Educating the client on oral hygiene (Proceedings)

How important is oral hygiene? Just imagine what it would be like if you never brushed your teeth.

In the canine oral cavity, over 300 different species of bacteria have been identified. 615 different bacterial species have been found in the human mouth by faculty at the Harvard School of Dental Medicine...and they're still counting. Many recent studies indicate a relationship between periodontal disease and other conditions, such as heart disease, kidney disease and diabetes.

Bacteria are organized into colonies that make up plaque. The pellicle refers to a thin layer of salivary glycoproteins and organic molecules which naturally form on the tooth surface. This serves as a substrate for bacteria to attach and start forming plaque, which will then mineralize into calculus. Plaque formation can occur within 20 minutes of a dental cleaning, while calculus can form within just a few days.

Patients with periodontal disease frequently show no signs of discomfort until the disease is very advanced. This is a major reason why most patients do not receive dental care until they are older and/or need extensive treatment. Delaying dental care can translate to higher financial costs for the owner and a higher degree of procedural risk for the patient, due to the presence of advanced disease or the incidence of concurrent conditions.

What would your client like to see for their pet(s)?

      Less discomfort

      Increased activity

      Be healthier

      Longer life

      No bad breath! (for more kisses)

It has been this author's experience that all of the above can be achieved with appropriate oral care. Many owners report that their pets have become almost like puppies or kittens again after having their oral disease treated.

So if oral health is so important, why is it neglected as part of routine patient care, and why are most owners reluctant to provide an oral health routine?

What are the 4 major client objections?

      Anesthesia

      Cost

      Postoperative care

      Unable or unwilling to provide homecare.

It is important for a practice to establish an environment of mutual trust with the client.

Client education on the facts of dental hygiene at home versus at the practice is extremely important. The client must understand that we can do only 10 to 20 % of the oral care in a veterinary hospital setting, and that they are responsible for insuring their pet's oral health with an appropriate home care routine. By working together and educating our clients, we can assure that the pet has as healthy a life as is possible.

Accurate and descriptive terminology is an important tool in communicating with the client. Our body language and vocabulary will set the tone for the conversation.

Do not call the procedure "a dental" or use the phrase "teeth cleaning" when referring to treating dental and periodontal disease. Using the term "a dental" only minimizes the importance of the treatment. Clean teeth (and better breath) are only the final outcome of the procedure, and the importance of the degree to which periodontal and dental diseases affect overall health must be stressed.

Tools of the trade

As soon as the client leaves the office, they forget the importance of the treatment as well as the degree of disease present. To help the owner retain that information, take pictures before and after the treatment to send home with the owner to keep as part of the pet's medical record, along with instructions for home care. A copy of these photos should be maintained as part of the patient's hospital medical record as well. A digital camera is not a luxury anymore, but a necessity. This technology has become more inexpensive over the years, and models which take excellent images are readily available. Insure that the model you obtain is compatible with the practice's computer software so that images can be uploaded and saved into the patient's records.

Oral disease could be considered to be the most common health problem seen in the small animal practice industry. Studies show that 80% of dogs and 70% of cats will have some form of dental disease by age 3, with underlying plaque buildup being the root cause. Oral photographs taken during routine physical examination allows the client to compare the progression of their pet's oral health, and make comparisons to photos of the 4 stages of periodontal disease. Involve the client in the determination of their pet's oral health status by using these photos as a tool. By educating the client, they will be more interested in pursuing the appropriate course of treatment.

Give the owner a set of discharge instructions before they leave the office post procedure, or even following routine exam. These should be composed of:

      Before and after pictures.

      Information on what procedure was performed that day.

      Medication instructions if needed.

      When to follow- up post procedure ( 2 weeks, 1 month, 6 months and yearly).

      Education handouts on the disease process that the client can comprehend.

      Homecare instructions until the next visit.

Most clients are enthusiastic about taking care of their pets teeth after treatment and/or cleaning, but this enthusiasm may fade after a few months, so follow ups are important to help re-energize the client. Also, always to try to speak with the primary care giver, to go over instructions and demonstrations, since most messages will not be communicated well by a third party.

Recommending home care products

There are an abundance of products to choose from and many products can be confusing for clients.

What does your client really need at home to help maintain their pet's oral health?

Toothbrush and pet approved toothpaste (dentifrices).

Tooth brushing is the number one way to fend off periodontal disease. Ideally daily brushing is the gold standard, but at least 3 times weekly will be beneficial. Many Veterinary dentists feel that daily brushing is the only way to slow down established disease progression, and anything less is not effective.

Additional dental care items

      Dental diets and hygiene chews

      Chemical plaque control (breath enhancers)

Nothing replaces brushing! Teaching pets to tolerate brushing can be done at any age, but is easiest when started young.

      Not sure what products should be recommended?

      Contact the VOHC

Who or what is VOHC?

The Veterinary Oral Health Council is a part of the American Veterinary Dental College, that award a seal of acceptance for products that successfully meet pre-set criteria for effectiveness in controlling plaque and/or calculus deposition in dogs and cats.

See website: www.vohc.org

References

1. Veterinary Dentistry for the General Practitioner, Cecilia Gorrel, Saunders, 2004.

2. The Harvard Gazette "Discovering who lives in your mouth", William J. Crombie, 2002 http://www.news.harvard.edu/gazette/2002/08.22/01-oralcancer.html