Dental xray equipment choice

RE: Dental xray equipment choice

Alistair Graham-Evans — Thu, 23 May 2019 11:36:08 GMT

[quote user="Beats"]Currently I work on the basis of dentistry time ($xx/15minutes in addition to anesthetic costs).[/quote] How many hours have you wasted trying to extract ankylosed tooth roots? Dental X-rays can actually reduce the total time. Would you do orthopaedic surgery without an X-ray ? Love our CR system - takes 10 minutes to do full mouth series if you and a nurse work efficiently Sorry - just read your post about battle with suture reels. Small but slow steps! We ditched reels over 10 years ago - charge for sutures used (itemised on invoice) and never had a client question it.

RE: Dental xray equipment choice

Rob Davis — Wed, 22 May 2019 18:49:41 GMT

[quote user="Evelyn Barbour-Hill"]

I'd give a big plug to the Fire CR Dental Reader.

I've just had a look now and all the big dealers seem to have it.

[/quote]

I tried it and didn't particularly like it, though it is cheaper than the CR7.

RE: Dental xray equipment choice

Norman Johnston — Wed, 22 May 2019 18:45:00 GMT

Likewise the Apixia scanner which takes all sizes of plate up to size 5

RE: Dental xray equipment choice

Evelyn Barbour-Hill — Wed, 22 May 2019 18:40:24 GMT

I'd give a big plug to the Fire CR Dental Reader.

I've just had a look now and all the big dealers seem to have it.

RE: Dental xray equipment choice

Rachel Perry — Wed, 22 May 2019 17:45:12 GMT

I'm a bit late to comment on this one, but I'd go for a CR7 system. It's versatile and the image quality is superb- probably the best of all the systems I've seen, and I've seen a lot! I have one and also access to DR but never use the DR. The CR7 is also very quick, and being able to take 6 views of any size animal as an initial screen makes it super quick and easy.

If costs are prohibitive- you can always lease equipment- which works out to less then £100 a week- so if you are doing more than a couple of dental procedures per week, you make money from day 1!

RE: Dental xray equipment choice

rhmrcvs — Tue, 21 May 2019 17:00:53 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Beats"](a year to get the tops kept on the reels of suture comes to mind...).[/quote]

Sympathy.

[/quote]Evelyn, thank you for your time on the phone today. Pleasure to speak to you, very much appreciated.

RE: Dental xray equipment choice

Rob Loxley — Sat, 18 May 2019 13:24:55 GMT

[quote user="Kate Richardson"]

[quote user="Rob Davis"]With CR you can get a wider range of sensor sizes and the sensors are much less bulky. Assuming you only buy one DR sensor you are likely to have a size2,[/quote]

I think with cats you ideally need a size 1 and 2

[/quote]

If we had the budget for that we'd probably go for a nice CR system

RE: Dental xray equipment choice

Bob Russell — Fri, 17 May 2019 15:54:05 GMT

If you charge lowish and explain the reasons why then I fail to see why the Xray numbers should not be 100% of those you feel there is a clinical need.

If none of the other vets are using the equipment then it is either inadequate or their training is IMO!

Perhaps training at least one nurse to take radiographs would be in order. It is not difficult nor is it as challenging as some seem to think. A distorted tooth that includes the crown and roots still tells you the information you need and if not slight changes in positioning will give the results you want. It soon becomes second nature!

RE: Dental xray equipment choice

Bob Partridge — Fri, 17 May 2019 15:13:14 GMT

[quote user="Kate Richardson"]I think that's very/overly optimistic Bob and takes some things for granted, the main one being that everyone will be in on it.[/quote]

Where I have presented in practices the vets have taken the message seriously & upped their game. Yes, I am evangelical about dentistry - but hopefully that is what inspires vets in practices to get on-board.

As I say - I will put my money where my mouth is. The caveats being that vets work according to the principles I set out of putting the patient need first. This is what helps them get over the "Oh, clients don't agree". Would we put up with low level of compliance for Tx diabetes, hyperthyroidism etc? No, of course not. We'd put effort into doing the right thing for our patients. So why should dentistry be different?????

I feel sorry for BEATS (I hate this pseudonym thingy). Given the state of the market - why stay in a practice that so obviously doesn't appreciate him/her? If you are banging your head against a brick wall - you end up with bruises. Either set-up (there are some interesting possibilities - contact me off-list if you want) - or join a practice where your skills & enthusiasm can shine.

All best

Bob

RE: Dental xray equipment choice

Kate Richardson — Fri, 17 May 2019 14:21:37 GMT

[quote user="Bob Partridge"]

Only just seen comment re finances.

Balderdash!

The income stream from dental rads will pay for any of the systems within weeks. If you agree to use the system according to my advice & protocols (assuming you have 2+ FTE vets) - I will buy your dental unit & take the income from it & I will be quids in.

[/quote]

I think that's very/overly optimistic Bob and takes some things for granted, the main one being that everyone will be in on it. Don't get me wrong, its makes sense on all levels including business sense to do dentistry to a higher standard, but it relies heavily on having a) vets that want to do it and b) vets that will do it. Lastly c) clients that will or can afford to pay for it. But it starts with vets that are proactive about it and place value on it. Only then will clients place value on it as well.

I am lucky in that both my previous job where I developed my initial interest in dentistry and my current job are in reasonably affluent areas. Its must be so frustrating Beats to have the desire to progress things but be limited in your ability to do so. The fact that you alone have made your current system pay for itself is great, but the fact that [quote user="Beats"]and a year on I'm the only one of 8 vets to have used the unit[/quote] is sad and just shows how little interest many vets have in doing it; possibly from lack of interest, poss from lack of skills, lack of time to learn, but mostly lack of passion. Very similar situation in my last job, the difference being I had clients who were probably more affluent (not sure where you are?)

I now work as a sole charge vet in the branch I work in, cat only, and insisted on dental xray when we opened the cat clinic, I only work 3 days a week, the other vet who works the other days has learnt to do it, although I do the majority of the dental work here, and despite doing on average 3-4 dental treatments per week bewteen us and taking xrays on I would say 90+% of them, it took a year to cover the costs of buying the set up (IM3 Revolution) and now making profit. And we were charging £60 for a full mouth initially. I don't have figures for our main multi vet hospital which also has the same set up, but I suspect they haven't covered its costs as yet over the same time period.

RE: Dental xray equipment choice

Kate Richardson — Fri, 17 May 2019 13:48:15 GMT

[quote user="Rob Davis"]With CR you can get a wider range of sensor sizes and the sensors are much less bulky. Assuming you only buy one DR sensor you are likely to have a size2,[/quote]

I think with cats you ideally need a size 1 and 2

RE: Dental xray equipment choice

Evelyn Barbour-Hill — Thu, 16 May 2019 22:44:03 GMT

[quote user="Beats"](a year to get the tops kept on the reels of suture comes to mind...).[/quote]

Sympathy.

RE: Dental xray equipment choice

Beats — Thu, 16 May 2019 22:35:34 GMT

[quote user="rhmrcvs"]can i ask where you sourced your "previously enjoyed" unit from and what type it is?[/quote]

an unrivalled resource - vetsurgeon.

https://www.vetsurgeon.org/nonclinical/f/154/t/26831.aspx

I also got advice on what plates and chemicals to use and advice on my first attempts at intraoral radiographs. And as you can see there is a plethora of expertise on here glad to share advice.

Due to the unrivalled sharing of knowledge from the dentistry community it is possible to get you access to dental xrays in even a pretty basic practice like the one I work in (when I started there were only size 24 scalpel blades...).

Happy to discuss getting it past the boss. I have no doubt that a CR/DR unit is vastly preferable, but for me I was never going to see it happen and something is better than nothing - especially for cats. I've got some way to go yet, but I'm a realist - organisational change takes time and is an art, especially when you're not actually in command (a year to get the tops kept on the reels of suture comes to mind...).

RE: Dental xray equipment choice

rhmrcvs — Thu, 16 May 2019 21:01:44 GMT

[quote user="Beats"]

[quote user="Bob Partridge"]You need to get me in to do some dental training in your practice[/quote]

I would worry you would hang your head in despair...

[quote user="Bob Partridge"]Treat a "Dental x-ray screen" the same way as "anaesthetic monitoring" - have it as an included extra in your pricing.[/quote]

I like this approach you suggest as it is also not offensive to colleagues who are not yet converted to the benefits of using radiographs in the average dental procedure, and does not exclude the pet-owners unwilling to pay for a hiked price (if they were all willing to pay for a price hike, then I would suspect that the practice owner would profit most by hiking the price without engaging in any expenditure).

[quote user="Bob Partridge"]Very few will refuse it.[/quote]

At an extra 25 pounds per procedure, I have noticed a very low take-up (I would estimate 10%). In a year, I have just about managed to recoup the cost (not including the extra time spent) of 750pounds on a secondhand dental unit, some chemicals and films, and a pricey visit from the RPA. This may be poor promotion on my part, inexperience and lack of knowledge on my part (probably a very significant factor), a lack of time (I struggle to fit a day's work into a day as it is, so adding more tasks to the day I admit is a struggle) and a year on I'm the only one of 8 vets to have used the unit. However I even had a human dentist (presumably better informed than the average pet-owner) in the other day and she couldn't imagine why she would wish to pay an extra 25pounds to get her dogs teeth xrayed. I've mostly been targeting cats (less teeth to xray and clearer advantage in terms of whether to amputate crown or extract root on resorptive lesion teeth).

I'll re-double my efforts in learning and practising what I can before I try to attract any further investment I think. [PS - I'm a lowly employee, so can only really get things if I can actually demonstrate they might be profitable, or I spend my own cash which doesn't go too far these days...]

[/quote]can i ask where you sourced your "previously enjoyed" unit from and what type it is?

Thank you

RE: Dental xray equipment choice

Bob Russell — Tue, 14 May 2019 11:19:17 GMT

I don't ask if they want X-rays. They are done where there is clinical justification and that is most of the time!

We don't include it within the standard charges because there are still some dentals for a fiver practices around and it gives an opportunity to explain the procedure further.

RE: Dental xray equipment choice

Neil Wheadon — Tue, 14 May 2019 11:14:32 GMT

[quote user="Beats"]At an extra 25 pounds per procedure, I have noticed a very low take-up (I would estimate 10%). In a year, I have just about managed to recoup the cost [/quote]

Only an observation from a vet and a consumer, but can't you just include it within the dental cost? Ask the dental technician if she'd like her mouth dug about by a dentist without knowing what he is looking at. It's akin to an oil change in a car service, you expect it to be included?

I'm locumming at a practice that just radiographs all cats mouths, no questions asked, it's accepted and it saves so much time especially in cats and takes the stress out of 'root or no root?' Their charges are also very very reasonable, I'm in a position to easily compare that statistic.

Neik

RE: Dental xray equipment choice

Bob Russell — Tue, 14 May 2019 10:46:33 GMT

We charge £18 odd for 'partial' Xrays and £30 odd for full mouth. Once you are a bit more experienced this takes minutes and can be done by the nurse if you feel that way inclined. We do have DR so images are there the second we come back into the room. A cat can be thoroughly X-rayed in minutes so the income per hour is impressive.

We chose to be light on the charges so every patient can be imaged without fuss.

I would suspect even an impressive set up would pay for itself within a year.

Ours just 'evolved' so we did not really notice.

Norman is not in our neck of the woods but Matthew Oxford is and he spent a day with us. It made a massive difference to our confidence as well as providing the nurses with good, documented CPD.

One day we will have to say goodbye to our present set up but I like DR!!!!

RE: Dental xray equipment choice

Beats — Mon, 13 May 2019 23:49:22 GMT

[quote user="Evelyn Barbour-Hill"] So, dare I say, and don't take this personally: do a better job, charge more, and if you have slightly fewer patients to get through each day that's all to the good, isn't it?[/quote]

Currently I work on the basis of dentistry time ($xx/15minutes in addition to anesthetic costs). I actually give quite a wide estimate for cost from $xx to 4x$xx given that until I have the patient anesthetised it's hard to really know how much time may be required to treat the mouth. If I didn't also offer the option of a cap on fees (I start with the most pressing issues and continue until owners selected limit is reached), then procedures would be declined more frequently. To me that suggests that the maximum amount of spend per mouth is mostly already being reached.

RE: Dental xray equipment choice

Evelyn Barbour-Hill — Mon, 13 May 2019 23:32:14 GMT

[quote user="Beats"]) makes 230pounds each for a posh dental on average[/quote]

1. I'd say that was a very reasonable price for an ordinary periodontal procedure (which I am assuming is what you mean by "a dental' – you know I detest that term). And I'm not in an affluent area.

2. Time won't go up by 50-100%, nothing like.

3. Radiography is what you need to do a good job – or what you can use to a better job – it's not a sort of optional extra.

4. [quote user="Beats"] However I even had a human dentist (presumably better informed than the average pet-owner) in the other day and she couldn't imagine why she would wish to pay an extra 25pounds to get her dogs teeth xrayed. [/quote] AArgh. Well, human dentists and veterinary dentistry can sometimes be like GP doctors and veterinary medicine – they aren't interested, they know FA about it, they think they know everything about it and anyway "it's only a dog". Considering that the lady might get struck off if she doesn't do radiography whenever appropriate (which would include periodically surveying suspect areas of the dentition)...... words fail me.

5.[quote user="Beats"]a lack of time (I struggle to fit a day's work into a day as it is, so adding more tasks to the day I admit is a struggle)[/quote] So, dare I say, and don't take this personally: do a better job, charge more, and if you have slightly fewer patients to get through each day that's all to the good, isn't it?

RE: Dental xray equipment choice

Beats — Mon, 13 May 2019 22:05:42 GMT

[quote user="Bob Partridge"]You need to get me in to do some dental training in your practice[/quote]

I would worry you would hang your head in despair...

[quote user="Bob Partridge"]Treat a "Dental x-ray screen" the same way as "anaesthetic monitoring" - have it as an included extra in your pricing.[/quote]

[quote user="Bob Partridge"]Very few will refuse it.[/quote]

RE: Dental xray equipment choice

Bob Partridge — Mon, 13 May 2019 21:30:45 GMT

You need to get me in to do some dental training in your practice <BG>

Treat a "Dental x-ray screen" the same way as "anaesthetic monitoring" - have it as an included extra in your pricing. Very few will refuse it.

I'm also available for Bar mitzvahs & weddings <BG>

RE: Dental xray equipment choice

Beats — Mon, 13 May 2019 21:15:33 GMT

[quote user="Bob Partridge"]The income stream from dental rads will pay for any of the systems within weeks.[/quote]

I still don't quite get this, Bob, although i have heard it said before.

[quote user="Bob Partridge"]If you agree to use the system according to my advice & protocols (assuming you have 2+ FTE vets) - I will buy your dental unit & take the income from it & I will be quids in.[/quote]

I would love to believe this, but I think it must surely vary with the demographic of pet owners one serves amongst other things?

If I spend 6000pounds on dental xray equipment, then to be quids in after 50 weeks I would need to make be taking in an extra 150pounds in client-cash per week. Let's say 10 dental procedures on average per week, each costing on average 120pounds and taking 30-45minutes each. Price will now need to be 135pounds on average, and presumably the time taken will go up by 50-100% per procedure, so let's add an extra 50pounds to compensate for the extra time taken = 185pounds per procedure on average. So dental procedures would cost, on average, 50% more to the pet-owner? If that is done as a blanket price increase, then that will result in less dogs getting rotten teeth removed as more will decline the treatment. If that is done as an optional price increase ('basic dental' versus 'posh dental') then probably only 20% at most are going to choose the posh dental option, thus only 2 a week at increased cost, so 60pounds extra (+50pounds for extra time commitment) makes 230pounds each for a posh dental on average (about twice the cost of the basic offering ad probably quite a hard sell).

I am very likely going very wrong somewhere, but I'm being honest that I can't see how this could pay for itself in a practice not situated in an affluent area.

You have inspired me however to, once again, try to make an effort to improve my dentistry understanding and practice - I just don't see how it could be profitable in the process, especially if investing in such expensive equipment?

RE: Dental xray equipment choice

Bob Partridge — Mon, 13 May 2019 19:30:21 GMT

Only just seen comment re finances.

Balderdash!

Contact me off list if you like!

Bob

RE: Dental xray equipment choice

Bob Partridge — Mon, 13 May 2019 19:24:05 GMT

Some background - in the USA most vet dental specialists seem to use DR, in the EC they use CR.

X-Ray generators - usually pretty much the same sort of thing. You need small focal point (0.4mm rather than the older 0.7mm). Small focal point makes images sharper.

Important thing is the stability of the arm. If the arm is wobbling/oscillating for a few minutes after moving the head - then your 0.4mm spot becomes a 3mm spot! Try before you buy would be my advice. Personal experience is that the Progeny arm is one of the best, the iM3 arm is also pretty good. The 360 revolution iM3 head is pretty stunning technologically (I still don't understand how it connects!). The trick is to hold the rear of he head whilst you release the front catch system. A wireless release/exposure button I thought was a gimmick - but have really found it useful. Very easy to position the head and avoid having to stand anywhere near the exposure line.

With CR the quality does vary. Try to look at a number of plates from different providers. I'd also suggest not thinking of the CR as being purely a dental machine. In general practice - use it for carpii, tarsii, elbows, etc etc. You can identify grass seeds on a good paw exposure. This is where the larger plates come in. NB beware that Size 4 is Size 4 (size 4c is actually smaller!) don't be conned! Size 5 is basically an elongated Size 4.

DR is quick and fast. It is also an easy learn to change head positions if you miss. Whereas slipping CR plates in & out can move the head/angles etc. DR is limited to Size 2 & the sensors are relatively thick - which can make feline rads more difficult to position. As Norm says - the sensors are also expensive. Kevlar protection does work pretty well - but it is still a risk.

CR plates - do regard these as disposable items. Albeit it you will get many 100's of exposures. The "emulsion" will get damaged over time. Buy enough plates so that you are not waiting for one plate to process until you can get the next exposure.

Hope thathelps

Bob

RE: Dental xray equipment choice

Rob Davis — Mon, 13 May 2019 18:34:22 GMT

[quote user="robloxley"]Interestingly on the recent CPD I went on I got on much better with the DR than CR from usability, ease of adjusting positioning etc. so am interested what I am missing on CR?[/quote]

With CR you can get a wider range of sensor sizes and the sensors are much less bulky. Assuming you only buy one DR sensor you are likely to have a size2, which can be difficult to fit well into cats and small dogs. In addition it is not possible to fit a whole large dog canine tooth onto a size 2 sensor, but with size 4 you can see the whole thing (and all incisors on one picture etc). If you break your DR sensor this is the expensive part. I you damage your CR sensor you can buy another one relatively cheaply.

You can also get size 5 and rabbit sensors. The size 5 I'm not a great fan of, and decided to have an extra size 4 rather than trying to get too many teeth in one picture. I've not tried the rabbit sensors so I can't comment on how useful these are.