A Guide for the General Veterinary Practitioner
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By Tony M. Woodward, DVM, AVD
There exists today a tremendous opportunity for improving the level of veterinary dental care delivered by the average practice. Integrating a higher level of veterinary dental care into a general practice takes time and a level of commitment from the owner(s) of the practice, but the rewards in improved patient care, improved client loyalty, as well as financial rewards can be significant. Mastering a few basic techniques and educating your staff and clientele can help you successfully take your practice to the “next level” of dental care.
Where we are now: Practice Economics and Standards of Care
An October 2002 article in DVM Newsmagazine quoted an AAHA study showing small animal practices average around 14% of gross sales related to vaccination. Most practitioners feel that vaccination income is decreasing, and will continue to do so as more evidence is presented to the public about vaccine-related health concerns and duration of immunity. What will you do to replace this income? Increasing the level of dental care offered brings your patients in every 6-18 months, allows you to deliver care that makes your patients act noticeably better, and establishes you as more of a medical professional and less of a “vaccine purveyor”.
The awareness by the general public regarding dental care for veterinary patients continues to grow. Clients are willing to pay for veterinary dental care if they are educated about the reasons for that care. Many clients I see in my practice are disappointed or angry that their regular veterinarian did not tell them about a painful problem in their pet’s mouth. Owners cannot understand how there might still be oral problems in a pet when their pet just had a “dental”. Clients know that there is more to dentistry than just cleaning, and they assume that their pet has received a high level of care, when in many cases it has been a minimal level of care. They really understand the difference a few weeks after dental proper treatment, when their pet is acting several years younger.
The “dental cleaning” in some facilities consists of cleaning the calculus that is visible above the gum line, perhaps cleaning a little under the gum line, and then extracting any loose teeth. In many cases, the entire procedure, including extractions, is left to the technician staff. In 46 states, according to the State Practice Acts, it is illegal for a veterinary technician to perform any surgery, including oral surgery and dental extractions. Position statements by the Academy of Veterinary Dental Technicians (AVDT) and the American Veterinary Dental College support this position. Many veterinarians allow this to occur, in spite of the legal risks, because they are uncomfortable diagnosing and treating dental problems, especially in the earlier phases. Since a technician is doing the work, we tend to undercharge for the service, which decreases our interest in doing a better job. This type of treatment is a disservice to the veterinary practice, the owner, and most importantly the patient who frequently continues in pain for years. Dentalaire Products 800.866.6881 2
A human dental hygienist spends two years in an intensive college level program to learn how to clean teeth and identify oral pathology. Can you imagine how you would react if this well trained hygienist started to extract one of your teeth after cleaning them? Obviously, you would demand that the dentist, with their formal training, provide this service. The average veterinary technician has very little dental training, yet may be given free rein to decide about what should be done.
In many cases, a tooth is not considered to have a problem until it is mobile. This is a “wait and see” attitude that treats problems only after they are so obvious that they cannot be ignored any longer. By taking a more proactive approach and diagnosing dental problems earlier, we improve patient care, financial rewards, and client satisfaction
Where we can go: The Potential for High Quality Veterinary Dental Care
The market potential for dental care is astounding. Half of all dogs and cats in your practices are currently in need of some level of dental care. By providing higher quality dental care, we can diagnose many painful conditions that otherwise might go undetected for years. In my experience, 50% of dogs and cats over the age of five have at least one painful problem in their dentition. Few practices have come close to realizing the delivery of even a small fraction of needed dental services.
According to Owen McCafferty, CPA, most general veterinary practices average 2.5-3.5% of gross sales related to dental care, including anesthesia, IV fluids, extractions, suture,
medications, etc. used during dental procedures. He feels that the potential is to have 15-20% of your gross sales be dental-related. In my prior three doctor general practice, we averaged around 17%, including over $650 per month from dental radiographs alone. This included very little in the way of “advanced” dental cases. Almost all of what we did was well within the grasp of an interested general practitioner.
To illustrate the market potential within a typical practice, imagine a solo doctor practice with 1000 canine and feline patients. Half of those patients (500) require some dental care right now, so there are 500 medically indicated procedures waiting to be delivered. Many may need only cleaning, while others will require several hours of oral surgery. Most will require dental X-rays. I will assume an average fee for each of these cases to be $300, which is ridiculously low. If all 500 were cared for and the needed treatment administered, the total fees generated would be around $150,000. If a practice nets a conservative 30% of gross revenues, this represents $45,000 of annual profit. What if you have 2000 or 3000 patients in your files?
Most veterinarians can achieve these kind of results if they are willing to learn how to provide a quality cleaning procedure, actively look for painful problems, and treat them before end-stage disease (i.e.- loose teeth) exists. Treating these problems requires more than a technician simply removing a tooth that was about to fall out on it’s own; it requires the veterinarian to perform skilled procedures… and to be paid for doing so.