Fearless columnist Natalie L. Marks is an educator, consultant and practicing Chicago veterinarian. Dr. Marks is a leader within the Fear Free movement, was a member of the original Fear Free advisory board and is Fear Free Certified Elite. She passionately believes that all veterinarians should be committed to the physical and emotional health of their patients.Read Articles Written by Natalie Marks
Odontophobia: the fear of going to the dentist. Millions of people have it and the human dental industry has spent years trying to overcome it, from allowing patients to customize music choices and sit in a massage chair to using less-painful nerve blocks and providing faster, more comfortable cosmetic choices. Still, a significant number of people are reluctant to see a dentist even once a year, and this fear can translate into fewer visits and less dental compliance with veterinary patients.
But the moment has arrived. We now have new and very effective strategies in veterinary medicine that can lessen fear, anxiety and stress in all aspects of the dental visit.
Why should every small animal practitioner read this article? Three reasons.
- Oral disease is one of the most common diseases diagnosed in veterinary medicine. Over 80 percent of dogs and 70 percent of cats will have some form of periodontal disease by age 2.
- A dental machine is the most commonly purchased piece of veterinary equipment for small animal practice. It also should be the most used and charged for, helping to pay off the lease or debt and drive up the profit center.
- Utilizing techniques to lessen fear, anxiety and stress in both the patient and owner builds trust in the veterinary-client-patient relationship. This allows the veterinarian to explain the value of the preanesthetic blood work requirement (not a recommendation), the new but safer anesthesia protocol, the benefit to anesthetic monitoring and the importance of the pain management cocktail. Clients, as we’ve discussed before, will then believe more in the process and become more compliant, increasing the quality of medicine and revenue in the practice.
Show and Tell
Even though periodontal disease is one of the most common conditions seen in small animal practice, some of the signs can be quite subtle, especially to pet owners. The start of every veterinary dentistry procedure is the initial consult exam. In this time together, showing the inside of the patient’s mouth to the client is incredibly important, but doing so might be difficult when the patient has a painful mouth and fears the hospital, the staff or the restraint.
We can’t immediately resolve the pain of periodontal disease or resorptive lesions, but client administration of trazodone to dogs or gabapentin to cats two hours before an exam will help the patient be more tolerant of a thorough physical and painless oral exam. If your patient is relaxed, your client likely will be, too.
Note that many veterinary dentists recommend offering a prized food option during the physical exam, like cheese spread on a dog chew or pureed chicken baby food for cats. This step entices the patient and lessens fear and anxiety associated with the exam room.
The anxiety and stress of seeing their dog or cat in pain can be difficult for pet owners. However, clients also are fearful of the anesthesia associated with a procedure and the financial investment required to resolve the disease. Instead of looking at this struggle as a roadblock to successful dentistry, consider it an opportunity for implementing better medical and anesthesia protocols that can generate income for further hospital investment.
Consider this: Nationally recognized veterinary dentist Brook Niemiec, DVM, DAVDC, explains that if a practice can do one more procedure a day, five days a week, at an average retail cost of $400, the practice can earn an additional $8,000 a month. Eight thousand additional revenue dollars can make a big difference in any veterinary business.
Please the Senses
Once a client provides authorization, consider ways to reduce the fear, anxiety and stress associated with the entire procedure, including preoperative arrival and diagnostics and postoperative recovery.
Besides the universal recommendation of utilizing a pre-visit pharmaceutical for the patient, encourage clients to travel to the practice while listening to soothing music, like “Through a Dogs Ear” on iCalmPet. Pheromones like Adaptil for dogs and Feliway for cats can be very helpful creating natural relaxation in the car or carrier. The patient also can be administered a dose of maropitant in a small treat two to four hours before the procedure. This will reduce the chance of nausea and vomiting and get the animal to eat sooner after anesthesia.
Once the patient arrives and to lessen distractions, have a dental technician handle the admission inside an exam room, if possible. Painful stimuli, like blood draws and placement of intravenous catheters, can be drastically reduced if topical lidocaine gel is applied to a shaved site 15 minutes before the venipuncture. A ThunderShirt or Thundercap can be used in the hospital to reduce preoperative anxiety, and a warm towel or bed can bring extra comfort.
Each veterinary dental team should prioritize pain management cocktails to address intraoperative discomfort. Also, be sure to anticipate what will be needed in recovery. The postoperative process will succeed not only because of the pharmaceutical choices but due to diligent anesthetic monitoring and important feeding recommendations. Veterinary dentists recommend changing what the dog or cat eats into something they love. This might mean adding scrambled eggs to a dog’s diet or pureeing a soft canned food into a souplike meal for cats.
If the patient’s mouth is painful at meal time, the animal can develop an aversion to the food or to eating in general. This can develop into an anxiety that sometimes proves difficult to resolve.
‘42 Little Patients’
As another prominent veterinary dentist, Jan Bellows, DVM, DAVDC, DABVP, said in a podcast: “Nearly 70 to 80 percent of dogs and cats that present to your practice typically have some form of dental disease. Consider every dog as having 42 little patients inside their mouth, and 30 little patients inside the mouths of cats.”
If we think in this framework, we can put oral health in the forefront of the physical exam, demonstrate periodontal disease in real time to clients, and educate them about the disease, treatment options and prevention.
However, we must keep in mind that a large number of clients are fearful about their own dental visits, their pet’s dental appointment, anesthesia and the financial investment. Take a moment with your team to identify all the client and patient touch points in which fear, anxiety and stress can be reduced or eliminated. Consider the initial consult, the preanesthetic blood draw, the procedure and the recovery period.
As veterinarians, we have a unique opportunity to address and change fears associated with dentistry. We can build our business and continue to do better and be better for our clients and patients.