Appoint someone to track everyone’s formal dentistry training, and to research opportunities for dental CE, ongoing courses, and advanced training to meet the level and interest of each teammate. If your team members see this commitment, they will believe it and embrace it, and everyone benefits. Most importantly, your clients and patients will be happy and healthy, not just for a month or two after training, but for the long haul.
Stay tuned for next month’s installment to learn tips, tricks, and tools for educating your clients on dentistry and creating an atmosphere that guarantees an increase in compliance to your dental recommendations.
Andrew W. Schultz, Jr., is director of business development and clinical services for Midmark and serves on the board of directors of the Foundation for Veterinary Dentistry (FVD). Schultz also served as director of “Project Milkbone,” a study into the dental performance of companion animal practices and presenter of Double Your Dentistry” at the Veterinary Dental Forum (VDF).
Danielle Heberle, CVT, VTSH (dentistry), is clinical services manager for Midmark, and leads Midmark Academy where she oversees a network of more than 50 dental and anesthesia experts who train in over 500 veterinary hospitals a year from a course menu totaling 100-plus hours of related continuing education. She was awarded the American Veterinary Dental College Presidential Medal for Stewardship in 2018.
Anderson, J. G., Goldstien, G., Boudreaux, K. & Ilkiw, J. E. The State of Veterinary Dental Education in North America, Canada, and the Caribbean: A Descriptive Study. Journal of Veterinary Medical Education 44, (2017). doi:10.3138/jvme.1215-204R