Dental cleanings are a front-line defense against disease
By Graham Garrison

The visible signs of periodontal disease for one patient started in the knees. When Jim Auvil, a board certified veterinary dentist at Cincinnati, Ohio-based Grady Veterinary Hospital, examined an older dog, the warning signs were in weakened knees. But instead of treating the symptoms of gimpy legs, Auvil went after the problem by way of the mouth. So after giving the dog a teeth cleaning, examining and removing any teeth if need be, it wasn’t surprising to Auvil that the dog’s overall health improved.

“Within a few weeks, he didn’t have trouble with his knees again,” Auvil said.

Systemic
Periodontal disease has one starting point, but almost an unlimited number of avenues to attack the body. If there is one point that veterinarians try to stress to pet owners, it’s that teeth cleanings benefit more than just the teeth and gums. It benefits overall health.

“It’s a general systemic disease that no one thinks about,” Auvil says. “They think about bad breath, but 99 times out of 100, if you’ve got bad breath you’ve got some kind of disease in your mouth.”

Heart disease. Kidney failure. Weak legs and knees. All organs and parts of a pet’s body and health are fair game to the effects of poor oral hygiene. It starts with bacteria forming in the mouth. Then, one little abscess that goes undetected allows the bacteria to enter the blood stream. Auvil says the bacteria can be in the blood stream for up to a half hour before the pet’s immune system can take care of it. By that time, the problem could have spread to the kidneys, lodged in heart valves, or even started causing problems in the knees.

Indeed, oral care should be considered part of a pet’s regular health checkup. How often a pet needs to be examined depends on its breed and size typically, says Auvil. Cats, and smaller breeds of dogs should probably be examined
every six months, as they are more likely to have problems. Larger breeds of dogs such as German Shepherds and Labradors, which do a lot of chewing, can have an exam as part of their yearly checkup. Of course, there are certain things that veterinarians stress to pet owners with take-home care.

“Brushing is the gold standard for taking care of our health and for pets’ health,” Auvil says. “It’s very important.”

Dentistry as revenue for a vet practice
Grady Veterinary Hospital services the suburban Cincinnati area, providing care 24 hours a day seven days a week. It is staffed by nine veterinarians, including Auvil, a board certified veterinarian dentist, and is well stocked with advanced equipment in areas such as radiology and ultrasound, along with traditional services.

Auvil estimates that about 12 percent of the hospital’s revenue is generated through dental work, not including byproducts of the procedures that typically occur, like lab work. The hospital’s owner, Jeff Grady, DVM, says that the dental side of the business has been flat this year, which is to be expected given the current market conditions. Elective procedures in general are tougher sells to customers, he says. In the past, it may have taken just one or two examinations and consultations before customers elected to have dental cleanings done for their pets. Now the process is more drawn out.

“They’ll do it eventually, but they’re trying to put things off as much as possible on certain things they don’t perceive as emergencies,” he says.

Versailles, Ohio-based Midmark Corporation, which does business in the human dental and medical markets, launched its first products into the veterinary dental segment in August 2008. Jamie Renner, Midmark’s market manager – vet division, says he is getting much the same vibe as Grady – that is, that vet dentistry business is in a holding pattern. But as customers become less hesitant to spend money on elective procedures, the dental segment could see plenty of growth.

“Dental is a great opportunity for clinics to supplement their revenue,” Renner says. “Beyond the financial arguments for promoting dental in clinics, it is just good healthcare. More and more studies are proving the link between periodontal disease and other systemic health issues in dogs and cats, like heart disease, for example.”

Why efficiency matters
Veterinary practices need the equipment from distributors and manufacturers to put together an effective dental suite, yes, but there’s more to it than the big ticket items. In fact, building an effective suite doesn’t start with the tangibles, but rather, with the intangibles – workflow management and overall efficiency. The key for reps wanting to bring value to their customers with dentistry sales is to offer an expert eye on how the veterinary practice can increase its capabilities and number of procedures, without sacrificing quality.

Unlike some practices, Grady Veterinary Hospital hasn’t been in a holding pattern to upgrade its dental suite. In fact, it may be on the cutting edge. That’s because it recently entered into a partnership of sorts with Midmark. The manufacturer approached Grady, hoping to find a vet practice that would allow it to observe procedures and everyday workflow. Grady says they filmed procedures and brought the research back to their plant to study what could be improved. Grady and members of his staff were also able to tour the manufacturer’s facilities to get a better understanding of how it approaches workflow issues. Grady says it was an eye-opening experience.

“There’s been a lot of knowledge gained,” he says. “It’s made us more aware of workplace efficiency. The way they look at it from a manufacturing perspective is something we really haven’t done a good job of in vet medicine in general.”

So far, the results of the collaborative have been encouraging. With equipment upgrades and recommendations, the dental suite alone has seen a 15 to 20 percent increase in efficiency, and Grady is looking to implement more workflow management practices throughout the hospital in the coming weeks and months. The increase has meant more time to do cleanings.

“It’s enabled us to do an extra one every day,” Grady says. “Before, four was no problem; five was kind of pushing it. Now it’s not really pushing it. Hopefully as we keep improving this, we’ll also improve that number.”

The equipment
Grady says the hospital has seen big gains in productivity by upgrading its wet tables and X-rays. Older wet tables couldn’t be raised or lowered, and positioning large patients on them could be cumbersome and slow-going. Plus there were cords to deal with on the low speed and high speed drills, and angles to consider for technicians and the doctor performing the cleaning.

Upgrading to digital X-rays was a huge improvement as well, Grady says. “That allows us to take an X-ray of the teeth, and we have an image within five seconds. Before, it was about three minutes per X-ray. The dental X-rays are a little bit trickier to take, and sometimes you need to do retakes. So, before, you might have to do a couple of retakes to get the shot you want. Now, if we take an image and do a couple of retakes, it might take a minute, whereas before it took us eight to 10 minutes. That’s been a huge improvement.”

Renner says the Grady experience shows that distributor reps should encourage customers who are considering offering more dental care to avoid skimping on the equipment.

“For a clinic that has not been promoting dental at all, the basic tool of the trade to properly treat the majority of issues they will see is a high speed dental delivery system,” he says. “The basic components of the system should include a high speed hand piece, low speed hand piece (or hygienist hand piece), air/water syringe and ultrasonic scaler. The quality of this system is critical for the clinic to have a successful journey into this new territory, and distributor reps don’t want to have to deal with the headaches associated with poor quality equipment. There are systems that are self-contained, meaning the compressor is built into the cart, as well as systems that can run on centrally supplied compressed air or nitrogen.”

Sidebar:

Signs of oral and dental diseases in dogs and cats:

• Bad breath.
• Loose teeth or teeth that are discolored or covered in tartar.
• Pet shies away when you touch the mouth area.
• Drooling or dropping food from the mouth.
• Bleeding from the mouth.
• Loss of appetite or loss of weight (this combination can result from diseases of many organs, and early veterinary examination is important).

Source: American Veterinary Dental College (www.avdc.org)