Only Brush the Teeth You Hope to Keep!

Well, I just got a Facebook message from a technician from New York that asked the question, " is there any special way a pup/dog's teeth should be brushed?"  I was looking for the next topic from which to blog and this was the perfect subject.  It is actually one about which I am very passionate.

I believe that it is important to break this training down into baby steps.  

1.  Find out what your pet perceives as a reward.  Some pets like Pet Poultry Toothpaste. if so, I would use this as the reward and at first just put a dab on your finger for the pet to lick off.  You may need to reward with peanut butter, or a small piece of cheese.

2.  I will ask you to choose a place in your house where you will be apt to do it EVERY day. Plaque begins to lay down after 8 hours after a meal but I can not expect pet owners to do it three times a day.  Most people have a hard time providing that care for themselves despite the fact that is recommended.

3.  Pick a time of the day when you are apt to be able to do it EVERY DAY.  No fair doing it before you go to work one day and then before bed another.

4.  When your pet comes when called to that place and at that time...reward the behavior. So, for me, when I called Crayons, my cranky cat, to the bathroom at 7 am and she showed up, I rewarded that behavior alone.  For cats, attention and fuss may not be perceived as a reward...a treat may.  Dogs tend to like attention, so feel free to speak in a high voice and give a treat as well.  I do nothing further.  I repeat this daily until the pet starts to show up on his/her own looking for the reward.  Note the shift in power...they are now asking for it, you are not forcing it.

This took 2 weeks for Crayons to show up in the bathroom at 7 am.  But, I did not "up the anty" until that time.

4.  Now introduce that TOOTH BRUSH"!   If your pet likes the toothpaste, then load the toothbrush with the toothpaste.  When the pet comes to your chosen place at the chosen time, just let them lick it off the toothbrush.  Some pets may be reticent to do so.  Coax them nicely and reward the behavior when they do so.  

For Crayons...the first day of toothbrush introduction was slow.  She approached it slowly as if it were going to bite her.  But, she smelled the toothpaste (her reward and slowly tested it.  Then everyday she became a little more confident.  After about 2 weeks of this step...she would run into the bathroom at 6:50 am and meow for the toothbrush and toothpaste.  Now, time to step it up.

5.  Now, for cat owners, you may prefer the pet be on a higher surface.  So for me I had to add the step of Crayons jumping onto the bathroom vanity counter.  The first day of this step took forever, but eventually she did it.  When she did, I rewarded her with the toothpaste on the toothbrush (just licking it off).  Eventually, Crayons was sitting on the counter, waiting for her treat at 6:50 am.  For dogs this step is not appropriate.

6.  Now we have to get the pet comfortable with us touching the head/mouth.  So, I put my hand above the pet's head, touching it so lightly that I could barely feel the hair touching the palm of my hand.  Then I redirect their attention to the toothbrush and reward.  I NEVER BREAK their trust.  When they eat the toothpaste off the toothbrush, I take my hand away and reward with a little bit more toothpaste.

The next day I put the tiniest bit more of pressure to the top of the head.  Then every day a little more pressure.  My goal after about 2 weeks is to be able to drop my thumb to the cheek and pull the cheek back a little and DAB the couple teeth you may see with the toothbrush and reward the pet for allowing this.  The next day, I dab the right and the left.  The next day I may use a little brushing action and reward.  Then every day I increase it a little bit and reward.

Eventually, your pet will come to trust you handling their mouth and will actively ask to have this done purely because they want the reward.

I have no pattern I want you to do...back and forth, in a circle, while you are standing on your head....I don't care.  Just get in their and get the food off of the teeth.

Some final thoughts:

• If they don't like the toothpaste, use water on the brush and reward with something else.
• Use pet toothpaste not human.  Human toothpaste is not designed to be consumed.  It has whitening agents, abrasives and foaming agents added.  These can cause GI upset in your pet.
• Use some sort of toothbrush with nylon bristles.  It is the gold standard in human medicine...why would it be different with these teeth?  The finger brush with rubber bristles is good for training but you should switch to nylon bristles eventually.
• Take it as slow as you have to.  Golden retrievers may train very fast while a Yorkie or Pug may take much longer.
• Tooth brushing does not negate frequent professional cleanings but it may decrease the frequency required to maintain your pet's oral health.
• Be honest with your veterinary professional.  if you can't manage the training, your pet is particularly nervous, or you can't find the time to do this, let the veterinary staff know.  This will help them know how frequently they need to recommend professional cleanings.  They will want to tailor the recommendations to your pet individually.

I have put a link here to a video of my brushing my cat's teeth.  It is about 34 seconds long.  She has had this done daily since she was a kitten and she is 17 years old now.  She has never had gingivitis, periodontitis nor any resorptive lesions.  I do clean her teeth about every 18 months.  My veterinary dentistry bills are low.

Crayons Tooth Brushing Video

For the vet professionals out their...here is your homework.  If you have not trained your own pets to tolerate and participate with tooth brushing, I recommend you give it a try.  All it will cost you is 34 seconds and a little patience.

Are We REALLY Educating our Clients?

After decades of client interactions with those that have provided expensive dentistry for their pets, I began to notice a pattern in statements made by these clients.  When they came in for their post extraction rechecks, they were asking the same thing; "How did this happen?  How did Diogee's mouth get so bad that he required 12 extractions?" I would then explain periodontal disease and the care necessary to keep oral health in check, and their eyes often glaze over.  That look says it all; "I can't brush my pet's teeth and it is so expensive."  Frustration ensues!

A light went on for me and I realized they do not know how to train their pets to have their teeth brushed and they do not know what products to purchase.  I have also come to know that our clients do not know how to properly choose a chew toy, how often dentistry is required, the importance of dentistry, what a dental diet is and most have no idea that animals do not overtly demonstrate pain unless it is acute, but that they experience it the same as we do none-the-less.  

That made me ask, what else do they not know?  Do they know that halitosis is NOT normal?  Do they know that often a fractured tooth is painful even if they are wagging their tails or purring?  Do they know what steps the practice takes to safe guard their pet during anesthesia?  Do they know that we will only continue the procedure if the anesthetist feels it is safe?

I then understood why the clients are all saying the same thing.  They have not been educated and they feel like it is all out of their control.  It is sort of how I feel when I pick my car up from the service station.  I write a big check.  I don't really understand what was done and I thought by changing my oil and getting my transmission checked, I had done what I was supposed to do to make sure my transportation is reliable. Frustration ensues!  And, does that experience make me apt to swing by for wiper blades or will I stop by Walmart for them?  Walmart!  And, if a friend shared that they got service elsewhere cheaper, am I apt to switch?  Unfortunately, YES! And, aren't these experiences similar?

What are you doing in practice to make sure all of these questions are addressed? Are you using brochures? Do you actually hand them out?  Have you developed your website enough?  And, if you have, have you tracked the success or does it just cost money and make you feel better?  Do you brush your own pet's teeth everyday and if not, how can you teach a client how to do so?

Very commonly, practices today use the word wellness on their websites, but are we providing wellness if we are not educating our clients?  Is it even possible to provide all of that information within the confines of a 20 minute appointment?  I have found that it is not, especially since most clients do not bring their pets in specifically for oral assessments.  Dentistry needs are most commonly discovered during the examination for some unrelated problem that needs to be addressed first!

So, a challenge for you all out there:  If you believe your clients deserve oral health education, maybe it is time for you or one of your staff members step up and create an educational experience for your clients.  This is something that I have done at the practice at which I work clinically.  Once a month, I stay to provide a FREE dentistry seminar for our client base.  The clients are invited by staff members for a variety of reasons; new puppy or kitten owners, owners that are reticent to provide recommended care, or owners that presented to the practice for an unrelated issue but dentistry needs were identified.

Has this been successful?  Absolutely.  For me, this experience takes about an hour and a half.  I schedule the event at 7 pm on varying weeknights.  My initial expectation was as I am sure yours is; they would be antsy and eager to get out the door.  But, that is not my experience.  With questions, the clients keep me an additional hour.  They are thirsty for this knowledge and any animal knowledge. It is no coincidence that the Animal Planet is one of the most popular cable stations available.

I have found it helps your attendance to provide a 10% off discount for attending. The discount is the initial motivator!  And, make no mistake, I do understand that there is NOT a wide profit margin on dental services.  But, what the practice gets in return is an educated owner.  That owner understands the wisdom of providing home care and the financial and medical benefit of frequent professional care and shorter, safer anesthetic experiences.  That discount is recouped many times over by the increased care that the owner now provides.  

There are so many benefits to this program:

• owners get the "tools" to maintain health and comfort for their pets
• owners provide more frequent care
• actual prophys are added to the dentistry schedule more frequently
• the increased numbers of prophys means less stressful dental/anesthetic experiences for the staff
• it gives the client a "behind the scenes" understanding of the support provided by the dentistry/anesthetic staff
• it bonds the client to the practice in a huge way

Finally, for me personally, I know that the practice has provided a system of education and ultimately we supported wellness when it comes to dentistry.

Is this tried and true?  I have provided this seminar once a month for over 5 years.  I also have been subcontracted to provide this seminar for another practice monthly for about 3 years now.  I have had attendance numbers ranking anywhere from 12-40 clients per month.

For me this program is a win-win.  The practice wins in many ways; a booked dentistry schedule, less stressful cases, better practice health and ultimately we rest knowing we are providing wellness services for our patients.

The client wins by understanding their pet's needs, their dentistry bills are more manageable and the pet wins by having better overall health and comfort.   Isn't that what we all went into this profession anyway, to help  pets because they can not help themselves.  This is an awesome opportunity to fulfill that mission!

If you would like to create an experience like this for your practice, feel free to email me (Gr8vettek@aol.com) for an outline of topics you can use.  All you have to add is your own energy, passion and love.

Good morning!  I woke up this morning and there was a notification on my PetED Facebook page.  The notification was informing me that someone that I have not met, "liked" the page.  Such a nice feeling. So, I was having my cup of "wake-the-heck up" and found myself staring at PetED's logo and day dreaming.

While in Las Vegas at the Western States Veterinary Conference, I gave a technician one of my cards after we chatted for a bit about dentistry and X-rays at the Technician Fair.  She politely took the card and innocently asked; "If you teach dentistry, why didn't you design a logo around that and why the briefcase?"  So, I thought I would share how I responded about the PetED logo.

First of all, the name of the company; PetED.  It is true that at this point, most of the business is centered around veterinary dentistry.  I am the president and that is my clinical specialty and main focus.  However, I envision a company that has a much larger scope. Having been invited into almost 50 practices to teach dentistry, I am aware that some practices have areas other than dentistry that they would appreciate help expanding or further developing.  One of the common issues that comes up whenever I teach dentistry is anesthesia.  Once practices start doing full mouth radiographs and finding additional pathology, the patients are under general anesthesia longer.  That often necessitates a good look at the practices' anesthetic protocols and practices.  

That led me to know that I wanted the company to be the resource for any of their educational and training needs.  I can't be an expert in all disciplines. Fully embracing that fact, PetED has technicians that I have had the honor and pleasure of getting to know, that are considered experts in other disciplines that can be scheduled to consult for the company.

Why the briefcase?  Well, that is to show that PetED trainers come with materials for you to keep as references when we leave your practice.  If I train technicians how to perform regional nerve blocks, I leave you with pre-calculated dosage charts.  If I teach intraoral radiographs, I leave the practice with a CD of images that show the proper position for each image.  

The briefcase also shows that we are mobile.  We pack up and come to you (although we do have a wet lab site).  The practice could be in our geographic area or we frequently travel to other states as needed.  PetED is not limited to any geographic area. As a matter of fact, I am scheduled to speak to a group in Modesto, California in a few weeks.

The paw prints are pretty self-explanatory.  This is a small animal veterinary resource (although PetED does have access to one of the leading equine technicians in the country).  

The colors?  I wanted to be memorable and that yellow jumps out at you, hopefully catching your attention.  I want you to think of PetED and our trainers when you see that yellow and blue.

And why cartoon-type imaging?  I intentionally chose images and a font that invokes a feeling of fun!  Practice life can get intense but the educational experience does not have to be.  PetED is serious about the materials and the information shared but the trainers PetED has chosen are intentionally ones that are respected but share the information in comfortable and relaxed way.  When a PetED experience is schedule, I want the staff to want to be present that day.  Education should be something to look forward to instead of something to avoid.

Well, as I look out the window and see the very early March buds on some of the trees, I marvel at the miracle of Spring.  This is a time of hope and rebirth.  The seed of PetED was planted in the fall and through the darkness of winter there was a lot of underground work done in preparation for its birth.  My hope is that the PetED trainers will be able to plant the seeds of understanding and inspiration to revitalize how you experience this profession you so passionately sought.

Have a spectacular day!

Vickie

"I didn't say they could extract THAT MANY TEETH!"

Sorry it has taken me a while to post the next blog.  Right after I posted the first, I was in the midst of a whirl wind pet sitting for a dear friend, speaking to a class of sophomore and junior high school students, speaking at Rau Animal Hospital's  client education seminar and preparing to travel to Las Vegas to present at the Western States Veterinary Conference.  The wind has settled and I have poured a cup of coffee to sit and catch up with you.  Can I refill your cup before we chat?

I had the opportunity to speak to a large group of technicians while in Las Vegas about developing a thriving dentistry department.  One of the discussions we had concerned dentistry admissions processes and consent forms.  I shared that when I visit practices often I see that the consent form has three selections from which to sign off:

Some look like this:

If further problems are detected while my pet is under anesthesia (initial all that apply)
__________ Do whatever is needed to give my pet a healthy oral cavity, but not limited to tooth extractions.
__________ Do only what is authorized
__________ Please contact me before doing any additional procedures.  if I can not be reached while my pet is under anesthesia then:
                         ___________ Perform whatever procedures are needed
                         ___________ Do only what I have authorized

I would like to challenge this form of consent.  I understand that this is an attempt to handle problems that occur every day in practices across the country.  Our patient is under anesthesia, the mouth is cleaned, charted and all X-rays have been taken.  We now know that there is much more pathology than originally expected.  A call is placed to the pet's guardian and they can not be reached.  This leaves the veterinarian in a quandary and a state of frustration.  Do we do whatever is needed or not?  With this form of consent many feel they have "informed consent" to proceed with therapy and surgery or at least it gives them guidelines and client expectations under which to proceed. 

I also know from having talked to many employing this type of consent, that clients are still disappointed with the bill.  They feel they did not give consent to spend "that much money" and they are shocked at the number of teeth extracted.   And, unfortunately, it is common practice for the receptionist to present the client with the total bill and it is often she/he that has to take the initial heat...in front of all of the other clients.  So, in many cases, the person that has the least amount of dentistry training on staff, the person that was probably not involved at all, the person that has no power to amend the bill, often bears the brunt of the client's disappointment.  And we wonder why practices find it hard to keep wonderful customer service representatives and why some our front line staff members can get surly with our clients!

So, my question is, if we asked these clients; did we meet your expectations, do you think they would say "YES!"  Do you think they are going to be apt to provide the same services next year?  Do you think these clients are going to recommend this experience?