As the public and their vets grasp the importance of dental health, sales reps can grasp selling opportunities

Veterinary dentistry makes up an estimated 4 percent to 5 percent of a typical veterinary practice’s revenue, yet an estimated 70 percent to 80 percent of dogs and cats over age three have periodontal disease. “Either vets are missing a big opportunity, or they’re totally undercharging for their services,” says Scott Handler, DVM, MBA, director of marketing communications and education for Webster Veterinary Supply, Sterling, Mass. Chances are, it’s the former. But that’s changing, and veterinary products sales reps have a big opportunity to change with it.

Vet students and practitioners have more interest in veterinary dentistry today than they did even 10 years ago, says John Lewis, VMD, FAVD, DAVDC, assistant professor of Dentistry and Oral Surgery at the School of Veterinary Medicine at the University of Pennsylvania in Philadelphia. “Although it’s not a program in every vet school – in fact, only about eight schools have one – it is getting more and more attention in the curriculum.” Lewis is president-elect of the American Veterinary Dental Society. “That’s partly reflected by the fact that more and more general practitioners want to hire veterinarians with experience in veterinary dentistry.”

“Twenty or 25 years ago, the attitude [among vet students] was, ‘If I wanted to be a dentist, I would have gone to dental school,’” says Handler, who still practices once a month. But a number of things have changed since then. “People are starting to realize not only the health benefits of veterinary dentistry, but the business benefits too.

“When I was in veterinary school, courses on vet dentistry were electives,” he adds. “Now they’re incorporated into the curriculum. There’s more of a realization of how dental health affects the overall health of the animal.”

As recently as 21 years ago, veterinary dentistry was not even recognized as an approved specialty. Then, in 1988, an organizing committee of eight veterinarians established the American Veterinary Dental College. Provisional accreditation as a veterinary specialty college was granted in 1988 by the American Board of Veterinary Specialties of the American Veterinary Medical Association. Exams for new members were first held the following year, as was the establishment of the first AVDC-approved full-time residency training program. Full recognition as an approved specialty was granted in 1995. Today, approximately 100 veterinarians are certified as Diplomates in the AVDC worldwide.

Oral health

More vets are incorporating dental exams into their general exams than ever before, says Handler. “Even if a dog or cat is somewhat aggressive in the exam room, for the most part, with the aid of a proper restraint, the vet can flip the lip up and get a good look at the teeth,” says Handler. “If any periodontal disease is detected, the veterinarian can inform the client of what should be done from a medical perspective.”

Though owners may be more cognizant of the need for good dental care, they may need some convincing, he continues. “When I speak to owners, I let them know we’re not performing dental procedures to make their pet’s teeth shiny or white,” says Handler. “Instead, we’re looking out for the health of the animal.”

In humans, periodontal disease has been linked to organ failure, and there’s no reason to believe this isn’t the case with animals as well, says Handler. Periodontal disease can lead to a buildup of harmful bacteria in the mouth, which can then be passed on to various organs, such as the liver or kidneys, where it can lead to infection. “Human studies have shown that people with poor oral health tend to be prone to other diseases, and the same is thought to be true with animals,” he says.

Clinical signs of a dental problem may be an almost indetectable change in behavior or attitude. Maybe the pet snaps if someone touches its face, because its teeth are sore. The animal may not be as playful as it used to be, the pet may have bad breath, or the owner might see food falling out of the animal’s mouth as the pet tries to eat, which may be an indication that the animal is finding it difficult to chew.

Technology has advanced

Today’s veterinarians are better equipped than ever to diagnose and treat oral health problems, according to those with whom Vet-Advantage spoke. Indeed, this is where distributor sales reps can play a key role in advancing the state of the art.

“One of the most important technological advances is dental radiography,” says Lewis. “Radiography makes diagnosis and treatment of dental disease more of a science than guessing what’s going on underneath the gum line.” Though conventional X-rays are good, digital equipment is even more efficient. “It makes it easier for the GP to obtain information in a relatively quick and easy manner.”

Today’s vets also have a better recognition of pain management, a must for successful dental procedures. “There are more options for developing the skills necessary to provide appropriate pain relief prior to doing some of these procedures,” says Lewis. And today’s regional anesthetics can last up to 10 hours, offering post-operative pain relief as well.

The science and technology of anesthesia itself has progressed, says Lewis. “You can’t do a good job of cleaning under the gum line – where bacteria in the mouth have an opportunity to get into the bloodstream and spread to other parts of the body – without the patient being under anesthesia.” Even if the animal is in good oral health, the vet who cleans the teeth will need to polish them, to prevent a rapid buildup or plaque and tartar. “And to polish appropriately, the animal has to be under anesthesia.”

Some in the veterinary community today are endorsing non-anesthetic cleanings, but Lewis frowns on the practice. The reason is, if the vet identifies a problem that calls for extraction or periodontal therapy – a real likelihood given the large number of teeth in a dog or cat’s mouth – then general anesthesia will have to be administered anyway. What’s more, advances in regional anesthesia minimize the amount of general anesthesia needed. “That makes general anesthesia safer,” he says.

Says Handler, today’s anesthetic techniques allow the patient to wake up much quicker than in years past. “Twenty years ago, a dog would have to be kept overnight because it wasn’t awake enough to go home,” he says. Today, post-operative pain management is much more sophisticated, he adds. “In the past, the vet would pull three teeth and send the dog home on soft food. Now, you send them home with pain medication.” The animal recovers more quickly, and the doctor doesn’t receive a call four days after the procedure from an owner complaining that his pet hasn’t eaten since the dental extractions.

The bare necessities

“The bread and butter of the general practitioner is the routine dental cleaning,” says Lewis. “I should strike ‘routine’ in my wording, because it’s rare we have one. We often find some pathology in the mouth. Probably ‘professional dental cleaning’ would be more appropriate to describe what the general practitioner does. That’s a big part of it, as well as extractions.”

Adds Handler, “For the most part, 80 to 90 percent of general practitioners will get no more sophisticated than performing what some call a dental prophy, that is, cleaning, full mouth X-rays with extraction as needed, and associated pain management. A very small percentage may get into more advanced procedures – endodontics, periodontics, restoration.”

That could be changing. “As pet owners become more aware of the significance of dental health to the overall health and longevity of their animals, we’re seeing a shift from basic procedures to periodic assessment, treatment and prevention – much like the treatment patterns associated with human dental care,” says Mike Walker, vice president and general manager, Veterinary Division, Midmark, Versailles, Ohio. “I believe that as more manufacturers provide equipment and maybe even services to facilitate that movement to more efficient practices with better clinical outcomes, you’ll see more of that happen.” Midmark has been a supplier of exam tables, autoclaves and other equipment to medical doctors and dentists for some time. It created a distinct veterinary business unit about two years ago. Among its offerings are exam and treatment tables, anesthesia equipment, lighting systems and casework.

Given the growing interest in dentistry among their customers, Vet-Advantage readers find themselves providing their customers with the equipment and materials necessary for exams, cleaning, drilling and extractions. That would include:

• Hand instruments (including scalers, curettes, probes for measuring pocket depth around teeth, explorers for examination of hard-tissue defects, and prophy cups and paste.
• Diagnostic equipment, particularly conventional and digital X-ray units.
• Dental drill units, handpieces, and burs.
• Extraction instruments, such as dental elevators, forceps and root tip elevators.
• Anesthesia and monitoring equipment.

As in medical and dental practices, vet practices are more concerned than ever about infection control, so sales reps should expect to sell a variety of disinfectants, instrument cleaners, autoclaves and personal protective apparel.

Sales opportunity

“It’s a growing market,” says Handler. Even if a veterinarian has to spend $10,000 to properly outfit his or her practice for dentistry, the investment is well worth it. “The vet can charge what’s appropriate for his or her area, and the potential client base is tremendous.

“The good distributor rep is hopefully having conversations such as, ‘Doctor, how do you want to build your practice?’” he continues. “If the doctor responds, “Things were great for the first five years, but I can see they’re starting to trend flat, and I need to think of things I can do to increase my practice revenue,’ then dentistry could be one avenue that the rep brings up.”

Reps can also bring to their customers training opportunities, something that’s particularly valuable for vets who graduated long ago, when dentistry was not taught in veterinary school, adds Lewis. “It was always a highlight for me when I was a GP to go to a meeting and bring home many new ideas and treatment modalities,” he says. “That’s probably a big part of how distributors can serve their customers. And they can help them identify the good instruments to use based on [their conversations] with people who have had exposure to many different types of instruments.”

Says Walker, “If we can find ways to help our customers enhance their revenue and work more efficiently while provide a higher quality of care, they’ll do it. We have to provide them the education and equipment to help them get there.”