So welcome to veterinary nurses leading the way, running effective oral care clinics. My name is Stacey. I'm a referral, anaesthesia and dental nurse and owner of Bertie's Boutique Veterinary CPD.
So I'm really excited to give you this session. I think veterinary nurses have a real. In increasing footfall and patient care and and the knowledge that we can offer owners to improve the oral hygiene and health of our, our patients is, is really good.
I just think it's something that isn't facilitated as much as it possibly could be. So we've got a few objectives to go through on this session. We're gonna talk about how to actually conduct an oral care clinic so that we're confident in doing so, what we might see at these care consultations, how we can therefore support owners in dental health.
How we can create a successful oral care clinic. And how we can try and make dentistry a priority because I think sometimes because it's hidden in the mouth. You know, you had this horrible disease and inflammation and infection potentially.
I do believe if it was anywhere else on the body, it would be treated a lot more quickly and taken perhaps a little bit more seriously, by owners and veterinary teams. So I think it's really important to work out how we can try and bring it to the forefront a little bit more. And the key to making any of this work is client communication, which we're going to cover as well.
So let's start with the actual oral care consultation. How can we fully utilise these, if we want to get them in place in a GP clinic or a referral clinic or. If you're doing home visits, whatever services you have as a clinic, I do believe it's something that you can instigate within there.
So if we want to utilise an oral care consultation, we need to think about when we can kind of catch the clients to discuss this with them. So I think when they have their new kitten or new puppy. We should be seeing them quite regularly anyway, but we should definitely be having a look at their teeth.
So it's about having a consultation within the original consultation. But also looking at. If you have an oral care consultation service, what sort of clients can be referred into that.
So with our kitten and puppies, we need to have a look at their teeth at least every sort of 6 weeks or so, much more often if the teeth are not appearing or disappearing as they should be. And we definitely need to keep an eye on these patients until the full adult dentition is through to make sure they're coming through comfortably and appropriately. They're being fed the right things, not being allowed access to the wrong things that could.
Cause damage. A really good way of utilising an oral care consultation is for post-op checks of surgical extractions to make sure that these happen. So we've got that contact with the client.
They don't just drop off post-op because everything seems fine because no one's actually looked in the mouth. I think it's really important to have those in place. And also once we've done, you know, an awesome job at dentistry, we need to, if they have any teeth left, bless them, we need to be looking at.
Assisting the owner with brushing the teeth and helping them train to do that, so ongoing oral care and follow-ups, cleaning the teeth, seeing how they're doing. And then just general dental checks, you know, as humans, we go to the dentist quite regularly or hopefully we can if we can get an appointment or if we can get registered somewhere. But ideally we should be having, every 6 to 12 months minimum general dental checks, just to make sure that everything's OK.
Cause I, you know, I know a little bit about dentistry for veterinary obviously, but I don't know anything about human dentistry. So I feel like I could easily miss some things, so as an owner, you can very easily miss things in your, your pet's mouth, and I think having these general dental checks allows things not to go too long undetected. And sometimes the owner may well have noticed something, maybe they've noticed the mouth is a bit more smelly, they're a bit more droolly.
Or maybe they have seen that the, the patient has fractured a tooth or something looks wobbly or inflamed or is bleeding. So if they've noticed any changes, they could come to start with if waiting times are quite long, they could come to have an oral care consultation. And often the pet will come for other reasons to the vet, just for a general consultation, maybe a vaccine, or they're limping, or they found a lump, or they've got an upset tummy.
But they've also noticed at that consultation that there's something wrong with their mouth, whether that's periodontal disease, gingivitis, and it may not be something that's their predominant issue right now. Obviously if they're lame, we need to find out why, or upset tummy, we need to get that sorted. But it's good to let the owner know that once we're over this bit, we really would benefit from getting the patient in for an oral care consultation with the nursing team, have a good look at the mouth, see what's going on and see what might be needed.
And that allows the care to continue without expecting that to happen within that 15 minute consult when the owner hasn't come in for that, and in that moment there may be more pressing things to deal with. You can also look at using the oral care consultations for admitting and discharging patients for dentistry procedures. This can take some of the weight off the rest of the team.
And also allows you to talk more fully and in depth about what's required and what might happen, on the admit. Or you can even have pre-consultations. So if you know they're coming in on a certain date, but the owner has questions or concerns or wants to get their pet used to coming into the clinic, we can use that as a facilitation at the oral care consultation as well.
This frees up the team to do other consultations or see emergencies as well. So it's really utilising the team fully. It can also really increase your efficiency and patient care, so at these pre-checks, once the vet has confirmed what is needed, then we could look at as nurses obtaining preoperative blood.
So instead of just doing it on the morning, finding there's an increase in liver or kidney values perhaps, or a concern with low potassium or something untoward. Instead of we've waited X amount of times for the surgery date, now we can't do it, we need further bloods, we need further treatment, we need to delay. Further diagnostics and things, we can deal with that and maybe still get them in for their actual dentistry date, knowing exactly what's going on.
We've had time for an echo if it was needed, we've had time for a liver scan or we've decided that pre-operative fluids might be good. Really good time to get a blood pressure reading to see where your patient's at prior to the morning of surgery, check for any abnormalities. Keep an eye on their weight, make sure it's not fluctuating.
If they do need dentistry, but it's not what we call super urgent and your client's patient isn't morbidly obese, for example, you may need to try and get that weight down before the anaesthesia to make it a little bit safer. Equally, if they're losing weight at a rapid rate, we need to look into why. And instead of trying to deal with all of that on the morning of surgery, having these oral care consultations leading up to the treatment.
Can be really useful. And obviously we need to discuss these things with the veterinary surgeon in charge of the patient. But it might be that the patient is incredibly anxious about coming into the surgery, so you may need to discuss and look at the vet dispensing some relaxation drugs, some sedation for the patient to have at home.
And instead of just giving them over the counter and being like just follow what it says on the box, you can have that time to talk to the owner about, this is why we suggest this, this is how we suggest you give it. And this is why, this is what you can expect from the drug. And if they've been referred for oral surgery, quite likely they're in some level of discomfort.
So why are we not sending them home on some sort of pain relief, so it's something that you can take the time to discuss with the owner as to why that might be needed, and again, how to give it and what side effects and such to look out for. Really good time to have a good listen to the heart and lungs. Again, it'll leave time for a workup prior to an admit if there are any concerns, .
I don't know about you, but whenever my pets have anaesthesia, I really don't like it. It's a really stressful experience for me, even though I trust my team, I trust the surgeon. No one's at fault apart from my own brain and the fact I just hate having to choose for my animals to go under anaesthesia.
So you can imagine when you are not from that area of work at all, it can be even more stressful perhaps. So talking them through the plan, what to expect on the day, how we're going to communicate. So you're going to come in at 8:30, we're going to go through and do a consent form.
We're going to take Fluffy through to the wards, going to place an IV, nice and relaxed, cosy bedding. Aiming to induce around X time, what we'll do is give you a call once we've got those X-rays. Once we've got those X-rays, had a good look in the mouth, and we've discussed a treatment plan with you on the phone, we will make sure that we complete that under the anaesthesia, and then we'll give you a call when Fluffy's in recovery, and at that point we'll look at making a going home time.
And the going home time is around 10 to 1 time. That will shorten, hopefully, the time you spend on the morning of surgery, and you can also give them a rough discussion or perhaps a handout as to what to expect post-operatively. So yeah, they may be a little bit sleepy, you're gonna need some soft, bland food at home, you're gonna need to remove any toys or boisterous activity.
Things like that. So now we know kind of how we can maybe utilise and be efficient within oral care clinics. We need to look at how we can maybe look at setting one up in in clinic.
I think when you're trying to get any new project started, there's really no point pushing people that have absolutely no interest in that subject. It needs to be led with a passion, someone that isn't being forced into doing something. So if you have anyone on your team that does have an interest in dentistry.
Then discuss it with them and work as a team from the very beginning, and work out what your objectives are, what, what are you trying to achieve by starting oral care clinics? Are you wanting to get more dentistry procedures through? Are you wanting to streamline the ones you're doing?
Are you wanting to make it a more pleasurable experience for the owners and the pets? Are you trying to increase revenue? Maybe it's a mixture of all those things, but we need to work out what the goal is.
So You need to know when you can hold these, so first of all, working out a day and maybe a time of those particular day or days that a consult room is free. This shouldn't be conversations that's happening in the car park or in the waiting room. You know, it should be a good oral care clinic where the owner and the patient feels that they've been given lots of your time and attention to discuss everything.
If there's any further education that a member of a team has been looking into doing or has done, can definitely lean into that and perhaps that person can then help with some in-house CPD to share that passion and that knowledge with the team. Because even though they, other members of the team may not be highly involved in the running of those oral care clinics, everyone's going to be looking into feeding into that and understanding how it works and what it can offer. Whoever wants to be part of the oral care clinic could look at spending time with a specialist vet dentist to see what we get up to.
I just think just to get that bit more education, so you know what more to look out for and what treatment might be available, when referral might be indicated. And once you're set up and know what you're doing, definitely advertise it, it's something to be really, really proud of, that you care and to put in effort and time into maintaining good oral care. Posters and literature in that consult room, we don't want too much, no one wants to see 1000 leaflets in front of them, and obviously that consult room's probably going to be used for something else as well when it's not an oral care clinic.
But having a good couple of posters up perhaps showing, common dental disease and and blunt and quick reasoning as to why it should be treated, and I think pictures speak 1000 words when it comes to this type of thing. You could launch the oral care clinic by offering a free oral health check to all your clients. People love a freebie, veterinary care can be very expensive, and they ultimately, most owners really want to do what's best for their patient, for their pets and our patients.
So if we can say to them we're happy to have a 10 minute consult for free, we can look into everything and then if treatment is needed, obviously they can then have an estimate created and it's, they can then make an informed decision if they proceed or not. And then we need to work out a booking schedule, so how many consults are you gonna be able to see? How long do those consults need to be, do you need different length consults for your first initial consultation and then your follow up on teeth cleaning or your post-op check or your admin?
Are you gonna have a feline only clinic so you can make it feline only on a certain afternoon and then have dogs on another, things like that, so. Lots of logistics that you will know more based within your clinic. Some clinics have like 80% canine patients, some have more feline.
So it's just really knowing your clinic and working, as I said, as a team to work out the best approach to get this set up. So if you've got the passion to look at getting it started and looking at how we can run them, once you've now got your patients coming in, we kind of need to know what we're doing. So this could be a 10 hour lecture, which we won't let it be, but I just wanted to include a few things about how to physically examine our patient and some.
Of the presentations that you may see that you may be aware of, but not quite sure what to do with or maybe you're not familiar with, so. Let's go through that together. So, we'll start by saying that a healthy mouth should not be painful to examine.
They may not be used to having handling of the area, and that's perfectly normal. But it shouldn't be painful, they shouldn't be crying or or jumping as you touch certain areas. Definitely wear gloves, make sure you've introduced yourself to the patient and the owner and spend some time fussing the patient, having a little listen to the owner.
The owner's probably a bit stressed from the journey, from the fact that they're there, they may be worried that something is the matter, so just spend time, let everyone decompress for a moment. Let the dog sniff around, let the cat wander around if you can do that in a safe environment. It may be easier for a colleague to restrain the patient gently if needed, but always go slowly and talk the owner through what you're doing and work methodically.
Now whatever way that works for you, so if you always start at a certain area of the mouth and work your way around, then try and keep doing it that way so that you don't miss certain areas. For us, you, we suggest gently lifting the lip and start looking there, working your way from the back to the front. As the nose is actually a bit more sensitive and keep including little bits of fuss and head strokes, and each patient is different, as we know.
This cat didn't really want to be held. No one had been able to look in this cat's mouth, but we just gave him a little burrito. He'd had some time to chill.
I was stood off just to the left so I could. Intervene if anyone needed any assistance there, but actually this cat wrapped on a little burrito with minimal hands on, allowed Rachel to have a really good look at its entire mouth to see what was going on. And it's not just about the teeth, so we need to be palpating bones, muscles, lymph nodes, glands, checking for symmetry or asymmetry.
And if you can, make sure you look under the tongue and at the back of the mouth. And remember that the tooth is a 3D object, so we need to look at it from all sides, not just one. And when you do find any abnormalities, let the owner have a peek, like, oh, I'm just seeing a tooth there that looks like it could be fractured.
There's some gum recession here that could be uncomfortable. You can see here, you can actually see the gap, the flocation between the teeth, that's not normal. They don't want to look, or if for any reason you're still working curbside, or it's not the owner that brought the patient in, take some pictures, so you can email them.
And then obviously unless they're about to proceed with anaesthesia or sedation, give them a treat if the owner's happy with that at the end, so it's kind of a nice positive experience. Make sure you make accurate notes and include the owner's feedback, whether they are up for surgery or not, whether you've seen anything abnormal or not. And if you've made a plan, like the owner wants to think about things and would like to be contacted in a week or so, or the owner would like to get booked in, make sure you make some really good accurate notes in in the file.
If there's any areas of your patient that you weren't able to look at, which can be common in our conscious patients, make sure you note that down as well, so there's no point saying everything looked fine if you weren't able to look at everything. State the area that you weren't able to have access to. And then as well as doing the physical consultation, having that verbal communication with the owner is really important.
So it may not be the primary caregiver that's brought them in, so it might be that you need to follow up with a telephone consultation with them as well. But have they noticed or have you noticed at the consult, is there anything smelling, so halitosis in the mouth? Has the patient lost weight, so keep an eye on the graph, or do they feel rather skinny?
Have they noticed any excess salivation? Is their coat matted where perhaps their mouth hurts and they haven't wanted or been able to groom as well? Have they been acting subdued or hiding away?
Are they playing less? Are they actually a bit more aggressive perhaps, and just not tolerant of as much interaction with you? Is there any smell or sign of infection?
Do they appear to be uncomfortable when they yawn at home or when they're eating, or when you open their mouth at the consult? And if there's any calculus in the mouth, is it symmetrical or is it one or more side or the other? And often I think, as we all know, dentistry.
Or concerns will have no signs of dental disease. It's only once you've found something and then it's been treated. That the owner then says, oh my goodness, yeah, I definitely see such an improvement in him or her after we've performed the treatment.
So let's go on to some of the things that you might see in the mouth. So I think a common one is gingivitis or periodontitis, and differentiating between the two and the owner understanding the differences between the two is, is important. So gingivitis is kind of how it sounds, it's inflammation of the gingiva.
There are different indices used when you complete a dental examination or a chart perhaps to place a numerical value on gingivitis. And gingivitis can be the earliest sign of what we call periodontal disease. So the inflammation that we see with gingivitis is not actually associated with the destruction or loss of any supporting tissues of the tooth, but if you leave it untreated, it may develop into peridontitis.
So gingivitis is reversible, and the primary cause of gingivitis is the accumulation of dental plaque on the tooth surface. So if we can remove that dental plaque and prevent it from keep coming back, then we can hopefully prevent it from developing into periodontitis. So signs of gingivitis, swelling, reddening, bleeding of the gingival margin, and smelly breath.
Might be a little bit tender and uncomfortable, but it shouldn't be painful in itself. So as I touched on, the aim of treatment of gingivitis is to reverse it and then prevent it proceeding into periodontitis. So that treatment would be removal of plaque and calculus by professional cleaning under GA.
In very minor cases, you may be able to do it with home cleaning alone, if the patient allows you. So what we want to do is restore the inflamed gingiva to a good health. But the owner does then need to keep on top of removing or reducing the amount of plaque accumulation, so that that ginger can remain healthy and happy.
If unable to do that, it could then lead on to periodontitis, which, as you can see, looks a lot more angry, and this is uncomfortable. So the inflammatory actions that we see with periodontitis result in the destruction of the periodontal ligament, which is what holds the tooth in, and the alveolar bone, which is what the tooth sits within. So if we leave this untreated, the tooth will therefore just exfoliate.
So therefore fall out because there'll be nothing holding it in because it's just all been destroyed. But this isn't something that we should just allow to happen naturally, cos it's a really painful process. There's also circumstantial evidence that a focus on infection in the mouth can actually cause disease of distant organs like the heart, liver and kidneys.
This is because of transient bacteremia released every time the animal chews, so it's important that we don't just watch and wait for these teeth to rot out basically. We'd probably be fairly horrified if we went to the dentist and they said you've got really bad periodontitis there. Really do need to have that tooth extracted, but you know, you could just let it rot out while it's infected.
I think we'd all look at our dentist a little bit confused if we were told that. So periodontitis is not reversible. And it's caused by plaque on the tooth surface, which is just not regularly removed.
And it just allows for these horrible areas of bacteria and plaque to build up. It is a site specific disease, so it may affect one area or just one tooth or it can affect many teeth. So signs of periodontitis can be a really smelly mouth.
You may see lots of physical dental deposits on the teeth, gingival recession, vocation exposure, wobbly teeth, teeth have actually gone already, excess drooling, lack of grooming, favouring one side to eat, and you may even end up seeing some ulceration of the oral mucosa. So treatment for periodontal disease, the aim is to prevent development of any new lesions at other sites and prevent further tissue destruction at sites that are already affected. So supra and subjugival scaling, crown polishing, root planing, likely extractions, particularly this mouth on the right.
And then if we do have any teeth left, we need to look at ongoing home care. And even if they can do that, some cases still need regular professional cleaning under GA. And if they can't do that, then obviously they are going to need to keep coming back regularly, and that's where that client communication comes in and setting the expectations from the beginning.
So as well as this horrible periodontal disease and all this plaque accumulation on the left, we may see things such as worn teeth on the right, often confused for fractured teeth. Fractured teeth tend to be more jaggedy, worn teeth tend to be more smooth. Often dogs that really love fly ball, tennis ball, or they're really obsessed with rubber balls and use them kind of on one side all the time.
And you often see a black dot on the tooth that people often think of pulp, but it's the tertiary dentin laying down, just trying to keep up with that wear of the tooth. This on the left is a fractured tooth. You can see it's actually bleeding here and it is also a bit more jaggedy.
So options for kind of worn teeth that we can either do a root canal if the root has been compromised or place a sealant. These teeth don't have to be extracted necessarily. And the same with the fractured teeth, depending on the tooth and the fracture sites, how low it goes below the gingiva, we may be able to perform a root canal, so we don't have to take all these teeth out, and the owner should be offered the option of speaking to a dentist about whether a tooth can be preserved.
We can offer you that advice free of charge, just take a picture, send it to a dentist, give them a little bit of history, and you can normally get an answer saying, most likely we could do a root canal, this is what it involves, this is the cost, this is the wait time. And then you can speak to the owner and they can make an informed decision. It can be really difficult to backtrack that sort of process if you miss that step.
We do see a lot of large dogs come in for . Sort of, they've had a a large tooth extracted, but not the whole tooth or the wound's broken down, they've then been referred. And the owner has looked into it a little bit more though at that point because of the complications and such, and realised that the tooth potentially could have stayed and they would have liked a root canal had that been offered to them.
So, definitely not a conversation to skip, and not all owners are going to be up for it. Maybe not the travel, maybe not the cost, maybe not the follow-ups. But I think everyone would appreciate the, option to think about it.
You may often see swelling under the eyes, which is often confused for eye issues or tumours, particularly in older patients, but often it could be that there's a tooth throat abscess, so having a good look in the mouth and seeing if it appears there's any draining sinus tract or fractured carnassales or really bad dental disease and such I think is really, really important. You could find horrible ulcerations in the mouth, which can be a really extreme reaction to plaques such as CCUS in dogs or gingivose dermatitis in cats. We've got the marked inflammation that goes over the mucosal junction.
So you just keep an eye out for that as well, so we're not just looking at the actual teeth. You can see that ulcer in that mouth lays perfectly when you lay it down, lay that lip back down. It perfectly contacts that upper left canine, so often that's confused for they may have licked a toxin or .
An electrical burn or or bad kidneys or things like that, but often you might not even see any plaque, these patients just have like a crazy immune reaction. You can have hyperplastic gingiva, so way too much gingiva growing, often seen in, patients on some immune suppressing drugs like atoppica. So it's something that we do need to treat.
You can imagine that the bacteria that's building up in there, so it's not something that can be left. And on the right you see there, with the swab behind it, that there is a tooth, the lower left canine. That's looking a bit purple and the upper left is also looking a little bit purple.
That's a bruised tooth, so it's a bit like falling over and, and bumping your knee, and then you can see all the capillaries sort of bursting underneath, you get a horrible bruised knee. So that can be uncomfortable, it's not a sign of infection, it's caused by blunt trauma and it should be investigated if it doesn't go away because, all that pressure and that swelling can cause death of the pulp. Which can be painful will then lead to it just waiting to get infected, so.
Treatment for that would be potentially extraction or root canal treatment if the patient and the owner wanted that, but you can get the owner to take weekly pictures and sometimes that bruising will disappear. You're gonna have a look for any missing teeth, also gonna have a look for any retained deciduous or any extra teeth, during the consult as well. Any, swellings or masses that you may see or what we call mallocclusions, so teeth not sitting where we would, we would expect them to.
So you can see a class one where one or two tooth are just in the wrong direction, but the actual jaw lengths are OK, like on the right. All we can see. The actual jaw length discrepancy of this dog on the left, that's a class 3.
So anything that's abnormal, we need to be noting and seeing if we need to do anything about with regards to jaw lengths and mal occlusions. Or, you know, this cat on the right, definitely, that is not a normal occlusion, so we need to be thinking about why that could have happened. And you can see that that lower right canine is going to be causing some trauma to the roof of the mouth.
You might see some damage to the enamel, that's enamel hyperplasia, that's something that needs to be treated as well. So go to a dentist and have some sealants placed, or you may see some absorptive lesions such as on the right on that cat. If you're seeing a lot of puppies, we need to keep an eye out for any cleft palates, so it's not all about the teeth.
And we also need to look at the palate just in general, even if they don't have a cleft palate, this guy had a maocclusion which went unmissed for a little while. And you can see that the lower canine has actually made a massive hole in the roof of the mouth, which is compromising the adult canine as well, and that has actually already gone through and caused an aura nasal fistula. So making sure we try and catch things before they get this far.
But if they haven't seen the vet or they've just taken the pet on from someone, just making sure there isn't something cooking already. I touched on this earlier, so always look at the entire mouth if the patient allows you to. So this patient came to see us because they couldn't close their mouth.
They'd had a vaccine two weeks ago and been told in the notes said that everything in the mouth looked fine. This is the front of the mouth, lower and upper, and it does look fine, . But this is the back of the mouth, which doesn't look so fine.
Now, this is a Jack Russell who hadn't allowed the vet at the vaccine to look at the entire mouth, so it would have been in hindsight, better to write that the front of the mouth looked good, that the patient didn't allow access to the back, because as it stood there, they said to the owner, everything looks fine, and they were like, does they need any dental treatment, they're like, no, no, no, all good. But unfortunately, they did. This dog picked up or chased a rat and picked it up and it broke its jaw because of the degree of dental disease that you can see going on back here and the owner was a little bit upset if they'd been told that there was marked dental disease, they would have done something about it and hopefully avoided this situation.
The patient went on to do very, very well, but it's just all about that clear communication and saying, you know, I can't look at this bit, or maybe if we don't have time, that's where the oral care consultation is really good to say. You know, we would like you to see the oral care clinic. And I said it multiple times already, but it's not just about the mouth.
So even without looking in this patient's mouth, we can see that he's not very happy. And he got referred for gingivostomatitis, and he is so uncomfortable. His ears are flat, his face is pinched, he's all rigid.
He was a sad, sad man. We performed dental treatment, and this is the picture his owner sent us, a month or so after, and you can see a much happier, happier cat. He looks like a new man, so.
Just thinking about how your patient holds themselves as well. So communication really is key I think the most complaints within anything in any industry, it's probably lack of communication or miscommunication. So it's how can we make sure communication.
Is working well to run good oral care clinics and have them be a success for the owner of the clinic and most importantly for the patient to get good oral care. So allocating appropriate time consults so nobody feels rushed. And some people may not be able to come in, so maybe if the vet took pictures of what they were concerned at at that vaccine, for example, and then you could have a look at that and give them a call.
And discuss that for them. Collecting images, so that you've got kind of a back lay of how things were, how things are progressing. We don't want to give them too much literature, but if, you know, they've got a fractured tooth and you've made a leaflet about that, this is the options you have.
We could extract it, or we could send you for a referral, and this is what it normally includes, and this is our local referral centres for you to look into, that kind of thing. Some more tailored literature, not just a massive dental bundle because that's that's just too much, people don't have that attention span anymore. I think using images of other cases to explain the process can be really, really good, such as, you know, if the patient does look like it needs a lot of extractions, pictures of other patients pre, during the surgery in recovery and how it looked after and and sort of how the owners reflected how things went can be really good.
And I just think we need to listen to our clients. We're so rushed a lot of the time, but our consults times can be quite short, so again, allowing enough time in these oral care clinics to. Devote to our consult to that patient and owner and actually listening to listen and not just waiting to talk, not just waiting to tell them information because we're excited and we've learned these new things and want to relay it.
But really listening to what they have to say and then sort of tailoring what we say back. And then going through, as I said earlier, what would happen if they did decide to proceed with a dental procedure with you, equally, without trying to scare them, you know, if you decline treatment, this is what could happen. And that's just part of giving informed consent.
So they've decided not to consent to a procedure based on X, but they understand the risks of that decision. And that all needs to be noted in their clinical notes. So, I think it's important as well as literature, but just being able to communicate clearly, if you've seen something, what it is that you've seen.
How that might affect their pet, and in a way that's not too scientific or overloading and gauging the client and what they need. Some clients want more information, some just want the blunt facts, some need it to be wrapped a little bit more nicely. Some want it to be more scientific.
It really depends on their background and what they're wanting. So it's kind of reading the room, understanding that client, and we don't want anyone to feel pressured or scared. We just want to give them the information gently so everyone can be comfortable with an informed decision whether that goes towards treatment or not.
And often people want to know what, you know, in brackets, gold standard, if you like that term or not, oral care is. And I think we just need to break it down to basics of, well, what do we do as humans for our teeth. And we clean them, hopefully, 23 times a day.
And I don't think you'll find many dogs or cats. Even that belong to dentists. Or vet nurses, or veterinary surgeons that do actually clean their teeth, clean their pet's teeth rather, that regularly, it can be really difficult to fit into a busy routine of life.
And a lot of the time, the pet just isn't up for it, so. There's lots of studies that we can let our owners know about. Again, let's not overwhelm them, but.
Just to show them the effectiveness if they're thinking of trying it, cos there are, you know, some owners you may surprise you and and be all up for doing it twice a day, and we should really facilitate giving them that chance and education to do so, so. In dogs, there's been some studies that saying using a hard filament toothbrush twice a day actually showed trauma to the gingiva, so that's, we don't want a hard filament toothbrush, we want kind of a medium soft one. That every other day brushing didn't really maintain a very healthy gingiva.
Another study that showed 1 to 3 times a week brushing was not as effective at maintaining healthy gingiva. But that brushing every day was effective at returning Gingiva to a healthier state, so. It probably is better to do it at some point rather than nothing.
But it really is to reiterate that doing it every day is, is the ideal. And then with cats, teeth brushed every day or twice a day had 95% less calculus buildup. If they brushed just once weekly in the study, it had 75% less calculus, but they didn't look at the gingivitis in that study, so.
These are are what we use in clinic and recommend at the moment. In 2025 is, a busy brush. The angle is really good, because you can use it with your left or right hand on the left or right side of the patient because the curve allows you to access all areas, and it's important to give them a little guide if you're gonna do that.
And then there's, we, at the moment use pet dents, so either toothpaste or or the gel. So if an owner wants to do toothbrushing, it's really important that we support them within that. So as we know it's the single most effective means of removing plaque because gingivitis will develop within a few weeks of plaque accumulating.
But daily brushing we know can assist in bringing those gums back to good health. So ideally it should be introduced quite early on into that pet's life. But then we don't always get pets when they're young, so again that can be difficult.
But it does always need to be introduced really gradually. As I said earlier, the bristles need to be soft and medium. You might want to use a finger brush or a cloth that could be easier, but be careful that you don't get bitten or they don't eat the item, and they might not be quite as effective.
I've seen some dogs that will actually accept an electric toothbrush. These don't cause any harm, so you can look at that. But basically it is the mechanical activity of the brush that's doing the work.
The paste is sometimes kind of just there for the palatability for the patient, which will allow brushing for longer and make it a more pleasant experience. And remember, plaque isn't something we see with the naked eye, it's calculus that we do. And it's the plaque that we need to really stop from building into that calculus.
And remember, no human toothpaste, it has a high fluoride content which can cause acute or chronic toxicity. We as humans have fluoride, but we know to spit and rinse our mouth out when we clean our teeth, and animals can't do that. And when you start cleaning it, they likely will bleed if they've got gingivitis a little bit and that's normal.
So don't be alarmed and make sure the owner is aware of that. And ideally we need to try and get that part of their daily care. Our pets are living longer, so we really want to try and be preventative with this oral care and not allow it to go into horrible periodontitis.
And the main aim of the brushing is just to remove that plaque, but while we're doing that, we don't want to damage the teeth or the gingiva. So as a guide, make sure they're in a comfortable environment, maybe on a nice soft bed, on a lap. Approach them from the side, not front on with the toothbrush.
And start at the back with the pre-molars and molars. They can be a little bit more accepting of the lip being lifted there rather than by the nose. And then start with the mouth doesn't need to be open, just lift the lip and get that toothbrush in.
Angle the brush at a 45 degree angle to the tooth surface so the bristles can enter the gingival sulcus, and then a nice circular motion will ensure that the crevices in and around the teeth are cleaned. So side to side or a circular motion at the teeth, the actual tooth, we need to remember we need to be looking at that gingival margin, which is where all that nasty bacteria can really build up. So in older patients it'll be more difficult to get a new routine in, but maybe try and add it to a an existing routine that you have such as at the end of a groom or a walk or treat time.
And also for us humans if we try and do something at a regular time and it's more consistent, we're actually more likely to remember. And then just work in stages and wait until the pet is comfortable with every stage before progressing to the next. Managing expectations is so important, so if the mouth is, you know, one of those trench mouths, there's no point sending them home with a toothbrush and some dental diet.
We need to get that mouth into a good place for regular home care to be effective. So by performing regular homecare, it can prevent professional cleaning being required as often, but it may still need to be required. The genetics of that patient may be more inclined to have bad teeth than bad oral care.
But we can do the best we can to try and elongate the gaps between those professional cleans. So also compare our dental care as humans, as we said earlier, and our health to those of our pets. So we hopefully are cleaning our teeth, as I said, 2 to 3 times a day.
But even then we still may have cavities or gingivitis or gum recession. It's just happens, so even if the owner is doing amazing at cleaning their pet's teeth, they may still need assistance. Definitely Giving the the pet slash the owner a reward once they're allowing this teeth cleaning to happen, so for the pet that may be edible or a particular toy they like, and for an owner, using some sort of plaque disclosing solution in the consults to say, look, look how you've progressed.
So before, when we used this application, it was showing a huge amount of plaque, but now you can see how much less we are seeing there, and it can show maybe some areas that they need to work a little bit harder on. Or that are finding a bit more difficult to get to and it just gives you something to work on together. It's really important if you start toothbrushing to have follow ups, so consults to see the efficiency of brushing is another way of really utilising the oral care clinics.
As I said, using plaque closing solutions and managing the expectations of how, how are you finding it? How are you feeling and how's it going? And again, listening and that communication and what you can maybe tweak or any suggestions to help them.
But as we've said, brushing often isn't possible at all for our patients. It's not something out of my three cats I'm able to do, I would get absolutely shredded, so it's not something I'm able to do. There's lots of things out there in normal shops and supermarkets.
That are aimed at owners to say they're improving oral health, but there's many that actually, although they may help a little bit, they come with potential real dangers, so, nylo bones, antlers, bones. Basically, if you can't dent something with your thumbnail, it has the potential to fracture a tooth, so we should be letting the owner know that. They then may decide to still give them whatever it is that the, the animal loves because they want to.
But again, it's about informed consent, and if you never told them. Then you know they've come to neural care clinic and you haven't told them what they can't have. Then, you know, that's something we need to get them educated on.
Because these items will fracture teeth, and we see it. All the time. And there's another one there with a draining tract from that fractured carnas, and these are uncomfortable.
There's loads of scientific studies out there, Mars Petcare are doing some really good stuff in there. Workshops and everything to see, you know, what treats are appropriate and at what pressure they can take. And there's also loads and loads of products that owners can get quite lost in about what can help, but you just need to again manage your expectations.
If you've got a mouth full of calculus and say or try a dentist stick or try a dental diet, it's not gonna get that plaque off. But it may help to do alongside dental cleaning once you've got the mouth into a good place. And how those dental diets work is that they're designed with textural properties to maximise self-cleansing effects, and they can help with reducing the accumulation of dental deposits, and therefore the gingivitis that might develop after.
But they do have to be eaten in a certain way, and they are never going to be as effective as toothbrushing, so again, it's managing those expectations. What we don't want to do is for them to get their normal food and a load of this food, and then they get fat, so you've just added another problem. And people say, oh, you know, they, my dogs and cats being on dry food, they don't need a dental, but actually they've shown that in studies, neither makes much difference.
And as I said, if you can't dent a tube with your thumbnail, then please don't give it to your pet because it can fracture teeth. If the owner wants to try these things, then make sure it's definitely got the Veterinary Oral Health Council's accepted stamp. It just means that studies have been performed that the product can show the results that they claim, but what they're claiming is going to be different to every single product, so we just need to see what that is or the owner does, so they can then manage expectations again.
So I said, you can't expect to just give a dentist stick and get rid of a mouth that's been disgusting with loose teeth and vocation exposures. It's definitely just, again, continuing the education and communication. Everyone loves a goodie bag, loves them.
So I think when you start an oral care consultation. Think about what you can include, talk to reps, different companies that you want to use their products of, that you believe in. Maybe we can put a little toothbrush in there, a little sample of toothpaste, an appointment card so we know when they're coming back.
If they're looking at a dental diet, we can have a little trial of that. The patient's dental chart, if they have had a chart performed consciously or under anaesthesia, so the patients only knows where they're at, a good guide to brushing teeth, and maybe a fact sheet about whatever it is that you found in that mouth, so that they can go home and have a good read about everything. Also, be really proud about what you're doing.
If you're starting up these oral care clinics and you've got people that have got further education and expertise in your clinic, the BVNA do an amazing oral care nurse certificate. It's really affordable, it's got such good content and. They also have a really cool practical day.
I think like top however percentage of the class gets invited. It's just a really good course that would include a lot. And you should tell everyone that you've got that education within your practise and that you're running these oral care nurse consults and just.
Really let everyone know, whether that's on social media, emails, if you have like a monthly newsletter, posters in the clinic, whatever you can do to be proud of what you're doing. And also, if you're taking dental radiographs, and I really hope you are, you need to show the owners what they're paying for, and they can be quite interested. Some people say I don't want to see them, that's fine.
Other people are really interested, so you know, we took this tooth out and this is why you can see that this is a normal tooth, but this one had absorption and you can see how that's going to be uncomfortable. We found this a little strange area, an abscess here. Knowing what they've paid for and that you can physically show them what a good job you did, because you can't do that by lifting the lip, they wouldn't see any of this, is, is really helpful.
And as we know And that owners don't, there's so much more going along below the gum line where it's hard to see. And as I said, you could put a picture of their dental chart, make sure it's not covered in blood, . In their post-op bag or if you've completed it cos they're really good and you were able to at least have a little look, conscious, then you can give them this so they've got something to go home and have a look at.
And sort of having models in that consultation to show them what teeth should look like, how many teeth there should be, the fact that you shouldn't be able to see those vocations, there shouldn't be gum recession, it should come to here, seeing what's normal can sometimes really alert them to what is actually going on that's really abnormal in their their pet's smell. And there's so many ways of advertising now, making sure if you're using pictures of clients' pets that you've got consent, of course, but there's many, many ways to advertise what you're doing and then why it's such a good thing that you're doing it. So utilise that if you've got someone that's really into social media and clinic, you can get them on on the case.
And then I think we used to do it a lot pre-COVID, but open days, you know, allowing them to see what, where you're doing your dentistry, the dental radiography that you've got, some before and after cases in pictorial form, you know, how you're looking after them and what sort of oral care clinics we can offer and and how you're keeping them safe under anaesthesia as well, so I think having an open day. For the whole clinic, but also really to show off your dental skills is good. And don't forget that February is always National Pet Dental Health Month, so doing a bit more of an awareness around that month as well, I think can work really well.
Communication for follow-ups is so important, so if it's, we've ascertained we need to do a dental, you wanna think about it, you need to follow them up, do they want to book in? You've done a dental, you need to follow up how they're doing post-operatively. We need to see you as a post-op check.
You know, you, you've started tooth cleaning, we need to see you for a follow up. How are you doing? Communication is so important.
Patients will just drop off otherwise, and it's really important to try and not to allow that to happen. And I think some people just think I can't afford it, it's not possible, but a lot of pet insurance does cover the cost of dental care. It's definitely worth looking into.
And finally, I wanted to discuss how we can make dentistry a priority in clinic, and I was thinking, well, why is it not already? It seems to be in the in the quite well anticipated and looked after in the human industry. If you need cardiac surgery, for example, unless it's true emergency, that if you've got any oral health concerns, like you your teeth out or you've got really bad oral health, they will make you fix that before you go under anaesthesia.
That doesn't happen, we are. Seeing it that we're doing lots of elective surgeries, such as TPLOs and things, and that you go to intubate the patient and it's rotten in there. That would not happen in a human anaesthesia surgery situation, that mouth would need to be corrected before we then went in and made any incisions or did any big orthopaedic or such surgery, so.
I think we're a little bit behind, and we need to try and sort that out. I think because it's hidden in the mouth, so. The answer is to try and train everyone to lift the lip, every consult, every surgery, every time, and refer them to the oral care dental consult team within your clinic that hopefully you will be able to set up.
I think owners just don't understand dental disease and the impact on their pet's health. It's normal. Dogs' mouths smell, don't they?
Cats' mouths smell like fish. That's normal. It's, it's not normal.
So we need to think about how we can try and encourage the education. So verbally, social media, leaflets, waiting room displays, testimonials and before and after posters, books, posts. Everyone learns differently.
So we need to try and kind of not bombard people, but had different options for how they would like to learn more about it. There's some reluctance to spend money sometimes, particularly on geriatric patients, and a lot of them need dental surgery, or it may not be the reluctance, but it's just the inability at the moment to have that spare money. Maybe they just don't, couldn't afford the insurance anymore and never had insurance, their insurance may not cover it, and they don't understand the importance of the treatment that's needed, so.
We need to be proud of what we're doing, letting clients know how well the density has performed and how much skill, equipment and training is involved so they can understand that breakdown of the cost that little bit more. So difficult when you have the NHS which are amazing, but obviously we don't pay that in bulk every time we have a treatment. We pay it gently throughout our lives, but we don't have that big bill.
If we were to have it comparatively, then our, our fees aren't as expensive for people are concerned, but it's still finding that money. Understanding where that money is going to and what that means for your pet can make it a little bit more tolerable. I think it's getting better, but I do think there's a big lack of veterinary education at college and university for us veterinary professionals.
You only get a couple of days as a vet. I think I didn't do much as a nurse. So we need to now learn it once we've graduated.
So attending CPD such as this, and share what you've learned and allow those with a passion in a certain area to flourish. There's not many dental specialists in the UK. I think there's now about 8 or 9.
We are working on that, but it's very difficult when there's not many dentists to train many dentists. So, if you're loving dentistry or know a vet that does, and they want to do a residency, definitely push them towards becoming a dentist. We need more of them.
And as I touched on earlier, insurance might not cover dentistry. So it's really important when we get our patients coming in when they're younger or they've just obtained them to say, you know, when you get your insurance, make sure it's got a good dental policy, read the small print. It is more often the more expensive premiums that will carry it, but I do think it can be really worth it.
And read the small print because it may say they only cover like accidental things, and most dentistry things aren't an accident. They are, you know, gingivitis, periodontal disease, so. Yeah, it's definitely worth trying to have insurance that have full dental cover, or just explaining that if they can't, maybe trying to pop some money aside for it.
Just trying to support the owners that want to do that, really. So if you've enjoyed this session and want to learn a little bit more about veterinary dentistry, these two books are two that I refer to very often. I always like to try and suggest some literature, and these books are amazing, very pictorial, for both vets and nurses, to learn that a little bit more.
So hopefully you feel, a little bit more inspired and have some ideas as to how you can encourage oral care clinics and especially veterinary nurse led ones in clinic. Thank you very much. If you have any questions off the back of this session, you can email me at Stacey@ Bertie'sboutique.com.
If you want any veterinary dentistry advice on any cases, or send any pictures, or have any more sort of more clinical, questions that you'd like to go directly to a veterinary dentist, then the team at Perry Referrals will be very happy to help you, and the best way to contact them is hello@ perryreferrals.co.uk.
So thank you very much and good luck in your endeavours to start an oral care clinic. I hope they are successful and you enjoy them and we can increase patient care. So thank you.