Introducing Veterinary Dentistry to Your Practice
Steven Holmstrom United States
Increasing the quality and number of dental procedures performed is a rewarding method of increasing both the quality of practice and income of the veterinary practice. It is a service that many patients need, and once they understand what is going on, clients are eager to have these problems solved in their pets. With the increased study of dental disease, most practitioners are surprised at the amount of dental disease encountered among their patients. Informing and performing dental procedures will result in raising the esteem in the eye of many clients for the practitioner astute enough to spot and solve dental disease in their pets. In order for this to take place, the practitioner’s duty is not only to learn to identify and treat dental problems, but also to market these skills in dentistry.
Marketing is an activity that identifies and satisfies consumer needs and wants. By examining the patient, the veterinarian determines what medical needs the patient has and then informs the client in such a manner that the client understands the need and wants the service. In order to effectively market a product or service the first step is to determine what the patient’s need is. In veterinary medicine, practitioners must first educate themselves and become familiar with all of the aspects relating to the service that is going to be delivered. Marketing is more than just presenting the service to the client. However, this is what many consider to be marketing. In reality, marketing begins with developing your product through education.
DEVELOPING YOUR PRODUCT
The practitioner needs to conceptualize goals and formulate a plan of how to arrive at these goals. These plans need to be reviewed on a periodic basis and a method of monitoring the achievement established. The plan should include such items as education and training, equipment acquisition, performance, and “the bottom line.”
One way to become trained is by attending continuing education courses and reading journals and textbooks. As dental theory is learned, the veterinarian can start to evaluate how it fits into the individual practice. For some, learning a little dental theory will persuade them they want to provide minimal dental service and refer more extensive work to someone else. Others, as they learn more dentistry, will decide they want to become involved in the delivery of even more complex dental service. It is helpful to recognize that there are many sub-specialties in dentistry. The reader should plan to start with only those areas that they has become thoroughly familiar with and are able to provide competently. Other aspects can be added as knowledge and skill level has been developed. Prior to performing the procedure gain the skills necessary, and remember, the client remembers a botched job for a long time.
The dental practitioner has an abundant number of instruments and materials to aid in the treatment of patients. Some of these supplies are mandatory to get the job done. Other “toys” are optional and make it easier to perform the procedure, or quicker, or both. Part of the plan is to establish what is essential for the procedures to be performed and what is not. From there, a budget for equipment and supplies can be established. While dentistry time and time again has proven itself to be economically viable and a profit center, the expense must be balanced with the income.
In continuing the plan, the performance of the dental procedures must be evaluated. A realistic goal should be established as to the numbers of procedures to be performed over a period of time. This goal may be re-evaluated as needed. However, at the time of re-evaluation, the practitioner must ask, why is the goal being re-evaluated? If the goal was set too low, great, congratulations! If the goal was set too high, what was the problem? Unrealistic expectations? Or were there other reasons that the procedure was not performed? Examples of this might include: lack of training, lack of equipment, lack of confidence in performing the procedure, or lack of time (the client has been talked into another procedure which takes less time, but is not as beneficial for the patient.) These factors must be evaluated before setting a new written goal.
Finally, the practitioner must evaluate the bottom line. Is/was the expense of the education, instruments, and materials worth the time and effort for the practice? The anticipated expenses must be subtracted from the anticipated income. Hopefully, the answer will be affirmative.
The best place to start in increasing the veterinary dental practice is to increase the prophylactic or periodontal services. Most of the time the practice is already performing dental “prophys” and periodontal disease is the most common dental disease encountered. The practitioner should reevaluate the dental product provided, improve upon it, and introduce other products as needed. Many times, veterinarians are reluctant to perform a procedure because of the lack of experience in performing that procedure. This can be overcome, as there are many situations within the practice that can be used to sharpen skills. For example, a tooth that is going to be extracted can first be scaled before being extracted. The tooth is subsequently extracted and a visual check of the work can be performed. This same extracted tooth can be used to perform an endodontic procedure and restorative technique. Finally, the tooth can be taken to a colleague or dentist for critique. All of this experience can be gained on just one tooth that was extracted from the patient.
INTRODUCING THE PRODUCT
As confidence with the practitioner’s skills is gained, the veterinary staff needs to become involved (if they haven't already shown an interest). It is best to produce a protocol of how the procedures should be performed. This way the entire staff will be better able to assist in the effort. For the most part, the staff can be expected to reflect the attitude of the veterinarian towards this new project. This written protocol can be in the form of text or text with pictures
DELIVERING THE PRODUCT
After all of this preparation, it is time to go public. Time should be taken to thoroughly examine every patient's mouth. Dental disease is rampant in veterinary medicine, so there are many opportunities to use dental skills among patients. Periodontal disease is very widespread, and even with exerted efforts, it is likely that periodontal disease will never be cured in many patients; however, patients will be made more comfortable and their quality of life increased. Evidence of periodontal disease encountered while examining the patient should be shown to the client and the importance of preventive care and treatment discussed. This can be related to patient’s preventive dental care. The veterinarian and client can start to develop a treatment plan considering the patient's needs, the client's available time, the client’s finances, and the expertise of the practitioner. One of the nice things about dentistry is that it can be delivered one step at a time. Therefore, the patient can be checked for progress and the treatment plan modified as needed.
Another example of an unfilled need is fractured teeth. Unfortunately, when fractured or discolored teeth are discovered they are often ignored. When the indications for treatment are understood and recognized, they should be relayed to the client. There are only four options with a patient needing endodontic treatment: ignore it, extract it, perform endodontic therapy, or refer it. The ramification of each approach should be explained to the client. Once educated, most clients want to do something to solve the problem. If the practice is charging a fee that is fair to all parties, there will be a mix of both exodontic and endodontic procedures. This also relates to marketing. Options should be presented to the client and then let them decide which option best suits the their needs. If the client is not given the opportunity to accept or reject a treatment by offering the treatment, the treatment will not be performed.
MARKETING FOR NEW CLIENTS
Marketing for new clients is known as external marketing (outside your practice). This has the effect of educating the public and letting the community know that you are interested in their pet’s health. It can be by Yellow Pages, advertising, direct mail advertising, cooperative direct advertising, and interviews (feature articles or promoting special events) by newspaper, magazine, radio, or TV.
For most practices, there is enough “untapped” dental disease in current patients to keep the practitioner busy for a lifetime! For these practitioners, external marketing is not necessary. There are a variety of methods that can be used for client education and “getting to yes.” These aids add credence to the presentation to the client. Materials that can promote internal marketing include: hospital brochures, in-hospital displays, smile books, posters, newsletters, invoices and statements, telephone messages on hold, sign boards, and handouts, both preoperatively and post-operatively.
ESTIMATE AND CONSENT
While thought of mostly for legal reasons the estimate and consent form is a valuable marketing tool. By using an estimate, a treatment plan may be written up prior to the procedure. Many veterinarians will figure out what to charge the client only after the procedure. Unfortunately, they sit down, think “this costs too much” and start whittling away at their fees. The best method is to write it down beforehand, and be fair to the practice and client. Developing a treatment plan and estimate serves as a focus for discussion of the patient’s needs and the client’s wishes.
Of course, there always can be unexpected procedures that need to be performed. One method to handle this is to give the client three choices on the standard estimate/surgical release/drop off form. These choices are: “1) Do anything the doctor feels necessary; 2) Call first, if I cannot be reached, do what is necessary; 3) Do nothing if you cannot contact me.” These three questions eliminate the game of “give me a call” only to find out the client is not expected in the office for three hours (while the patient is under anesthesia!).
Recall cards can be a very valuable method of reminding the client to return for repeat visits. Recall reminders should be customized according to the patient’s needs. Generally healthy and patients with gingivitis should be recalled yearly. Patients with established periodontal disease every three to six months and patients with advanced periodontal disease every three months.
One method is to use plastic dental models. Plastic dental models have become available for the practitioner to use for client education. This education lets the client know the condition that a patient has, and as well as what can be done to help the patient. Three companies currently distribute plastic dental models of the canine and feline oral anatomy and disease conditions. Butler Company (800 344-2246) and Henry Schein Company (800 872-4346) make models with excellent representations of dental abnormalities and pathology. Dr. Shipp's Laboratories (800 442-0107) have models with plastic teeth imbedded in clear plastic. These models are excellent for demonstrating root structure.
When discussing the patient’s dental problem with the client, you should discuss the cause of the condition, the options for treatment, the advantages, disadvantage, possible complications of each option, your recommended treatment, and the reasonable expectation of the outcome if no treatment is performed. The opportunities for other treatment demonstrations and uses are limitless! Your skills and education must be taken into account when discussing these procedures with the client.
Every patient who comes through the hospital door has a mouth and in these mouths are many problems that need to be solved. Each problem that needs to be solved can be viewed as a marketing opportunity to provide better service to the patient.
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