Comprehensive oral prevention in dogs and cats

Did you know that February is Pet Dental Health Awareness Month? In honor of this, dvm360 is providing is a sneak peek of this week’s episode of The Vet Blast Podcast presented by dvm360 that is all about dentistry, including how to get clients more on board with dental care! Through the episode, and this preview, our host Adam Christman, DVM, MBA, and special guest Jan Bellows, DVM, DAVDC, DABVP, FAVD, share more on COPAT vs COHAT, the importance of dental imaging at all appointments, and more!

Adam Christman, DVM, MBA: Let's get into it. The first one, I really love this, because we tend to, how do I word this? Jan, I think, to the pet owner, we talk about the dental cleaning because it's perceived that that's what they understand. But we like to say the words like COHAT or even COPAT with the P at the end. So tell us more about that.

Jan Bellows, DVM, DAVDC, DABVP, FAVD: Alright, so clients associate their mouths with the animal's mouth that they go in for a prophy. And a “proph” stands for prophylaxis, which means you're going to bring your clean mouth to the dentist to clean your clean mouth, and you don't have halitosis, and it's just a preventative type of thing. With animals, the dogs and cats that we take care of, in most cases, it is to treat periodontal disease because this oral mouth odor going on. So what we do is not a preventative type of procedure, but we should change our minds to make it a preventative type of procedure, and this is done by starting by putting prevention first.

So on our practice, we call it a COPAT, comprehensive oral prevention assessment and treatment. If your practice calls it a COHAT, you are missing, in my opinion, the most important part of this tripod, the prevention. And if we start prevention, and we urge prevention on every single visit, no matter what the animal is coming in for lameness, diarrhea, skin problems, coughing, whatever it is, you take a look at the mouth, and you see plaque and tartar. You talk to the clients about wiping the teeth or brushing the teeth, or using water additives or VOHC accepted chews, but always urge prevention, because the clients see that it's important to you, then they'll see it's important to their pet. We call this a co COPAT Pat, rather than a COHAT, and we certainly never call it a dental. Our receptionist when they're queried, ‘yes, I'd like to bring my dog in for a dental procedure or a teeth cleaning,’ the clients would call it. They will say, ‘oh, a COPAT,’ so the our clients start to understand how important it is to us.

The second part of that is that the client needs to know that there's going to be 2 parts of this dental procedure. The first part is yes, the cleaning, the second part is the assessment, which can lead to a third part, treatment. But the client must know that the halitosis is not coming from the stomach, it is coming from the teeth, and there will be an additional treatment from whatever you diagnose. The clients need to understand that from 2 parts. One is that, yes, the animal's going to go home with sweet smelling breath, but unless the pockets are taken care of, then it's going to start to smell again, because it's like putting food in your own pocket and not taking your pants off for 6 months, your leg will ride off and it's going to stink.

So it's important that clients know that, yes, you're going to clean the teeth, yes, you're going to take dental X rays and you're going to call them on what the pet needs, and it's the client's decision whether they want to go forward and do the treatment at that time or stage it let them come back in a month and do the treatment.

Christman: I love that, and I love that you share that. There is a clinic I think it's somewhere on the East Coast that really cares about prevention overall. And what they did in the waiting room is they had a whole area on heartworm prevention, the prevention of what we could do, versus the treatment of heartworm disease, prevention of fleas and ticks, versus the treatment of flea bite anemia. And then they have one on the prevention of dental disease, all the things that they list from wipes and brushing the teeth and water additives and toys versus the cost and expense of doing X rays and advanced dental work.

I love that, because this practice got a lot of great social media likes on that because of the fact that, Wow, you really are putting prevention front and center and being more proactive than a reactive approach to that med. What are your thoughts on that?

Bellows: I think that's fabulous. I think we all should do that and send home clients with literature and having it in the waiting room and they have nothing else to do that. That sounds way, way positive.

Christman: Okay. The second thing that we're talking about is the use of, and the importance of, taking full mouth radiographs. So share with us more about that.

Bellows: Understand that in animals, in dogs and cats, 60% of the tooth is below the gum line. In people, only 30% is below the gum line. But in animals, because God put them in there to chase rabbits and squirrels and hamsters to eat, they put big roots in there. If you're assessing the mouth and treating it with non-anesthetic dentals, or just not addressing the roots, then you're missing so much disease that's there, and your animals are absolutely suffering. So every animal needs to have full mouth radiographs, intraoral radiographs every single time.

[You’re like] Oh yeah, great. I'm glad Dr Bellow’s is recommending that. But how am I going to pull it off? If you're in a corporate practice, or if your practice offers a wellness plan, just incorporate it in the wellness plan. Figure out what you normally charge for a professional anesthetic and teeth cleaning and dental X rays, full mouth X rays, and then cut it up into 12 pieces and incorporate that in their monthly fee. Clients will accept it once they see that you really feel that it's important for them, and they will get it at least once a year, complete oral X rays.

In fact, our office has a CT, and we include the CT in our monthly plan at really no additional charge, because we believe in it so much. Even if you discount it fairly heavily, you'll find there is so much disease that you will find with full mouth X rays that it will be real easy for you to for the office to profit if that's your motivation, but so much good care will come out of that with the full mouth X rays. You must allot enough time to evaluate them, and you have to a lot enough time to treat the amount of dental disease that's there. Now, once you take full mouth X rays on every case, you will be amazed on the disease that's there. The question is, oftentimes, okay, great, I found something, I'm going to have to treat it. How do I get the client to give me approval?

So tell the client that during the procedure, you're going to take radiographs, take a picture of them with your cell phone, tell the client you're going to text them the image, and you're going to give them a phone call, and so the clients know what's going to happen later on that day, once you find what's causing the disease. And even if, if you the radiographs are normal, but there's an 8-millimeter pocket you just put the probe in. Take a picture of it and say, well, we're going to treat this either by taking out the tooth or using PerioVive, which we're using a lot now, and helping your patient.

Christman: Love that. I'm always surprised on what we see. I always call the iceberg effect, you know, what's below the surface on those radiographs? So great piece of advice.

Want to hear the rest of the conversation? Tune into this week’s episode of The Vet Blast Podcast presented by dvm360 to hear more from Bellows and Christman available anywhere you get your podcasts at 5 PM EST!