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Making Recommendations and Client Education

Discuss the findings of the initial examination and additional diagnostic and/or therapeutic plans with the client. Those plans will vary depending on the patient; the initial findings; the client’s ability to proceed with the recommendations; as well as the client’s ability to provide necessary, lifelong plaque prevention.
 

When either an anesthetic examination or procedure is not planned in a healthy patient, discuss preventive healthcare, oral health, and home oral hygiene. Options include brushing and the use of dentifrices, oral rinses, gels and sprays, water additives, and dental diets and chews. Discourage any dental chew or device that does not bend or break easily (e.g., bones, cow/horse hooves, antlers, hard nylon products). The Veterinary Oral Health Council lists products that meet its preset standard for the retardation of plaque and calculus accumulation.15 Illustrate to the owner how to perform oral hygiene, such as brushing, wiping teeth, application of teeth-coating materials, and the use of oral rinses and gels. Allow the client to practice so they will be able to perform the agreed-upon procedure(s) at home.

All home oral hygiene options, from diet to the gold standard of brushing, along with any of their potential limitations need to be discussed with the client. It is essential that the oral health medical plan is patient-individualized to attain the greatest level of client compliance. For example, “dental” diets and chews can be used until the client is comfortable either brushing or applying an antiplaque gel, rinse, or spray with a wipe. The gold standard is brushing the pet’s teeth using a brush with soft bristles either once or twice daily. If the client is either unable or unwilling to persevere with brushing, use any of the other oral hygiene options that the patient will tolerate.

Explain the two-part process involved in a diagnostic dental cleaning and patient evaluation to the client. It is critical that he/ she understand the hospital protocol to minimize miscommunication and frustration. The procedure involves both an awake component and an anesthetized component for a complete evaluation. It is not until the oral radiographs have been evaluated that a full treatment plan including costs of the anticipated procedure(s) can be successfully made with any degree of accuracy.

Evaluation of a patient for dental disease involves the awake procedure as the first step. This is where an initial assessment is made. Although many problems may be seen at this point of the evaluation, a thorough diagnosis and treatment plan cannot be determined until charting, tooth-by-tooth examination of the anesthetized patient, and dental radiographs have been taken and evaluated. Studies have demonstrated that much of the pathology in a patient’s oral cavity cannot be appreciated until dental radiographs are taken and assessed; therefore, have protocols in place within the practice to give clients ample time to make an informed decision on how they want to proceed with the proposed treatment plan.16

Some hospitals may want to do the awake examination and the anesthetic component (charting, cleaning, and dental radiographs) as the first procedure. They can then stage the treatment plan as a second procedure. This will give the hospital staff adequate time to explain to the client the treatment plan, including giving educational information on the diagnosis, reviewing radiographic findings, and going over costs. Other hospitals may want to perform the treatment plan during the first anesthetic event so everything is done at that procedure. Whichever way the hospital chooses, there must be a client communication plan in place so the client is involved and feels comfortable going forward with the proposed treatment plan.

Perform the anesthetized portion of the dental evaluation of charting, cleaning, and radiographs when abnormalities are seen on the awake exam (such plaque or tartar at the free gingival surface of the maxillary canines or fourth premolars) or at least on an annual basis starting at 1 yr of age for cats and small- to mediumbreed dogs and at 2 yr of age for large-breed dogs. Details on the recommended frequency of examinations are discussed under Progress or Follow-Up Evaluation (below).

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