Originally published in the February 2015 issue of Veterinary Practice News Imagine you’re a dog owner and visit the veterinarian for your dog’s annual checkup. You spend $208 for an exam, vaccines and diagnostic tests.1 During the exam, the doctor diagnoses your dog with grade 2 dental disease and recommends treatment. A technician gives you an estimate for $427.1 You’re facing a total of $635 in veterinary care—when you assumed your dog just needed an exam, vaccines and heartworm/tick and intestinal parasite tests. Not surprisingly, 34 percent of pet owners say their veterinary bills are higher than they expected, according to the Bayer Veterinary Care Usage Study.2 Veterinarians often diagnose dental disease during routine exams because 80 percent of dogs and 70 percent of cats age 3 and older have dental disease, according to the American Veterinary Dental Society.3 Your team’s ability to confidently explain the dental diagnosis, treatment and fees will determine whether pets get needed medical care. To take a fresh approach to client communication, look at dentistry from the client’s side of the exam table. Here are common client reactions when hearing dental recommendations and how to respond: “Sure, my pet has bad breath. That’s normal.” Teach pet owners that bad breath equals infection. A third of pet owners are unaware that bad breath is a serious health issue, according to a Banfield Pet Hospital study.4 Bad breath is an early indicator of dental disease, which is the most common disease among pets. The survey found that more than half of dog owners (57 percent) admit their pets have bad breath, yet only 6 percent cite the smell as a reason to schedule a dental cleaning. When performing the oral exam, veterinarians should show pet owners signs of dental disease. To stress the fact that bad breath equals infection, take an audible deep breath during the oral exam. If you smell stinky breath, say, “Wow, have you smelled your pet’s bad breath? That means there is an oral infection. Let me explain what we need to do to treat your pet’s oral infection.” Help clients realize that dental disease can have serious health consequences such as: Painful abscess Jaw becomes fragile and can fracture Toothache can cause the animal to eat less or not at all Bacteria passing through the bloodstream can cause problems with kidneys, lungs, heart and liver To educate clients about the severity of dental disease, score dental disease during every exam. Just as veterinarians do body condition scoring, they should assign a dental score of grade 1, 2, 3 or 4 to each patient. This medical recordkeeping habit encourages continuity of care in multi-doctor practices and is more accurate than “mild, moderate or severe.” Veterinarians should ask assistants or technicians to present a dental treatment plan whenever a pet scores grade 1 or higher. The veterinarian would say, “<Pet name> has grade 2 dental disease. She needs a dental treatment now to slow the progression of her dental disease and to treat the infection. As her dental disease gets worse, serious health problems could happen. It’s common for pets to get painful abscesses or toothaches that cause them to eat less or not at all. Bacteria in the mouth can pass through the bloodstream and permanently damage the kidneys, heart, liver and lungs. A dental treatment will remove built-up tartar and plaque. I will have my technician explain our 12 steps of a professional dental cleaning and also talk with you about easy home-care products that fit into your schedule.” “Will my pet wake up?” Address clients’ fear of anesthesia. Many pet owners may be afraid of anesthesia, yet veterinary teams often jump to judgment and assume rejection centers on price. Unlike people, pets won’t tolerate a thorough full-mouth examination, dental cleaning and extractions without anesthesia. In human medicine, a third of patients have a fear of anesthesia distinct from their fear of the surgery itself.5 Anesthetic-related death is 1 in 1,000 pets, according to Richard M. Bednarski, DVM, MSc, Dipl. ACVAA, a board-certified veterinary anesthesiologist at The Ohio State University College of Veterinary Medicine. Pre-existing diseases, such as chronic heart or lung disease, are an increased but acceptable risk.6 To overcome the fear, have your staff stress the importance of preanesthetic testing. Use the word “include” if preanesthetic testing is required because “required” sounds like a rule that some clients might challenge. You won’t get any arguments if it’s included in the dental procedure. If preanesthetic testing is optional, use the word “recommend.” Say, “We include/recommend preanesthetic testing. Just as your doctor would have you get a blood test before undergoing surgery, we offer the same for pets. This simple blood test can significantly reduce medical risk and ensure your pet’s health and safety.” Also discuss surgical monitoring, which will reassure clients and is similar to their experiences in human medicine. Avoid medical jargon that makes the procedure sound expensive and scary. Never say, “We will hook your pet up to an electrocardiogram and pulse oximeter.” Instead say, “We’ll monitor your pet’s heart rate, level of oxygen in the blood and body temperature during the dental treatment.” “I can’t afford the dental procedure.” The first no is not the final no. Never let money concerns get in the way of pets receiving the medical care they need. Present third-party financing so you can deliver needed medical care. Say, “I understand you’re concerned about the cost of Sophie’s dental procedure, which is $600. We offer CareCredit, a payment plan for approved clients, which has six months of deferred interest. Would $100 per month better fit your family’s budget?” If a client gets declined, present the option of a co-applicant. Say, “Although you were not approved, CareCredit offers the option of co-applicants. Do you have a family member, friend or neighbor who could be a co-applicant with you?” Temporarily erase your veterinary expertise and look at dentistry through clients’ eyes. What would cause you to hesitate to have an anesthetic procedure on your own pets? Write down potential objections and then create talking points that address those concerns. When you look through the eyes of clients—and think like a pet owner—you’ll be a more effective communicator and get more pets the dental care they need. References 1. AAHA Veterinary Fee Reference, 8th edition, AAHA Press 2013; pp. 55, 59 and 115. 2. 2011 Bayer Veterinary Care Usage Study conducted by the National Commission on Veterinary Economic Issues, Brakke Consulting, and Bayer Animal Health. Accessed Dec. 26, 2013 at http://avmajournals.avma.org/doi/full/10.2460/javma.238.10.1275. 3. American Veterinary Dental Society. Accessed at www.vetmed.ucdavis.edu/vmth/small_animal/ dentistry/client_info/dental_care.cfm on 08-18-14. 4. Banfield sinks its teeth into pet dental health. Feb. 6, 2013. Accessed at www.banfield.com/about-us/news-room/news-archives/banfield-sinks-its-teeth-into-pet-dental-health on 09-17-14. 5. Levenson, J.L., MD; Psychiatric Issues in Surgical Patients Part I: General Issues, Primary Psychiatry. 2007;14(5):35-39. Accessed 12-15-14 at http://primarypsychiatry.com/psychiatric-issues-in-surgical-patients-part-i-general-issues/. 6. Vanrenen, B. The only thing to fear is the anesthesia. AAHA Pets Matter, Jan. 3, 2014. Accessed on 12-15-14 at www.aahanet.org/blog/%28X%281%29%29/petsmatter/post/2014/01/03/096527/The-only-thing-to-fear-is-the-fear-of-anesthesia.aspx.
