Problems with length of dental procedures

RE: Problems with length of dental procedures

Bob Russell — Mon, 30 Nov 2015 12:43:32 GMT

Ignore what I said about positioning being easy. Just re-Xrayed a root canal canine and had the devil's own job getting a nice image of the good opposite canine!

Most of the time it is not that difficult or time consuming!!

Another option should you be enthusiastic about dentistry would be to pretty much take it over. Do more courses if necessary and work a little bit more independently from those doing other types of surgery. Lots of practices would jump at this! Clearly staff numbers and facilities are likely to have an impact on the viability of this. Dentals take as long as they take and I hate being pushed into rushing them so I don't!

RE: Problems with length of dental procedures

Robin Grimmer — Mon, 30 Nov 2015 12:09:31 GMT

Anon - do you actually enjoy dental work? It sounds as though you do. Do you like your current job apart from the dental issue? If yes then you will need to come to some sort of compromise. If no, then look for another job with a practice that maybe specialises or has a special interest in dentistry.

Alternatively you could do OOH work and avoid dentals entirely.

RE: Problems with length of dental procedures

Bob Russell — Mon, 30 Nov 2015 09:35:41 GMT

"Radiographs help, but positioning is fiddley and time consuming and yes, i do worry about GA time, even with excellent nurses and all the toys."

Positioning should not be that fiddly and it does not need to be that time consuming!

Matthew Oxford spent a day with us and we very quickly learned that exact positioning is not that important but knowing how to correct the errors is! Moving the plate, tube head etc.

Once you get the better of this you can stop worrying about bisecting angles etc and it become second nature!!

RE: Problems with length of dental procedures

Hannah Wynne Richards — Mon, 30 Nov 2015 08:38:49 GMT

An On Yes The advantage of owning a small practice.

Wynne

RE: Problems with length of dental procedures

Evelyn Barbour-Hill — Sun, 29 Nov 2015 22:44:23 GMT

[quote user="An On MRCVS"] but it is often implied that anything going over £450-500 is too much, and this amount pays for a dental procedure lasting about 45-60 minutes at our practice (including the rads and meds, plus bloods and IVFT).[/quote]

Bloods? What bloods? Anyway, if he's getting £450 for a badly done 45-minute periodontal procedure, he's coining it.

[quote user="An On MRCVS"]and there still is an element of 'take out the worst' to improve, but not always fix, the situation in the animal's mouth.[/quote]

Which is just nonsensical.

[quote user="An On MRCVS"]An animal with some bad teeth left is better than one that dies because the GA was too long (though, to be fair, this very rarely happens - we are very good with monitoring and temperature regulation).[/quote]

I just hate this business of dividing teeth into "bad teeth" and "the others" and the assumption that the "bad" ones must be extracted, and the "others" just need a cosmetic scale and polish. I don't think that's your attitude, Anon (is it?) but it's probably the commonest one in practice. Q. "Why are you doing this procedure?" A. "Bad teeth" Oh, that's very scientific.

[quote user="An On MRCVS"] But I think there is a propensity to treat the dental as the 'quick' procedure at the end of the list, when in reality they are often the longest of the lot.[/quote]

Yes, that's another common attitude, even though it was out of date twenty-five years ago.

[quote user="An On MRCVS"] I'm often starting my dentals at midday or sometimes later, after the clean ops are obviously done. It only leaves 3 hours before the nurses start consulting, and 3.5 hrs before I start consulting (and that's without a lunch break).[/quote]

That's bad management.

[quote user="An On MRCVS"]Should I be speaking to my boss about ensuring fewer things are booked in on days when a dental is scheduled? I'm not sure if this would be viable in terms to maintaining the practice income. And not every dental I do is very long anyway[/quote]

You might. Somebody with a day's operating list shouldn't be starting consulting at 3.30. And he shouldn't be losing his theatre nurse at 3 because she's scheduled to start "consulting".

[quote user="An On MRCVS"]May I also ask what others consider a reasonable cost for a more involved dental procedure, for example one requiring multiple extractions with some partially ankylosed roots that don't always come out smoothly?[/quote]

I doubt I'd charge more than £600 for that, ever.

[quote user="An On MRCVS"]I started doing my scale and polish before the extractions because I read this was the best way - the 'surgical scrub' for the mouth? If this isn't the case, I can certainly swap back! [/quote]

You need to clean up the tooth you are going to extract. You don't need to do the minute surface treatment you would give a tooth that's staying. And you certainly don't need to polish before extracting, that's absurd. Polishing is the least important part of the whole procedure: if I were to skip anything, it would be the polishing.

[quote user="An On MRCVS"]The suturing is also tricky to swallow, having had it drilled (another pun, I'm on fire today!) Into me that, infected sockets aside, one should always close a surgical wound in the gingiva![/quote]

Whatever others have told you, I assure you that if you have done a "closed" extraction, without excessive trauma, neither suturing nor anything else is necessary. You will find at your check-up a week later that the socket has practically healed already.

Of course there are exceptions. For instance, if you have removed a whole row of premolars the gingiva tends to gape a bit: a few sutures help there. Then again, in this situation for example: there's deep bone loss interproximally between 408 and 409. You extract 408 in order to salvage 409. It's very beneficial there to mobilise and suture the gum that used to belong to 408 so that you can snug it up against the exposed mesial surface of 409.

And, while acutely aware that some may find this tedious, I'd like to repeat that there is a whole spectrum of treatments for unhealthy teeth in between the extremes of "extract" and "do sweet FA".

RE: Problems with length of dental procedures

Stephen Courtney — Sun, 29 Nov 2015 20:21:00 GMT

Grumpy has a good point - we have some local vets who do much cheaper dentals than we do. Fair enough - I think they also do good work, but may not have invested in the training and equipment that our practice has, and our prices reflect that. We are fortunate in that our area has a proportion of clients who want the higher standard, but there are also people who woudn't dream of spending a penny on their animal's teeth

If there is a vet around who wants to do greyhound dentistry for tiny fees....go for it! We don't worry too much about price matching - the time our dentals tend to take means we can't do em cheap, end of. ( not talking about simple scale and polish of course!)

RE: Problems with length of dental procedures

grumpyoldman — Sun, 29 Nov 2015 20:11:31 GMT

I think that some people do create pressure for themselves by quoting for the best possible case quickie dental ,then finding themselves involved in multiple extractions ,so its probably worth spending the time weighing up the individual case properly ,if it will let you of course. Depends where your working ,and what the local competition is charging. Our top line would be £300-350 anymore and we have tantrums in the waiting room and price match quotes from other chains, that activity probably does keep costs and quality down below optimal levels. The above quotes for 400-800 are probably a better representation of true costs but we all have to work in our own local markets.

RE: Problems with length of dental procedures

Anthony Todd — Sun, 29 Nov 2015 19:35:08 GMT

[quote user="Evelyn Barbour-Hill"]and I have a couple of suggestions.[/quote]

See, already there is time to be saved with no loss of quality.

RE: Problems with length of dental procedures

grumpyoldman — Sun, 29 Nov 2015 18:35:37 GMT

Depends entirely on the mouth and number of extractions , Practice splitting and extracting healthy teeth on cadavers that way you will learn how much physical force is safe to use,(a lot of people are over cautious when they first start ,that is better than being gung-ho about it. When people are in a hurry elevators start skidding off in all directions, particularly in cats, no one wants an ONF, retrobulbar access or iatrogenic orbital penetration), and you will make your mistakes there and deal with them without wasting the nurses time and anaesthetic time , and invest in a rounded hoof knife sharpener to keep your elevators sharp between patients , local anaesthetic blocks before you start your surgery in the mandible and maxilla will enable you to keep the patient "lighter".

As the boss if I see someone struggling i think its quite reasonable to step in and help a bit particularly if its an old patient that is struggling .

RE: Problems with length of dental procedures

Stephen Courtney — Sun, 29 Nov 2015 17:59:23 GMT

We have visiting veterinary dentist who does our really hard stuff, and who has trained us to do things right, and we all try to do things as well as possible. In our hands a three hour procedure could cost about £1200 - this is assuming fancy anaesthesia with all the monitoring, full mouth radiographs, scale and polish ( ie 'preparing the mouth for oral surgery) local blocks and closed extractions with sutures, plus post operative analgesia. Why do i say could? Well i'm still learning and i don't think a bill of £1200 for my work, even if it did take three hours, would be fair.

Most of my dental estimates - for say a 12 year old small breed dog with a heart murmur and likely needing multiple extractions - are for £450-800 and most will end up in the middle of that area. All clients get an explanation of why it might cost more, and are asked to keep themselves available for a phone call if we find something unexpected - like 12 FORLs when we thought it was 'just' a broken canine to remove, etc. I find cats much harder to predict, and frankly much harder to do. If I feel I've misjudged the estimate and it's my fault, or I've been faffing about 'training' on the dental Xray machine, I'll usually discount the work to the top of the estimate, but always charge it initially so the client can see what was done based on the invoice - plus we give them copies of the charts, and if need be show the radiographs etc. And post operatively, advice on prophylaxis/ brushing if possible , etc.

Radiographs help, but positioning is fiddley and time consuming and yes, i do worry about GA time, even with excellent nurses and all the toys.

Dentistry done by our visiting dentist tends to end up about the same price wise because she is both super efficient and fast and thorough, doesn't cut corners but works quickly, and even she will do a maximum of three big procedures in a day at our hospital. Good dentistry takes time - and if you don't allow the time, you can't do good dentistry. you should not have to sacrifice your lunch in order to do a good job!

What i have found is that the more of these I do, the easier I find them, and the quicker i am getting - it does pay off with practice, but there is a limit to how fast you can be and do it right.

If a client isn't prepared to pay for me or a colleague to do a procedure the way we want, there are plenty of vets around who will do it for less, and I'm not going to fret over people who can't or won't let us do it. Dentistry is hard work, and doing it cheap is demeaning and will never allow you to justify the time requirement to your boss.

FYI if i have a cat dental I assume it will be a long job, 2-3 hours, and book accordingly, so i have plenty of time to do it! Our boss is happy with this so long as we charge properly, and as i get more accomplished, this is getting easier!

RE: Problems with length of dental procedures

An On MRCVS — Sun, 29 Nov 2015 17:40:28 GMT

I started doing my scale and polish before the extractions because I read this was the best way - the 'surgical scrub' for the mouth? If this isn't the case, I can certainly swap back!

I don't do flaps for every extraction; I've tended to if there is a lot of bone still present (for example a RL as opposed to periodontal disease), or if there are root fragments that need to be found. However, this has given me something to think about and I think I should revise the indications for flaps.

The suturing is also tricky to swallow, having had it drilled (another pun, I'm on fire today!) Into me that, infected sockets aside, one should always close a surgical wound in the gingiva!

Again, maybe I am extracting the wrong teeth. I was wondering this in my first post. I am more likely to leave a tooth with root exposure in, say, a greyhound whose owner can brush teeth, than in a cat whose owner has no chance of getting in there. My employer and I have differing views on what constitutes a tooth that can be left. Back to the drawing board maybe?

I don't consider myself very knowledgeable in dentistry, but I have a willingness to learn and I am aware that 'you don't know what you don't know', if you see what I mean. My boss didn't seem clear on what the significance of a purple or grey tooth was before I told them a couple of years ago.

RE: Problems with length of dental procedures

An On MRCVS — Sun, 29 Nov 2015 17:28:01 GMT

Thanks everyone for the responses. They do make me feel less like I'm doing it all wrong.

I should probably clarify that my boss has never said the words 'an average dental should take 45-60 minutes' - I don't want to put words into their mouth unfairly - but it is often implied that anything going over £450-500 is too much, and this amount pays for a dental procedure lasting about 45-60 minutes at our practice (including the rads and meds, plus bloods and IVFT).

Whoever said my boss isn't a bad person - think it was Stephen - is right. They're not, and they're actually a very good vet who does keep very up to date with other aspects of medicine and surgery. Sadly, however, I think their view on dentistry is still rooted (pun intended!) in the days when X-rays were less readily available, and there still is an element of 'take out the worst' to improve, but not always fix, the situation in the animal's mouth.

An animal with some bad teeth left is better than one that dies because the GA was too long (though, to be fair, this very rarely happens - we are very good with monitoring and temperature regulation).

Michael: I appreciate where you're coming from in the faffage department. I know you only have my word for it, but I really don't mess about during dental procedures because I'm so hyper-conscious of the time pressure that I'm under. Every second wasted is - well, a second wasted.

In terms of routine surgeries, I'm by no means a fast surgeon but I don't think I'm really slow, and neither my boss or the nurses have ever expressed any concerns over my operating times. I do an average cat spay in 15 minutes and an average bitch spay in 35-40 minutes. It's just the dentals that seem to take such a long time!

Wynne, you mentioned that you only book dentals in on their own - do you really just book in a single dental as the sole procedure for the day, or am I misunderstanding? I would never be permitted to do this deliberately. I'm often starting my dentals at midday or sometimes later, after the clean ops are obviously done. It only leaves 3 hours before the nurses start consulting, and 3.5 hrs before I start consulting (and that's without a lunch break). But I think there is a propensity to treat the dental as the 'quick' procedure at the end of the list, when in reality they are often the longest of the lot.

Should I be speaking to my boss about ensuring fewer things are booked in on days when a dental is scheduled? I'm not sure if this would be viable in terms to maintaining the practice income. And not every dental I do is very long anyway.

May I also ask what others consider a reasonable cost for a more involved dental procedure, for example one requiring multiple extractions with some partially ankylosed roots that don't always come out smoothly? Our maximum dental costs are usually £500-600 and this would be considered an awful lot, yet some of mine come to twice that when booked up correctly (obviously I have to discount it back in line with the estimate).

I have been told by my boss that I should be calling these owners during the procedure to tell them it's taking longer than expected and will cost £X amount more, but I'm never sure what to say: I've spent so long believing that my dentals take so long because of something I'm doing wrong that I can't feel comfortable telling an owner they have to pay more for what I see as my incompetence, if you see what I mean.

Stephen, I agree with you that asking my boss to supervise a procedure with me might not be all that productive, but on the other hand it might enable them to see that I'm not messing about and the procedure really does take me that long - and you never know, they might be able to give me some legitimate pointers to help me along. Perhaps I should suggest it.

Thanks again. I really do feel in a bind!

RE: Problems with length of dental procedures

Stephen Courtney — Sun, 29 Nov 2015 17:22:56 GMT

I doubt Anon takes 2-3 hours for a scale and polish - they said perhaps 10 minutes - which is fairly fast.

Personally I would much rather do a regular S&P than do multiple extractions on an animal that will, guaranteed, have suffered considerably to reach that point. Prevention is better than cure and I spend a lot of time teaching puppy owners how to brush teeth. I get better follow through with owners who have spent a fair amount on a dental procedure though...

Doing a 3 hour dental might be necessary, but it is far from pleasant no matter how good you are at them - and adding in the stress factors imposed by a bean counting termagant employer makes it much worse.

It's hard to do a good conscientious job in those circumstances, and hard not to view it as bullying either. Anyone who has done the necessary extra training to lift their dentistry out of the level most of us were taught at vet school would feel the same way.

But the flip side of this is you need to charge realistically, and it is damn hard to justify to many clients when someone up the road with a pair of pliers, a bottle of ether and a hacksaw blade will do it for peanuts.

Dental care is the last big welfare hurdle for otherwise well-cared for pets in this country. For vets as well as owners.

RE: Problems with length of dental procedures

Evelyn Barbour-Hill — Sun, 29 Nov 2015 17:04:27 GMT

Anon, I've been reading your post again, and I have a couple of suggestions.

Don't complete your scaling (i.e. the subgingival work) before doing extractions, and certainly don't polish before extractions. You don't want to waste time on meticulous scaling and polishing of teeth you are going to extract! (Though you should clean them, of course). Moreover, there will always be bits that need scaling (and polishing perhaps) after your extractions: for instance, if you have extracted a severely compromised upper 9 from a dog, obviously you then need to attend to the distal surface of the neighbouring 8, which was previously inaccessible.

Then you say you make flaps, and it's not clear whether you mean you make flaps when necessary, or whether you mean you make flaps for every extraction. Flap surgery adds a lot of time, and is by no means necessary for every extraction. Certainly suturing the alveouls closed after every extraction is completely unnecessary. (There is a myth that has been invented in the USA that to always close the alveolus is best practice. Nonsense.)

And are you sure that you are not extracting teeth that could be salvaged? (Then again, some of the other procedures you could be doing could also be time-consuming.....) Your boss won't understand this at all though.

I might be wrong, but I would risk a small wager that your employer would rather flog the client some Dentastix and a bag of "dental diet" than spend time instructing the owner how and how not to brush the teeth and advising rawhide chews.

RE: Problems with length of dental procedures

Evelyn Barbour-Hill — Sun, 29 Nov 2015 16:28:34 GMT

[quote user="Anthony Todd"]

[quote user="Michael Woodhouse"]So where is the time going? When I watch inexperienced surgeons doing any kind of operating they seem to spend 70% of the time doing nothing - looking, inspecting, thinking, choosing random instruments, dabbing miniscule bleeders etc. The good surgeons make everything look planned and purposeful. I don't have a problem a new grad taking 90 minutes to spay a bitch, but when the operating time only takes 20, then I would [reasonably] expect them to get faster and more proficient. That would apply to everything - including dentistry.[/quote]

+1 in spades. The time usually goes faffing as above.

You could always ask your boss, or an experienced colleague, to watch you, and suggest how you could save time without compromising results?

That's what I did, and all the best surgeons I know did it too. [I was still slow and just "adequate" before anyone comments.....]

If he won't help, or isn't constructive, be disappointed and leave!

[/quote]

Anthony, Michael, I do follow what you are saying, but Anon is not having trouble with his time for a bitch spay..... a fairly standard and predictable procedure.

We already know how his boss will suggest how to save time: by doing a poor job.

Wynne, while I don't agree that 2 surgeries each of 1.5 hours is better than one of three hours (and it would certainly be more expensive for the client), I do agree with you in principle: there is nothing wrong with stopping a procedure at a suitable point and coming back to do the rest a couple of weeks later. The trouble is that Anon's boss wants to just cut it off at an hour and do nothing more. (Yet this boss "markets" his dentistry as being "thorough").

RE: Problems with length of dental procedures

Anthony Todd — Sun, 29 Nov 2015 15:06:38 GMT

[quote user="Stephen Courtney"]So a three hour procedure done properly is no worse than a 90 minute procedure[/quote]

I can't agree that a longer procedure is, necessarily, better than a shorter procedure. As others have said there can be a lot of time just faffed away.

Be interesting to find out how long the OP takes to do a C/S or do others say the longer it takes the better the procedure for that too?

My current dentist is much quicker than any other I've seen and the results seem just as good.

The local goes in whilst I'm just getting settled into those excruciating, but multi-adjustable "chairs".

RE: Problems with length of dental procedures

Hannah Wynne Richards — Sun, 29 Nov 2015 14:17:50 GMT

Well sometimes a scale and polish is all that's needed. Other times the "dental" is actually major jaw bone surgery.

An On sounds a much much better dentist than his/her boss.

Wynne

RE: Problems with length of dental procedures

Stephen Courtney — Sun, 29 Nov 2015 12:49:09 GMT

If you do your anaesthesia properly, with IV fluids, blood pressure monitoring, capnography and a cocoon blanket ( Bair hugger) so the animal doesn't get cold, and the anaesthesia is monitored properly, then the length of the anaesthesia becomes much less important as a factor affecting the outcome for the patient. We also use local blocks, so the actual depth of the anaesthesia is surprisingly shallow - I expect an animal to be sitting up within 5-10 minutes post operatively.

So a three hour procedure done properly is no worse than a 90 minute procedure, and it means the animal doesn't have to have a second session with additional costs. Having said that, it isn't unreasonable to split a major procedure if that is safer for the circumstances.

Sadly many people still practice poor dentistry out of the dark ages. Asking Anon's boss to supervise a procedure seems pointless, I doubt the boss concerned is a bad person but equally doubt that he/she has the knowledge or skill to judge what seems to be a good standard of work. If Anon is doing dentals in the manner described, he/she is doing them correctly and that takes time, and doing less is a disservice to the animal. The boss could not do it any faster without cutting corners or bodging it- If they did have the skills, surely they would use them, and realise that if you do it properly, there is no such thing as a quick dental.

RE: Problems with length of dental procedures

Anthony Todd — Sun, 29 Nov 2015 11:34:16 GMT

+1 in spades. The time usually goes faffing as above.

You could always ask your boss, or an experienced colleague, to watch you, and suggest how you could save time without compromising results?

That's what I did, and all the best surgeons I know did it too. [I was still slow and just "adequate" before anyone comments.....]

If he won't help, or isn't constructive, be disappointed and leave!

RE: Problems with length of dental procedures

Hannah Wynne Richards — Sun, 29 Nov 2015 10:36:54 GMT

An On It sounds as though your boss would be criticising Evelyn!

I thinkthe biggest problem comes from the term "dental" which makes some owners think it isn't proper surgery.

I will never book something else in for surgery at the same time as a dental. This means I may spend most of the morning twiddling my thumbs, but it also means no pressure if I need to spend an hour and a half. I don't spend more than that. When it's booked in, I give the owners a range of prices, from 15 mins surgery to 1 ansd 1/2 hours plus drip plus radiography. They are also warned before 1st surgery that if I haven't finished by an hour and a half, then the animal will need to be rebooked to finish in a couple of weeks. I think 2 x 1 and 1/2 hour surgeries are better for the animal than 1 x 3 hour surgery

An Ons boss sounds like a dinosaur who thinks a dental just means chipping off scale, and removing anything that's obviously wobbling By the way do you have fixed price dentals? Some practices still do, then tailor the surgery to the price,as opposed to the price being tailored to the surgery. You aren't having problems with your dentistry. You are having problems with your boss!!!!!!!!!!!!!!!!!!!!!!!!!

Wynne

RE: Problems with length of dental procedures

Andy Elliott — Sun, 29 Nov 2015 10:21:34 GMT

If your dentist said that you needed a long list of procedures, do you think that he/she would try to do it all in one sitting?

I tend to establish what dental work needs doing, discuss this with the owner over the phone and make a plan. If there are lots of difficult extractions required then it is perfectly reasonable to sort out the left side of the mouth today and schedule another session 3-4 weeks later to do the right side of the mouth. I have found most people are very understanding of this. This avoids the 3 hour dentals!

RE: Problems with length of dental procedures

Stephen Courtney — Sun, 29 Nov 2015 10:07:05 GMT

I think you need a new boss. How would he feel if his own dentist did a half assed job on his mouth? Seems like a trading standards issue at the very least.

A three hour dental is a three hour dental. If you don't have time to do a procedure properly then that is a management failing. Evelyn's comments cut to the bone of this better than I can.

Clients need to know what a procedure is likely to cost, and providing you are not operating inefficiently, then that's what it costs. If your practice has fixed price for dentistry, then those prices need to reflect the time taken. It seems to me you are doing everything properly, and that does take time.

RE: Problems with length of dental procedures

Michael Woodhouse — Sun, 29 Nov 2015 01:49:01 GMT

[quote user="An On MRCVS"]I'm having problems with the length of my dental procedures. They are not all really long, but recently there have been a few that have gone on for two or three hours.[/quote]

So where is the time going? When I watch inexperienced surgeons doing any kind of operating they seem to spend 70% of the time doing nothing - looking, inspecting, thinking, choosing random instruments, dabbing miniscule bleeders etc. The good surgeons make everything look planned and purposeful. I don't have a problem a new grad taking 90 minutes to spay a bitch, but when the operating time only takes 20, then I would [reasonably] expect them to get faster and more proficient. That would apply to everything - including dentistry.

If you are doing genuine work on the teeth at a high level for 2-3 hours then it's work and its chargeable. Is there an issue that you are doing a lot more than your boss [basically working at a higher level] and therefore his expectations are unrealistic in terms of time? The its a case of education. If it is meaning you are not getting all your work done, or you are keeping the nurses back on 2 hours overtime every night - then there is a problem.

[quote user="Evelyn Barbour-Hill"]

It doesn't have to be charged rigorously by time. Something a lot of bosses have trouble grasping

[/quote]

Yes and no. The time taken for any procedure has to have a big bearing on its cost. You cannot be earning anything else whilst doing a 3 hour procedure. Nor can your nurse. You use a linear amount of oxygen, iso (sevo), electricity and share of depreciation for each hour of the three hour procedure. You have tied up the table and the anaesthetic machine preventing another vet using it. Some fixed costs are the same (set up, cleaning, instrument cleaning). As a practice owner I am very happy giving someone time to learn, but once they are proficient then the time is the biggest factor that determines cost and by that I mean why the 3 hour op costs more than the 2 hour one.

So I would talk to your boss and see what the issue actually is (other work, cost, holding up facility). Maybe get him to watch you do some teeth and see if he has any feedback - are you faffing about too much? Discuss your decision making together. Come up with a plan going forwards - even if it means some compromises - the 'best' treatment will cost £500, but we can vastly improve his oral hygiene for £300 etc.

RE: Problems with length of dental procedures

Evelyn Barbour-Hill — Sat, 28 Nov 2015 23:44:04 GMT

I often take two to three hours.

Your boss is wrong. An "average dental procedure" – what the hell is that?

Possibly, you are doing too many extractions or making them too elaborate – I don't know. Remember that there are other things you could, and should, be doing with diseased teeth. Sometimes they can be salvaged even with considerable bone loss. It depends upon the individual animal and its owner.

I'd rather your approach than the technique, unfortunately still very prevalent, of yark out the bad 'uns and do some cosmesis on the rest.

Oh, and I do recognise – how I do recognise it – that situation where you are under ever greater pressure and you do an ever worse job, and the boss still isn't happy.

But, it is perfectly all right to "leave teeth that need to come out" if time really has run out. "Time running out" will vary with the patient: 3 hours may be perfectly all right for one, while another you want to get recovering again as soon as possible. What should not dictate time running out, however, is the boss wanting you to go off and do the branch surgery or help him get through the consultations so that he won't be late home for dinner.

[quote user="An On MRCVS"]My employer doesn't take long to do dentals but says they prioritise the work and if the animal has been asleep too long they will only take out the worst teeth and leave the others, because they don't think they will cause the animal so many problems for the next few years[/quote]

Bullsh1t.

[quote user="An On MRCVS"] very, very big bill for the client[/quote]

It doesn't have to be charged rigorously by time. Something a lot of bosses have trouble grasping.

[quote user="An On MRCVS"]we market our dentistry as thorough but could we being doing an inferior job for more money? Plus, how would I get round educating the client on the consequences of not treating dental disease when booking the dental, only to discharge it later by telling them that we didn't remove all the diseased teeth?[/quote]

The boss actually "markets" the practice dentistry...... but does bad dentistry. I wish I could say I'm shocked, but it's a common phenomenon.

RE: Problems with length of dental procedures

Kate Richardson — Sat, 28 Nov 2015 22:47:17 GMT

Oh (and apologies for turbo posting) but the biggest hinderence to progression of vet dentistry are vets themselves