How do you get clients to understand the importance of dental treatment

Re: How do you get clients to understand the importance of dental treatment

Kate Richardson — Fri, 15 Jul 2011 10:02:57 GMT

I think the basic problem is that unless a pet is showing obvious clinical signs of illness or pain, owners generally judge their animals general health by very basic things- their appetite and their energy levels. If their pet is eating well, they don't perceive a problem. How many of us have heard an owner with a lame dog say, "but I don't think he/she is in pain". Just because they are not yelping in agony. You have to explain to most of them that the reason he is limping is because it is painful to use his leg properly. Using human analogies often helps, such as if you have a cut on the tip of your finger it doesn't hurt all the time, only when you use that finger. Or would you like to have a mouth that looked like this?

So we need to find simple analogies for dental disease. Some owners will understand the association between systemic disease and dental disease and that will work.

[quote user="Noweia"]tell them it's slowly posioning their dog/cat. [/quote]

I like this phrase, it's simple and gets the more complicated message across

[quote user="Rachel Perry"]Animals' instincts are to survive and to survive they have to eat[/quote] This is also good, as it helps them to understand why their animal appears to be fine ie it is eating ok. Also because the disease is chronic and develops over time, they don't see their pet going from being well one day to ill the next, it is a slower change, and like treating arthritis, it is only when the pain/disease is taken away quickly with pain relief or a dental treatment that they then come back and say, actually you were right, he is so much brighter and happier since he has had the treatment. But it's hard getting them to believe it until they do it, and that experience will make them more amenable to accepting treatment in the future.

Re: How do you get clients to understand the importance of dental treatment

Laurence Webb — Fri, 15 Jul 2011 09:15:16 GMT

[quote user="amanda nicholls"]Has anyone reported a cleint to the RSPCA?[/quote]No, but I had a client who was prosecuted by the RSPCA for neglecting her animals and one of the main factors they used was the periodontitis. In exasperating cases I have told owners that a client was taken to court for allowing her animals teeth to deteriorate, and your pet's teeth are worse than that. It's a tricky line to tread and not scare them away from seeking any veterinary help at all.

Re: How do you get clients to understand the importance of dental treatment

Julian Earl — Thu, 14 Jul 2011 22:27:00 GMT

I agree with a lot of what has been said and now adopt the, "This will be seriously painful" approach, together with, "Associated with other diseases", and finally, "It will be a hell of a lot cheaper to deal with this sooner rather than later as well as it being better for Fido/Ginger".

But there are always those who won't be told.

[Also, Rachel, a word to the wise: paragraphs make long posts a lot easier to read. TY.]

Re: How do you get clients to understand the importance of dental treatment

Noweia — Thu, 14 Jul 2011 20:49:40 GMT

I like to show the owners the pus, and tell them it's slowly posioning their dog/cat. Sometimes that makes them listen.

The insurance companies that only pay when there is pathology aren't that great either - because then the clients sits on the problem for ages until it get sos bad that there's no way the insurance company won't pay for loose teeth/FORL/abscesses/osteomyleitis!

Re: How do you get clients to understand the importance of dental treatment

Amanda Nicholls — Thu, 14 Jul 2011 20:44:47 GMT

[quote user="Evelyn Barbour-Hill"]

Frankly I think this is perfectly fair. Insurance is not a health scheme, it's insurance against the unexpected. You can't expect the insurer to pay out for something which could have been treated less expensively earlier, especially if it's been creeping up, neglected, for years.

[/quote]

In some cases yes but I think FORLs should be covered.

Has anyone reported a cleint to the RSPCA? I get very frustrated with clients who continuously refuse dental treatment for the pet, if I don't get them to book in after a couple of follow up phone calls I send them a letter outlining their responsibilities under the animal welfare act but haven't taken it further than that. I have a case at the moment that I am considering reporting them or threatening to, canine tooth crown has broken, root is retained, another canine is fractured and has a lot of inflammation, few premolars remain all have resorptive lesions.

Re: How do you get clients to understand the importance of dental treatment

Evelyn Barbour-Hill — Thu, 14 Jul 2011 19:52:30 GMT

[quote user="Laurence Webb"]So...how do you tackle a problem that people won't accept is significant![/quote]

Just keep blattering away, I guess. But you have to be enthusiastic yourself. If you say one thing but your tone and demeanour are belittling it, the client will get the message that you don't mean what you are saying.

Ten-minute consultation a constraint? That's easy. Allow longer. Take as much time as it takes.

[quote user="Laurence Webb"]"Dont' bother looking at his teeth, the vet's been telling me they're bad for years. HaHaHa"[/quote]

If anybody tries that with me they get a shortish answer, on the lines of "I'm not surprised, they are **** (adjective suited to client) awful. Look here, for *** (epithet suited to client) sake".

[quote user="Clive Ansell"] The same owner recent brought another show dog for a dental, but expressly specified no teeth to be extracted [/quote]

I wouldn't accept a condition like that. What's the point of "treating" them under that condition? "Certainly madam. What techniques would you like me to employ to preserve the teeth that have lost gingival attachment? Gingival surgery? Guided tissue regeneration? Osseoinductive materials? Extracellular matrix proteins? Do you have several thousand pounds to spare for the purpose? Can you provide the scrupulous oral hygiene essential for success?

[quote user="Rachel Perry"]The other thing I would suggest, and this could be whole other thread, is to move away from the concept of 'your dog needs a dental'.[/quote]

I couldn't agree more. Far too many veterinary practices can themselves only conceive of "a dental". Many have gone further and heartily embraced the concept of "dentals" as just another "profit centre". Some see it as especially profitable because it's so simple "the nurses can do it". Heaven preserve us from the "dental".

[quote user="Rachel Perry"]dependent on the animal having had a 'dental check' in the last 12 months- if clients are not vaccinating and this as part of the annual health check then companies may refuse to pay out. Or if a vet recommends dental treatment which the client declines, I have seen companies try to refuse payment because advice was not followed![/quote]

Grump, grump, grump......

Re: How do you get clients to understand the importance of dental treatment

Rachel Perry — Thu, 14 Jul 2011 18:18:16 GMT

This does depend on the insurance policy. A lot of the cheaper policies have a blanket "no dental treatment" which is ludicrous. Pet Plan and several others are very good. Also fractured teeth are almost always covered due to it being caused by trauma/accident. it's worth reading the small print. What can catch some clients out is that payment is dependent on the animal having had a 'dental check' in the last 12 months- if clients are not vaccinating and this as part of the annual health check then companies may refuse to pay out. Or if a vet recommends dental treatment which the client declines, I have seen companies try to refuse payment because advice was not followed!

Re: How do you get clients to understand the importance of dental treatment

Tom Ward — Thu, 14 Jul 2011 17:50:50 GMT

[quote user="Mark Holmes"]

Consulting is a too way process. Clients who are enthusiatic generate an enthusiam in the vet. A day full of clients with a moribund disinterest is a difficult thing to face and maintain an interest of your own. [/quote]

Couldn't agree more. I've been amazed how a client's mood/enthusiasm directly affects the consult. It makes for a more useful experience for the client and a more rewarding one for the vet.

I often find that mentioning the relation to cardiac disease (as someone mentioned above) helps. People need to see the significance on the larger scale as so many animals hide the (presumably) excruciating pain they must be in. I would much rather run the risk of dying under anaesthetic (a risk which I feel is often overstated) than live my remaining years with chronic oral pain. Shame a lot of clients don't really see that.

Re: How do you get clients to understand the importance of dental treatment

Mark Rowland — Thu, 14 Jul 2011 16:54:34 GMT

I also think that in the current climate, the fact that insurance companies wont cover dental treatment must play a part in all this. I find my clients are usually quite compliant with this issue but there is an ethos out there that clients insure their animals so they don't have to pay out and they can therefore begrudge having to do just that. Gold standard treatment also includes pre op bloods and ivft also not to be covered. Sorry if I sound cynical

Re: How do you get clients to understand the importance of dental treatment

Rachel Perry — Thu, 14 Jul 2011 16:34:42 GMT

Hi Laurence,

I think it is a common problem, and can be a very difficult issue to convince owners of. All the above arguments are valid- the disease progression, the systemic effects, the increasing costs and length of eventual anaesthetic once treatment is sought. I tell people that gingivitis is reversible with good oral care at home. However once we have periodontitis (ie attachment loss for teeth/bone loss/gingival recession etc) then this is essentially irreversible. I tell people that dogs and cats generally won't stop eating. I spoke with a vet at the London Vet Show who told me he had tooth pain for several months before the dentist sorted it. He told me he didn't stop eating, but became the grumpiest Dad around! often it's the same for pets. I tell people it can be subtle behavioural changes- often people will tell us afterwards that their dog/cat is likley a puppy/kitten again, more interactive, playing with toys again etc. Animals' instincts are to survive and to survive they have to eat. The eating pattern may alter though, for instance eating on one side of the mouth, or gulping food so fast so that no chewing is necessary (not uncommon in cats with FORL and owners think their cats have a ravenous appetite- in actual fact this is the only way they can eat without pain). If you see asymmetrical calculus accumulation in the mouth (eg L worse than R) then this is a sign of pain as one side is doing more chewing. Dental disease is hidden, and dog-breath is not normal! Another problem is that pets are often left until their mouth is a festering pit of infection- not because of the owner, but because we as vets are not giving the owners the correct information early enough in the disease process. I think we should be educating clients about dental disease from a young age, getting them used to the fact that dental treatment under an anaetshetic might at some point be needed, and of course to introduce the concept of oral care at home. Often there is gingivitis in a mouth, and because the client has come in for something else, there is no time to discuss it, or we find it hard when the client is really worried about the sebaceous cyst. It's difficult in a 10min consult, I agree, to cover the clients' concerns, physical examination, other findings, advice on preventative care etc. The other thing I would suggest, and this could be whole other thread, is to move away from the concept of 'your dog needs a dental'. This means nothing to the client, and certainly doesn't equate with several hundred pounds. I try explaining the whole process to the client- what we can see consciously is the tip of the iceberg, and the main disease process is happening beneath the gingiva - this can only be assessed under a general anaesthetic, ideally with dental radiography. At the least every tooth should be probed and a dental chart created. If you envisage extractions, explain the process- dog and cat teeth and generally harder to extract than human teeth- they are carnivores and the teeth are designed to stay in the jaws, the roots are longer (and in cats thinner/more fragile), many teeth have 2-3 roots, surgical extractions may required requiring elevation of mucogingival flaps, sectioning of teeth, suturing, pain relief, antibiosis if required, IV fluids, safest anaesthetic protocols, patient warming- all can be explained to justify the costs involved. At the end of the day you can only advise on the best course of treatment for the pet, and then the client makes an informed decision. At least you are detecting dental disease and advising on it- it can be easily overlooked by vets as much as owners!

Re: How do you get clients to understand the importance of dental treatment

Mark Holmes — Thu, 14 Jul 2011 15:18:56 GMT

I agree but one can understand how clients fail to get excited by it and why compliance is poor. Equally when compliance is poor it is a very difficult daily grind talking about the same subject every ten minutes to people who have little interest themselves. Consulting is a too way process. Clients who are enthusiatic generate an enthusiam in the vet. A day full of clients with a moribund disinterest is a difficult thing to face and maintain an interest of your own. Another thread talks about consulting times, with 10 minute apoointments it is possible to see 40+ clients a day. ( I once locumed in a practice where the norm would be closer to 80 on Saturdays.) That is an awful lot of repetition on a daily weekly and monthly basis.

Re: How do you get clients to understand the importance of dental treatment

Chris Geddes — Thu, 14 Jul 2011 15:06:03 GMT

I brush my dogs' teeth! But then it would be pretty bad if I didn't!

There have been a few discussion in the past on here, e.g. http://www.vetsurgeon.org/blogs/veterinary_news/archive/2010/12/03/28337.aspx

I don't think the fact that a vet doesn't brush his own dog's teeth means hs can't recommend best practice to an owner though? It's then up to them to decide if they want to put the effort in or not! My dog enjoys having his teeth brushed (probably mainly due to the flavour of the toothpaste and the fact the he gets a treat afterwards) - and it really isn't much effort if you're going to spend a bit of time with your dog every day anyway! Much easier when you start them at puppyhood, and start it gradually.

Chris

Re: How do you get clients to understand the importance of dental treatment

Mark Holmes — Thu, 14 Jul 2011 14:52:30 GMT

I think that before you worry about clients dogs you need to think about vets' dogs, We are supoosed to encourage clients to take their dental health seriously but how many brush their own dogs' teeth? My dog is 11 and wouldn't recognise a tooth brush, neither would the pets of any (as far as I know) of my colleagues or nurses. No we know all the stuff we are supposed to be teaching our clients yet we don't do it. How many on this forum do? It is a little difficult to imagine the general public will be any more inclined.

Re: How do you get clients to understand the importance of dental treatment

Chris Geddes — Thu, 14 Jul 2011 14:03:46 GMT

Hi Laurence,

I think there are two issues: getting clients with healthy pets to start brushing, and getting those with pets with teeth that need attention to agree to investigation/treatment. Both can be difficult, but of course brushing is a lot cheaper than a procedure. In fact, pointing out to an owner of a new puppy how much dental procedures can cost is an added incentive to encourage them to begin to brush! I think you have covered most things (eg resolution of halitosis and pain - point out how much happier dogs and cats are after having dental treatment). One thing that you missed in your post is pointing out to them the relationship between oral disease and renal/hepatic/cardiac disease. Owners who really refuse to brush daily: point out that once every other day brushing has 60% of the benefit. If owner refuse to brush at all, there are of course alternatives like rinses, chews and diet - not as good, but better than nothing. Virbac provide leaflets and posters to help educate clients, and have just this week brought out a merchandising kit so that nurses can create a display in the waiting room - usually more noticeable than a poster!

Chris (Product Manager for dentistry at Virbac)

Re: How do you get clients to understand the importance of dental treatment

Clive Ansell — Thu, 14 Jul 2011 14:02:26 GMT

Common problem I find.

I feel we can only advise best practice, but cannot do anymore than that. It is ultimately the clients choice. If severe and we feel it is a welfare issue a call to RSPCA inspectorate may be an option.

I was discussing a case with colleagues only this morning. A Lhasa apso show dog I saw last august with purulent peridontitis, swollen mandible, and possible osteomyelitis has still not been attended too. I think such owners should be prosecuted. The same owner recent brought another show dog for a dental, but expressly specified no teeth to be extracted - we almost had to hold them in place to stop them being removed during descaling. Actually, I was fairly heavy handed with the scaler and about 8 "fell out" when we removed the ET tube.

Re: How do you get clients to understand the importance of dental treatment

Alan Tevendale — Thu, 14 Jul 2011 13:50:58 GMT

I would imagine that most vets on this site would have many similar experiences to those you have described. I don't think that there are any easy answers however. As you have already said showing the owner the problem and trying to get them to understand is essential.

We're running a health checks in the park open day in just over a week. The practice nurses will be giving free check up to anyone who comes along as part of vet nurse week. Hopefully by steady client education we might over a period of many years start to change peoples attitudes.