K. Istace, RVT
Pet owners are often reluctant to make an appointment to have their pet’s teeth cleaned. To increase compliance, we must find out why.
The first thing that you should do is address your client’s concerns. Is she worried about having her pet undergo a general anesthesia? Sometimes, you may find that the client has more than just a vague fear: a previous pet or even a human family member may have had a very slow recovery or died after anesthesia. Let your client know that her fears are common, but that advances in pre-anesthetic health screening, anesthetic drugs, and anesthetic monitoring during the past decade have minimized the risks of anesthesia for dental cleaning, even in older pets. Of course, your hospital must be capable of providing all of the above. If the pet is compromised in some way, such as with heart or kidney disease, you may want to offer referral to a board-certified veterinary dentist who will best be able to accomplish any required dental work in the least amount of time spent under anesthesia. Referral to a board-certified veterinary anesthesiologist may also help ease the client’s anxieties.
Fear over general anesthesia may not be the driving force behind your client’s objection to scheduling the dental procedure. The client may not see the necessity of paying for anesthesia when he can have his own teeth cleaned while awake. In this case, the onus is upon us to educate the client about how periodontal disease develops and how it is treated. Because human patients are able to understand what is going on and cooperate, dental scaling of human teeth can be performed by a professional hygienist without anesthesia. In dogs and cats, however, access to the most important areas of a dental scaling (below the gum line where periodontal disease begins) is impossible while the pet is awake, not only because it’s unlikely we will be able to get him to lie on his back under a bright light while holding perfectly still with his mouth wide open for a prolonged procedure, but because the areas under the gum line are often much more sore and diseased than comparable areas in a person’s mouth due to lack of oral hygiene. Even a pet without any sore areas in his mouth would be frightened by all of this unusual poking around in his mouth, and only a small flinch during a dental scaling could result in severe damage to the oral tissues of the pet, not to mention the loss of the fingers of the technician!
Few Clinical Signs
Periodontal disease and even conditions, such as fractured teeth and tooth resorption, may not have clinical signs that are recognized by the pet owner, and so are deemed unimportant or not affecting the pet’s health or quality of life. We must educate the owner on the importance of dental hygiene, and the dangers of not resolving dental issues, such as pain, chronic infections, dental abscesses, osteomyelitis, oronasal fistulas, and pathological jaw fractures.
Distracted by Other Health Issues
Often, these conditions go unnoticed by pet owners until the pet presents for a physical examination at their annual vaccine appointment or for another health problem. A lack of veterinarian’s time during the physical exam, especially if there is another problem the owner is more concerned about, means this duty often falls to the veterinary technologist. How do we make owners care about dental disease when the owner is more concerned about their dog’s ear infection, or that their cat is urinating outside of the litterbox? Dental education and treatment may have to wait until the presenting problem is resolved, but it should not be forgotten. A no-charge follow-up appointment with the veterinary technologist can be useful in catching these patients who may otherwise slip through the cracks.
‘Anesthesia-Free Dental Cleaning’
Another reason a well-meaning client may not bring her dog in for a complete oral health assessment and treatment, despite the fact that you have recommended it, is that she assumes the ‘tooth brushing’ or ‘anesthesia-free dental scaling’ that her groomer performs every time she takes her dog in for a clip and bath is the same service as your hospital would perform, except that you charge more. Again, educating the client about periodontal disease, and what must be done to treat it, is the best way of ensuring the dental health of their pet. By law, only licensed veterinarians or properly supervised and trained technicians can practice veterinary medicine, including veterinary dentistry. Groomers or other untrained individuals who are performing dental scaling can be charged with a criminal offence. Not only are they completely unable to treat periodontal disease beneath the gum line, they are also incapable of performing a complete oral examination. They are not trained to recognize oral pathology, and they are physically unable to see areas such as tooth surfaces facing the tongue or oral mucosa far back in the mouth, which can only be evaluated properly while the pet is anesthetized or sedated.
They cannot probe periodontal pockets, recognize problems such as oral masses, tooth resorption, or gum recession, or take dental x-rays. Even worse, they can give the pet owner the false sense that their pet’s mouth is healthy when in fact only the crowns of the teeth are clean, while periodontal disease is raging beneath the gum line.
Don’t be afraid of addressing your clients’ concerns, whether they are about anesthesia, cost, or the necessity of professional veterinary dental procedures. Your clients want what’s best for their pets—that’s why they came to your hospital in the first place! Your role is to make them aware of the problem, educate them as to the best treatment, and to make that treatment available. The rest, ultimately, is up to them.
For further information, see the American Veterinary Dental College position statement on Companion Animal Dental Scaling Without Anesthesia online at https://afd.avdc.org/ (VIN editor: the original link was modified on 4/7/20).