Here’s something to chew on:

In the last 25 years, veterinarians have become increasingly concerned with their patients’ oral health, and today more than ever, they count on their distributor reps for the right products to provide the best oral care.

“In the 1970s, animal oral healthcare was about pulling teeth out,” says Jeffrey Klausner, DVM, MS, DACVIM, senior vice president and chief medical officer of Banfield, The Pet Hospital®. “Today, however, it has become a much larger part of veterinarians’ practice.” In fact, the mouth has come to be regarded as a window to pets’ overall health, he points out. “Oral disease can be a sign of poor systemic health or disease, and it can provide clues about pets’ overall health,” he says.
Indeed, periodontal disease is sometimes associated with a number of other health issues, notes Klausner. Ulcers on dogs’ and cats’ gums or lips can be a sign of renal failure or cancer in older pets, he explains. Immuno-suppressed animals may have oral inflammation. Ulcers in the mouth or changes in the breath may indicate uncontrolled diabetes.

Oral health becomes especially important in aging pets, he continues. “Over the years, periodontal disease takes its toll,” he points out. Cancer and renal disease often affect older pets. In addition, changes in gum coloring can indicate liver disease, heart disease or anemia.

The battle below the gums
Even when pet owners are careful about brushing their pets’ teeth, dogs and cats require a thorough oral exam as part of their bi-annual preventive health checkup, experts report. “It’s not what we see, but what’s under the gumline,” says Brett Beckman, DVM, Florida Veterinary Dentistry and Oral Surgery. “Periodontal disease can begin as soon as the adult teeth are in, at about five or six months of age.” However, puppies and kittens may require oral exams every four to six weeks as they mature, he says. “Problems such as teeth touching teeth or teeth touching gums require selective extractions to eliminate immediate contact and to help ensure the adult teeth develop correctly. In dogs, we commonly see the lower teeth contact their palate, often because the lower jaw is too short. This can be painful and prevents proper jaw development, setting the puppy up for problems with its adult teeth.

“A good oral exam includes an evaluation for malocclusions where a tooth is touching another tooth, or a tooth is touching the gum or palate tissue and causing problems or potential problems,” continues Beckman. “We look at all of the oral structures, including the tongue, the floor of the oral cavity under the tongue, the tonsils and the lip margins and we thoroughly evaluate the gums and cheek tissue. We also palpate the lower and upper jaw to detect pain or enlargements and evaluate lymph nodes for swelling.”

Animal oral exams are very similar to human oral exams, notes Klausner. The veterinarian relies on ultrasonic scaling, dental charting, polishing and an oral rinse. Some veterinarians rely on high-speed delivery systems (or drills), with an ultrasonic scaler incorporated into the system.

“We want to see below the gum line, [so] scaling is done under anesthesia,” Klausner explains. “The use of anesthesia is considered very safe as long as the animal doesn’t have another disease process going on. So, every animal gets a complete medical exam and lab workup [at the same time].” The safety of anesthesia isn’t necessarily associated with the animal’s age, as long as it is healthy, he adds.

Indeed, veterinarians can get a much closer look at the mouth when the patient is under anesthesia, notes Beckman. “We can more readily visualize the back part of the mouth, look more closely at each tooth and check for periodontal pockets,” he says. “This is very important in that pockets between the tooth and the gum are an early sign of periodontal disease.

“Any patient that does not have other diseases that may increase the risk of anesthesia does quite well, even [when undergoing] radical surgery, like multiple extractions or jaw surgery,” he continues. “Local anesthetic nerve blocks allow us to keep the patient at a light anesthetic plan, where it can still swallow. This allows blood pressure, heart function and respiration rate to be close to that of the awake patient.”
The use of anesthesia is “absolutely necessary” to enable veterinarians to examine below the animal’s gum line, says Kevin Stepaniuk, DVM, FAVD, Dipl. ADVC, College of Veterinary Medicine, University of Minnesota. “Clients often are afraid of using anesthesia, but it can be [administered] safely by providing IV fluid support, catheters, monitoring the patient and keeping it warm. [Regardless], the use of anesthesia is absolutely necessary for a proper dental evaluation.”

Even in circumstances where pet owners brush their pets’ teeth every day, pets still need to have their teeth cleaned and examined by the veterinarian, he continues. “The battle of periodontal diseases is a battle below the gum line,” he continues. “That’s where the battle is won or lost, and that’s why veterinarians need to use anesthesia.”

How important is radiography?
If you can’t see it, you can’t treat it, say many veterinarians. That’s why X-ray is perceived by many as an essential diagnostic tool. True, dogs and cats don’t develop dental cavities the way humans do, so the need for X-rays often is less for them, according to Klausner. Still, without X-ray, veterinarians cannot detect issues below the gum line, he points out.

“General veterinary practitioners can provide excellent routine care, but they should definitely have the capacity to take dental X-rays,” says Beckman. “A lot of periodontal disease is what we don’t see under the gum line, not what we do see on visual examination.” Furthermore, when veterinarians invest in dental radiography, “they probably have invested a lot of time in learning about veterinary dentistry.”

“We know that dental radiographs are essential,” adds Stepaniuk. After all, they allow the veterinarian to evaluate a number of things, including periodontal pockets, missing or fractured teeth, nasal discharge, draining tracts and potential tooth extractions. “However, the mode is up for debate. Standard film works well and is less costly, so it’s a good option for veterinarians getting started. But, digital radiographs are faster and allow the veterinarian to project images to a larger monitor to evaluate them and educate clients.” The risk, however, is that the veterinarian will over-interpret an image portrayed on a larger screen, he adds.

And, digital radiography is more costly than traditional X-ray, Stepaniuk says. A wall-mounted generator can cost between $7,000 and $10,000. A side chair developer costs about $500-$600. And, digital sensors (which can be added later on) range from $9,000 to $15,000.

Still, the return on investment makes digital radiography attractive to more and more veterinarians today, he notes. “Most two- and three-veterinarian practices I have consulted say they have been able to pay for their equipment in about six months,” he says. “Say a three-veterinarian practice takes two digital radiographs each day at $25 each. That equals $50 a day or $500 a week, $2,000 a month or $24,000 a year.” At the same time, the veterinarian is providing great patient care, he adds.

The rep’s role
Five years ago, only about five veterinary schools had dentistry programs, notes Stepaniuk. By comparison, of the 30 veterinary colleges in North America today, about 10 have oral programs, he says. “From a vendor standpoint, there’s a huge market out there.”

Distributor reps should familiarize themselves with their customers’ needs, notes Beckman. “Reps should get more exposure to dental labs,” he says. “They should get to know the equipment, [including] digital radiography and high-speed delivery systems. Know why this equipment is important, how it works and how it can help the veterinarian.

“Distributor reps should be involved in dental labs and attend lectures,” he continues. Their best bet is to be more knowledgeable than their customers are, he points out. “Make an effort to know and understand the equipment you sell.”
Veterinarians value clinical data and information, and distributor reps can help their customers by providing this, adds Klausner. “The more the veterinarian understands the diseases of the oral cavity, the better [he or she] can address them,” he says. And more and more veterinarians are coming to realize that without good dentistry, they’re not practicing the best medicine, he points out. “This is a way [not only to] generate resources for the practice, but to do a great job taking care of patients. The mindset among veterinarians has changed in the last 30 years,” he says.

The bottom line: If your customers don’t sink their teeth into this branch of medicine soon, they – and their patients – are missing out.

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