February 21, 2018

One Tooth at a Time

General practitioners can gain a great deal by getting involved in veterinary dentistry.
By American Veterinarian Editorial Staff
February is National Pet Dental Health Month, a time for veterinary practices to highlight the importance of pet dental care. With approximately 175 board-certified veterinary dentists in the United States, the need for general practitioners to perform basic dentistry is great. But how do interested veterinarians get involved, and how much dental work should they be doing?

Barden Greenfield, DVM, DAVDC— owner of Your Pet Dentist of Memphis, Tennessee; president of the American Veterinary Dental College (AVDC); and the only veterinarian member of the Tennessee Dental Association—is a huge proponent of general practitioners becoming more involved with pet dental care. Richard Meadows, DVM, DABVP (Canine & Feline Practice),  who leads the Community Practice Section at the University of Missouri Veterinary Health Center in Columbia, Missouri, has been doing dental work since 1981. American Veterinarian® spoke with these 2 veterinarians about why—and how— more general practitioners should offer dental services.

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With relatively few boarded specialists in the United States, there must be many areas of the country where access to a veterinary dentist is lacking. 
Barden Greenfield, DVM, DAVDC: I totally agree. In a rural environment, it’s pretty hard to find a dental specialist. As the profession becomes more educated and as veterinary schools incorporate more dentistry into their curricula, we hope that broadens. The AVDC itself is still young. It’s just a matter of time before additional dentists will be available to those in more remote areas.

Dr. Meadows, what propelled your interest in dentistry?
Richard Meadows, DVM, DABVP (Canine & Feline Practice): There were a few things. First, it’s obvious that dogs and cats—and other species, like rabbits, which I know precious little about—commonly suffer from dental problems. Their owners “suffer,” as well, from bad breath you can smell from across a room. Second, over 30 years ago, 1 of my top incisors became abscessed from a previous blunt trauma injury to my face, and the pain was intense. But when my dentist opened up that tooth and let it drain, the pain went away—like turning off a light switch. At the time I thought, “I can do that just like he just did, and my patients will benefit just as much as me.”

Finally, in 1998, I was working in a fast-growing private practice in San Antonio, Texas, and the veterinarians there talked about who was going to update and improve the quality and quantity of dentistry we did. I volunteered, and that put me on a path that I remain on today: continually improving my own dental skills and that of others.

What steps did you take to ramp up the dental aspects of your practice?
RM: I started attending the annual Veterinary Dental Forum and taking master-level courses taught by experts. I also had help in advancing my skills from 3 prominent, board-certified veterinary dentists who are University of Missouri alumni—Drs. Steven Holmstrom, William (Bill) Gengler, and Curt Coffman.

Do you think it's important for general practitioners to get more involved in dentistry?
RM: Absolutely! I could go on for hours about why. First, it will improve the health of their patients in nearly 100% of the cases. It will improve the financial health of the practice without adding any more patients. And it will improve the morale of the entire veterinary team to know they are making these pets feel better and be healthier—and potentially helping them live longer.

Is it common for general practitioners to provide high-level dental care, such as root canals, orthodontics, or surgical oncology?
BG: No, and it shouldn’t be. There’s enough work in the practice to do basic care and some simple extractions. That is enough to keep any practice very, very busy and also quite profitable. Learning how to do a root canal or other advanced periodontal procedures or orthodontics takes years of experience—and a lot of money for equipment. Oral surgery, surgical oncology, things that I do like cancer surgery, where you have to know the principles of oral surgery to understand margins and how to reconstruct—those are things that a specialist would do.

But the good news is that dental specialists work very well with private practitioners. I would love to clean teeth or do more basic dental work, but the general veterinarian is quite capable of doing those things. When they see and diagnose more advanced things they send them to us. I don’t feel I need to compete with them; I want to help them. I know that a rising tide raises all ships, so if I can teach them how to do a good job, I’m going to be happy.

How has the University of MIssouri incorporated dentisty into the curriculum?
RM: At the Veterinary Health Center, we are continually improving our dental caseload, and we have clinical students that directly benefit from helping us with those cases. Dentistry is not an adequate part of the curriculum in most veterinary schools, period. At Missouri, I have fought and am still fighting to increase the time dentistry gets in the curriculum.

How can general practitioners who are interested in dentistry learn more?
BG: Veterinarians who don’t have much dental education should attend a national dental meeting to understand it better. Dentistry can grow a practice in a lot of areas, and in this economic time, what better way to do it? It’s not a gimmick; it’s not a simple product. It takes work, it takes knowledge, but guess what—we were trained to be doctors, so this is a great way to learn how to do it. I think that’s really the key: to educate, educate, educate. The more we’re educated, the more we can convey to our clients the benefits of periodontal care. It’s a slow process, 1 tooth at a time, but I know very few AVDC members who don’t love to teach. We get out there and try to do the best we can to promote dentistry.

RM: For years now, I have been the co-chair of Veterinary Dental Educators [VDE], a subcommittee of the American Veterinary Dental Society, which is now part of the Foundation for Veterinary Dentistry. The VDE has had 2 active projects and several less active projects.

First is a low-cost ($40) online veterinary dental course through the University of Illinois. This multimodule course was written by Sandra Manfra Marretta, DVM, DACVS, DAVDC. Roughly 1000 students from the United States, Canada, and Australia complete the course each year. There is no CE [continuing education] credit for the course; it is strictly voluntary on the student’s part. They get a framable certificate of completion and a good deal of dental knowledge.

Second is what is commonly referred to as the Bill and Richard traveling road show. Thanks to grant writing and support from our corporate partners, the University of Missouri has more veterinary dental teaching equipment than any other veterinary school I know of. Each year, we load up a literal truckload of veterinary dental teaching equipment and supplies and go to the annual Student American Veterinary Medical Association Symposium and put on 2 or 3 very hands-on veterinary dental wet labs. Dr. Bill Gengler, a large group of other veterinarians with interest and skills in veterinary dentistry, and I volunteer our time, and we typically have roughly 80 students take these 3- or 4-hour labs.

One of the things that drew me to the veterinary dental profession is the people. Veterinary dentists and those with dental zeal, like me, are very willing and anxious to give back to the profession by teaching other veterinarians, technicians, and students as much as we can about dentistry. I see teaching veterinary dentistry as a way to pay it for-ward to a profession that has given me a good life. To date, we have done these VDE wet labs at Ohio State, Louisiana State, Purdue, Colorado State, Iowa State, and Texas A&M universities, as well as the University of Wisconsin. We are planning to expand

to the University of Pennsylvania in 2018 and the University of Georgia in 2019. The teacher-to-student ratio at these labs is excellent, and the students give us a great deal of positive feedback.

Have you seen more generalists at dental CE venues?
BG: Yes, we see them year after year, and we love it. I’ve gotten to know many firsthand, gotten to be friends with them. They love to perform great dentistry. They don’t necessarily do root canals and more advanced procedures, but they continue to want to learn and see the new products out there, and these people are extremely important in the community for providing dental care. They’re all such good doctors and do such good dental work.

What type of monetary investment and equipment are needed to start performing veterinary dentistry?
RM: The Veterinary Health Center is a tertiary referral hospital, so we have invested heavily. For a general veterinary practice, $25,000 to $30,000 can buy an excellent setup, and the return on investment would be great.

How can interested veterinarians get their staff involved?
RM: For me, that was the easy part—they saw the instant gratification of helping animals, and they were hooked.

Have you seen growing interest from clients regarding dental care for their pets?
RM: Although the answer to that question is an emphatic yes, it is still very common for the veterinary team to have to bring it up to owners. It’s about education and communication, and I learned years ago that the key to a successful dentistry business is that pet owners need to know is what’s in it for them. You have to have frank, honest conversations with owners about needs and benefits—the need for dental care and the benefit to the client and pet.

The simplest answer to that is a better quality of life for their pet—and for them, when horrific halitosis is present. Then you have to get enough equipment and [team] training to be able to practice current, progressive veterinary dentistry. At that point, your biggest problem will be keeping up with the amount of dental work you find by simply flipping lips and taking whole-mouth, intraoral dental radiographs.

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