By Tony M. Woodward, DVM, AVDC
Previous articles have presented the rationale for expanding your veterinary dental services and presented a specific marketing plan you can use to implement a higher level of dentistry in your practice. In this article, we will begin to cover the specific veterinary dentistry services you need to provide.
There are a few basic dental procedures that every small animal veterinarian should be prepared to deliver. There are five basic services that will allow you to deliver 90% of all the needed dental care that comes through your doors, and generate 15-20% of your total practice revenue. You do not need to master advanced procedures such as endodontics or surgical periodontal therapy to deliver the majority of dental care to your patients. These procedures are all well within the grasp of any interested practitioner, and include:
- A thorough 12-step cleaning
- Dental radiology
- Basic periodontal treatment
- Surgical extractions
- Bonded sealants for exposed vital dentin
We will cover these procedures and the rationale for their use in the next few articles, beginning with a thorough 12-step dental cleaning procedure.
Historically, veterinary dentistry has centered on a “scrape and yank” mentality. This type of procedure involves supragingival calculus removal and removal of any mobile teeth. Clients are becoming more educated today, and demand a higher level of service. Mobility is the least common reason for extracting teeth in my referral practice, and this also holds true for many practices that have begun to deliver improved dental care. The key to identifying the painful problems in a patient’s oral cavity is a thorough 12-step cleaning procedure, which provides a consistent approach to identifying existing pathology. The basic steps include:
- History and physical exam– provides many clues to what you might find in the oral cavity. For example, dogs with fear of thunderstorms frequently have fractured teeth that require treatment.
- Initial oral survey– after anesthetic induction, look for any obvious areas of dental problems such as fractured teeth, mobile teeth, discolored teeth, oral tumors, etc. Anything out of the ordinary should be noted.
- Supragingival scaling– this is the least important part of the 12-step cleaning, but the most visible to the owner. Typically this will involve a combination of ultrasonic scaling and hand instrumentation. Note that this is the only part of the 12-step cleaning that can be done in a non-anesthetized patient, and the quality of the scaling will be poor.
- Subgingival scaling– this is the most important part of the procedure, but the least visible to the owner. No animal will allow cleaning under the gum line unless anesthetized, particularly if there is root exposure or a deep periodontal pocket. Those of you that have had root planing can vouch for the discomfort involved.
- Polishing– removes irregularities created by scaling and slows the accumulation of future plaque and calculus.
- Lavage of the gingival sulcus– removes infectious debris and foreign material from underneath the gum line. Polishing paste under the gum line can be very irritating to the gingival tissues if not rinsed away.
- Fluoride treatment– Fluoride strengthens enamel and helps desensitize exposed root surfaces and exposed dentin. Although veterinary dentists disagree about the need for fluoride treatment in veterinary patients, it is unlikely to cause any harm.
- Complete charting of all pathology– Charting helps keep track of areas requiring radiographs and further treatment. A full-page form is recommended to allow detailed charting. The small dental labels that can be placed in a medical chart are too small to be of value. Serial dental charts are invaluable when evaluating progression of the patient’s disease over time.
- Dental radiographs– Radiographs are an absolute requirement for quality dental care. Treating dental conditions without dental radiographs is like treating internal medical conditions without blood work. It cannot be done. If you are not regularly taking dental radiographs, you are leaving painful problems in many of your dental patients. Dental radiology will be covered in more detail in future articles.
- Develop your treatment plan and present it to the owner with conviction. A systematic approach to your cleaning procedure will yield an organized treatment plan for the patient. Be sure to charge fairly for your time and to include your materials and medications in the estimate. When presenting your recommendations to the owner, it is essential that you explain the reasons for your recommendations and let the owner know that you truly believe this is what the pet needs.
- Provide the indicated dental treatment after gaining permission from the owner. In many cases this can be done the same day, but at times you will need to delay treatment until a later time or divide treatment into two phases. As they begin to deliver the basic services discussed here, many practitioners find that just four average dental patients can provide a full day of work for one doctor and one technician. They also find that these “dental days” provide their highest production of any of their workdays.
- Go over home care and “plant the seed” for the next needed dental care. When the patient goes home, that is the time to let them know when the pet needs their next oral exam, cleaning, etc. I recommend that you provide re-check exams after any procedure beyond a simple cleaning. The re-check exam is the time to assess the success of your treatment, to go over home care, and to demonstrate your recommended home care on the client’s pet, in front of the client. When clients purchase their home care products from your practice, it provides another opportunity to bond them to your practice.
The above steps are the backbone of quality dental care for general practitioners, and are
presented in more detail in a variety of dental textbooks. Methodical application of the above steps will allow you to identify painful pathology long before teeth are loose. Your clients and your patients will notice a difference.