Veterinary nurses: Become your practices dentistry VIP!

October 26, 2018
Candice Hoerner, CVT, VTS (dentistry)

Candice Hoerner is a certified veterinary technician and veterinary technician specialist in dentistry. She works at Ponderosa Veterinary Hospital in Kalispell, Montana, and is the owner of Big Sky Veterinary Dentistry Education.

Its well known that a majority of pets suffer from dental disease at some point in their lives. Help your practice help them by becoming the dentistry advocate.

Photo courtesy of Conejo Valley Veterinary Clinic.

Every day we veterinary nurses are asked to perform a multitude of tasks to provide our patients with excellent care and service. One of these life-lengthening services is dentistry. If you look at the current data, we know that approximately 75% of patients over 3 years old have periodontal disease, among a myriad of other dentistry-related conditions. Why do so many suffer in silence? It's our role as veterinary nurses to become our practices' dentistry advocates and promote dental care to our clients to provide the highest standard of care for our patients.

Roles of a dentistry VIP

Client communication-Your patients need high-quality dental care, and the best way to convey this to your clients is by properly educating yourself first. When you take the time to educate yourself on the subject and understand the pathology and physiology and the effects on the animal, you will then be able to share this information with the client and provide a tremendous benefit to the patient. If you're informing the client of the proper care with passion, enthusiasm and sincerity, they are more likely to accept your recommendation. All can be lost if the whole team isn't supplied with the proper knowledge to inform the client. There are many sources of education available to the veterinary team to improve their understanding of veterinary dentistry. (For example, check out the resources on periodontal disease at dvm360.com/dentalessential.)

Development of a practice's dentistry message can also help to solidify the information you want to deliver. If only one person says something about dental care and isn't backed up by the rest of the team, the client is less likely to take that recommendation seriously. Therefore, it's necessary to train anyone who has contact with the client to deliver the same message. You want your team to be able to give intelligent answers to your clients' questions and concerns. If your clients see that everyone in the practice believes dentistry is important, they will follow your prescribed oral health plan.

Workflow coordinator-As a VIP nurse, you can coordinate and manage the day-to-day dentistry cases in an efficient manner to improve patient care and optimize staff time. When the client and patient arrive in the clinic, the dentistry VIP will likely be the initial contact with them. They will provide information regarding the examination that will be performed that day as well as any possible treatments for pathology already identified. The dentistry VIP then serves as a consistent point of contact throughout the day.

When the client has left the animal for the procedure, it will be the dentistry VIP nurse's duty to manage that patient's care from beginning to end. When the dentistry services have been initiated, the nurse will contact the client with any pathology that has been identified and recommend treatment plans established by the veterinarian. When the patient is recovering from anesthesia, the dentistry VIP will again contact the client with a progress update and schedule a discharge appointment. At the appointed discharge time, the dentistry nurse can meet with the client to review the procedure and establish follow-up care.

The dentistry VIP can also become the practice's asset in creating standard operating procedures. They can create and manage protocols for patient care, instrument set up and maintenance, and client education and communication tools.

Complete oral health assessment and treatment (COHAT)-A complete periodontal cleaning is required to remove the "disease" elements of periodontitis. This includes removal of bacteria-laden supragingival and subgingival calculus and plaque. The intent of professional dental cleaning is to prevent periodontitis, but most patients already have significant disease. The terms “prophy,” “prophylaxis” and “dental” are often misused as very rarely are we actually preventing periodontitis.

Dental procedures must be performed by a licensed veterinarian, a credentialed technician or a trained veterinary assistant under the supervision of a veterinarian in accordance with state or provincial practice acts. Practice acts vary from jurisdiction to jurisdiction, and the veterinarian must be familiar with those laws. Surgical extractions are to be performed only by trained, licensed veterinarians.

In 2013, the AAHA published the Dental Care Guidelines for Dogs and Cats, which are guidelines for the practice of companion animal veterinary dentistry. It's the dentistry VIP's duty to be highly skilled in all of these areas to provide the patient with the highest standard of care, which needs to include the following steps:

> Anesthesia-Appropriate protocol is determined by the patients' health status and tailored to the procedure being performed.

> Patient positioning and monitoring-The patient is positioned in a safe and appropriate manner for the procedure, and vital parameters are reviewed according to hospital protocol.

> Oral exam-A complete oral examination, including thorough dental charting, should be performed.

> Radiographs-Full-mouth radiographs are required to identify any hidden pathology.

> Power scaling-An ultrasonic scaler should be used to remove the majority of plaque and calculus from the teeth.

> Hand instrumentation-Dental-specific instruments should be used to remove additional plaque and calculus and fine tune the cleaning.

> Detect missed plaque and calculus-This is done by air drying or use of disclosing solution to highlight debris.

> Repeat of oral exam and plan for additional treatments-The patient may need additional treatments to alleviate pain and infection.

> Polishing of teeth-Teeth should be polished to smooth the enamel surface and reduce the reattachment of plaque and bacteria.

> Homecare and follow up-A homecare plan should be developed and discussed with the client.

The dentistry VIP must be supported in their endeavors to provide this care. Many times we feel like we don't have a voice within our practice. I believe that if you can find an area of veterinary medicine that really drives you, you can do anything you set your heart to! Working in a practice that values the strength and passion to become a specialized nurse is priceless, but being underutilized is a detriment and leads to employee dissatisfaction. Educate yourself and those around you. Lead from within and others will follow. Remember-knowledge is power. I want you to feel the power of being a VIP within your practice!

Candice Hoerner is a certified veterinary technician and veterinary technician specialist in dentistry. She works at Ponderosa Veterinary Hospital in Kalispell, Montana, and is the owner of Big Sky Veterinary Dentistry Education.