7 Steps to turn your so-so dental program into awesome!
First up, I need to admit that I still have a LOT of learning to do in the field of veterinary dentistry. When Judy contacted me to ask if I would be interested in blogging about dentistry, I was obviously delighted to help but a little concerned because technically I am far from a great dentist. Thankfully Judy has contacted some real veterinary dentists to deal with the technical stuff so I am simply going to share some Masterchef style ‘top tips’ which will hopefully help get some of your dental programs firing on all cylinders.
About 2 years ago I made a concerted effort to rev up our dentistry program. As a self-confessed ‘Veterinary practice management social media junkie’, I figured that maybe it was actually possible to get dentistry running at 10% of turnover as I had read so many times, as opposed to the 3-4% that had been standard in our business for years.
Anyway, here’s a step-by-step guide to making dentistry a GREAT part of your practice:
Step 1: Find a Dental ‘Champion’
You need a dental ‘champion’ to help drive the program. In our practice, this was a newish graduate that we sent to one of the 2-day dental training camps held by VetPrac. Yes, some extra training in dentistry is important…..you don’t need to be technically amazing to do great dental work but you do need a vaguely decent knowledge of dental anatomy, pathophysiology, procedures and radiology. A go-to staff member that is revved up about the program will make a huge difference and it doesn’t necessarily have to be you! Of course, you’ll get carried away with how cool dentistry is and end up reading all of the course notes and buying dental radiology textbooks anyway, but you get the concept.
Step 2: You MUST have Dental Radiology.
Sorry, but it’s true. There’s a reason why every VIN dental discussion talks about the importance of radiology and to be honest I didn’t believe that until we bought our first system. Now I can’t live without it and feel naked if it breaks down.
As far as I am concerned IM3 are the gurus and the system we have from them is awesome (Judy feel free to make them pay you for me saying that!). We have the CR-7 system with little plates that you put in a machine and cool images pop up. Once you start taking x-rays you will never go back.
(I x-rayed a normal looking premolar yesterday that had a fractured root below the gingival margin requiring extraction…there are huge health as well as income benefits from radiology but that’s for the experts to discuss). It will cost about $20k for the complete setup which you will get back in no time if you use it properly. While you are talking to IM3 ask them for some copies of their dental goldmine training DVD which you will use for your staff training.
If you happen to live somewhere warm and holiday-friendly feel free to fly me up to show you how to use the system and print out the funky glossy dental reports that you will start giving to every client.
Step 3: Accept that Technology is Awesome
Accept that technology is awesome and use it for everything.
Apart from the dental radiology unit the biggest factor in increasing our dentistry service was using the technology that we already had. I’m talking smartphones, tablets and computer screens by the way. When discussing dentistry with a client after you have just looked in their pet’s mouth, we show them the progression of the disease using an iPad app …. “While I have the app open would you mind if I emailed some information on dentistry so you can show your husband who couldn’t be bothered coming in today?”
Despite their meagre salaries almost every vet and nurse has a smartphone. Use them to take photos of every mouth and email them straight away to a central point (we use an iPad). It’s amazing how much more worried owners are when they see an enlarged image of their dog’s rotting carnassial tooth. When it comes to the procedure itself make sure you take before and after photos to run through at discharge. This goes a HUGE way in helping to explain the value of what you have just done.
Step 4: The Consultation – discuss the procedure in detail and book it in.
At our clinics we discuss dental disease IN DETAIL at the consult, explaining the grading system and why yes, Grade 1 dentals need to be performed and how plaque turns into tartar and goes subgingivally and the infection gets into the bone and causes excruciating pain etc. We show them pictures on the iPad and email them an e-book (straight from the App) about dental management. We then explain the whole process of the dental procedure itself; something along these lines:
- We discuss how we will run a blood test here and now as a pre-anaesthetic screen to check liver and kidney function…..insert your own effective blurb here.
- We discuss the admission procedure, sedation, general anaesthesia, scale and polish, x-rays, extractions (surgical vs non-surgical), local and systemic pain relief and the discharge procedure
- We then explain that this is only the starting point and that 10 days post dental we will get them back in to check the mouth, make sure any wounds have healed and discuss at-home care in detail ie brushing, oral gels, dental diets and the like. We also discuss the annual or twice-annual scale and polish that will be needed.
Once we have done this we show them the dental estimate chart which shows them the costs and explain why there is such a range. For example “If we take x-rays and the teeth, including their roots, are sound the charge will be at the lower end of the range. If extractions are required then we will need to use local anaesthetic, perform the extractions, give pain relief and costs can get up towards the higher end.” We always leave discussing cost till the very end once the client understands the importance of the procedure and by this stage they hardly ever blink an eye (ASSUMING the vet doesn’t have cost issues in their own head and project that on to the client which is a whole other topic).
(Click here to read Rhys’ thoughts on ‘Discounting of Grade 1 Dentals? The argument for….’)
We (whichever vet or nurse happens to be doing the dental check or consult) then physically walk the client to reception and say “(insert receptionist name), we need to book Bubbles in for some dental work (let her know which grade) next week. Can you please book that in and run through the pre-anaesthetic preparation?” This last bit increases your “sales” of dentals massively and feels weird at first but works wonders….
Step 5 : Charge appropriately
Why is it that we feel ok charging $1000 for a large lump removal but can’t do it for a dental procedure which may take even longer, uses just as much vet and nurse time and equivalent sterilisation/preparation? Everyone’s fee structure will be different but my lightbulb moment came when we decided to charge per tooth extraction rather than on time spent. This means that it doesn’t matter how fast or slow the vet or nurse is, the same price gets charged for the procedure. This could be a whole topic in itself but you get an idea from our estimate chart on roughly what we charge for dentistry.
Step 6: Train all of your staff and get cracking.
For us, training our staff involved our dental champion running through some grading examples and watching the dentistry goldmine DVD over a Thai takeaway, followed by some case studies and a general discussion. The reality is that once you start doing lots of dentistry and the client feedback is overwhelmingly positive the staff training and motivation almost takes care of itself.
After we launched our new program we decided to take full mouth x-rays on every dental case for a month. This helped massively in getting everyone’s technique up to scratch and now it takes one of our nurses about 3 minutes to x-ray a cat’s mouth and about 5 minutes for a small dog, with only the occasional repeat exposure.
Step 7: Take a well-earned holiday to Fiji as your staff perform amazing dentistry every day.
Also be prepared to be doing multiple dentals a week in the $500-1500 range with clients walking away being amazed by the quality and value of the service.
So there you have my tips for creating a successful veterinary dental program… so far. I’m sure there is much more to discover in the future.
I’d be interested to hear any tips you may have for creating successful dental programs or feel free to ask me any questions you may have in the comments section below.