By Amy Birchall, RVT

Although veterinary technicians often come into their role expecting to work with animals, we don’t always consider the other aspect of the job: working with clients. The reality is we spend a lot of time communicating with clients. As we must help them learn what is happening with their animals and why certain things are needed for their pet’s health, we play a crucial role in our patients’ long-term well-being.

This communication becomes especially vital when addressing prevalent health issues such as periodontal disease, which affects approximately 80 per cent of dogs and 70 per cent of cats by age two.¹ These issues present a significant animal welfare concern. Yet, even though dental and oral diseases are some of the most frequently seen diseases in cats and dogs, they are still frequently under treated.² When talking with clients, we can explain how this can affect their pet’s quality of life and their bond with them.

In this article, we are going to explore how veterinary technicians can help clients understand the prevalence and significance of periodontal disease.

The typical appointment

Let’s look at the typical vaccine appointment on any given day.

The client and their pet, a two-year-old Labrador Retriever, get settled in the room. I enter, introduce myself, and explain that I will be performing an initial physical assessment and getting some history before we’re joined by the veterinarian.

I start with a nose to tail assessment, checking temperature, pulse, and respiration while chatting with the client. Everything is going smoothly. I examine mucous membranes and capillary refill time. While doing that, I look at the pet’s teeth. There is little to no calculus that I can see but the gingiva do look red with maybe some edema. Nothing too worrisome.

After, I update the attending veterinarian. I let them know my findings are mostly normal and there is some gingivitis with no visible calculus. The veterinarian does their assessment, makes recommendations, gives vaccines, and we finish up.

I leave thinking I’ve done my best for the client and their pet. Imagine my shock when I discover I’m doing them a serious disservice.

The disservice? Being dismissive of gingivitis noted during the initial physical assessment. At the time, I thought those teeth were okay and that the situation was not so dire that we needed to discuss dentistry.

Yet, postponing such discussion is not helping the client or their animal in any way. If the veterinary medical team waits until the periodontal disease is more pronounced to talk about dentistry, the patient is going to require extended anesthesia, suffer through multiple extractions, bear the risk of increased infection, and so much more!

We must switch gears and work in a prophylactic manner—rather than treating to fix a dental issue, let’s focus on maintaining a healthy mouth from the start. Discuss dentistry early on and frequently. The time to advocate for proper dental care begins with the first appointment, regardless of the patient’s age.

Explaining periodontal disease to clients

The process of periodontal disease starts with plaque. I describe plaque as “fuzzy slippers.” When we wake up in the morning before we brush our teeth, it often feels as though our teeth are wearing little fuzzy slippers. That is plaque. We brush our teeth, and the fuzzy slippers go away. Our pets, however, do not brush their teeth first thing in the morning.

Plaque touching the gum causes a reaction. The gums then become red and swollen—telling you that circumstances are ripe for the development of periodontitis. The proverbial stage has been set. Blood flow to the area increases, bringing in more white blood cells. This reaction tends to lift the gumline off the tooth surface slightly, allowing for plaque and tartar to enter the area and cause further damage.

This is exactly what is happening in the patient scenario I described above. I cannot tell you how many of these exact patients I let walk out the clinic door without a proper talk about dentistry.

What the client needs to know is, at this point, the damage can be reversed with proper treatment (if there is no bone loss observed on radiograph). We can save teeth, pain, lengthy anesthesia, extractions, and cost. They need to understand that this disease process will advance if nothing is done. It is only a matter of time.

If nothing is done in early stages, the first tissues to be attacked are the fibres of the attached gingiva at the cemento-enamel junction (CEJ). Once this destruction has occurred, further damage is done by the bacteria and the body’s own defense mechanisms. The periodontal ligament and cementum are the next tissues to be attacked and damaged.

Periodontal disease causes either gingival recession (most commonly) or gingival hyperplasia. Once the attachment loss is severe enough, the tooth will loosen. Usually, any movement of a tooth with more than one root will mean extraction is necessary. This is due to the level of damage needed to loosen the tooth.

When an animal has a moderate to severe infection in its mouth eats, it causes abrasions to the fragile and friable gingiva, mucosa, and bone. These abrasions result in torn tissue and capillaries, allowing bacteria to enter the bloodstream. In severe cases, this can lead to septicemia. Bacterial translocation occurs when the colony of mostly gram-negative bacteria enters the bloodstream through the oral cavity. The likelihood of the bacteria attacking a high blood flow organ like the heart, liver, brain, or kidneys is very high.

We need to be doing everything we can to prevent the disease from advancing to this point. When you have conversations with clients, do not scare them. Instead, communicate so they understand that, as it is a progressive disease, waiting to start proper management will not save them anything (even though they may feel it could in the short term).

What can technicians do during appointment time

When days are very busy and booked steadily from start to finish, it is easy to look past something like minor calculus on teeth in young animals, but we need to start educating clients on tooth health from the start. Remember, take the time it takes!

If the animal is a puppy or a kitten, talk about training for tooth brushing, healthy food and toy choices that are proven to remove plaque and calculus, and the dental care the hospital can provide under anesthesia.

If the animal is young and healthy, talk about stopping the process of periodontal disease in its tracks with a comprehensive oral health assessment and treatment (COHAT) and what the plans will be to maintain that healthy mouth moving forward (the annual COHAT, tooth brushing, dietary changes).

If the COHAT is the required course of action, explaining that procedure should always include a breakdown of associated costs. This can be a scary moment. The clients are worried about receiving the information and we are often worried about presenting it, but do not shy away from your estimate. You are providing valuable services; this is your time to highlight those services.

Take the time to explain each line item. These different explanations can include the benefits of pre-anesthetic bloodwork, proper sedation, IV catheter and IV fluids, full mouth dental radiographs, the cleaning itself (including subgingival curetting), pain management (including regional analgesia), anesthetic monitoring and support, etc. In my experience, once clients understand why we do those things and how they benefit their pets, the barrier of cost becomes less so.

If cost concerns are truly unsurmountable, do not let that client and pet walk away with nothing. You still need to ensure they understand periodontal disease and understand (and keep) the estimate. You can still talk to them about tooth brushing and/or maybe provide them with samples of food that have the Veterinary Oral Health Council (VOHC) seal of approval.

Use this time for education and advocacy regardless of the outcome. It is time you need to invest.

Why recommend preventative COHAT?

Let’s look at two patients. Patient A is young and healthy with minor calculus on their premolars and molars, and some gingivitis. Patient B is older with severe gingivitis, bleeding, and multiple teeth requiring extractions.

Patient A is going to have little to no visible impact at home. They will be playing with their toys and eating normally. There will be no signs of oral pain. Their COHAT is likely to be brief anesthesia, including full mouth radiographs (hopefully showing no structure loss), and cleaning of both the crown and the subgingival space. Afterwards, Patient A can wake up and go home to start on additional care and maintenance. Patients like them are ideal, they’re right at the stage where we can make a massive difference in reversing the periodontal disease process before it fully begins.

On the opposite end of the spectrum is Patient B, an animal with severe disease. The owners are likely to have seen changes at home, including less chewing or play behaviours, changes in diet, and a bad smell in the mouth (possibly altering their bond with their pet). There will be marked signs of oral pain. That patient’s COHAT is likely to be a lengthy anesthesia, possibly requiring staging (i.e. some portions of the mouth done in one session, and then the remaining portion being completed during a secondary session of anesthesia), full mouth radiographs likely to show structure loss, infection management, increased pain management, extractions, and extensive cleaning of the remaining teeth.

Although this procedure will have marked benefit to Patient B’s quality of life and is required, it comes with increased risk and cost. Would it not be better to see more patients like Patient A, those who had their COHATs booked much earlier on? With follow up care, we can maintain a better standard of health for that animal.

What can technicians do after a COHAT

A lot of care needs to happen after a COHAT, so I use a phased approach to discharging a COHAT patient. On the day of discharge, talk to clients about post-anesthesia related care: When their pet can eat and what can they eat, what signs may concern them but are not an issue, and what signs should prompt them to call your clinic.

Before a client leaves with their pet, book a follow up appointment with a technician in seven days. This is a complimentary appointment where you can talk about the COHAT itself. Look at before and after pictures of the teeth, the full mouth radiographic series, the veterinarian’s findings, and the plan moving forward to keep the mouth healthy. Owners should understand that one COHAT is not a permanent fix. Plaque starts to adhere to the teeth again approximately six hours after the cleaning. Now that the mouth is well into the healing process from any extractions, you can explore teeth brushing, diet changes, and regular assessments for tooth health.

I find many questions are answered during this follow up and a true understanding of the disease and its management is developing. This, in my opinion, is truly a winning moment for the client, the pet, and the veterinary medical team.

Conclusion

Education in medicine is crucial. It is important to us as professionals, and it is important for clients to help them understand why we advocate for the procedures we do.

It is critical for us to start providing dental education to clients earlier and advocating for procedures like the COHAT when the animals have few signs of periodontal disease (such as gingivitis). These changes are key to helping animal family members live healthier, longer, and more comfortable lives. The animals and their people will thank us.

Amy Birchall, RVT, is an educator based in Nova Scotia. In 2003, after graduating from the veterinary technology program at Olds College in Alberta, she began her career in rural mixed-animal practice, then took a role at a small animal and exotics practice closer to Calgary, where she developed a love of small animal anesthesia and surgery. Birchall started teaching at Olds College in 2008, focusing first on small animal anesthesia and surgery and, later, dentistry. She joined the faculty of Dalhousie University’s veterinary technology program in 2015, leading lectures and hands-on courses on small animal anesthesia, emergency critical care nursing, pain management, and small animal dentistry.

References

1. Agraham. (2022, October 6). Periodontal disease: Utilizing current information to improve client compliance. Today’s Veterinary Practice. https://todaysveterinarypractice.com/dentistry/practical-dentistry-periodontal-disease-utilizing-current-information-to-improve-client-compliance/#:~:text=The%20following%20facts%20are%20particularly%20important%20to%20share,and%20toy%20breed%20dogs%20are%20particularly%20susceptible.%204
2. Niemiec, B. A., Gawor, J., Nemec, A., Clarke, D., McLeod, K. C., Tutt, C., Gioso, M. A., Steagall, P. V., Chandler, M., Morgenegg, G., & Jouppi, R. (2020). World Small Animal Veterinary Association Global Dental Guidelines. Journal of Small Animal Practice, 61(7). https://doi.org/10.1111/jsap.13132