Should dental x rays be recommended in all cases?

RE: Should dental x rays be recommended in all cases?

Bob Partridge — Fri, 01 Feb 2019 15:10:48 GMT

"I believe around 10% of feline upper 07s have a supernumerary third root........What population is this based on? .....I've never seen one"

& "I haven't dental radiography"

Says it all really... <BG>

The figures (from memory) were based on anatomic studies and are correct.

If you ain't got radiographs - you ain't going to see stuff.

All best

Bob

RE: Should dental x rays be recommended in all cases?

Lucy Fleming — Mon, 17 Dec 2018 15:06:05 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="George Cooper"]There is a simple rule in veterinary practice - "Anything that costs the practice, costs the client." [/quote]

Yes, but you can build the need for radiography in to your standard charge for this, that or the other procedure. You don't have to add an itemised charge, " Xrays £x" .

[/quote]

I didn't intend to upset you so much George! For what it's worth, we do charge for dental x-rays (around £45 for a full mouth series in a cat, I believe about £6 'per tooth' in canine patients, since Anthony Todd was curious) - however, I'm not sure I would say that your above point is necessarily always directly true...

Of course, the cost of buying new equipment has to come from the profits the practice makes, which are generated by the 'sales' of procedures (and meds). But that doesn't mean that specific piece of equipment must generate a charge every time it is used. For example, we recently(ish) purchased a multiparameter monitor for anesthetic monitoring - should we charge clients more to use this than if we don't? Or do we simply accept that it is a cost that we needed to outlay in order to increase the amount of patient information we were gathering and hopefully enhance safety? You could argue similar for the purchase and use of dental x-ray...

Alternatively, you could look at the cost of a procedure as being made up (roughly) of the consumables and drugs used and the cost of the staff time involved (plus a nebulous factor related to the skill of the staff involved, which is more difficult to calculate!) You could make an alternative argument that if Price = cost of drugs + cost of time, anything that saves you time saves you money. As being able to identify (for example) teeth with an intact periodontal ligament which require extraction and teeth which require only crown amputation saves enough time to eventually return to cost of investment (by, for example, being able to fit in another procedure that day with the time saved)...*

Or you could do what we do, and charge separately, or do what Evelyn does and build a cost of the radiographs into the cost of the procedure.... there's more than one way to skin a cat, after all.

(*This assumes no or minimal consumable cost associated)

RE: Should dental x rays be recommended in all cases?

Evelyn Barbour-Hill — Fri, 14 Dec 2018 19:33:02 GMT

[quote user="George Cooper"]There is a simple rule in veterinary practice - "Anything that costs the practice, costs the client." [/quote]

Yes, but you can build the need for radiography in to your standard charge for this, that or the other procedure. You don't have to add an itemised charge, " Xrays £x" .

RE: Should dental x rays be recommended in all cases?

Anthony Todd — Fri, 14 Dec 2018 17:02:39 GMT

What is a ball-park fee for dental xrays?? Or a high-low range [just for me to say "wow, back in the day etc. etc."]

RE: Should dental x rays be recommended in all cases?

George Cooper — Fri, 14 Dec 2018 16:59:18 GMT

[quote user="Lucy Fleming"]

[quote user="David Mills"]Mandatory things create barriers. In the case of dental radiography, costs (equipment, to the owner, further training)[/quote]

I appreciate your point, and don't mean to dismiss it, but I think in this case it doesn't necessarily have to add costs to the owner - it's up to the practice whether they charge any more for the procedure including radiographs than not including radiographs. Certainly there is a cost to the equipment and gaining skills to use it, but in my experience, feline dentistry in particular is so much faster with radiography that this represents a net saving per procedure (this is a vast oversimplification, of course )

(Edited to add that I also don't think it should be mandatory, but I do think, in feline cases, it represents part of a good standard of care)

[/quote]

Lucy - I can almost not believe your reply to this regarding charges. If you apply that philosophy to all that you do (and how on earth do you select what to apply it to, other than to simply save the client money?) you will not be around in practice.

There is a simple rule in veterinary practice - "Anything that costs the practice, costs the client." That way you make a profit, stay in business, pay your staff, buy new equipment, and can retire.

And before I get jumped on (you know who you will be!!) - there is ALWAYS room for ISOLATED acts of charity.

RE: Should dental x rays be recommended in all cases?

Anthony Todd — Fri, 14 Dec 2018 16:50:35 GMT

[quote user="Lucy Fleming"](Edited to add that I also don't think it should be mandatory, but I do think, in feline cases, it represents part of a good standard of care)[/quote]

My guess, as a dedicated dinovet, is that dental Xrays would usually, and probably, have added to even my dental care of my patients, arguably not much, but that's probably, because I've never had them.

RE: Should dental x rays be recommended in all cases?

Lucy Fleming — Fri, 14 Dec 2018 16:01:08 GMT

[quote user="David Mills"]Mandatory things create barriers. In the case of dental radiography, costs (equipment, to the owner, further training)[/quote]

(Edited to add that I also don't think it should be mandatory, but I do think, in feline cases, it represents part of a good standard of care)

RE: Should dental x rays be recommended in all cases?

Evelyn Barbour-Hill — Mon, 10 Dec 2018 02:53:38 GMT

[quote user="Anthony Todd"]I would suggest that the pressure to do something about it, even if just from the owner, might be enough to precipitate action.?[/quote]

No. I'm a professional.

RE: Should dental x rays be recommended in all cases?

Rob Loxley — Sat, 08 Dec 2018 10:48:10 GMT

[quote user="Rob Davis"]

[quote user="Anthony Todd"]There is still the chance of a lesion on X-ray being clinically or subjectively asymptomatic if you do not consider the clinical findings as well.[/quote]

Why would anyone not consider the clinical findings as well?

[/quote]

And the starting point was the patient had been booked in for dental treatment, for a reason; it's not like someone's suggesting xraying every tooth of every patient that walks through the door?

RE: Should dental x rays be recommended in all cases?

Anthony Todd — Sat, 08 Dec 2018 03:09:38 GMT

[quote user="Evelyn Barbour-Hill"]Anthony Todd suspects, on no particular grounds, that some dentists are incompetent or corrupt or both.[/quote]

That's far too much of a stretch and in no way am I suggesting that at all.

I think we have all experienced any owner's response when we mention any abnormality particularly a whopping great periapical lucency ......

[Try telling an owner that the dog's small wart is a "cancer" and see how the owner reacts.]

I would suggest that the pressure to do something about it, even if just from the owner, might be enough to precipitate action.?

RE: Should dental x rays be recommended in all cases?

Evelyn Barbour-Hill — Fri, 07 Dec 2018 23:51:43 GMT

[quote user="Anthony Todd"]Would you now automatically extract a clinically normal tooth with an ankylosed root on X-ray?[/quote]

No.

This is quite a common finding in, especially, the lower canines of cats. I don't remove them. (To be a bit nit-picking, you cannot extract a tooth that's ankylosed. You can remove it – if you should wish to). But it's useful, nay, important to know they are in that state. As the owner always appreciates.

But no, we shouldn't radiograph, should we, because we might find something and attempt to treat it, because we are all too incompetent to make the decision between treatment and monitoring, or at least Anthony Todd suspects, on no particular grounds, that some dentists are incompetent or corrupt or both.

RE: Should dental x rays be recommended in all cases?

Miriam Lodewyks — Fri, 07 Dec 2018 18:30:19 GMT

[quote user="Evelyn Barbour-Hill"]You may be unconsciously projecting an attitude. I mean that quite seriously.[/quote]

Yes!!!

I've found that to be really common: colleagues seem to really struggle to convince owners of the merits of dental surgery, whereas I generally don't find it hard to convince them that it really is worth it, probably because I passionately believe in it!

RE: Should dental x rays be recommended in all cases?

Miriam Lodewyks — Fri, 07 Dec 2018 18:20:49 GMT

[quote user="Julie Innes"]All advice appreciated[/quote]

As a newbie (since 2 months) to the wonderous world or oral radiography I can already attest to the fact that it definitely changes your treatment plan on a fairly regular basis. In my very first x-rayed patient I ended up removing 2 premolars I hadn't planned to and leaving 2 carnassials I thought I needed to remove - already saved me half an hour of unnecessary surgery.

Having said that, I believe the biggest impediment to "enjoyable dentals" is just having the wrong tools or not knowing how to use them correctly. Start with going on a CPD - I defy you not to come home with an entirely new interest and respect for the job.

RE: Should dental x rays be recommended in all cases?

Anthony Todd — Fri, 07 Dec 2018 15:53:02 GMT

I'm glad nobody yet has hoisted me by my own petard in that I've loudly claimed that cats, particularly, usually change completely mentally when their grotty rotten teeth are removed and they do it straight away even before anything has healed, like overnight...

[quote user="Rob Davis"]

Why would anyone not consider the clinical findings as well?

[/quote]

I suspect there will be dentists around who might want to do lots of expensive things to my radiolucency, even at this late, symptomless, stage.

RE: Should dental x rays be recommended in all cases?

Rob Davis — Fri, 07 Dec 2018 14:53:00 GMT

[quote user="Anthony Todd"]Would you now automatically extract a clinically normal tooth with an ankylosed root on X-ray?[/quote]

No of course not. Not all abnormalities require treatment, and not all dental treatment involves extractions. Some abnormalities will be incidental findings, some will be things which may progress and should be monitored (like your lucency), some will require treatment.

[quote user="Anthony Todd"]There is still the chance of a lesion on X-ray being clinically or subjectively asymptomatic if you do not consider the clinical findings as well.[/quote]

Why would anyone not consider the clinical findings as well?

RE: Should dental x rays be recommended in all cases?

Bob Russell — Fri, 07 Dec 2018 14:50:45 GMT

Of course you do something if you find pathology on the X-ray.

It may range from extraction because it is probably an abscess/granuloma where at worst you are removing a tooth that might not be painful. Of course it may well be very sore! Other occasions you may feel a wait and see option may be better.

As a human we can express whether dental pathology hurts. Our patients cannot so we have to make a judgement.

I can think of numerous patients that did not seem to be in pain but owners return saying they are like a puppy/kitten again.

This would suggest they were in pain but just masking it!

Part of being a clinician for patients that cannot talk.

RE: Should dental x rays be recommended in all cases?

Anthony Todd — Fri, 07 Dec 2018 14:33:11 GMT

[quote user="Rob Davis"]Contradictory, no?[/quote]

I suppose so, but if you have a client who thinks it's unnecessary quote the papers I did, or find a dodgy tooth and then say well, at least, we should X-ray this area but not vice versa.

Would you now automatically extract a clinically normal tooth with an ankylosed root on X-ray?

There is still the chance of a lesion on X-ray being clinically or subjectively asymptomatic if you do not consider the clinical findings as well.

A lame back-out it could well be said though....

RE: Should dental x rays be recommended in all cases?

Robin Grimmer — Fri, 07 Dec 2018 13:21:52 GMT

[quote user="Anthony Todd"]

[quote user="Robin Grimmer"]There is a tendency on this forum to criticise a technique that the poster is not familiar with themselves, to be negative about it generally and want it referenced to the nth degree. All really rather tiresome.[/quote]

And there was I thinking this was the age of Evidence Based Veterinary Medicine and dogma and prejudice was the preference of dinovets but no, it's still alive and well I see.

I can give lots of real evidence that some vets, fairly recently, love dentals and some hate them and just don't advise, so don't do them.

[/quote]

Not what I meant. Yes we need to question things and ask for evidence. But people on here should be able to explain and recommend things without having to publish umpteen b**** references. This thread being a good example. The benefits of dental radiography have been explained very well, but obviously not well enough for the veterinary Luddites.

Don't just take my word for it. Plenty of good cpd on this subject - you might just learn something .

RE: Should dental x rays be recommended in all cases?

Rob Davis — Fri, 07 Dec 2018 12:50:06 GMT

[quote user="Anthony Todd"]

X-ray a dodgy tooth, sure, and I'd do it I reckon, these days with the better kit, but finding an abnormality only on X-ray, but totally asymptomatic, then not so sure.

Some/most clients would consider it unnecessary?

[/quote]

And yet your response to the papers justifying the use of full mouth radiography was:

[quote user="Anthony Todd"]Touche X2, end of, certainly in older dogs.[/quote]

Contradictory, no?

RE: Should dental x rays be recommended in all cases?

Rob Davis — Fri, 07 Dec 2018 12:45:50 GMT

[quote user="Anthony Todd"]

I never resent disagreement! I do resent "disagreement" when it is not justifiable or explained, which hardly ever happens and helps nobody including the poster.

Arlo should arrange for "disagreement" to be always justified by specific comment or explanation or they may just be personal or point scoring which helps nobody.

This is why I clicked the button.

[/quote]

Perhaps I'm being dim, but I can't see where you have explained your reasons for disagreeing that radiographs may give you information about how difficult an extraction is likely to be.

RE: Should dental x rays be recommended in all cases?

Anthony Todd — Fri, 07 Dec 2018 12:12:19 GMT

[quote user="Liz Barton"]Pretty obvious to see a lucencies, ankylosed roots, root deviation and supernumeraries.[/quote]

Trouble is, as my personal example supports, is that if you find a problem on Xray, [and my radio-lucency is a good example] you "do something about it" which in my case would be pretty major which may be totally unnecessary, and 15+ years on, is the case.

X-ray a dodgy tooth, sure, and I'd do it I reckon, these days with the better kit, but finding an abnormality only on X-ray, but totally asymptomatic, then not so sure.

Some/most clients would consider it unnecessary?

RE: Should dental x rays be recommended in all cases?

Anthony Todd — Fri, 07 Dec 2018 11:59:59 GMT

[quote user="Rob Davis"]I know how you resent people disagreeing without an explanation.... so what is it about this that you disagree with, Anthony Todd ?[/quote]

I never resent disagreement! I do resent "disagreement" when it is not justifiable or explained, which hardly ever happens and helps nobody including the poster.

Arlo should arrange for "disagreement" to be always justified by specific comment or explanation or they may just be personal or point scoring which helps nobody.

This is why I clicked the button.

RE: Should dental x rays be recommended in all cases?

Julie Innes — Fri, 07 Dec 2018 09:00:33 GMT

[quote user="Thomas Johnson"]I would check whether you can process dental xrays in your current digital processor. We have a CR-30X and we have a cassette that you can open and put the dental xray plates in (it's magnetic), and then develop as normal.[/quote]

Thanks Thomas, I will!

RE: Should dental x rays be recommended in all cases?

Thomas Johnson — Fri, 07 Dec 2018 08:56:25 GMT

[quote user="Julie Innes"]Thank you guys- really encouraging! I hadn't realised it could be done quite so cheaply! We have digital xray, and I hadn't even thought about manual developing as a plausible option, just assumed we'd have to buy another digital processor (I'm guessing pricy!)[/quote]

I would check whether you can process dental xrays in your current digital processor. We have a CR-30X and we have a cassette that you can open and put the dental xray plates in (it's magnetic), and then develop as normal.

RE: Should dental x rays be recommended in all cases?

Peter Southerden — Thu, 06 Dec 2018 21:53:14 GMT

I suspect its the same for most centres but we see it as part of our job and we enjoy the interaction. You are welcome to send queries to us.