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Welcome everyone to the Positive Veterinary Dentistry Podcast, a podcast dedicated to helping veterinary professionals elevate patient care to do better dentistry, diagnostics, and decision making.
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I'm your host, Benita Altier, licensed veterinary technician, veterinary technician specialist in dentistry, and the founder of Positive Dental Education.
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Whether you're listening from a general or specialty practice, academia, or you're still a DVM student or technician in training, this podcast is designed to give you a practical, real-world insight you can take right back to the dental table today.
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Today's episode is titled Veterinary Dentistry is a Team Sport.
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And I'm very excited to welcome today's guest, Dr.
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Chris Bannon.
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Dr.
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Bannon received her veterinary medical degree from Texas AM University in 1998 and spent 10 years working in a small little hospital in Santa Fe, New Mexico, before establishing the very first veterinary practice in New Mexico that is dedicated specifically to oral health needs of companion animals.
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In 2008, she became the first veterinarian in New Mexico to earn the title Fellow of the Academy of Veterinary Dentistry.
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And in 2010, she became the first diplomate of the American Veterinary Dental College in the state of New Mexico.
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Dr.
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Bannon has also contributed significantly to the profession through leadership and service.
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She served on the board of directors for the American Veterinary Dental Society, includes serving as president from 2013 to 2015.
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She currently serves on the board of directors for the Peter Emily International Veterinary Dental Foundation, where she volunteers her advanced dental skills to help provide dental care for wildlife and animals in sanctuaries across the country.
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She's also a consultant on the dental specialty board for the Veterinary Information Network, or VIN.
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And Dr.
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Bannon is incredibly enthusiastic about dentistry, enjoys teaching quality dental care, and is passionate about helping veterinary teams understand the positive effects that good dental health and oral hygiene can have on the quality of life for our beloved animal companions.
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So, Dr.
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Bannon, welcome to Positive Veterinary Dentistry Podcast.
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Thank you.
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Absolutely.
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I'm so excited that you could be here today.
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I have got to know you over the past several years, teaching with you at some different events, and realized that we have a lot in common.
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We are both runners, and we were just talking about how I just finished my third half marathon of a 50 states half marathon in each state challenge, which I was inspired to start because of you.
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I definitely was so excited to hear about it because I have been a runner my whole entire life.
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And when I first met you, you were in the process of just finishing up the last several states of the 50 state half marathon challenge.
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And I'm like, wow, if she can do it, I think I can do it too.
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So I'm only three states in out of the 50.
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And so I'm gonna be drawing from your expertise and advice in regards to which half marathon to do in which state as I continue to roll out through the 50 states half marathon challenge.
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So thanks for being my inspiration.
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Oh, I'm so glad you're doing it.
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You're gonna have so much fun.
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I can't wait to hear about all of the exciting places that you get to visit and all of the things that you do.
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It's such a fun way to see the country.
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Really, really.
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I always say when you're running and you're doing something at that pace, you're able to really observe your environment around you and see the things and smell the smells and just really absorb.
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So that's personally why I love running so much and just even walking and being out in the outdoors is just getting to experience it at a slower pace because life is a little too fast sometimes, and so it's kind of nice to be a slow runner and go out and enjoy and just complete, right?
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Yeah, which is really cool.
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Absolutely, and I'm a back-and-tack runner, so I get to spend even more time out there, and you make friends out there too, right?
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Buddy up with somebody next to you and start talking to them.
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It makes the race go by a lot faster and get to make a new friend.
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I met a lot of very interesting people that way.
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Me as well.
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People that started running in their 70s.
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Oh, and now they're like, you know, 90 or something, and they're out there still doing it.
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And that's my goal is to keep running until I'm well into my 90s.
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That's cool.
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As long as I can and just get out there and enjoy life.
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So thanks for being my inspiration.
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Yeah.
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And you've also been my inspiration when it comes to veterinary dentistry.
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And I was so happy that you agreed to be on this podcast because I know you have such good advice and such good information to give.
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And that really stems from not only who you are as a person and all the things that you've learned through your experiences and everything, but just really everything that you've tried and done and learned from.
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I think that a lot of people could really benefit from that information.
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So well, thank you.
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Before we yeah, absolutely.
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Before we dive in today's topic, I always like to start with a fun question.
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So it's the tradition of the Positive Veterinary Dentistry Podcast to have my last guest leave a question for you so that we can pass it forward.
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You will also leave a question for my following guest at the end.
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So be thinking about something fun you'd like to ask someone like yourself or a VTS and dentistry technician like myself.
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So the question for you from my last guest is what is the strangest or most unusual thing you have ever found inside the mouth of a patient during an oral exam that absolutely did not belong there.
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Okay.
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Well, I would say the first thing that comes to my mind is three blueberries and a plastic bag and in the same mouth.
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Oh my goodness.
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And that was inside of a cleft palette.
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So, so this dog, her name was Nova.
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She was very, very sweet, but she loved blueberries.
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And so she had actually stolen blueberries off of the counter that had been in a Ziploc bag.
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And she got the blueberries and the plastic bag stuck up in her cleft palette.
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And so when we went the day we went to go and fix the cleft palette, we took the blueberries of the plastic bag.
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Oh my goodness, that is just crazy.
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I can't believe that.
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Yes, and it was like, oh, what happened to that bag of blueberries?
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The misplaced objects that wind up being found either inside a pet or somewhere where a pet has been and left it discarded.
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Yes, exactly.
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Exactly.
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Wow, that's just crazy.
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Well, that's a unique one for sure.
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So we'll be excited to hear what your question is for the next person.
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Okay.
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We've definitely come up with some interesting things.
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What we've had these situations happen with these found objects inside a pet.
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All right.
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So this episode is entitled Veterinary Dentistry is a team sport.
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And I think that phrase is really capturing the reality of how dentistry actually happens in a veterinary practice.
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From the outside, our clients are other people that don't really understand what happens when we do dental procedures.
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They may simply think it's just a veterinarian performing some procedure, right?
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But in reality, successful dentistry involves multiple team members working together in a more of a coordinated way to provide the best care for that patient.
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So, from your perspective as a veterinary dental specialist, how do you describe veterinary dentistry as a team sport?
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I would say dentistry absolutely starts at the front desk with the reception team, the customer service team.
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It is important for them to be involved in understanding proper dental care and understanding what's happening behind the scenes in the back of the clinic.
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And then it is with the assistants that are helping restrain the patients for their IBs and for their recoveries.
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And it is with the technicians that are running the anesthesia and technicians that are doing the cleaning, which are absolutely two different technicians on every patient.
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So you have to have multiple people involved with every procedure, and then the veterinarian that is doing the examination and the dental treatments that are required.
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So, and then uh on the back side of the procedure, when you're all done, the technicians that are doing the discharges and the technicians that are doing the follow-ups afterwards, or the assistants, whoever is responsible for doing that.
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And then again, back to the receptionists.
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It always starts at the front desk and ends at the front desk.
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And it is very important for the for those people to know how things are going and what happened and um to really understand the value of the procedure that was just performed.
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And it's great because so many of the CSRs are able to, you know, take those phone calls from the clients and say, oh my gosh, she's like a new dog.
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It's amazing.
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And so they can really appreciate the importance of what's happening.
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But it it's all starts with the entire team.
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It's all involved.
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And if there's groom, if there's groomers that are in the clinic, then they get involved too because they're doing a lot of the oral exams and often brushing the teeth for the clients, and that might be the only time the dog gets the teeth brush.
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And they can look at it and go, Oh, this is more than just the brushing.
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We need to get somebody else involved in this.
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So even the groomers that are part of the clinics are absolutely involved in in dentistry and oral care.
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Exactly.
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And I think that shouldn't be underestimated.
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The people who are caregivers in the back for the animals where they may be taking care of boarding patients or hospitalized patients, or they're there for grooming or something else, because often those are the people that actually have more interaction with the pet in a way that they may notice something's wrong with the mouth, right?
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So they can also be advocates for the patient just because they're giving them their breakfast every day while they're there boarding and they realize something or they understand, you know, what to look for.
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So it's important we train our whole entire team to be a part of this process.
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And another person I think that's on our team really has to be the client, right?
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Oh, sure.
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So we think about the team members being people that are actually employed at the hospital, but I would like to add that I think the client has to be a part of our team and we need to bring them into that role, being a part of the team that's helping all of us are there to help the animal.
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Absolutely.
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To define that a little bit more simply, too, when we think about the role of each person, maybe we could start with the receptionist.
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So can you expand a little bit more on how you think the phone call that's received by the receptionist for making an appointment for annual vaccines, let's say, or something to that nature, or when the person comes into the hospital and is standing in front of the receptionist, how can someone working in the front staff be more a part of that team to communicate with the pet owners the importance of oral health?
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Yeah, so when it starts with the phones, I would say the first thing is for the CSRs to really have a good understanding of what to be on the lookout for when the clients are calling.
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So if we have a client that is a dog owner that is calling, then perhaps they're a doxin owner, for example, and the client saying that, oh, the dog's been sneezing sometimes.
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And that's something that is a very clean problem with doxin, that if they get advanced periodontal disease, they get communication from the oral cavity up into the nose.
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And it's called an oronasal communication or an oronasal fistula.
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Or if you have an older dog that, like a small breed dog that has perhaps lost teeth and hasn't had the proper dental care, then the teeth have fallen out, and maybe they pull into their nose that way.
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And so chronic sneezing can actually be an indication of dental disease.
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And that's something that if the receptionists are well informed and understand that, then that can clue them in.
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And they can even mention, oh, well, let me get you in.
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The doctor will take a look at that.
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There's lots of reasons that can happen and meet might need some dental work, or they'll well, just let's get them in for an oral exam and be able to add that to their possible list of allergies and all of the things that they know to trigger the timing of their appointments and when they might put something into the schedule and how long they need to give the doctor or the technicians for that appointment block.
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And and then when they're in the in the lobby, either waiting for their appointments or maybe even checking out for their appointment after their consultation or their wellness exam, it's really important for the receptionists to have a good, strong feeling of the importance of the dental care.
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If the technician or the doctor has recommended dental care, that reception team can get them on the schedule to get that taken care of and they understand why this is important.
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So when that client is given their treatment plan or their estimate for a procedure and they go, Yeah, is that really necessary?
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I don't know.
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The doctor said something about getting his teeth cleaned, but we just did that three years ago.
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I don't know if that's really necessary.
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But what do you think?
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The reception team can say, oh gosh, yes, I just had last week, I just had this client that really didn't even know there was a problem.
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And now their dog is like a puppy again, and it's just amazing what happens when their teeth are clean and they're not in pain.
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And it's just such a wonderful feeling to see them come back in for that one week recheck and they're just trying in all happy to be here.
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So it's just such such a good feeling for the reception team to be able to share that positive feedback to those clients when they and support the recommendations of the team that was behind the scenes.
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So if the doctor or the technician is mentioning dental care, the reception team can really advocate for that patient and say, yes, this is important.
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We need to get this on the schedule before you leave.
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Not just so we'll give you a call in a couple of months when maybe when dental month comes around.
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I think the people that are the least trained in our veterinary staff is the CSRs.
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And they're often not given the tools that they really need to be able to understand those things that you just mentioned in order to have the foresight or the understanding of some of the signs or subtle things a client might say that would indicate that we might be dealing with something that has to do with dental or oral health.
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So I feel like this is leading to the idea that we need to create more training for our front staff and to prepare the client too for the fact that we're gonna do an oral exam.
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I think that can be a really important thing that they always mention it's part of their regular exam, right?
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So if they're coming in for an annual visit, they're going to get an oral health assessment while they're there so that we can better determine the urgency with which we need to place on dental care at that point.
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So all of those things are super important part of that.
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And as you mentioned too, the client might have questions and the CSRs may not feel prepared to answer those questions.
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And that's fair.
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Some questions the CSRs probably shouldn't be trying to answer, but definitely having an understanding of cause and effect, like you said, having stories or specifics, like there was this client and this pet last week that they were having the same questions as you.
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And when we did the dental procedure, they were amazed at how much better their pet felt.
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And I would definitely highly recommend that you consider this procedure because a lot of times the pets are in pain and they're not showing it or they have a lot of inflammation in their mouth and they could feel so much better if we took care of that.
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So sometimes just some basic things the receptionists could learn about and do.
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Is there anything else with the reception staff or CSRs that you recommend that we concentrate on their education as far as learning about dentistry?
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I think it's important for the CSRs to have a basic but a good understanding of anatomy of the oral cavity so that they can understand the medical records.
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If the doctor has recommended, let's say the medical record says that there's a stage three periodonsal disease on this patient and a slab fracture of the 108 that has a meaning to that front staff team and they know what to do with that.
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If that client then goes home, talks to their spouse, and calls back and says, Oh, I'm gonna, we're just gonna watch that and see what happens.
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That when they pull up the medical record to cancel an appointment or to reschedule an appointment, they know what they they're looking at and they say, Oh gosh, I see your dog's got a broken tooth that the doctor noted.
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It wasn't just a cleaning.
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This is really important that the sure you want to cancel that, or we need to reschedule that soon rather than rescheduling that in six months because this dog's got a broken tooth.
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It's not just a cleaning.
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So I think it's really important for the front team and the front staff team.
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They don't need to be the technician that's doing the charting that understands all of the in-depth notes of the dental chart, but to be able to just have a good solid understanding of what the medical records are telling them really it empowers them to make better decisions to advocate for the patients and help the clients make those decisions.
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Exactly.
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Because they're looking for translation between the doctor and the technicians and their verbiage and how we talk about it and whatnot, the clients often come up to the receptionists and hope for some sort of translation between what did the doctor just say to me, or what does my pet need, and how much is that gonna cost?
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Right.
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When can you get me in?
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And those kinds of things.
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And that can put a really heavy burden on the CSRs if they don't feel like they've been trained or had the opportunity to really get in depth with understanding how to interpret between it's almost two different languages, right?
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The medical records and then what we need to tell the clients so that they can best understand in layman's terms a little bit better what it is that we're trying to accomplish.
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Right.
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And like you said, so many dental conditions are don't have anything to do hardly with cleaning teeth.
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It really is about painful things that are needing to be treated, and that brings the urgency to the procedure, not that it's time for their annual cleaning.
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From your perspective, especially as a veterinary dental specialist, I know you rely heavily on your technical staff to make sure that everything runs smoothly.
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So, in your practice experience, how do you see the role of a veterinary technician when it comes to dentistry procedures?
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I think the veterinary dental technician is huge in the role of the procedures.
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And depending on the state, sometimes the role of the technician changes a little bit as far as what the technicians are legally allowed to do and not do.
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I would say that it's really important that there are two technicians with the patient at all times, or two people, whether it's a technician and a doctor, or two technicians.
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I think that is absolutely essential to the safety of the patient and to the sanity of the technician, to be fair.
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Because when I was in general practice, I do remember that there were situations where the technicians, when I didn't have control over what was happening in the clinic that I was working in, there were technicians that were put on the spot to run the anesthesia and clean the teeth at the same time.
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And I know it still happens to this day.
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That was over 20 years ago, and I didn't like it then, and I definitely don't like it now.
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But it is something that I know happens and I know happens occasionally when it's not intended, and that that is what it is, but when it's intended, I think that's really room for improvement at the clinic.
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Because when we have a situation where a technician is put into a position that they have to choose, are they going to focus on making sure that the patient is alive and their anesthesia is going smoothly?
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Or are they having to focus on doing a good job with their oral cleaning, dental charting, and dental geographs?
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They're being forced to choose between two very important roles in figuring out which one they're going to work on at that moment in time because they cannot do both well.
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I love my technicians, they are the most amazing people that I work with.
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I can't ask that of them.
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That is not fair to ask them to do two roles well that are completely contradictory to each other because they are both very time intense and they cannot do a good job with that.
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The very best technicians are the very best, and they still cannot do a good job with that because they're completely incompatible roles to do at the same time.
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You can absolutely have a technician that is great at anesthesia and great at doing the cleaning.
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They just need to be doing it on different patients.
00:21:38.720 --> 00:21:42.000
They cannot do both at the very same time on the same paper.
00:21:42.240 --> 00:21:47.279
And I understand there are situations where time is of the essence and staff is at a minimum.
00:21:47.359 --> 00:21:50.240
I suffer with that in my practice on a regular basis as well.
00:21:50.559 --> 00:21:56.240
Staff calls in sick, or we're just short staffed in general because of life and because of staffing.
00:21:56.400 --> 00:21:59.759
But I do think we need to try to schedule accordingly where we find.
00:22:00.240 --> 00:22:06.799
Way to have two people with that patient so that someone can focus on making sure that the anesthesia is stable.
00:22:06.960 --> 00:22:15.839
Because unfortunately, so many of the situations that we run into with clients is the sense of fear with anesthesia.
00:22:16.000 --> 00:22:21.039
And a lot of that stems from historically having had problems with anesthesia.
00:22:21.200 --> 00:22:28.000
And I see clients on a regular basis that say that they lost an animal out during or after a dental procedure.
00:22:28.160 --> 00:22:29.920
And it always seems to be a dental procedure.
00:22:30.079 --> 00:22:34.559
Occasionally it happens when they're being stayed or neutered or a mass removal or something like that.
00:22:34.720 --> 00:22:39.839
But almost always, if they had an anesthetics complication, it was during a dental procedure.
00:22:40.000 --> 00:22:43.440
And dental procedures themselves are not high risk for anesthesia.
00:22:43.599 --> 00:22:49.119
There's no reason that we should have a higher rate of anesthetic complications with dental procedures.
00:22:49.279 --> 00:22:57.920
I understand how many directions we are pulled in on a daily basis and on a moment-to-moment basis, how many things are going on at one time.
00:22:58.079 --> 00:23:09.519
But it is important that we take dental procedures just as seriously of an anesthetic procedure as we do a splenectomy or a limb fracture repair.
00:23:09.680 --> 00:23:23.440
And if you would be doing that as the doctor, if you would be doing those procedures by yourself in the surgery suite and running your own anesthesia while you're repairing a fractured leg, then that's what you can ask of your technicians for the dental procedures.
00:23:23.519 --> 00:23:32.880
But if that's not something we would want to do, if you would want a technician there monitoring your anesthesia so that you can be focused on the surgery that you're doing, then that's what we want.
00:23:33.119 --> 00:23:33.839
Dental procedures.
00:23:34.400 --> 00:23:34.880
Agree with that.
00:23:34.960 --> 00:23:40.480
And it's so important that we think about the fact that if we only do one thing right, we better do anesthesia right.
00:23:40.559 --> 00:23:40.799
Yes.
00:23:40.960 --> 00:23:44.400
Because the dental procedure, yeah, that's why we're anesthetizing them.
00:23:44.559 --> 00:23:50.799
But if they don't recover and aren't okay, we could have done irreparable harm to their organs or other things.
00:23:51.119 --> 00:24:00.640
Yeah, and just of course, just remembering too that recovery or or waking up from anesthesia is kind of a bare minimum of the acceptable anesthetic event.
00:24:01.039 --> 00:24:05.759
And so I always keep that in the back of my mind and say, okay, yeah, they recovered.
00:24:05.839 --> 00:24:06.400
That's good.
00:24:06.480 --> 00:24:11.200
That's that is absolutely important, but a low bar to set for the anesthesia.
00:24:11.279 --> 00:24:11.440
Yeah.
00:24:11.599 --> 00:24:15.039
Remembering that a lot of these patients are tiny animals.
00:24:15.200 --> 00:24:16.720
They are often older.
00:24:16.880 --> 00:24:21.680
So they get very cold very quickly, their blood pressure drops very quickly.
00:24:21.920 --> 00:24:30.319
The number of patients that we in our practice have to put on blood pressure support is high, but absolutely high when they're under anesthesia.
00:24:30.400 --> 00:24:43.279
So if we're not monitoring all of the same things that we would be monitoring during our sterile procedures, if we're not monitoring blood pressure, if we're not monitoring temperature and doing something about it, then we're doing a disservice to our patients.
00:24:43.440 --> 00:24:50.559
And they may recover and they may survive that procedure, but we also might, like you said, be doing irreparable harm.
00:24:50.640 --> 00:24:59.920
Then we want to make sure that we're not leaving them with clean teeth, but some kidney damage that we don't even know happens if we can all prevent it.
00:25:00.079 --> 00:25:01.359
And sometimes things happen.
00:25:01.599 --> 00:25:03.839
No one has a perfect record, including myself.
00:25:04.079 --> 00:25:13.279
And sometimes things happen, but the most that we can do is do our very best to minimize that and not ask anything of the technicians that we wouldn't ask of ourselves.
00:25:13.680 --> 00:25:18.960
So technicians have a lot of different skills that they are focused on doing.
00:25:19.119 --> 00:25:24.160
And you mentioned the anesthesia and how important it is having someone dedicated to that.
00:25:24.319 --> 00:25:34.160
In your practice, I know you have cone beam CT now, which is really amazing, so that you can go ahead and get that taken care of, and your technicians do that for the patient.
00:25:34.319 --> 00:25:36.880
And then they would then move on to the next step.
00:25:37.039 --> 00:25:44.799
So, specifically in your practice, what are some of the other things that you have your technical staff doing when it comes to working on the actual patient?
00:25:45.039 --> 00:25:45.680
Yeah, absolutely.
00:25:45.839 --> 00:25:52.319
So we break up our team into a dental technician and an anesthetic technician for each patient, and they rotate.
00:25:52.480 --> 00:26:01.680
So the technician on this patient will be the surgery tech, and in the next patient, they'll be the anesthesia tech for somebody else to be their surgery technician.
00:26:01.839 --> 00:26:06.000
Through the course of the day, they're running both anesthesia and doing the dental procedures.
00:26:06.240 --> 00:26:17.279
There's a lot of variety of ways that you can do that within the practice, whether you spend all day, one day running anesthesia and a separate day doing all of the cleanings or whatever works best for your team.
00:26:17.440 --> 00:26:22.880
With my team, that's the way it works best there's a technician that is dedicated to that patient for the day.
00:26:23.039 --> 00:26:31.599
So that technician is the one that goes up to the client, visits with them in the morning, gets the paperwork signed, and um gets the questions answered.
00:26:31.680 --> 00:26:36.799
So the client has a face for the person that is responsible for their pet throughout the day.
00:26:36.960 --> 00:26:50.000
And then that technician is the same one that is doing the cleaning, that is doing the interaction with the client on the phone or text messaging to let them know how their patient's doing and when they're getting started and all of those things.
00:26:50.160 --> 00:27:05.119
So after they've admitted them into the clinic, then they will reach out to the client and let them know at what point throughout the day we expect their patient to go under anesthesia because we check everybody in first thing in the morning and then stagger them throughout the day.
00:27:05.359 --> 00:27:12.079
So they may have checked in at 7:30 in the morning, but their patient may not start under anesthesia until after one or two in the afternoon.
00:27:12.240 --> 00:27:16.720
And clients don't love that, but it is just the way that the flow has to be.
00:27:16.880 --> 00:27:20.240
In our practice, we just can't have people checking in the middle of the day.
00:27:20.319 --> 00:27:32.000
And even yesterday in my practice, we had a plan and we told the clients, okay, this is the patient that's going in the morning, and this is a patient that'll be midday, and this is the patient that's in the afternoon.
00:27:32.160 --> 00:27:43.920
And the first patient of the morning was a young, healthy cat that was throwing VPCs as soon as we got the EKG hooked up and we contacted the owner and said, We really recommend a cardiologist.
00:27:44.000 --> 00:27:48.240
And she said, Oh my gosh, yes, let me go find out why Mike's throwing VPCs.
00:27:48.559 --> 00:27:52.720
So we woke that cat up, or actually, we'd never really gotten it fully asleep.
00:27:52.880 --> 00:27:59.599
And because we caught it on our pre-EKG, but we moved it out of the shift and said, Okay, everybody's moving up.
00:27:59.759 --> 00:28:04.559
Now that now our late morning, early afternoon procedure suddenly is going now.
00:28:04.799 --> 00:28:14.720
And so it is helpful to have all of the patients in the clinic at the first thing in the morning so that you really can get that kind of flow through the day.
00:28:14.880 --> 00:28:17.119
As much as the clients don't love it, I get it.
00:28:17.200 --> 00:28:18.640
I was a client too.
00:28:18.799 --> 00:28:24.640
And when I had my last kitten that I adopted when she got spayed, she happened at the end of the day.
00:28:24.720 --> 00:28:29.839
And I sat there all day long wondering how she was doing because I knew she was going to be last, but it was still hard.
00:28:30.000 --> 00:28:37.599
So I get it as a client, it's not fun, but it is best for the patients and it's best for the team to have everybody there.
00:28:37.759 --> 00:28:42.079
So, anyway, the tech the technician that's responsible is communicating with the client.
00:28:42.319 --> 00:28:49.839
I find in my practice, and I do believe in general practice as well, it's very important to take photographs of them when they are there for dental work.
00:28:50.079 --> 00:28:54.480
So we are doing photographs before we intubate.
00:28:54.640 --> 00:29:06.240
So this is very important, in my opinion, because we get so many cases where we will have a doctor reach out to us and say, What is wrong with this mouth or what's happening?
00:29:06.400 --> 00:29:11.359
And I will ask, when you were examining the mouth before you intubated, were the teeth hitting each other?
00:29:11.519 --> 00:29:14.000
Does the dog have a good occlusion?
00:29:14.160 --> 00:29:15.200
Is it normal?
00:29:15.359 --> 00:29:17.599
Or is there an underbite or an overbite?
00:29:17.680 --> 00:29:18.799
And they say, I don't know.
00:29:18.960 --> 00:29:22.319
My technicians intubated and I wasn't there, which is great.
00:29:22.480 --> 00:29:25.119
I mean, that's fantastic that they have a technician team.
00:29:25.200 --> 00:29:42.799
I'm not usually there when my technicians intubate either, but we actually have the technicians do photos of the mouth closed before they intubate so that we have a front view and then side views from each side so that we can see the occlusion if we do have an issue that we're wondering about.
00:29:42.960 --> 00:29:54.319
We can actually go back and look at the photographs and evaluate the occlusion without the breathing tube in so that we can see what that looked like and then be able to make a treatment plan that might be appropriate for that.
00:29:54.480 --> 00:29:57.519
So we start out with the occlusion photos before intubation.
00:29:57.599 --> 00:30:10.000
Once they're under anesthesia, then we do full mouth photos and we try to catch anything that might be maybe as far as like if there's a lump in the mouth that we might want to focus a separate photo on.
00:30:10.160 --> 00:30:14.640
Sometimes we don't catch those until the actual detailed exam, and then we'll take a photo then.
00:30:14.799 --> 00:30:17.119
So the technician will take a photo of the mouth.
00:30:17.279 --> 00:30:32.240
They will rinse the mouth with some chlorhexidine if it's appropriate, so that we can decrease the aerosolized bacteria in the mouth and the exposure to the staph of the bacterial release during the procedure.
00:30:32.400 --> 00:30:37.440
And then the technicians will set up for the CT scan and then start doing the cleaning.
00:30:37.599 --> 00:30:41.440
And after they've done their cleaning, then we do our radiographs.
00:30:41.599 --> 00:30:49.519
And my flow is photos, CT, cleaning, dental radiographs, and then we chart.
00:30:49.599 --> 00:30:52.640
And the technicians are doing the charting as well.
00:30:52.799 --> 00:30:57.519
And I feel good that if they're well trained, that's an appropriate role of a technician.
00:30:57.680 --> 00:31:01.839
Not all the technicians are comfortable with doing that, not even in my practice, and that's fine.
00:31:02.000 --> 00:31:14.480
But if they're a well-trained technician, they can do the dental charting and be able to help the doctor make some of the diagnoses of what's happening, or at least have an idea of what the doctor needs to focus their energies on.
00:31:14.640 --> 00:31:25.440
And then the doctor can go and double check the exam and at least evaluate the mouth, look at the radiographs while they're looking at the oral cavity.
00:31:25.680 --> 00:31:34.880
And then the doctor reaches out to the client with the plan while the doctor is talking to the client and getting permission for whatever we're recommending.
00:31:35.039 --> 00:31:43.039
The technician will finish up the cleaning, polish the teeth, and then take the post-cleaning photographs of the mouth.
00:31:43.200 --> 00:31:44.880
And then the doctor will scrub in.
00:31:45.200 --> 00:31:55.119
If they usually the doctor will have done the block, the regional nerve block at the time of the exam, and then start whatever procedure needs to be done at that point.
00:31:55.200 --> 00:32:14.079
And then that surgery technician that was doing the cleaning and the radiographs then switches to a surgery assistant for the doctor so that they can run suction or change out burrs or cut suture, take the intra-op or the post-op radiographs that are needed during the extractions, whatever assisting needs to be done.
00:32:14.480 --> 00:32:22.799
In a shorter staffed day, that surgery technician will then switch over and take over anesthesia while the doctor is doing surgery.
00:32:22.960 --> 00:32:30.079
And that anesthesia technician then can go off and do something else with their day if they need to or start working on another procedure.
00:32:30.240 --> 00:32:36.319
So there's still two people with the patient, but in my ideal day, I'll have three people when there's the doctor there.
00:32:36.480 --> 00:32:45.359
I'll have my surgery technician will get to stay as a surgery assistant and make everything faster for me so that we can keep our time under anesthesia at a minimum.
00:32:45.599 --> 00:32:59.839
That's important because in your specialty practice, you're doing just dentistry cases and you need to have that surgical support because you're trying to do some pretty complex work and you have multiple patients to take care of today.
00:33:00.000 --> 00:33:02.480
So that way you can be as efficient as possible.
00:33:02.720 --> 00:33:02.880
Right.
00:33:03.119 --> 00:33:10.960
In a general practice setting, veterinarian often has other surgeries and things that have nothing to do with dentistry that they have to do.
00:33:11.119 --> 00:33:17.039
So it may run slightly different in a general practice setting versus what you're doing.
00:33:17.359 --> 00:33:52.720
And having the ability to get that cone beam CT right off the bat expedites your process of diagnosis, confirming what you probably had suspected or potentially adding to the complexity of what you're up against, I'm sure, when you see what you see on that cone beam, making it so that the dental interval radiographs are maybe adding to the information for sure, but not necessarily your primary imaging modality at that point because you're really reliant on that cone beam CT to get that ball rolling.
00:33:52.880 --> 00:33:53.759
So true.
00:33:54.079 --> 00:34:04.079
But I I have some general practices that are in my area that have switched to using cone beam CT as well, and have actually dropped the dental radiographs.
00:34:04.160 --> 00:34:05.440
And I don't recommend that.
00:34:05.599 --> 00:34:09.119
I do not think that is an appropriate way to flow.
00:34:09.199 --> 00:34:15.199
It the cone beam absolutely makes things easier and faster, and you can get a good overall sense of what's happening.
00:34:15.360 --> 00:34:18.239
But it's very important to have dental radiographs at the same time.
00:34:18.400 --> 00:34:27.360
And especially if you don't have them at all, then that makes intra-operative radiographs or post-operative radiographs not available to you.
00:34:27.679 --> 00:34:33.840
So if you do decide in general practice to add cone bean CT, I mean it's a fantastic tool.
00:34:34.000 --> 00:34:45.280
And I do think that there are good uses of it in general practice, and I think it is great when general practitioners have it, but I also think it's important to still keep dental radiographs.
00:34:45.360 --> 00:34:52.480
Some of the salespeople for the cone bean CT say it's substitutes, and then actually they'll get rid of their dental radiographs.
00:34:52.559 --> 00:34:54.000
And I do not recommend that.
00:34:54.239 --> 00:34:55.360
Yeah, that's a great point.
00:34:55.440 --> 00:34:57.440
And I have encountered that once or twice.
00:34:57.599 --> 00:35:16.480
And I was told by someone like yourself that could almost be considered malpractice if they're not taking either interoperative as necessary and postoperative dental radiographs because they're not doing the entire steps of the procedure properly if they don't have the images to prove how they left the place.
00:35:17.039 --> 00:35:37.039
And cone beam CT, I think the reason some general practices think that it's gonna be a substitute is because they're looking for a quick fix, they're looking for something that's gonna suddenly make it so that it doesn't take so long to get the images because cone beam CT takes a couple minutes compared to like how long does it take to take dental radiographs.
00:35:37.280 --> 00:35:39.599
And so they think, oh, this is better.
00:35:39.679 --> 00:35:44.559
Let's just do that and get rid of this whole time-consuming thing, intral dental radiographs.
00:35:44.639 --> 00:35:52.480
But the other thing I have heard, which maybe you could clear up, is that if you do cone beam CT, you need to be prepared to read the whole entire thing.
00:35:52.960 --> 00:35:59.519
You can't just be looking at the teeth or the bones surrounding the teeth and not look at the whole entire head of the patient.
00:35:59.679 --> 00:36:00.559
Is that true?
00:36:00.719 --> 00:36:05.519
I mean, is it something where you could be up for litigation if you miss something?
00:36:05.760 --> 00:36:07.920
Yes, that's what I have been told as well.
00:36:08.079 --> 00:36:17.119
And I luckily have not reached a situation where I have been on a any type of litigious situation where I've had that challenged.
00:36:17.360 --> 00:36:23.840
But I absolutely have diagnosed problems that were outside of the oral cavity, including several brain tumors.
00:36:24.000 --> 00:36:29.519
So I do think it is important that we are looking at the entire scan.
00:36:29.679 --> 00:36:41.519
When we are doing our clon beam CT, we will be specific about where we end it and try to not include any neck or feet or other body parts that I don't intend to look at because of that.
00:36:41.679 --> 00:36:48.239
And so, especially when you have the very small patients, not a big of a deal when you've got a German shepherd and their head barely fits in it anyway.
00:36:48.400 --> 00:36:53.280
But when you've got a chihuahua, you could do an entire body scan in the cone beam CT.
00:36:53.519 --> 00:36:57.280
And unless you're prepared to interpret that, I would strongly advise against it.
00:36:57.519 --> 00:36:58.639
Yeah, that makes sense.
00:36:59.039 --> 00:37:15.199
I like that we pointed that out because I think that's a bit of a myth that's going around and maybe perpetuated by some of the people who are working towards selling you that cone beam CT, which, as we know, it has an amazing place in veterinary dentistry, but it doesn't replace dental radiographs.
00:37:15.440 --> 00:37:15.920
It's not.
00:37:16.000 --> 00:37:20.800
And it's even the litigious side of it for the post-operative radiographs is very important.
00:37:20.880 --> 00:37:23.519
And I have had some clinics say, Well, I do a post-op CT.
00:37:23.760 --> 00:37:25.199
Like, okay, that's great.
00:37:25.360 --> 00:37:36.320
And if you're looking at it with the same thoroughness as you looked at the pre-operative CT, then that's an okay documentation for legal purposes.
00:37:36.559 --> 00:37:42.960
But as far as the flow of your practice and your day, a lot of times that's a difficult thing to do.
00:37:43.119 --> 00:37:54.239
And also to look at it and actually take the time to assess it and make sure that there were no root tips left behind is difficult to find the time to really thoroughly look at the post-op CT.
00:37:54.400 --> 00:38:16.960
But really, where you're losing if you're just switching to CT is the intra-op radiographs because it is so important when you're doing extractions, especially that if you're struggling with an extraction and you break a root or you are just frustrated, the I mean, dentistry can be frustrating and it frustrates the best of us and the worst of us and everybody in between.
00:38:17.119 --> 00:38:20.480
And it can be frustrating and everybody breaks roots.
00:38:20.639 --> 00:38:21.360
I do too.
00:38:21.519 --> 00:38:22.639
And it happens.
00:38:22.719 --> 00:38:30.639
I broke one yesterday and I had to take about five x-rays with little needles in the x-ray to see is okay, where is this root?
00:38:30.800 --> 00:38:33.599
Is it on this side of the needle or this side of the needle?
00:38:33.760 --> 00:38:38.639
And and that's what I was doing yesterday in this upper fourth premolar in a husky that I had to extract.
00:38:38.880 --> 00:38:52.559
If you don't give yourself the opportunity to have intra-operative radiographs and use that, then you're doing yourself a disservice because you're going to struggle with your extractions much more than you need to.
00:38:52.719 --> 00:38:59.840
And if you're struggling with an extraction, the first thing that I recommend is to step back and do some radiation therapy on the patient.
00:39:00.000 --> 00:39:04.320
And so that is also known as having your technician take a dental radiograph.
00:39:04.480 --> 00:39:13.519
And in many cases, that also means when you're really struggling with that root that just broke on you and you can't figure out where it is and where did it go and why can't I get this?
00:39:13.760 --> 00:39:28.800
Best thing to do is step away from the patient, put your hands in the air, do a little lap around the treatment area, take a deep breath, go get a sip of water while your technician is taking that dental radiograph for you and again doing some radiation therapy on your patient.
00:39:28.960 --> 00:39:35.679
And you get two things: you get a quick breather and a quick break, and you get information about why you're struggling with it.
00:39:35.840 --> 00:39:38.719
Yeah, maybe it is broken in a way you didn't expect.
00:39:38.880 --> 00:39:41.760
Maybe the root is at a different angle than you thought.
00:39:41.920 --> 00:39:50.719
Uh, maybe it is in a different location or where you're removing your bone is nowhere near where your root is, which is what happened to me yesterday.
00:39:50.960 --> 00:39:55.360
So I looked at that and I went, oh my gosh, my roots there and I'm removing bone over here.
00:39:55.440 --> 00:39:58.320
No wonder my elevator is not doing what it's supposed to do.
00:39:58.480 --> 00:40:06.880
So I need to get those two pieces closer together and remove bone right next to the root instead of way over here on the other side of the head, it seemed like, based on my radiograph.
00:40:07.119 --> 00:40:07.360
Exactly.
00:40:07.599 --> 00:40:16.239
So once I had that information, I was like, wow, this root just came right out once I knew actually where it was and when what I was what my goal in life was.
00:40:16.480 --> 00:40:24.639
So if you don't take intra-operative radiographs when you're struggling with extractions, you're doing yourself a disservice.
00:40:24.800 --> 00:40:29.360
And it really is so much easier when you have all of the information that you need.
00:40:29.519 --> 00:40:33.679
It's like trying to manage a diabetic patient without periodically doing blood glucose.
00:40:34.000 --> 00:40:40.800
You're just not gonna, you might get to a good end goal if the it there, but it's gonna take a lot more work than you needed.
00:40:40.960 --> 00:40:41.519
I agree.
00:40:41.679 --> 00:40:49.760
When I hear the crack sound and then the swear word that comes out of my veterinarian's mouth, what I like to say is step away.
00:40:50.559 --> 00:40:54.800
Let me take an X-ray because it's my little rhyme.
00:40:54.880 --> 00:41:01.360
Because I think that veterinarians, bless your hearts, you guys want to get that tooth root out and you just broke it.
00:41:01.599 --> 00:41:21.920
But you don't want to be drilling and digging and just continuing on down without actually seeing what just happened, because it certainly could be made worse if you do those things, versus let's just see what we see on the radiograph and make sure we know where we're at and what happened and where is it broken or what broke.
00:41:22.079 --> 00:41:23.119
Is it the root that broke?
00:41:23.199 --> 00:41:24.320
Is it brone that broke?
00:41:24.559 --> 00:41:25.199
What happened?
00:41:25.360 --> 00:41:30.719
And just regroup and taking that little brain break and putting the drill and the instruments down, so important.
00:41:31.280 --> 00:41:33.280
My own cat specifically, too.
00:41:33.440 --> 00:41:35.199
Well, she's actually my grandkitty.
00:41:35.760 --> 00:41:44.000
I took her to a veterinary dentist here locally in the Phoenix area that I know because I wanted to make sure she got the best dental care we could give her.
00:41:44.079 --> 00:41:54.079
And we did cone beam CT on her first, but then we took interval radiographs and we caught tooth resorption on the radiographs that we could not see on the cone beam.
00:41:54.159 --> 00:41:54.559
Yep.
00:41:54.960 --> 00:42:00.400
And I was very suspicious that she did have tooth resorption because of some clinical signs.
00:42:00.559 --> 00:42:11.039
However, I was very interested in the fact that it would have been unapparent if we had just gone with the cone beam only and not did the dental radiographs.
00:42:11.199 --> 00:42:23.119
So I think that we definitely still want to have all the tools available to us, whether it's cone beam as well as radiographs, but not discounting the importance of those dental radiographs.
00:42:23.280 --> 00:42:24.239
Absolutely, absolutely.
00:42:24.400 --> 00:42:25.280
We we see that.
00:42:25.440 --> 00:42:27.440
We see that not infrequently for sure.
00:42:27.599 --> 00:42:30.719
Sometimes we pick up more resorption, sometimes we pick up less.
00:42:31.039 --> 00:42:35.760
And just like any tool that you have, the cone beam CT has its place.
00:42:35.920 --> 00:42:38.880
It has its advantages, but it has some disadvantages as well.
00:42:39.039 --> 00:42:39.760
So great.
00:42:40.000 --> 00:42:54.480
And talking about teamwork, where you had discussed the fact that veterinary technicians have certain skills that we can really work on to get really good at, but we are just a tool, honestly, of the doctor.
00:42:54.719 --> 00:43:07.440
We are the extra set of hands and eyes on the patient, and we could do the primary oral examination and using a probe explorer and chart all the things that we can find.
00:43:07.599 --> 00:43:29.440
But then you come in and see what we charted and then look at the patient yourself, touching, feeling, confirming visually and with probing depths and whatnot, what exactly your plan is so that we can keep this patient moving along and hopefully do things that will impact the patient's well-being with the time that we have with them under anesthesia.
00:43:29.760 --> 00:43:34.559
So you're using us to make sure that you can be as efficient as possible.
00:43:34.719 --> 00:43:49.199
So when it comes to veterinarian skills and you working as a specialist, but us talking more to general practitioners today, what would some things that you would tell general practitioners about where they need to put their efforts?
00:43:49.360 --> 00:44:03.760
Like, what should they do with their licensure and their time to make sure that we can help not only as many patients as we can in a given day, but also really Really do a good job of helping the ones that we do have under anesthesia.
00:44:03.920 --> 00:44:09.039
Is there any specific advice you'd have to give to a general practitioner or maybe a new graduate veterinarian?
00:44:09.360 --> 00:44:10.559
Yes, absolutely.
00:44:10.719 --> 00:44:32.719
I would say that one of the most important things that we really don't get an opportunity to learn in school, whether you're a new graduate or you've been out for 20 plus years, like I have, is a really good, strong understanding of dental radiographic anatomy and understanding the diagnostic process of what's happening here.
00:44:32.960 --> 00:44:36.480
So much of what we do is diagnosing the problem.
00:44:36.639 --> 00:44:38.800
And then treating it is a separate thing.
00:44:38.880 --> 00:44:45.760
But in many cases, we don't even know what we're supposed to be treating because we don't have a good understanding of the diagnosis.
00:44:45.840 --> 00:44:50.880
And I think that's really one of the frustrations of veterinarians with dentistry.
00:44:51.039 --> 00:44:54.000
I know a lot of veterinarians say, boy, I really hate doing dentals.
00:44:54.079 --> 00:44:56.000
They just, they're so frustrating to me.
00:44:56.159 --> 00:45:05.119
And a large portion of it is because we don't have enough training to understand what's happening and what we're supposed to be looking for.
00:45:05.360 --> 00:45:10.639
And when you see something that is not quite right, you don't know what to do with it.
00:45:10.800 --> 00:45:14.079
And it's it's not always your fault that you don't know what to do with it.
00:45:14.239 --> 00:45:17.920
It's like, I don't, I know something's not right, but what is that?
00:45:18.079 --> 00:45:19.440
And does it need treatment?
00:45:19.599 --> 00:45:20.800
Does it not need treatment?
00:45:21.039 --> 00:45:30.400
So I think that a large portion of the training of understanding the diagnostics of what you're doing and is this important?
00:45:30.559 --> 00:45:34.239
Is this clinically relevant to the patient is so important.
00:45:34.480 --> 00:45:54.800
And being able to take a dental radiograph and a dental chart and a dental examination and make a plan, even if you are not as comfortable with doing the extractions, if you at least have an understanding of what this patient needs and this tooth needs to be extracted, then if you're not comfortable doing it, great.
00:45:54.960 --> 00:45:58.719
There's gonna be somebody else that is, and that's absolutely okay.
00:45:58.960 --> 00:46:07.199
It is absolutely okay to say, I am not comfortable extracting that lower canine tooth in this four-pound chihuahua.
00:46:07.360 --> 00:46:11.280
I'm afraid I'm going to break the jaw and I don't want to extract it.
00:46:11.440 --> 00:46:13.519
That is absolutely okay.
00:46:13.760 --> 00:46:17.440
It is not something you have to do if you are not comfortable with it.
00:46:17.599 --> 00:46:26.880
But what you have to do is convince the client that extraction is the appropriate thing if it is, and make sure that they get to a person that can do it.
00:46:27.039 --> 00:46:38.880
Whether that's another doctor within your practice that is more comfortable or more trained in dental procedures that are extracting lower molars or lower canines with minimal complications.
00:46:39.119 --> 00:46:41.679
It might be the dental specialist that's in your area.
00:46:41.840 --> 00:46:45.199
Sometimes dental specialists are only an hour away.
00:46:45.360 --> 00:46:49.360
Some of us are four or six hours away from your practice.
00:46:49.519 --> 00:46:59.280
And being able to understand when you need to refer and not feel like it's, you know, oh, well, they're five hours away.
00:46:59.440 --> 00:47:00.880
I just have to do this.
00:47:01.119 --> 00:47:03.119
And that's not necessary.
00:47:03.360 --> 00:47:10.639
And sometimes there are situations where, yes, clients cannot accept referral, they can't drive that far, they can't afford it.
00:47:10.800 --> 00:47:12.559
All of those situations happen.
00:47:12.639 --> 00:47:16.159
And sometimes we're stuck doing things that we're not comfortable doing.
00:47:16.400 --> 00:47:27.519
But there are lots of situations where we don't have to, but we have to be able to understand what is in the best interest of the patient and know what our boundaries are.
00:47:27.599 --> 00:47:31.760
And if this is in our wheelhouse, if it's not in our wheelhouse, either way is okay.
00:47:32.000 --> 00:47:33.599
We are our patient advocates.
00:47:33.760 --> 00:47:41.599
So it's really important for us to feel comfortable with the diagnosis so that we know what this patient needs.
00:47:41.760 --> 00:47:45.280
And then we can figure out who's the best person to give that to that patient.
00:47:45.519 --> 00:47:46.639
Might be you, that's great.
00:47:46.719 --> 00:47:48.079
If it's you, that's fantastic.
00:47:48.239 --> 00:47:52.639
If it's not you, then it might be somebody else near you, might be somebody not near you.
00:47:52.880 --> 00:48:08.159
But once you really have a good understanding and a really strong confidence in your diagnosis, then you will be able to relay that to the client and equate it to doing back surgery in a doxend that's down.
00:48:08.400 --> 00:48:15.840
If you have a doxend that is paralyzed and the client says, I know you're not a neurosurgeon, but aren't you just comfortable doing that?
00:48:16.000 --> 00:48:17.599
Didn't you learn about that in school?
00:48:17.840 --> 00:48:23.920
And a lot of veterinarians are not gonna be okay with that, but they feel like they have to be because it's only a dental.
00:48:24.079 --> 00:48:32.320
And the clients are saying, It's a lower molar, and my dog's three pounds and it's a lower molar, and you know, it's only a tooth, right?
00:48:32.480 --> 00:48:35.440
And the veterinary is like, oh my God, I'm gonna break the jaw.
00:48:35.519 --> 00:48:36.880
I'm not comfortable with this.
00:48:37.039 --> 00:48:41.440
But the owners, I feel like I have to because it's only a dental and I should.
00:48:41.519 --> 00:48:44.800
I learned how to extract teeth, and it's not necessary.
00:48:44.960 --> 00:48:50.880
It really is not necessary for you to feel put into a situation where you are not comfortable doing this.
00:48:51.039 --> 00:49:01.519
If you would not do it in a different body part, if it was something that you learned about that never actually did before, if you don't feel like that's something, well, I would take that on.
00:49:01.679 --> 00:49:15.039
I would go ahead and try to see if I could uh do some release of that IVDD disc in this back dog and see if I can get it unparalyzed because the client really wants me to do it instead of go to the neurologist that's down the street.
00:49:15.199 --> 00:49:19.840
You know, it then okay, then that's the kind of person that you are and go for it.
00:49:20.000 --> 00:49:23.039
And if you feel comfortable that that's within your wheelhouse, great.
00:49:23.280 --> 00:49:35.039
But if it's not and it puts you in a place where you can't sleep at night and you're getting stomach ulcers because of the stress of being put in positions that you don't feel comfortable and don't feel trained for, don't do it.
00:49:35.119 --> 00:49:40.239
It is okay to say no, but it's not okay to not know what we need to do.
00:49:40.400 --> 00:49:48.000
And that's where I like to see my focus of my general practitioners is just having a good understanding of what the patient needs.
00:49:48.159 --> 00:49:50.000
And then we can figure out how to make that happen.
00:49:50.239 --> 00:49:54.320
I think that's good advice because, first of all, we have to recognize there is a problem.
00:49:54.480 --> 00:49:54.719
Right.
00:49:54.880 --> 00:49:59.039
And then we also have to recognize if we're capable of addressing that problem.
00:49:59.280 --> 00:50:00.400
My first episode with Dr.
00:50:00.559 --> 00:50:06.480
Naomi Hoyer was regarding the perfect partnership referral relationship with GP.
00:50:06.719 --> 00:50:07.199
Yes.
00:50:07.440 --> 00:50:09.440
And getting that feedback loop going.
00:50:09.519 --> 00:50:25.199
And I know you're such a resource in your area there in New Mexico, so that if there is a general practitioner around you and they have a case that they feel like they've never tried to tackle, but they feel like they'd like to learn how to tackle that case.
00:50:25.280 --> 00:50:30.719
And it's something a GP could certainly do, but that person just isn't comfortable.
00:50:30.960 --> 00:50:48.000
It may be great to refer that patient to you, but then get some feedback going, some information about how you felt that went, or how they could potentially have approached that if they decided to do it on their own, or for them to learn from you.
00:50:48.079 --> 00:50:57.599
I'm sure you offer some continuing education in your area as well for your GP vets, so that they can get better at doing things that could be in their wheelhouse.
00:50:57.760 --> 00:51:27.039
But we also talked about the fact that a lot of times things get referred because of anesthetic complexities and comorbidities and things that would be best served potentially in the hands of someone like yourself just because of those factors, not necessarily because of the dental procedure being too complicated or complex for that person, but maybe just the fact that they're a little uncomfortable with the anesthesia on that patient.
00:51:27.280 --> 00:51:27.760
Absolutely.
00:51:27.920 --> 00:51:31.039
And I think that's a very good reason for referral.
00:51:31.199 --> 00:51:35.199
I do extractions on a regular basis and on a daily basis, honestly.
00:51:35.280 --> 00:51:42.400
And some veterinarians, when I'm talking to them or in teaching, they say, Oh, well, you probably never see this stage four mouth the way that I do.
00:51:42.480 --> 00:51:44.480
And I'm like, oh, I see them every single day.
00:51:44.719 --> 00:51:46.880
That is absolutely not news to me.
00:51:47.039 --> 00:52:00.000
Those are not the patients that are not referred, and that these are ones that are seen in general practice absolutely on a daily basis with the teeth falling out, but they are also seen in specialty on a daily basis with the teeth falling out.
00:52:00.159 --> 00:52:04.239
And a lot of that is because of the anesthetic risks that go along with it.
00:52:04.480 --> 00:52:10.960
That's one of the reasons that perhaps they haven't had the dental work that they've needed all those years is because of the anesthetic risk.
00:52:11.119 --> 00:52:20.719
But they finally went to a veterinarian um that recognized that, hey, yes, there is an increased anesthetic risk, but there's somebody that can do something with that.
00:52:20.880 --> 00:52:26.079
And that there is a possibility of still anesthetizing that patient in the right hands.
00:52:26.239 --> 00:52:29.840
And I think that is absolutely a fantastic reason for referral.
00:52:30.000 --> 00:52:57.760
And I think it's really important, and I'm sure Naomi touched on this as well, that it's important to have a relationship with the veterinary dentist in your area and reach out to them if they have any way of if you have a patient that's under anesthesia, or if you have a patient that you just saw as a consultation, you can reach out to them via email, via text, via phone call, whatever it is, and say, hey, I just saw this and I have a question.
00:52:57.920 --> 00:53:03.840
I don't know what to do with it, or is this something you think I can tackle, or do you think I should refer this?
00:53:04.000 --> 00:53:07.360
And I do that in my local area with my GPs.
00:53:07.519 --> 00:53:15.280
They know they can reach out to us in a variety of ways and they can reach out to us interoperatively and say, hey, I've got this x-ray.
00:53:15.360 --> 00:53:16.320
Can you take a look at it?
00:53:16.400 --> 00:53:20.800
I don't know what I'm seeing, and I don't know what do I need to extract this tooth or not.
00:53:20.960 --> 00:53:31.119
And we as veterinary dental specialists understand that veterinarians do not have all of the information that they need and they don't have all of the training they need.
00:53:31.280 --> 00:53:32.639
And we are here to help.
00:53:32.800 --> 00:53:39.519
We are not here to judge, we are not here to question whether you know what you're doing or not.
00:53:39.679 --> 00:53:46.159
We're all here for the same reason, which is to help those patients and be the patient advocate and make them better.
00:53:46.320 --> 00:53:49.119
And we are here to help you, we are here to support you.
00:53:49.280 --> 00:53:57.039
And in many situations, you will find that if you have not spoken to your local veterinary dentist in person, absolutely call them.
00:53:57.199 --> 00:54:01.519
Set up a time to go and see them, talk to them and find out.
00:54:01.679 --> 00:54:05.280
Are they open to you calling them and saying, hey, I'm stuck?
00:54:05.360 --> 00:54:06.320
What do I do?
00:54:06.480 --> 00:54:15.440
I have this complication, I have this situation, I don't know what I need to do in order to get myself out of it, or I don't know what to do in this situation.
00:54:15.679 --> 00:54:22.480
Most of us are very open to helping you and make it easier to get through your day because that's gonna help.
00:54:22.639 --> 00:54:27.920
I can only help so many patients in a day, and I can't do it all, and I don't want to do it all.
00:54:28.079 --> 00:54:32.639
I love doing dentistry, but I can't do every dental procedure on every animal in New Mexico.
00:54:32.719 --> 00:54:33.679
It's not gonna happen.
00:54:33.840 --> 00:54:35.920
I need my general practitioners.
00:54:36.079 --> 00:54:41.199
They are in a very vital and important part of every patient's care.
00:54:41.360 --> 00:54:46.719
And it's very important that they are also doing a good job and they want to do a good job.
00:54:46.800 --> 00:54:47.599
I know they do.
00:54:47.760 --> 00:54:58.880
I know they have the best interests of the patients, and I want to help them do their job as best as their abilities will allow and continue to improve their abilities over time.
00:54:59.119 --> 00:55:01.039
And most of us feel that same way.
00:55:01.199 --> 00:55:01.679
I would agree.
00:55:01.760 --> 00:55:21.599
I haven't met any veterinary dentist that has not told me something very similar about their willingness to help, which is why this podcast has been so amazing and fun for me because I have so many of you guys that are I consider really dear friends or just even acquaintances, but I know you all have so much energy for this and you have a lot to give.
00:55:21.679 --> 00:55:31.440
And we are talking about dentistry being a team sport, I'm thinking part of our team is gonna be our local or somewhat local veterinary dentist, right?
00:55:31.840 --> 00:55:35.920
So it's not just the people that work in your hospital that are on our team.
00:55:36.079 --> 00:55:42.159
It really has to be others that we pull into the team, and that could be a veterinary anesthesiologist.
00:55:42.239 --> 00:55:50.000
You know, if we have a patient that is higher risk, we know ASA levels, we're talking about comorbidities and different things.
00:55:50.159 --> 00:56:08.079
Let's pull in some other team members from outside our hospital to help us really have a strong plan for this particular patient, whether we're tackling that case in our hospital or we're actually referring them out to a specialty facility that maybe has more capabilities.
00:56:08.239 --> 00:56:11.599
No matter what, we're still advocating for this patient's best care.
00:56:11.760 --> 00:56:12.159
Absolutely.
00:56:12.320 --> 00:56:28.400
So we've got the client service representatives, we have the technicians, we have adjacent to technicians assistants, and so those people could be assisting the technicians to help make sure patients are comfortable and safe and monitored and all that good stuff.
00:56:28.480 --> 00:56:41.840
We even talked about the groomer, we talked about other people that are in our hospitals potentially being advocates for the patients when it comes to getting the dentistry care that they need, or even during the day of the procedure.
00:56:42.000 --> 00:56:44.960
How do these people relate to the care of the animal?
00:56:45.199 --> 00:56:55.599
We talked about the client being a part of this because if the pet could drive themselves to the vet, they probably wouldn't because they don't want to come in and get things done.
00:56:55.679 --> 00:57:09.760
But the pet parent, they want to take good care of their pet, they're willing to drive the pet to us and have us look at the pet and figure out how we can best work with them to make sure that this pet stays healthy and happy throughout their whole entire lifetime.
00:57:10.000 --> 00:57:17.840
Is there anybody else in the veterinary team that you feel like is really important to building a strong dental program?
00:57:18.079 --> 00:57:26.320
Because I feel like men in general practice really want to improve the level of dentistry they provide, but sometimes they feel overwhelmed and don't know where to begin.
00:57:26.480 --> 00:57:30.159
They may be struggling with, like you said, getting training and education.
00:57:30.320 --> 00:57:40.719
They may be struggling with getting the right equipment or technology, they may be struggling with not understanding how much time dentistry takes, or even their team being confident.
00:57:41.599 --> 00:57:53.199
So, is there any other thing with the team members that we have that you feel would help with these foundational elements that veterinary practices need in order to have a strong dental program?
00:57:53.440 --> 00:58:07.119
Well, I think definitely the management of the practice is important to the care as well, whether that management is in-house and the practice manager or it is at a higher up.
00:58:07.199 --> 00:58:28.320
So if you're in a corporate practice, or if you have a multi-location practice and so your management is off-site, I think it's very important that the management have a good strong understanding of the importance of dentistry and making sure that you're supported as a team to have the proper tools.
00:58:28.480 --> 00:58:47.920
And if something is not working correctly, if you if you don't have a dental radiograph machine andor maybe the laptop is not working correctly, that there is someone that understands that we need to get the proper equipment and have good working equipment and that we have to have a good team in order to be able to support that.
00:58:48.159 --> 00:59:04.880
And if there is not a good management support and they're forcing we need 10-minute appointments and you need to be doing 15 dental procedures every day in order to meet your goals, then that is not going to be in the best interest of your patients.
00:59:05.119 --> 00:59:10.639
So, uh, or of your sanity as a veterinary team member.
00:59:10.880 --> 00:59:28.000
So having the management of your practice understand how important this is to you as a doctor and you as a technician, because you are patient advocates or you as a CSR team, it's important that you have a good support team behind you.
00:59:28.239 --> 00:59:34.559
The leadership is so important, and that can honestly make or break whether or not dental programs are successful.
00:59:34.719 --> 00:59:40.960
Because dentistry is a little different than high volume, low cost type situations.
00:59:41.119 --> 00:59:44.000
They're fairly incompatible with one another.
00:59:44.239 --> 01:00:26.559
Because if we're trying to do high volume, short, quick, basically looking at dollars and cents, it really is incompatible with dentistry because dentistry done right takes time and it costs money and it does require equipment, instrumentation, and training and further support on scheduling parameters and understanding how not to overbook, like we could have a whole episode about just these types of things because it's just so difficult because dentistry is the great unknown, it's not a spay, it's not a neuter, which we know basically how long those should take and the level of equipment and experience and techniques and all the things that are required doing something like that.
01:00:26.719 --> 01:00:44.079
But dentistry is a lot more complex and definitely management, I feel, needs to understand too that the team requires a lot more support when it comes to being able to facilitate dental procedures that are successful on so many fronts that we've discussed today.
01:00:44.400 --> 01:00:56.079
So I feel that when we get the management involved and understanding in a deeper level what is involved with dentistry, the revenue will create itself with dentistry.
01:00:56.239 --> 01:00:57.199
That's not a problem.
01:00:57.360 --> 01:00:58.719
I've never seen that be a problem.
01:00:58.880 --> 01:01:02.719
If we're doing good dentistry, the revenue speaks for itself.
01:01:03.039 --> 01:01:23.119
But the team needing support and making sure that every team player is supported, getting breaks, making sure we're not just overworking these people because dentistry is such a physically and mentally demanding sport that you don't, it's not, we don't want to turn it into a marathon going back to our running.
01:01:23.199 --> 01:01:26.239
And it really, you have to pace yourself here a little bit.
01:01:26.719 --> 01:01:30.400
Not book really complex, difficult patients back to back.
01:01:30.559 --> 01:01:41.119
And when we talk about making sure to switch people out and give people breaks and make sure that they have the instruments that they need, they have equipment that works, they have training.
01:01:41.360 --> 01:01:47.760
Training is ongoing, it needs to happen again and again and again, and that's how you build a really solid team.
01:01:47.920 --> 01:01:54.719
And myself, as well as you, we go out into these hospitals across the nation and really try to help with that.
01:01:54.880 --> 01:01:57.039
But training isn't usually a one and done.
01:01:57.119 --> 01:02:08.079
It definitely has to happen over time many, many times, because of the lack of learning in veterinary schools and technician programs when it comes to comprehensive dental curriculum.
01:02:08.239 --> 01:02:11.599
So we've come a long way, but we have much farther to go.
01:02:11.760 --> 01:02:18.960
So just to wrap it up here, is there any big takeaways that you would like the listeners to get from this episode?
01:02:19.199 --> 01:02:27.920
I think that for me, when I do my teaching with general practitioners, because as you said, I love going into practices.
01:02:28.079 --> 01:02:33.199
I'm actually this afternoon gonna catch a plane to another part of the country to do that tomorrow.
01:02:33.440 --> 01:02:42.000
Going to go into a practice and spend the day teaching about extraction techniques and dental radiographs and all of those things.
01:02:42.159 --> 01:02:43.039
I love doing this.
01:02:43.199 --> 01:02:44.559
This is what I'm gonna do on my weekend.
01:02:44.639 --> 01:02:47.679
And then Monday morning I'm going back to work and do what we do for fun.
01:02:48.320 --> 01:02:48.719
Exactly.
01:02:48.880 --> 01:02:52.239
What I do for fun on the weekend is the same thing that I do all week.
01:02:52.400 --> 01:02:52.719
Yeah.
01:02:53.199 --> 01:02:55.599
Um, but it is I I love doing that.
01:02:55.679 --> 01:03:24.880
But I think the the main takeaway that I really want for people to understand and know is that it is a every team member, every clinic member, every employee, like you said, every client is important to the whole flow, and that it is good to have that information where you take a moment and sit back and say, okay, what do we need to incorporate?
01:03:25.039 --> 01:03:35.039
We learn things every time we go to a conference, every time we listen to a podcast, every time we do a one-hour race CE webinar.
01:03:35.199 --> 01:03:40.559
What do we need to do to actually incorporate these amazing things that we've learned into our practice?
01:03:40.800 --> 01:03:58.320
And so I think it's really good to sit down and take a few minutes and have a group and make a plan to say, okay, when we have something that we want to change within the practice relating to dentistry, I'm gonna have one CSR, one manager, one doctor, and one technician.
01:03:58.400 --> 01:04:06.400
And we're gonna, that's my little team that I'm gonna get together with and we're gonna have a meeting and we're gonna say, okay, let's we learned this stuff.
01:04:06.639 --> 01:04:09.760
How do we now incorporate this into our practice?
01:04:10.000 --> 01:04:20.239
Because the staff meeting where you have every person in the room involved, there's a lot of things that we have to talk about in our practice on a day to day or a week to week or a month to month.
01:04:20.559 --> 01:04:26.320
We don't have time to make little changes here or there or tweaks or incorporate, hey, let's start taking photographs.
01:04:26.480 --> 01:04:28.880
That's we're not gonna talk about that at the staff meetings.
01:04:29.119 --> 01:04:33.440
We we've got to troubleshoot all the other million things that are happening right now.
01:04:33.599 --> 01:05:00.000
But if you can maybe set aside every couple of months, or maybe after a doctor has gone to a CE or something where you just have one little meeting of just a core group of people in the practice that you say, these people, we're gonna sit down and we're gonna meet, and then we're gonna write out a plan, just like a like this is a three-month plan of how are we gonna incorporate what we just got excited about and learned, how are we gonna incorporate this into our day-to-day practice?
01:05:00.239 --> 01:05:10.639
Take small bites, change one thing in a period of time, and then get really good at doing that, and then go back and say, what was that that I just learned?
01:05:10.800 --> 01:05:17.519
And change something else, and be able to, if you don't have that plan of here's what we're gonna do.
01:05:17.599 --> 01:05:19.920
And I look at it just like triaging a patient.
01:05:20.079 --> 01:05:24.960
We've looked at our patient, we've said, okay, these are all of the health issues that we're concerned about.
01:05:25.119 --> 01:05:26.320
What's top priority?
01:05:26.480 --> 01:05:27.920
Okay, the dog's vomiting.
01:05:28.000 --> 01:05:29.360
Okay, let's address the vomiting.
01:05:29.519 --> 01:05:32.239
Great, let's figure out what we need to do to fix the vomiting.
01:05:32.400 --> 01:05:34.639
Okay, now we also notice that there's a broken tooth.
01:05:34.719 --> 01:05:35.840
He's no longer vomiting.
01:05:36.000 --> 01:05:37.840
Great, let's address the broken tooth.
01:05:37.920 --> 01:05:52.639
And so stage it out, triage it out, but have a written plan that you want to take away from whatever learning that you did so that you can go back to it when life gets in the way and practice gets in the way.
01:05:52.800 --> 01:05:59.599
You can circle back around to it and say, Hey, yeah, when I was at that CE last summer, I really learned that I.
01:06:00.159 --> 01:06:02.239
Want to learn how to do a better nerve block.
01:06:02.320 --> 01:06:03.760
Now I'm ready to do that.
01:06:03.920 --> 01:06:12.239
And so those are the types of things that I think is really important to find a way to make a good plan for how you want to improve.
01:06:12.400 --> 01:06:24.239
And if it's important to you to incorporate something that have a technician do something that maybe they didn't know how to do or train the receptionists in something, then make a plan for how you're going to have that happen.
01:06:24.320 --> 01:06:28.159
Are you going to bring somebody like us in that is going to train your team?
01:06:28.320 --> 01:06:30.960
And we would love to come talk to your receptionist.
01:06:31.199 --> 01:06:35.119
Maybe you don't have time or you don't really not understand what the receptionists need to know.
01:06:35.360 --> 01:06:41.360
Plan a time where you can figure out, okay, who do I call to train my reception team to do a better job?
01:06:41.519 --> 01:06:46.960
I may not know that right now, but I'm going to write down in a month that I'm going to go figure out how to do that.
01:06:47.119 --> 01:06:47.920
And that's great.
01:06:48.079 --> 01:06:49.519
That's absolutely fantastic.
01:06:49.840 --> 01:07:02.559
That's important because we talked about dentistry being a team sport here, but you need to identify maybe some key players on your team that could help drive forward some of your goals for dentistry.
01:07:02.800 --> 01:07:09.679
And so you mentioned having your hospital manager, a doctor, and a technician, a CSR.
01:07:09.920 --> 01:07:19.599
Those people are going to be the ones that have a lot of ideas and can help to not only brainstorm out ideas, but also drive those ideas forward.
01:07:19.760 --> 01:07:29.599
So something as simple as, hey, let's start evaluating occlusion and let's actually start documenting that in photographs and in words.
01:07:29.840 --> 01:07:33.920
That could be a huge difference that you could make for your patients.
01:07:34.079 --> 01:07:37.760
It's not super complex, but it does take some planning.
01:07:37.840 --> 01:07:42.480
And then to execute the plan, the most important thing is to create a habit, right?
01:07:42.639 --> 01:07:49.039
So getting a habit going really requires buy-in from all of your team members that are involved with that patient.
01:07:49.199 --> 01:07:52.880
So that way they're actually doing the thing that you want to do, right?
01:07:53.360 --> 01:08:05.199
So I feel like there's a lot of layers to this, but it's all super important because we often think about things that we'd like to do better, that we want to change, but then we just don't know what to do to make that actually happen.
01:08:05.280 --> 01:08:15.199
And we're so caught up in just survival mode versus thrive mode in our practices because of all the things coming at us that it's really hard to make these changes happen.
01:08:15.440 --> 01:08:15.840
Perfect.
01:08:15.920 --> 01:08:16.399
I love it.
01:08:16.560 --> 01:08:42.079
That's great advice so that the listeners can take away some ideas that they can actually use to create this team effort that will really be successful and really help to improve not only the care that we can give these patients, but honestly, I would say our team satisfaction because working in a team where you feel like everyone has a voice, communication will improve, which can really affect patient safety.
01:08:42.159 --> 01:08:46.319
If you ask me, when we're communicating much better, patients are a lot safer.
01:08:46.560 --> 01:08:53.520
And we'll also increase our client confidence because they will trust us more if we're better at communicating.
01:08:53.680 --> 01:08:59.359
And they can also see that we all have a plan and we're all working well together.
01:08:59.600 --> 01:09:17.840
If we communicate well, I really feel like our clients can see that and they want to trust us more because they feel like we do have our communication down and we do know what we're doing, and then they feel like they want to entrust us with their pets well-being and their pets' life and something as scary as anesthesia.
01:09:18.239 --> 01:09:24.079
So, as we wrap up our episode here, did you happen to think of a question for the next guest?
01:09:25.039 --> 01:09:30.720
My question for the next guest is so how you have to hear the whole question.
01:09:30.880 --> 01:09:43.520
So, yes, how wealthy would you be if you had a nickel for every time you were asked, oh my gosh, he needs how many extractions?
01:09:43.680 --> 01:09:45.920
How will he be able to eat?
01:09:46.159 --> 01:09:57.520
Okay, how wealthy would you be for every time you've been asked if you were receiving a nickel for how many extractions and how will my pet ever be able to eat?
01:09:57.680 --> 01:09:58.319
Yes.
01:09:59.119 --> 01:10:00.159
Okay, great.
01:10:00.319 --> 01:10:00.800
I love that.
01:10:00.960 --> 01:10:02.880
That is such a common question, right?
01:10:03.119 --> 01:10:07.439
And I always say way better because he's gonna feel so much better.
01:10:07.600 --> 01:10:19.600
You're gonna have to be careful he doesn't overeat because you haven't realized how he's been suffering and just eating because he's hungry and not being able to accomplish that task very easily.
01:10:19.920 --> 01:10:21.439
Very relevant, great question.
01:10:21.680 --> 01:10:22.560
So thank you, Dr.
01:10:22.640 --> 01:10:24.560
Bannon, so much for your time today.
01:10:24.720 --> 01:10:40.640
I feel like this information is really valuable and I appreciate you sharing your knowledge and passion for veterinary dentistry and also really just bond with you on the love of getting out there into the world and laying down some foot tracks and doing some running.
01:10:40.880 --> 01:10:45.119
Thank you for listening today to the Positive Veterinary Dentistry Podcast.
01:10:45.279 --> 01:10:54.079
If you enjoyed this episode, please be sure to subscribe, share it with your colleagues, and help us continue spreading better dentistry for veterinary patients everywhere.
01:10:54.319 --> 01:11:04.479
Until next time, keep elevating patient care through Positive Dentistry, and I will catch you at the next episode of the Positive Veterinary Dentistry Podcast.
00:00:01.919 --> 00:00:12.480
Welcome everyone to the Positive Veterinary Dentistry Podcast, a podcast dedicated to helping veterinary professionals elevate patient care to do better dentistry, diagnostics, and decision making.
00:00:12.640 --> 00:00:21.039
I'm your host, Benita Altier, licensed veterinary technician, veterinary technician specialist in dentistry, and the founder of Positive Dental Education.
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Whether you're listening from a general or specialty practice, academia, or you're still a DVM student or technician in training, this podcast is designed to give you a practical, real-world insight you can take right back to the dental table today.
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Today's episode is titled Veterinary Dentistry is a Team Sport.
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And I'm very excited to welcome today's guest, Dr.
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Chris Bannon.
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Dr.
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Bannon received her veterinary medical degree from Texas AM University in 1998 and spent 10 years working in a small little hospital in Santa Fe, New Mexico, before establishing the very first veterinary practice in New Mexico that is dedicated specifically to oral health needs of companion animals.
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In 2008, she became the first veterinarian in New Mexico to earn the title Fellow of the Academy of Veterinary Dentistry.
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And in 2010, she became the first diplomate of the American Veterinary Dental College in the state of New Mexico.
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Dr.
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Bannon has also contributed significantly to the profession through leadership and service.
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She served on the board of directors for the American Veterinary Dental Society, includes serving as president from 2013 to 2015.
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She currently serves on the board of directors for the Peter Emily International Veterinary Dental Foundation, where she volunteers her advanced dental skills to help provide dental care for wildlife and animals in sanctuaries across the country.
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She's also a consultant on the dental specialty board for the Veterinary Information Network, or VIN.
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And Dr.
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Bannon is incredibly enthusiastic about dentistry, enjoys teaching quality dental care, and is passionate about helping veterinary teams understand the positive effects that good dental health and oral hygiene can have on the quality of life for our beloved animal companions.
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So, Dr.
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Bannon, welcome to Positive Veterinary Dentistry Podcast.
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Thank you.
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Absolutely.
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I'm so excited that you could be here today.
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I have got to know you over the past several years, teaching with you at some different events, and realized that we have a lot in common.
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We are both runners, and we were just talking about how I just finished my third half marathon of a 50 states half marathon in each state challenge, which I was inspired to start because of you.
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I definitely was so excited to hear about it because I have been a runner my whole entire life.
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And when I first met you, you were in the process of just finishing up the last several states of the 50 state half marathon challenge.
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And I'm like, wow, if she can do it, I think I can do it too.
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So I'm only three states in out of the 50.
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And so I'm gonna be drawing from your expertise and advice in regards to which half marathon to do in which state as I continue to roll out through the 50 states half marathon challenge.
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So thanks for being my inspiration.
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Oh, I'm so glad you're doing it.
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You're gonna have so much fun.
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I can't wait to hear about all of the exciting places that you get to visit and all of the things that you do.
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It's such a fun way to see the country.
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Really, really.
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I always say when you're running and you're doing something at that pace, you're able to really observe your environment around you and see the things and smell the smells and just really absorb.
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So that's personally why I love running so much and just even walking and being out in the outdoors is just getting to experience it at a slower pace because life is a little too fast sometimes, and so it's kind of nice to be a slow runner and go out and enjoy and just complete, right?
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Yeah, which is really cool.
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Absolutely, and I'm a back-and-tack runner, so I get to spend even more time out there, and you make friends out there too, right?
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Buddy up with somebody next to you and start talking to them.
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It makes the race go by a lot faster and get to make a new friend.
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I met a lot of very interesting people that way.
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Me as well.
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People that started running in their 70s.
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Oh, and now they're like, you know, 90 or something, and they're out there still doing it.
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And that's my goal is to keep running until I'm well into my 90s.
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That's cool.
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As long as I can and just get out there and enjoy life.
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So thanks for being my inspiration.
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Yeah.
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And you've also been my inspiration when it comes to veterinary dentistry.
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And I was so happy that you agreed to be on this podcast because I know you have such good advice and such good information to give.
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And that really stems from not only who you are as a person and all the things that you've learned through your experiences and everything, but just really everything that you've tried and done and learned from.
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I think that a lot of people could really benefit from that information.
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So well, thank you.
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Before we yeah, absolutely.
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Before we dive in today's topic, I always like to start with a fun question.
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So it's the tradition of the Positive Veterinary Dentistry Podcast to have my last guest leave a question for you so that we can pass it forward.
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You will also leave a question for my following guest at the end.
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So be thinking about something fun you'd like to ask someone like yourself or a VTS and dentistry technician like myself.
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So the question for you from my last guest is what is the strangest or most unusual thing you have ever found inside the mouth of a patient during an oral exam that absolutely did not belong there.
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Okay.
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Well, I would say the first thing that comes to my mind is three blueberries and a plastic bag and in the same mouth.
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Oh my goodness.
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And that was inside of a cleft palette.
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So, so this dog, her name was Nova.
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She was very, very sweet, but she loved blueberries.
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And so she had actually stolen blueberries off of the counter that had been in a Ziploc bag.
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And she got the blueberries and the plastic bag stuck up in her cleft palette.
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And so when we went the day we went to go and fix the cleft palette, we took the blueberries of the plastic bag.
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Oh my goodness, that is just crazy.
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I can't believe that.
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Yes, and it was like, oh, what happened to that bag of blueberries?
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The misplaced objects that wind up being found either inside a pet or somewhere where a pet has been and left it discarded.
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Yes, exactly.
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Exactly.
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Wow, that's just crazy.
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Well, that's a unique one for sure.
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So we'll be excited to hear what your question is for the next person.
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Okay.
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We've definitely come up with some interesting things.
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What we've had these situations happen with these found objects inside a pet.
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All right.
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So this episode is entitled Veterinary Dentistry is a team sport.
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And I think that phrase is really capturing the reality of how dentistry actually happens in a veterinary practice.
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From the outside, our clients are other people that don't really understand what happens when we do dental procedures.
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They may simply think it's just a veterinarian performing some procedure, right?
00:07:13.839 --> 00:07:22.079
But in reality, successful dentistry involves multiple team members working together in a more of a coordinated way to provide the best care for that patient.
00:07:22.319 --> 00:07:29.040
So, from your perspective as a veterinary dental specialist, how do you describe veterinary dentistry as a team sport?
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I would say dentistry absolutely starts at the front desk with the reception team, the customer service team.
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It is important for them to be involved in understanding proper dental care and understanding what's happening behind the scenes in the back of the clinic.
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And then it is with the assistants that are helping restrain the patients for their IBs and for their recoveries.
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And it is with the technicians that are running the anesthesia and technicians that are doing the cleaning, which are absolutely two different technicians on every patient.
00:08:10.160 --> 00:08:22.079
So you have to have multiple people involved with every procedure, and then the veterinarian that is doing the examination and the dental treatments that are required.
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So, and then uh on the back side of the procedure, when you're all done, the technicians that are doing the discharges and the technicians that are doing the follow-ups afterwards, or the assistants, whoever is responsible for doing that.
00:08:37.200 --> 00:08:39.360
And then again, back to the receptionists.
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It always starts at the front desk and ends at the front desk.
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And it is very important for the for those people to know how things are going and what happened and um to really understand the value of the procedure that was just performed.
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And it's great because so many of the CSRs are able to, you know, take those phone calls from the clients and say, oh my gosh, she's like a new dog.
00:09:03.120 --> 00:09:03.840
It's amazing.
00:09:04.000 --> 00:09:08.320
And so they can really appreciate the importance of what's happening.
00:09:08.399 --> 00:09:11.039
But it it's all starts with the entire team.
00:09:11.120 --> 00:09:11.840
It's all involved.
00:09:12.000 --> 00:09:23.679
And if there's groom, if there's groomers that are in the clinic, then they get involved too because they're doing a lot of the oral exams and often brushing the teeth for the clients, and that might be the only time the dog gets the teeth brush.
00:09:23.840 --> 00:09:27.200
And they can look at it and go, Oh, this is more than just the brushing.
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We need to get somebody else involved in this.
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So even the groomers that are part of the clinics are absolutely involved in in dentistry and oral care.
00:09:36.399 --> 00:09:36.960
Exactly.
00:09:37.120 --> 00:09:39.919
And I think that shouldn't be underestimated.
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The people who are caregivers in the back for the animals where they may be taking care of boarding patients or hospitalized patients, or they're there for grooming or something else, because often those are the people that actually have more interaction with the pet in a way that they may notice something's wrong with the mouth, right?
00:10:02.000 --> 00:10:13.759
So they can also be advocates for the patient just because they're giving them their breakfast every day while they're there boarding and they realize something or they understand, you know, what to look for.
00:10:13.840 --> 00:10:17.919
So it's important we train our whole entire team to be a part of this process.
00:10:18.639 --> 00:10:23.600
And another person I think that's on our team really has to be the client, right?
00:10:23.840 --> 00:10:24.399
Oh, sure.
00:10:24.639 --> 00:10:41.360
So we think about the team members being people that are actually employed at the hospital, but I would like to add that I think the client has to be a part of our team and we need to bring them into that role, being a part of the team that's helping all of us are there to help the animal.
00:10:41.759 --> 00:10:42.080
Absolutely.
00:10:42.799 --> 00:10:50.879
To define that a little bit more simply, too, when we think about the role of each person, maybe we could start with the receptionist.
00:10:51.039 --> 00:11:17.679
So can you expand a little bit more on how you think the phone call that's received by the receptionist for making an appointment for annual vaccines, let's say, or something to that nature, or when the person comes into the hospital and is standing in front of the receptionist, how can someone working in the front staff be more a part of that team to communicate with the pet owners the importance of oral health?
00:11:18.000 --> 00:11:30.320
Yeah, so when it starts with the phones, I would say the first thing is for the CSRs to really have a good understanding of what to be on the lookout for when the clients are calling.
00:11:30.559 --> 00:11:43.759
So if we have a client that is a dog owner that is calling, then perhaps they're a doxin owner, for example, and the client saying that, oh, the dog's been sneezing sometimes.
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And that's something that is a very clean problem with doxin, that if they get advanced periodontal disease, they get communication from the oral cavity up into the nose.
00:11:55.440 --> 00:11:59.120
And it's called an oronasal communication or an oronasal fistula.
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Or if you have an older dog that, like a small breed dog that has perhaps lost teeth and hasn't had the proper dental care, then the teeth have fallen out, and maybe they pull into their nose that way.
00:12:12.799 --> 00:12:16.879
And so chronic sneezing can actually be an indication of dental disease.
00:12:17.039 --> 00:12:23.519
And that's something that if the receptionists are well informed and understand that, then that can clue them in.
00:12:23.600 --> 00:12:26.080
And they can even mention, oh, well, let me get you in.
00:12:26.399 --> 00:12:27.600
The doctor will take a look at that.
00:12:27.759 --> 00:12:52.000
There's lots of reasons that can happen and meet might need some dental work, or they'll well, just let's get them in for an oral exam and be able to add that to their possible list of allergies and all of the things that they know to trigger the timing of their appointments and when they might put something into the schedule and how long they need to give the doctor or the technicians for that appointment block.
00:12:52.240 --> 00:13:08.480
And and then when they're in the in the lobby, either waiting for their appointments or maybe even checking out for their appointment after their consultation or their wellness exam, it's really important for the receptionists to have a good, strong feeling of the importance of the dental care.
00:13:08.639 --> 00:13:19.200
If the technician or the doctor has recommended dental care, that reception team can get them on the schedule to get that taken care of and they understand why this is important.
00:13:19.440 --> 00:13:26.320
So when that client is given their treatment plan or their estimate for a procedure and they go, Yeah, is that really necessary?
00:13:26.480 --> 00:13:26.879
I don't know.
00:13:26.960 --> 00:13:31.679
The doctor said something about getting his teeth cleaned, but we just did that three years ago.
00:13:31.840 --> 00:13:33.679
I don't know if that's really necessary.
00:13:33.840 --> 00:13:34.879
But what do you think?
00:13:35.039 --> 00:13:42.960
The reception team can say, oh gosh, yes, I just had last week, I just had this client that really didn't even know there was a problem.
00:13:43.120 --> 00:13:50.720
And now their dog is like a puppy again, and it's just amazing what happens when their teeth are clean and they're not in pain.
00:13:50.879 --> 00:13:58.399
And it's just such a wonderful feeling to see them come back in for that one week recheck and they're just trying in all happy to be here.
00:13:58.559 --> 00:14:10.799
So it's just such such a good feeling for the reception team to be able to share that positive feedback to those clients when they and support the recommendations of the team that was behind the scenes.
00:14:10.960 --> 00:14:20.159
So if the doctor or the technician is mentioning dental care, the reception team can really advocate for that patient and say, yes, this is important.
00:14:20.320 --> 00:14:22.799
We need to get this on the schedule before you leave.
00:14:22.960 --> 00:14:28.080
Not just so we'll give you a call in a couple of months when maybe when dental month comes around.
00:14:28.240 --> 00:14:33.279
I think the people that are the least trained in our veterinary staff is the CSRs.
00:14:33.440 --> 00:14:54.480
And they're often not given the tools that they really need to be able to understand those things that you just mentioned in order to have the foresight or the understanding of some of the signs or subtle things a client might say that would indicate that we might be dealing with something that has to do with dental or oral health.
00:14:54.720 --> 00:15:06.720
So I feel like this is leading to the idea that we need to create more training for our front staff and to prepare the client too for the fact that we're gonna do an oral exam.
00:15:06.879 --> 00:15:13.440
I think that can be a really important thing that they always mention it's part of their regular exam, right?
00:15:13.519 --> 00:15:26.480
So if they're coming in for an annual visit, they're going to get an oral health assessment while they're there so that we can better determine the urgency with which we need to place on dental care at that point.
00:15:26.639 --> 00:15:29.759
So all of those things are super important part of that.
00:15:29.919 --> 00:15:38.720
And as you mentioned too, the client might have questions and the CSRs may not feel prepared to answer those questions.
00:15:38.879 --> 00:15:39.759
And that's fair.
00:15:39.919 --> 00:15:56.960
Some questions the CSRs probably shouldn't be trying to answer, but definitely having an understanding of cause and effect, like you said, having stories or specifics, like there was this client and this pet last week that they were having the same questions as you.
00:15:57.279 --> 00:16:02.879
And when we did the dental procedure, they were amazed at how much better their pet felt.
00:16:03.039 --> 00:16:15.759
And I would definitely highly recommend that you consider this procedure because a lot of times the pets are in pain and they're not showing it or they have a lot of inflammation in their mouth and they could feel so much better if we took care of that.
00:16:16.000 --> 00:16:21.120
So sometimes just some basic things the receptionists could learn about and do.
00:16:21.360 --> 00:16:31.919
Is there anything else with the reception staff or CSRs that you recommend that we concentrate on their education as far as learning about dentistry?
00:16:32.080 --> 00:16:42.799
I think it's important for the CSRs to have a basic but a good understanding of anatomy of the oral cavity so that they can understand the medical records.
00:16:43.039 --> 00:16:58.480
If the doctor has recommended, let's say the medical record says that there's a stage three periodonsal disease on this patient and a slab fracture of the 108 that has a meaning to that front staff team and they know what to do with that.
00:16:58.639 --> 00:17:06.960
If that client then goes home, talks to their spouse, and calls back and says, Oh, I'm gonna, we're just gonna watch that and see what happens.
00:17:07.119 --> 00:17:18.079
That when they pull up the medical record to cancel an appointment or to reschedule an appointment, they know what they they're looking at and they say, Oh gosh, I see your dog's got a broken tooth that the doctor noted.
00:17:18.319 --> 00:17:19.839
It wasn't just a cleaning.
00:17:19.920 --> 00:17:30.319
This is really important that the sure you want to cancel that, or we need to reschedule that soon rather than rescheduling that in six months because this dog's got a broken tooth.
00:17:30.400 --> 00:17:32.000
It's not just a cleaning.
00:17:32.400 --> 00:17:36.559
So I think it's really important for the front team and the front staff team.
00:17:36.720 --> 00:17:57.359
They don't need to be the technician that's doing the charting that understands all of the in-depth notes of the dental chart, but to be able to just have a good solid understanding of what the medical records are telling them really it empowers them to make better decisions to advocate for the patients and help the clients make those decisions.
00:17:57.680 --> 00:17:58.000
Exactly.
00:17:58.319 --> 00:18:19.200
Because they're looking for translation between the doctor and the technicians and their verbiage and how we talk about it and whatnot, the clients often come up to the receptionists and hope for some sort of translation between what did the doctor just say to me, or what does my pet need, and how much is that gonna cost?
00:18:19.440 --> 00:18:19.599
Right.
00:18:19.920 --> 00:18:21.039
When can you get me in?
00:18:21.200 --> 00:18:22.400
And those kinds of things.
00:18:22.559 --> 00:18:35.920
And that can put a really heavy burden on the CSRs if they don't feel like they've been trained or had the opportunity to really get in depth with understanding how to interpret between it's almost two different languages, right?
00:18:36.400 --> 00:18:45.920
The medical records and then what we need to tell the clients so that they can best understand in layman's terms a little bit better what it is that we're trying to accomplish.
00:18:46.480 --> 00:18:46.559
Right.
00:18:46.880 --> 00:18:52.000
And like you said, so many dental conditions are don't have anything to do hardly with cleaning teeth.
00:18:52.400 --> 00:19:03.599
It really is about painful things that are needing to be treated, and that brings the urgency to the procedure, not that it's time for their annual cleaning.
00:19:03.759 --> 00:19:13.359
From your perspective, especially as a veterinary dental specialist, I know you rely heavily on your technical staff to make sure that everything runs smoothly.
00:19:13.519 --> 00:19:21.200
So, in your practice experience, how do you see the role of a veterinary technician when it comes to dentistry procedures?
00:19:21.440 --> 00:19:26.640
I think the veterinary dental technician is huge in the role of the procedures.
00:19:26.880 --> 00:19:37.279
And depending on the state, sometimes the role of the technician changes a little bit as far as what the technicians are legally allowed to do and not do.
00:19:37.440 --> 00:19:48.319
I would say that it's really important that there are two technicians with the patient at all times, or two people, whether it's a technician and a doctor, or two technicians.
00:19:48.480 --> 00:19:56.720
I think that is absolutely essential to the safety of the patient and to the sanity of the technician, to be fair.
00:19:57.039 --> 00:20:14.240
Because when I was in general practice, I do remember that there were situations where the technicians, when I didn't have control over what was happening in the clinic that I was working in, there were technicians that were put on the spot to run the anesthesia and clean the teeth at the same time.
00:20:14.400 --> 00:20:16.400
And I know it still happens to this day.
00:20:16.640 --> 00:20:22.319
That was over 20 years ago, and I didn't like it then, and I definitely don't like it now.
00:20:22.559 --> 00:20:34.880
But it is something that I know happens and I know happens occasionally when it's not intended, and that that is what it is, but when it's intended, I think that's really room for improvement at the clinic.
00:20:35.200 --> 00:20:48.960
Because when we have a situation where a technician is put into a position that they have to choose, are they going to focus on making sure that the patient is alive and their anesthesia is going smoothly?
00:20:49.119 --> 00:20:56.160
Or are they having to focus on doing a good job with their oral cleaning, dental charting, and dental geographs?
00:20:56.319 --> 00:21:05.119
They're being forced to choose between two very important roles in figuring out which one they're going to work on at that moment in time because they cannot do both well.
00:21:05.359 --> 00:21:09.119
I love my technicians, they are the most amazing people that I work with.
00:21:09.279 --> 00:21:10.720
I can't ask that of them.
00:21:10.880 --> 00:21:23.039
That is not fair to ask them to do two roles well that are completely contradictory to each other because they are both very time intense and they cannot do a good job with that.
00:21:23.200 --> 00:21:31.519
The very best technicians are the very best, and they still cannot do a good job with that because they're completely incompatible roles to do at the same time.
00:21:31.680 --> 00:21:36.160
You can absolutely have a technician that is great at anesthesia and great at doing the cleaning.
00:21:36.240 --> 00:21:38.000
They just need to be doing it on different patients.
00:21:38.720 --> 00:21:42.000
They cannot do both at the very same time on the same paper.
00:21:42.240 --> 00:21:47.279
And I understand there are situations where time is of the essence and staff is at a minimum.
00:21:47.359 --> 00:21:50.240
I suffer with that in my practice on a regular basis as well.
00:21:50.559 --> 00:21:56.240
Staff calls in sick, or we're just short staffed in general because of life and because of staffing.
00:21:56.400 --> 00:21:59.759
But I do think we need to try to schedule accordingly where we find.
00:22:00.240 --> 00:22:06.799
Way to have two people with that patient so that someone can focus on making sure that the anesthesia is stable.
00:22:06.960 --> 00:22:15.839
Because unfortunately, so many of the situations that we run into with clients is the sense of fear with anesthesia.
00:22:16.000 --> 00:22:21.039
And a lot of that stems from historically having had problems with anesthesia.
00:22:21.200 --> 00:22:28.000
And I see clients on a regular basis that say that they lost an animal out during or after a dental procedure.
00:22:28.160 --> 00:22:29.920
And it always seems to be a dental procedure.
00:22:30.079 --> 00:22:34.559
Occasionally it happens when they're being stayed or neutered or a mass removal or something like that.
00:22:34.720 --> 00:22:39.839
But almost always, if they had an anesthetics complication, it was during a dental procedure.
00:22:40.000 --> 00:22:43.440
And dental procedures themselves are not high risk for anesthesia.
00:22:43.599 --> 00:22:49.119
There's no reason that we should have a higher rate of anesthetic complications with dental procedures.
00:22:49.279 --> 00:22:57.920
I understand how many directions we are pulled in on a daily basis and on a moment-to-moment basis, how many things are going on at one time.
00:22:58.079 --> 00:23:09.519
But it is important that we take dental procedures just as seriously of an anesthetic procedure as we do a splenectomy or a limb fracture repair.
00:23:09.680 --> 00:23:23.440
And if you would be doing that as the doctor, if you would be doing those procedures by yourself in the surgery suite and running your own anesthesia while you're repairing a fractured leg, then that's what you can ask of your technicians for the dental procedures.
00:23:23.519 --> 00:23:32.880
But if that's not something we would want to do, if you would want a technician there monitoring your anesthesia so that you can be focused on the surgery that you're doing, then that's what we want.
00:23:33.119 --> 00:23:33.839
Dental procedures.
00:23:34.400 --> 00:23:34.880
Agree with that.
00:23:34.960 --> 00:23:40.480
And it's so important that we think about the fact that if we only do one thing right, we better do anesthesia right.
00:23:40.559 --> 00:23:40.799
Yes.
00:23:40.960 --> 00:23:44.400
Because the dental procedure, yeah, that's why we're anesthetizing them.
00:23:44.559 --> 00:23:50.799
But if they don't recover and aren't okay, we could have done irreparable harm to their organs or other things.
00:23:51.119 --> 00:24:00.640
Yeah, and just of course, just remembering too that recovery or or waking up from anesthesia is kind of a bare minimum of the acceptable anesthetic event.
00:24:01.039 --> 00:24:05.759
And so I always keep that in the back of my mind and say, okay, yeah, they recovered.
00:24:05.839 --> 00:24:06.400
That's good.
00:24:06.480 --> 00:24:11.200
That's that is absolutely important, but a low bar to set for the anesthesia.
00:24:11.279 --> 00:24:11.440
Yeah.
00:24:11.599 --> 00:24:15.039
Remembering that a lot of these patients are tiny animals.
00:24:15.200 --> 00:24:16.720
They are often older.
00:24:16.880 --> 00:24:21.680
So they get very cold very quickly, their blood pressure drops very quickly.
00:24:21.920 --> 00:24:30.319
The number of patients that we in our practice have to put on blood pressure support is high, but absolutely high when they're under anesthesia.
00:24:30.400 --> 00:24:43.279
So if we're not monitoring all of the same things that we would be monitoring during our sterile procedures, if we're not monitoring blood pressure, if we're not monitoring temperature and doing something about it, then we're doing a disservice to our patients.
00:24:43.440 --> 00:24:50.559
And they may recover and they may survive that procedure, but we also might, like you said, be doing irreparable harm.
00:24:50.640 --> 00:24:59.920
Then we want to make sure that we're not leaving them with clean teeth, but some kidney damage that we don't even know happens if we can all prevent it.
00:25:00.079 --> 00:25:01.359
And sometimes things happen.
00:25:01.599 --> 00:25:03.839
No one has a perfect record, including myself.
00:25:04.079 --> 00:25:13.279
And sometimes things happen, but the most that we can do is do our very best to minimize that and not ask anything of the technicians that we wouldn't ask of ourselves.
00:25:13.680 --> 00:25:18.960
So technicians have a lot of different skills that they are focused on doing.
00:25:19.119 --> 00:25:24.160
And you mentioned the anesthesia and how important it is having someone dedicated to that.
00:25:24.319 --> 00:25:34.160
In your practice, I know you have cone beam CT now, which is really amazing, so that you can go ahead and get that taken care of, and your technicians do that for the patient.
00:25:34.319 --> 00:25:36.880
And then they would then move on to the next step.
00:25:37.039 --> 00:25:44.799
So, specifically in your practice, what are some of the other things that you have your technical staff doing when it comes to working on the actual patient?
00:25:45.039 --> 00:25:45.680
Yeah, absolutely.
00:25:45.839 --> 00:25:52.319
So we break up our team into a dental technician and an anesthetic technician for each patient, and they rotate.
00:25:52.480 --> 00:26:01.680
So the technician on this patient will be the surgery tech, and in the next patient, they'll be the anesthesia tech for somebody else to be their surgery technician.
00:26:01.839 --> 00:26:06.000
Through the course of the day, they're running both anesthesia and doing the dental procedures.
00:26:06.240 --> 00:26:17.279
There's a lot of variety of ways that you can do that within the practice, whether you spend all day, one day running anesthesia and a separate day doing all of the cleanings or whatever works best for your team.
00:26:17.440 --> 00:26:22.880
With my team, that's the way it works best there's a technician that is dedicated to that patient for the day.
00:26:23.039 --> 00:26:31.599
So that technician is the one that goes up to the client, visits with them in the morning, gets the paperwork signed, and um gets the questions answered.
00:26:31.680 --> 00:26:36.799
So the client has a face for the person that is responsible for their pet throughout the day.
00:26:36.960 --> 00:26:50.000
And then that technician is the same one that is doing the cleaning, that is doing the interaction with the client on the phone or text messaging to let them know how their patient's doing and when they're getting started and all of those things.
00:26:50.160 --> 00:27:05.119
So after they've admitted them into the clinic, then they will reach out to the client and let them know at what point throughout the day we expect their patient to go under anesthesia because we check everybody in first thing in the morning and then stagger them throughout the day.
00:27:05.359 --> 00:27:12.079
So they may have checked in at 7:30 in the morning, but their patient may not start under anesthesia until after one or two in the afternoon.
00:27:12.240 --> 00:27:16.720
And clients don't love that, but it is just the way that the flow has to be.
00:27:16.880 --> 00:27:20.240
In our practice, we just can't have people checking in the middle of the day.
00:27:20.319 --> 00:27:32.000
And even yesterday in my practice, we had a plan and we told the clients, okay, this is the patient that's going in the morning, and this is a patient that'll be midday, and this is the patient that's in the afternoon.
00:27:32.160 --> 00:27:43.920
And the first patient of the morning was a young, healthy cat that was throwing VPCs as soon as we got the EKG hooked up and we contacted the owner and said, We really recommend a cardiologist.
00:27:44.000 --> 00:27:48.240
And she said, Oh my gosh, yes, let me go find out why Mike's throwing VPCs.
00:27:48.559 --> 00:27:52.720
So we woke that cat up, or actually, we'd never really gotten it fully asleep.
00:27:52.880 --> 00:27:59.599
And because we caught it on our pre-EKG, but we moved it out of the shift and said, Okay, everybody's moving up.
00:27:59.759 --> 00:28:04.559
Now that now our late morning, early afternoon procedure suddenly is going now.
00:28:04.799 --> 00:28:14.720
And so it is helpful to have all of the patients in the clinic at the first thing in the morning so that you really can get that kind of flow through the day.
00:28:14.880 --> 00:28:17.119
As much as the clients don't love it, I get it.
00:28:17.200 --> 00:28:18.640
I was a client too.
00:28:18.799 --> 00:28:24.640
And when I had my last kitten that I adopted when she got spayed, she happened at the end of the day.
00:28:24.720 --> 00:28:29.839
And I sat there all day long wondering how she was doing because I knew she was going to be last, but it was still hard.
00:28:30.000 --> 00:28:37.599
So I get it as a client, it's not fun, but it is best for the patients and it's best for the team to have everybody there.
00:28:37.759 --> 00:28:42.079
So, anyway, the tech the technician that's responsible is communicating with the client.
00:28:42.319 --> 00:28:49.839
I find in my practice, and I do believe in general practice as well, it's very important to take photographs of them when they are there for dental work.
00:28:50.079 --> 00:28:54.480
So we are doing photographs before we intubate.
00:28:54.640 --> 00:29:06.240
So this is very important, in my opinion, because we get so many cases where we will have a doctor reach out to us and say, What is wrong with this mouth or what's happening?
00:29:06.400 --> 00:29:11.359
And I will ask, when you were examining the mouth before you intubated, were the teeth hitting each other?
00:29:11.519 --> 00:29:14.000
Does the dog have a good occlusion?
00:29:14.160 --> 00:29:15.200
Is it normal?
00:29:15.359 --> 00:29:17.599
Or is there an underbite or an overbite?
00:29:17.680 --> 00:29:18.799
And they say, I don't know.
00:29:18.960 --> 00:29:22.319
My technicians intubated and I wasn't there, which is great.
00:29:22.480 --> 00:29:25.119
I mean, that's fantastic that they have a technician team.
00:29:25.200 --> 00:29:42.799
I'm not usually there when my technicians intubate either, but we actually have the technicians do photos of the mouth closed before they intubate so that we have a front view and then side views from each side so that we can see the occlusion if we do have an issue that we're wondering about.
00:29:42.960 --> 00:29:54.319
We can actually go back and look at the photographs and evaluate the occlusion without the breathing tube in so that we can see what that looked like and then be able to make a treatment plan that might be appropriate for that.
00:29:54.480 --> 00:29:57.519
So we start out with the occlusion photos before intubation.
00:29:57.599 --> 00:30:10.000
Once they're under anesthesia, then we do full mouth photos and we try to catch anything that might be maybe as far as like if there's a lump in the mouth that we might want to focus a separate photo on.
00:30:10.160 --> 00:30:14.640
Sometimes we don't catch those until the actual detailed exam, and then we'll take a photo then.
00:30:14.799 --> 00:30:17.119
So the technician will take a photo of the mouth.
00:30:17.279 --> 00:30:32.240
They will rinse the mouth with some chlorhexidine if it's appropriate, so that we can decrease the aerosolized bacteria in the mouth and the exposure to the staph of the bacterial release during the procedure.
00:30:32.400 --> 00:30:37.440
And then the technicians will set up for the CT scan and then start doing the cleaning.
00:30:37.599 --> 00:30:41.440
And after they've done their cleaning, then we do our radiographs.
00:30:41.599 --> 00:30:49.519
And my flow is photos, CT, cleaning, dental radiographs, and then we chart.
00:30:49.599 --> 00:30:52.640
And the technicians are doing the charting as well.
00:30:52.799 --> 00:30:57.519
And I feel good that if they're well trained, that's an appropriate role of a technician.
00:30:57.680 --> 00:31:01.839
Not all the technicians are comfortable with doing that, not even in my practice, and that's fine.
00:31:02.000 --> 00:31:14.480
But if they're a well-trained technician, they can do the dental charting and be able to help the doctor make some of the diagnoses of what's happening, or at least have an idea of what the doctor needs to focus their energies on.
00:31:14.640 --> 00:31:25.440
And then the doctor can go and double check the exam and at least evaluate the mouth, look at the radiographs while they're looking at the oral cavity.
00:31:25.680 --> 00:31:34.880
And then the doctor reaches out to the client with the plan while the doctor is talking to the client and getting permission for whatever we're recommending.
00:31:35.039 --> 00:31:43.039
The technician will finish up the cleaning, polish the teeth, and then take the post-cleaning photographs of the mouth.
00:31:43.200 --> 00:31:44.880
And then the doctor will scrub in.
00:31:45.200 --> 00:31:55.119
If they usually the doctor will have done the block, the regional nerve block at the time of the exam, and then start whatever procedure needs to be done at that point.
00:31:55.200 --> 00:32:14.079
And then that surgery technician that was doing the cleaning and the radiographs then switches to a surgery assistant for the doctor so that they can run suction or change out burrs or cut suture, take the intra-op or the post-op radiographs that are needed during the extractions, whatever assisting needs to be done.
00:32:14.480 --> 00:32:22.799
In a shorter staffed day, that surgery technician will then switch over and take over anesthesia while the doctor is doing surgery.
00:32:22.960 --> 00:32:30.079
And that anesthesia technician then can go off and do something else with their day if they need to or start working on another procedure.
00:32:30.240 --> 00:32:36.319
So there's still two people with the patient, but in my ideal day, I'll have three people when there's the doctor there.
00:32:36.480 --> 00:32:45.359
I'll have my surgery technician will get to stay as a surgery assistant and make everything faster for me so that we can keep our time under anesthesia at a minimum.
00:32:45.599 --> 00:32:59.839
That's important because in your specialty practice, you're doing just dentistry cases and you need to have that surgical support because you're trying to do some pretty complex work and you have multiple patients to take care of today.
00:33:00.000 --> 00:33:02.480
So that way you can be as efficient as possible.
00:33:02.720 --> 00:33:02.880
Right.
00:33:03.119 --> 00:33:10.960
In a general practice setting, veterinarian often has other surgeries and things that have nothing to do with dentistry that they have to do.
00:33:11.119 --> 00:33:17.039
So it may run slightly different in a general practice setting versus what you're doing.
00:33:17.359 --> 00:33:52.720
And having the ability to get that cone beam CT right off the bat expedites your process of diagnosis, confirming what you probably had suspected or potentially adding to the complexity of what you're up against, I'm sure, when you see what you see on that cone beam, making it so that the dental interval radiographs are maybe adding to the information for sure, but not necessarily your primary imaging modality at that point because you're really reliant on that cone beam CT to get that ball rolling.
00:33:52.880 --> 00:33:53.759
So true.
00:33:54.079 --> 00:34:04.079
But I I have some general practices that are in my area that have switched to using cone beam CT as well, and have actually dropped the dental radiographs.
00:34:04.160 --> 00:34:05.440
And I don't recommend that.
00:34:05.599 --> 00:34:09.119
I do not think that is an appropriate way to flow.
00:34:09.199 --> 00:34:15.199
It the cone beam absolutely makes things easier and faster, and you can get a good overall sense of what's happening.
00:34:15.360 --> 00:34:18.239
But it's very important to have dental radiographs at the same time.
00:34:18.400 --> 00:34:27.360
And especially if you don't have them at all, then that makes intra-operative radiographs or post-operative radiographs not available to you.
00:34:27.679 --> 00:34:33.840
So if you do decide in general practice to add cone bean CT, I mean it's a fantastic tool.
00:34:34.000 --> 00:34:45.280
And I do think that there are good uses of it in general practice, and I think it is great when general practitioners have it, but I also think it's important to still keep dental radiographs.
00:34:45.360 --> 00:34:52.480
Some of the salespeople for the cone bean CT say it's substitutes, and then actually they'll get rid of their dental radiographs.
00:34:52.559 --> 00:34:54.000
And I do not recommend that.
00:34:54.239 --> 00:34:55.360
Yeah, that's a great point.
00:34:55.440 --> 00:34:57.440
And I have encountered that once or twice.
00:34:57.599 --> 00:35:16.480
And I was told by someone like yourself that could almost be considered malpractice if they're not taking either interoperative as necessary and postoperative dental radiographs because they're not doing the entire steps of the procedure properly if they don't have the images to prove how they left the place.
00:35:17.039 --> 00:35:37.039
And cone beam CT, I think the reason some general practices think that it's gonna be a substitute is because they're looking for a quick fix, they're looking for something that's gonna suddenly make it so that it doesn't take so long to get the images because cone beam CT takes a couple minutes compared to like how long does it take to take dental radiographs.
00:35:37.280 --> 00:35:39.599
And so they think, oh, this is better.
00:35:39.679 --> 00:35:44.559
Let's just do that and get rid of this whole time-consuming thing, intral dental radiographs.
00:35:44.639 --> 00:35:52.480
But the other thing I have heard, which maybe you could clear up, is that if you do cone beam CT, you need to be prepared to read the whole entire thing.
00:35:52.960 --> 00:35:59.519
You can't just be looking at the teeth or the bones surrounding the teeth and not look at the whole entire head of the patient.
00:35:59.679 --> 00:36:00.559
Is that true?
00:36:00.719 --> 00:36:05.519
I mean, is it something where you could be up for litigation if you miss something?
00:36:05.760 --> 00:36:07.920
Yes, that's what I have been told as well.
00:36:08.079 --> 00:36:17.119
And I luckily have not reached a situation where I have been on a any type of litigious situation where I've had that challenged.
00:36:17.360 --> 00:36:23.840
But I absolutely have diagnosed problems that were outside of the oral cavity, including several brain tumors.
00:36:24.000 --> 00:36:29.519
So I do think it is important that we are looking at the entire scan.
00:36:29.679 --> 00:36:41.519
When we are doing our clon beam CT, we will be specific about where we end it and try to not include any neck or feet or other body parts that I don't intend to look at because of that.
00:36:41.679 --> 00:36:48.239
And so, especially when you have the very small patients, not a big of a deal when you've got a German shepherd and their head barely fits in it anyway.
00:36:48.400 --> 00:36:53.280
But when you've got a chihuahua, you could do an entire body scan in the cone beam CT.
00:36:53.519 --> 00:36:57.280
And unless you're prepared to interpret that, I would strongly advise against it.
00:36:57.519 --> 00:36:58.639
Yeah, that makes sense.
00:36:59.039 --> 00:37:15.199
I like that we pointed that out because I think that's a bit of a myth that's going around and maybe perpetuated by some of the people who are working towards selling you that cone beam CT, which, as we know, it has an amazing place in veterinary dentistry, but it doesn't replace dental radiographs.
00:37:15.440 --> 00:37:15.920
It's not.
00:37:16.000 --> 00:37:20.800
And it's even the litigious side of it for the post-operative radiographs is very important.
00:37:20.880 --> 00:37:23.519
And I have had some clinics say, Well, I do a post-op CT.
00:37:23.760 --> 00:37:25.199
Like, okay, that's great.
00:37:25.360 --> 00:37:36.320
And if you're looking at it with the same thoroughness as you looked at the pre-operative CT, then that's an okay documentation for legal purposes.
00:37:36.559 --> 00:37:42.960
But as far as the flow of your practice and your day, a lot of times that's a difficult thing to do.
00:37:43.119 --> 00:37:54.239
And also to look at it and actually take the time to assess it and make sure that there were no root tips left behind is difficult to find the time to really thoroughly look at the post-op CT.
00:37:54.400 --> 00:38:16.960
But really, where you're losing if you're just switching to CT is the intra-op radiographs because it is so important when you're doing extractions, especially that if you're struggling with an extraction and you break a root or you are just frustrated, the I mean, dentistry can be frustrating and it frustrates the best of us and the worst of us and everybody in between.
00:38:17.119 --> 00:38:20.480
And it can be frustrating and everybody breaks roots.
00:38:20.639 --> 00:38:21.360
I do too.
00:38:21.519 --> 00:38:22.639
And it happens.
00:38:22.719 --> 00:38:30.639
I broke one yesterday and I had to take about five x-rays with little needles in the x-ray to see is okay, where is this root?
00:38:30.800 --> 00:38:33.599
Is it on this side of the needle or this side of the needle?
00:38:33.760 --> 00:38:38.639
And and that's what I was doing yesterday in this upper fourth premolar in a husky that I had to extract.
00:38:38.880 --> 00:38:52.559
If you don't give yourself the opportunity to have intra-operative radiographs and use that, then you're doing yourself a disservice because you're going to struggle with your extractions much more than you need to.
00:38:52.719 --> 00:38:59.840
And if you're struggling with an extraction, the first thing that I recommend is to step back and do some radiation therapy on the patient.
00:39:00.000 --> 00:39:04.320
And so that is also known as having your technician take a dental radiograph.
00:39:04.480 --> 00:39:13.519
And in many cases, that also means when you're really struggling with that root that just broke on you and you can't figure out where it is and where did it go and why can't I get this?
00:39:13.760 --> 00:39:28.800
Best thing to do is step away from the patient, put your hands in the air, do a little lap around the treatment area, take a deep breath, go get a sip of water while your technician is taking that dental radiograph for you and again doing some radiation therapy on your patient.
00:39:28.960 --> 00:39:35.679
And you get two things: you get a quick breather and a quick break, and you get information about why you're struggling with it.
00:39:35.840 --> 00:39:38.719
Yeah, maybe it is broken in a way you didn't expect.
00:39:38.880 --> 00:39:41.760
Maybe the root is at a different angle than you thought.
00:39:41.920 --> 00:39:50.719
Uh, maybe it is in a different location or where you're removing your bone is nowhere near where your root is, which is what happened to me yesterday.
00:39:50.960 --> 00:39:55.360
So I looked at that and I went, oh my gosh, my roots there and I'm removing bone over here.
00:39:55.440 --> 00:39:58.320
No wonder my elevator is not doing what it's supposed to do.
00:39:58.480 --> 00:40:06.880
So I need to get those two pieces closer together and remove bone right next to the root instead of way over here on the other side of the head, it seemed like, based on my radiograph.
00:40:07.119 --> 00:40:07.360
Exactly.
00:40:07.599 --> 00:40:16.239
So once I had that information, I was like, wow, this root just came right out once I knew actually where it was and when what I was what my goal in life was.
00:40:16.480 --> 00:40:24.639
So if you don't take intra-operative radiographs when you're struggling with extractions, you're doing yourself a disservice.
00:40:24.800 --> 00:40:29.360
And it really is so much easier when you have all of the information that you need.
00:40:29.519 --> 00:40:33.679
It's like trying to manage a diabetic patient without periodically doing blood glucose.
00:40:34.000 --> 00:40:40.800
You're just not gonna, you might get to a good end goal if the it there, but it's gonna take a lot more work than you needed.
00:40:40.960 --> 00:40:41.519
I agree.
00:40:41.679 --> 00:40:49.760
When I hear the crack sound and then the swear word that comes out of my veterinarian's mouth, what I like to say is step away.
00:40:50.559 --> 00:40:54.800
Let me take an X-ray because it's my little rhyme.
00:40:54.880 --> 00:41:01.360
Because I think that veterinarians, bless your hearts, you guys want to get that tooth root out and you just broke it.
00:41:01.599 --> 00:41:21.920
But you don't want to be drilling and digging and just continuing on down without actually seeing what just happened, because it certainly could be made worse if you do those things, versus let's just see what we see on the radiograph and make sure we know where we're at and what happened and where is it broken or what broke.
00:41:22.079 --> 00:41:23.119
Is it the root that broke?
00:41:23.199 --> 00:41:24.320
Is it brone that broke?
00:41:24.559 --> 00:41:25.199
What happened?
00:41:25.360 --> 00:41:30.719
And just regroup and taking that little brain break and putting the drill and the instruments down, so important.
00:41:31.280 --> 00:41:33.280
My own cat specifically, too.
00:41:33.440 --> 00:41:35.199
Well, she's actually my grandkitty.
00:41:35.760 --> 00:41:44.000
I took her to a veterinary dentist here locally in the Phoenix area that I know because I wanted to make sure she got the best dental care we could give her.
00:41:44.079 --> 00:41:54.079
And we did cone beam CT on her first, but then we took interval radiographs and we caught tooth resorption on the radiographs that we could not see on the cone beam.
00:41:54.159 --> 00:41:54.559
Yep.
00:41:54.960 --> 00:42:00.400
And I was very suspicious that she did have tooth resorption because of some clinical signs.
00:42:00.559 --> 00:42:11.039
However, I was very interested in the fact that it would have been unapparent if we had just gone with the cone beam only and not did the dental radiographs.
00:42:11.199 --> 00:42:23.119
So I think that we definitely still want to have all the tools available to us, whether it's cone beam as well as radiographs, but not discounting the importance of those dental radiographs.
00:42:23.280 --> 00:42:24.239
Absolutely, absolutely.
00:42:24.400 --> 00:42:25.280
We we see that.
00:42:25.440 --> 00:42:27.440
We see that not infrequently for sure.
00:42:27.599 --> 00:42:30.719
Sometimes we pick up more resorption, sometimes we pick up less.
00:42:31.039 --> 00:42:35.760
And just like any tool that you have, the cone beam CT has its place.
00:42:35.920 --> 00:42:38.880
It has its advantages, but it has some disadvantages as well.
00:42:39.039 --> 00:42:39.760
So great.
00:42:40.000 --> 00:42:54.480
And talking about teamwork, where you had discussed the fact that veterinary technicians have certain skills that we can really work on to get really good at, but we are just a tool, honestly, of the doctor.
00:42:54.719 --> 00:43:07.440
We are the extra set of hands and eyes on the patient, and we could do the primary oral examination and using a probe explorer and chart all the things that we can find.
00:43:07.599 --> 00:43:29.440
But then you come in and see what we charted and then look at the patient yourself, touching, feeling, confirming visually and with probing depths and whatnot, what exactly your plan is so that we can keep this patient moving along and hopefully do things that will impact the patient's well-being with the time that we have with them under anesthesia.
00:43:29.760 --> 00:43:34.559
So you're using us to make sure that you can be as efficient as possible.
00:43:34.719 --> 00:43:49.199
So when it comes to veterinarian skills and you working as a specialist, but us talking more to general practitioners today, what would some things that you would tell general practitioners about where they need to put their efforts?
00:43:49.360 --> 00:44:03.760
Like, what should they do with their licensure and their time to make sure that we can help not only as many patients as we can in a given day, but also really Really do a good job of helping the ones that we do have under anesthesia.
00:44:03.920 --> 00:44:09.039
Is there any specific advice you'd have to give to a general practitioner or maybe a new graduate veterinarian?
00:44:09.360 --> 00:44:10.559
Yes, absolutely.
00:44:10.719 --> 00:44:32.719
I would say that one of the most important things that we really don't get an opportunity to learn in school, whether you're a new graduate or you've been out for 20 plus years, like I have, is a really good, strong understanding of dental radiographic anatomy and understanding the diagnostic process of what's happening here.
00:44:32.960 --> 00:44:36.480
So much of what we do is diagnosing the problem.
00:44:36.639 --> 00:44:38.800
And then treating it is a separate thing.
00:44:38.880 --> 00:44:45.760
But in many cases, we don't even know what we're supposed to be treating because we don't have a good understanding of the diagnosis.
00:44:45.840 --> 00:44:50.880
And I think that's really one of the frustrations of veterinarians with dentistry.
00:44:51.039 --> 00:44:54.000
I know a lot of veterinarians say, boy, I really hate doing dentals.
00:44:54.079 --> 00:44:56.000
They just, they're so frustrating to me.
00:44:56.159 --> 00:45:05.119
And a large portion of it is because we don't have enough training to understand what's happening and what we're supposed to be looking for.
00:45:05.360 --> 00:45:10.639
And when you see something that is not quite right, you don't know what to do with it.
00:45:10.800 --> 00:45:14.079
And it's it's not always your fault that you don't know what to do with it.
00:45:14.239 --> 00:45:17.920
It's like, I don't, I know something's not right, but what is that?
00:45:18.079 --> 00:45:19.440
And does it need treatment?
00:45:19.599 --> 00:45:20.800
Does it not need treatment?
00:45:21.039 --> 00:45:30.400
So I think that a large portion of the training of understanding the diagnostics of what you're doing and is this important?
00:45:30.559 --> 00:45:34.239
Is this clinically relevant to the patient is so important.
00:45:34.480 --> 00:45:54.800
And being able to take a dental radiograph and a dental chart and a dental examination and make a plan, even if you are not as comfortable with doing the extractions, if you at least have an understanding of what this patient needs and this tooth needs to be extracted, then if you're not comfortable doing it, great.
00:45:54.960 --> 00:45:58.719
There's gonna be somebody else that is, and that's absolutely okay.
00:45:58.960 --> 00:46:07.199
It is absolutely okay to say, I am not comfortable extracting that lower canine tooth in this four-pound chihuahua.
00:46:07.360 --> 00:46:11.280
I'm afraid I'm going to break the jaw and I don't want to extract it.
00:46:11.440 --> 00:46:13.519
That is absolutely okay.
00:46:13.760 --> 00:46:17.440
It is not something you have to do if you are not comfortable with it.
00:46:17.599 --> 00:46:26.880
But what you have to do is convince the client that extraction is the appropriate thing if it is, and make sure that they get to a person that can do it.
00:46:27.039 --> 00:46:38.880
Whether that's another doctor within your practice that is more comfortable or more trained in dental procedures that are extracting lower molars or lower canines with minimal complications.
00:46:39.119 --> 00:46:41.679
It might be the dental specialist that's in your area.
00:46:41.840 --> 00:46:45.199
Sometimes dental specialists are only an hour away.
00:46:45.360 --> 00:46:49.360
Some of us are four or six hours away from your practice.
00:46:49.519 --> 00:46:59.280
And being able to understand when you need to refer and not feel like it's, you know, oh, well, they're five hours away.
00:46:59.440 --> 00:47:00.880
I just have to do this.
00:47:01.119 --> 00:47:03.119
And that's not necessary.
00:47:03.360 --> 00:47:10.639
And sometimes there are situations where, yes, clients cannot accept referral, they can't drive that far, they can't afford it.
00:47:10.800 --> 00:47:12.559
All of those situations happen.
00:47:12.639 --> 00:47:16.159
And sometimes we're stuck doing things that we're not comfortable doing.
00:47:16.400 --> 00:47:27.519
But there are lots of situations where we don't have to, but we have to be able to understand what is in the best interest of the patient and know what our boundaries are.
00:47:27.599 --> 00:47:31.760
And if this is in our wheelhouse, if it's not in our wheelhouse, either way is okay.
00:47:32.000 --> 00:47:33.599
We are our patient advocates.
00:47:33.760 --> 00:47:41.599
So it's really important for us to feel comfortable with the diagnosis so that we know what this patient needs.
00:47:41.760 --> 00:47:45.280
And then we can figure out who's the best person to give that to that patient.
00:47:45.519 --> 00:47:46.639
Might be you, that's great.
00:47:46.719 --> 00:47:48.079
If it's you, that's fantastic.
00:47:48.239 --> 00:47:52.639
If it's not you, then it might be somebody else near you, might be somebody not near you.
00:47:52.880 --> 00:48:08.159
But once you really have a good understanding and a really strong confidence in your diagnosis, then you will be able to relay that to the client and equate it to doing back surgery in a doxend that's down.
00:48:08.400 --> 00:48:15.840
If you have a doxend that is paralyzed and the client says, I know you're not a neurosurgeon, but aren't you just comfortable doing that?
00:48:16.000 --> 00:48:17.599
Didn't you learn about that in school?
00:48:17.840 --> 00:48:23.920
And a lot of veterinarians are not gonna be okay with that, but they feel like they have to be because it's only a dental.
00:48:24.079 --> 00:48:32.320
And the clients are saying, It's a lower molar, and my dog's three pounds and it's a lower molar, and you know, it's only a tooth, right?
00:48:32.480 --> 00:48:35.440
And the veterinary is like, oh my God, I'm gonna break the jaw.
00:48:35.519 --> 00:48:36.880
I'm not comfortable with this.
00:48:37.039 --> 00:48:41.440
But the owners, I feel like I have to because it's only a dental and I should.
00:48:41.519 --> 00:48:44.800
I learned how to extract teeth, and it's not necessary.
00:48:44.960 --> 00:48:50.880
It really is not necessary for you to feel put into a situation where you are not comfortable doing this.
00:48:51.039 --> 00:49:01.519
If you would not do it in a different body part, if it was something that you learned about that never actually did before, if you don't feel like that's something, well, I would take that on.
00:49:01.679 --> 00:49:15.039
I would go ahead and try to see if I could uh do some release of that IVDD disc in this back dog and see if I can get it unparalyzed because the client really wants me to do it instead of go to the neurologist that's down the street.
00:49:15.199 --> 00:49:19.840
You know, it then okay, then that's the kind of person that you are and go for it.
00:49:20.000 --> 00:49:23.039
And if you feel comfortable that that's within your wheelhouse, great.
00:49:23.280 --> 00:49:35.039
But if it's not and it puts you in a place where you can't sleep at night and you're getting stomach ulcers because of the stress of being put in positions that you don't feel comfortable and don't feel trained for, don't do it.
00:49:35.119 --> 00:49:40.239
It is okay to say no, but it's not okay to not know what we need to do.
00:49:40.400 --> 00:49:48.000
And that's where I like to see my focus of my general practitioners is just having a good understanding of what the patient needs.
00:49:48.159 --> 00:49:50.000
And then we can figure out how to make that happen.
00:49:50.239 --> 00:49:54.320
I think that's good advice because, first of all, we have to recognize there is a problem.
00:49:54.480 --> 00:49:54.719
Right.
00:49:54.880 --> 00:49:59.039
And then we also have to recognize if we're capable of addressing that problem.
00:49:59.280 --> 00:50:00.400
My first episode with Dr.
00:50:00.559 --> 00:50:06.480
Naomi Hoyer was regarding the perfect partnership referral relationship with GP.
00:50:06.719 --> 00:50:07.199
Yes.
00:50:07.440 --> 00:50:09.440
And getting that feedback loop going.
00:50:09.519 --> 00:50:25.199
And I know you're such a resource in your area there in New Mexico, so that if there is a general practitioner around you and they have a case that they feel like they've never tried to tackle, but they feel like they'd like to learn how to tackle that case.
00:50:25.280 --> 00:50:30.719
And it's something a GP could certainly do, but that person just isn't comfortable.
00:50:30.960 --> 00:50:48.000
It may be great to refer that patient to you, but then get some feedback going, some information about how you felt that went, or how they could potentially have approached that if they decided to do it on their own, or for them to learn from you.
00:50:48.079 --> 00:50:57.599
I'm sure you offer some continuing education in your area as well for your GP vets, so that they can get better at doing things that could be in their wheelhouse.
00:50:57.760 --> 00:51:27.039
But we also talked about the fact that a lot of times things get referred because of anesthetic complexities and comorbidities and things that would be best served potentially in the hands of someone like yourself just because of those factors, not necessarily because of the dental procedure being too complicated or complex for that person, but maybe just the fact that they're a little uncomfortable with the anesthesia on that patient.
00:51:27.280 --> 00:51:27.760
Absolutely.
00:51:27.920 --> 00:51:31.039
And I think that's a very good reason for referral.
00:51:31.199 --> 00:51:35.199
I do extractions on a regular basis and on a daily basis, honestly.
00:51:35.280 --> 00:51:42.400
And some veterinarians, when I'm talking to them or in teaching, they say, Oh, well, you probably never see this stage four mouth the way that I do.
00:51:42.480 --> 00:51:44.480
And I'm like, oh, I see them every single day.
00:51:44.719 --> 00:51:46.880
That is absolutely not news to me.
00:51:47.039 --> 00:52:00.000
Those are not the patients that are not referred, and that these are ones that are seen in general practice absolutely on a daily basis with the teeth falling out, but they are also seen in specialty on a daily basis with the teeth falling out.
00:52:00.159 --> 00:52:04.239
And a lot of that is because of the anesthetic risks that go along with it.
00:52:04.480 --> 00:52:10.960
That's one of the reasons that perhaps they haven't had the dental work that they've needed all those years is because of the anesthetic risk.
00:52:11.119 --> 00:52:20.719
But they finally went to a veterinarian um that recognized that, hey, yes, there is an increased anesthetic risk, but there's somebody that can do something with that.
00:52:20.880 --> 00:52:26.079
And that there is a possibility of still anesthetizing that patient in the right hands.
00:52:26.239 --> 00:52:29.840
And I think that is absolutely a fantastic reason for referral.
00:52:30.000 --> 00:52:57.760
And I think it's really important, and I'm sure Naomi touched on this as well, that it's important to have a relationship with the veterinary dentist in your area and reach out to them if they have any way of if you have a patient that's under anesthesia, or if you have a patient that you just saw as a consultation, you can reach out to them via email, via text, via phone call, whatever it is, and say, hey, I just saw this and I have a question.
00:52:57.920 --> 00:53:03.840
I don't know what to do with it, or is this something you think I can tackle, or do you think I should refer this?
00:53:04.000 --> 00:53:07.360
And I do that in my local area with my GPs.
00:53:07.519 --> 00:53:15.280
They know they can reach out to us in a variety of ways and they can reach out to us interoperatively and say, hey, I've got this x-ray.
00:53:15.360 --> 00:53:16.320
Can you take a look at it?
00:53:16.400 --> 00:53:20.800
I don't know what I'm seeing, and I don't know what do I need to extract this tooth or not.
00:53:20.960 --> 00:53:31.119
And we as veterinary dental specialists understand that veterinarians do not have all of the information that they need and they don't have all of the training they need.
00:53:31.280 --> 00:53:32.639
And we are here to help.
00:53:32.800 --> 00:53:39.519
We are not here to judge, we are not here to question whether you know what you're doing or not.
00:53:39.679 --> 00:53:46.159
We're all here for the same reason, which is to help those patients and be the patient advocate and make them better.
00:53:46.320 --> 00:53:49.119
And we are here to help you, we are here to support you.
00:53:49.280 --> 00:53:57.039
And in many situations, you will find that if you have not spoken to your local veterinary dentist in person, absolutely call them.
00:53:57.199 --> 00:54:01.519
Set up a time to go and see them, talk to them and find out.
00:54:01.679 --> 00:54:05.280
Are they open to you calling them and saying, hey, I'm stuck?
00:54:05.360 --> 00:54:06.320
What do I do?
00:54:06.480 --> 00:54:15.440
I have this complication, I have this situation, I don't know what I need to do in order to get myself out of it, or I don't know what to do in this situation.
00:54:15.679 --> 00:54:22.480
Most of us are very open to helping you and make it easier to get through your day because that's gonna help.
00:54:22.639 --> 00:54:27.920
I can only help so many patients in a day, and I can't do it all, and I don't want to do it all.
00:54:28.079 --> 00:54:32.639
I love doing dentistry, but I can't do every dental procedure on every animal in New Mexico.
00:54:32.719 --> 00:54:33.679
It's not gonna happen.
00:54:33.840 --> 00:54:35.920
I need my general practitioners.
00:54:36.079 --> 00:54:41.199
They are in a very vital and important part of every patient's care.
00:54:41.360 --> 00:54:46.719
And it's very important that they are also doing a good job and they want to do a good job.
00:54:46.800 --> 00:54:47.599
I know they do.
00:54:47.760 --> 00:54:58.880
I know they have the best interests of the patients, and I want to help them do their job as best as their abilities will allow and continue to improve their abilities over time.
00:54:59.119 --> 00:55:01.039
And most of us feel that same way.
00:55:01.199 --> 00:55:01.679
I would agree.
00:55:01.760 --> 00:55:21.599
I haven't met any veterinary dentist that has not told me something very similar about their willingness to help, which is why this podcast has been so amazing and fun for me because I have so many of you guys that are I consider really dear friends or just even acquaintances, but I know you all have so much energy for this and you have a lot to give.
00:55:21.679 --> 00:55:31.440
And we are talking about dentistry being a team sport, I'm thinking part of our team is gonna be our local or somewhat local veterinary dentist, right?
00:55:31.840 --> 00:55:35.920
So it's not just the people that work in your hospital that are on our team.
00:55:36.079 --> 00:55:42.159
It really has to be others that we pull into the team, and that could be a veterinary anesthesiologist.
00:55:42.239 --> 00:55:50.000
You know, if we have a patient that is higher risk, we know ASA levels, we're talking about comorbidities and different things.
00:55:50.159 --> 00:56:08.079
Let's pull in some other team members from outside our hospital to help us really have a strong plan for this particular patient, whether we're tackling that case in our hospital or we're actually referring them out to a specialty facility that maybe has more capabilities.
00:56:08.239 --> 00:56:11.599
No matter what, we're still advocating for this patient's best care.
00:56:11.760 --> 00:56:12.159
Absolutely.
00:56:12.320 --> 00:56:28.400
So we've got the client service representatives, we have the technicians, we have adjacent to technicians assistants, and so those people could be assisting the technicians to help make sure patients are comfortable and safe and monitored and all that good stuff.
00:56:28.480 --> 00:56:41.840
We even talked about the groomer, we talked about other people that are in our hospitals potentially being advocates for the patients when it comes to getting the dentistry care that they need, or even during the day of the procedure.
00:56:42.000 --> 00:56:44.960
How do these people relate to the care of the animal?
00:56:45.199 --> 00:56:55.599
We talked about the client being a part of this because if the pet could drive themselves to the vet, they probably wouldn't because they don't want to come in and get things done.
00:56:55.679 --> 00:57:09.760
But the pet parent, they want to take good care of their pet, they're willing to drive the pet to us and have us look at the pet and figure out how we can best work with them to make sure that this pet stays healthy and happy throughout their whole entire lifetime.
00:57:10.000 --> 00:57:17.840
Is there anybody else in the veterinary team that you feel like is really important to building a strong dental program?
00:57:18.079 --> 00:57:26.320
Because I feel like men in general practice really want to improve the level of dentistry they provide, but sometimes they feel overwhelmed and don't know where to begin.
00:57:26.480 --> 00:57:30.159
They may be struggling with, like you said, getting training and education.
00:57:30.320 --> 00:57:40.719
They may be struggling with getting the right equipment or technology, they may be struggling with not understanding how much time dentistry takes, or even their team being confident.
00:57:41.599 --> 00:57:53.199
So, is there any other thing with the team members that we have that you feel would help with these foundational elements that veterinary practices need in order to have a strong dental program?
00:57:53.440 --> 00:58:07.119
Well, I think definitely the management of the practice is important to the care as well, whether that management is in-house and the practice manager or it is at a higher up.
00:58:07.199 --> 00:58:28.320
So if you're in a corporate practice, or if you have a multi-location practice and so your management is off-site, I think it's very important that the management have a good strong understanding of the importance of dentistry and making sure that you're supported as a team to have the proper tools.
00:58:28.480 --> 00:58:47.920
And if something is not working correctly, if you if you don't have a dental radiograph machine andor maybe the laptop is not working correctly, that there is someone that understands that we need to get the proper equipment and have good working equipment and that we have to have a good team in order to be able to support that.
00:58:48.159 --> 00:59:04.880
And if there is not a good management support and they're forcing we need 10-minute appointments and you need to be doing 15 dental procedures every day in order to meet your goals, then that is not going to be in the best interest of your patients.
00:59:05.119 --> 00:59:10.639
So, uh, or of your sanity as a veterinary team member.
00:59:10.880 --> 00:59:28.000
So having the management of your practice understand how important this is to you as a doctor and you as a technician, because you are patient advocates or you as a CSR team, it's important that you have a good support team behind you.
00:59:28.239 --> 00:59:34.559
The leadership is so important, and that can honestly make or break whether or not dental programs are successful.
00:59:34.719 --> 00:59:40.960
Because dentistry is a little different than high volume, low cost type situations.
00:59:41.119 --> 00:59:44.000
They're fairly incompatible with one another.
00:59:44.239 --> 01:00:26.559
Because if we're trying to do high volume, short, quick, basically looking at dollars and cents, it really is incompatible with dentistry because dentistry done right takes time and it costs money and it does require equipment, instrumentation, and training and further support on scheduling parameters and understanding how not to overbook, like we could have a whole episode about just these types of things because it's just so difficult because dentistry is the great unknown, it's not a spay, it's not a neuter, which we know basically how long those should take and the level of equipment and experience and techniques and all the things that are required doing something like that.
01:00:26.719 --> 01:00:44.079
But dentistry is a lot more complex and definitely management, I feel, needs to understand too that the team requires a lot more support when it comes to being able to facilitate dental procedures that are successful on so many fronts that we've discussed today.
01:00:44.400 --> 01:00:56.079
So I feel that when we get the management involved and understanding in a deeper level what is involved with dentistry, the revenue will create itself with dentistry.
01:00:56.239 --> 01:00:57.199
That's not a problem.
01:00:57.360 --> 01:00:58.719
I've never seen that be a problem.
01:00:58.880 --> 01:01:02.719
If we're doing good dentistry, the revenue speaks for itself.
01:01:03.039 --> 01:01:23.119
But the team needing support and making sure that every team player is supported, getting breaks, making sure we're not just overworking these people because dentistry is such a physically and mentally demanding sport that you don't, it's not, we don't want to turn it into a marathon going back to our running.
01:01:23.199 --> 01:01:26.239
And it really, you have to pace yourself here a little bit.
01:01:26.719 --> 01:01:30.400
Not book really complex, difficult patients back to back.
01:01:30.559 --> 01:01:41.119
And when we talk about making sure to switch people out and give people breaks and make sure that they have the instruments that they need, they have equipment that works, they have training.
01:01:41.360 --> 01:01:47.760
Training is ongoing, it needs to happen again and again and again, and that's how you build a really solid team.
01:01:47.920 --> 01:01:54.719
And myself, as well as you, we go out into these hospitals across the nation and really try to help with that.
01:01:54.880 --> 01:01:57.039
But training isn't usually a one and done.
01:01:57.119 --> 01:02:08.079
It definitely has to happen over time many, many times, because of the lack of learning in veterinary schools and technician programs when it comes to comprehensive dental curriculum.
01:02:08.239 --> 01:02:11.599
So we've come a long way, but we have much farther to go.
01:02:11.760 --> 01:02:18.960
So just to wrap it up here, is there any big takeaways that you would like the listeners to get from this episode?
01:02:19.199 --> 01:02:27.920
I think that for me, when I do my teaching with general practitioners, because as you said, I love going into practices.
01:02:28.079 --> 01:02:33.199
I'm actually this afternoon gonna catch a plane to another part of the country to do that tomorrow.
01:02:33.440 --> 01:02:42.000
Going to go into a practice and spend the day teaching about extraction techniques and dental radiographs and all of those things.
01:02:42.159 --> 01:02:43.039
I love doing this.
01:02:43.199 --> 01:02:44.559
This is what I'm gonna do on my weekend.
01:02:44.639 --> 01:02:47.679
And then Monday morning I'm going back to work and do what we do for fun.
01:02:48.320 --> 01:02:48.719
Exactly.
01:02:48.880 --> 01:02:52.239
What I do for fun on the weekend is the same thing that I do all week.
01:02:52.400 --> 01:02:52.719
Yeah.
01:02:53.199 --> 01:02:55.599
Um, but it is I I love doing that.
01:02:55.679 --> 01:03:24.880
But I think the the main takeaway that I really want for people to understand and know is that it is a every team member, every clinic member, every employee, like you said, every client is important to the whole flow, and that it is good to have that information where you take a moment and sit back and say, okay, what do we need to incorporate?
01:03:25.039 --> 01:03:35.039
We learn things every time we go to a conference, every time we listen to a podcast, every time we do a one-hour race CE webinar.
01:03:35.199 --> 01:03:40.559
What do we need to do to actually incorporate these amazing things that we've learned into our practice?
01:03:40.800 --> 01:03:58.320
And so I think it's really good to sit down and take a few minutes and have a group and make a plan to say, okay, when we have something that we want to change within the practice relating to dentistry, I'm gonna have one CSR, one manager, one doctor, and one technician.
01:03:58.400 --> 01:04:06.400
And we're gonna, that's my little team that I'm gonna get together with and we're gonna have a meeting and we're gonna say, okay, let's we learned this stuff.
01:04:06.639 --> 01:04:09.760
How do we now incorporate this into our practice?
01:04:10.000 --> 01:04:20.239
Because the staff meeting where you have every person in the room involved, there's a lot of things that we have to talk about in our practice on a day to day or a week to week or a month to month.
01:04:20.559 --> 01:04:26.320
We don't have time to make little changes here or there or tweaks or incorporate, hey, let's start taking photographs.
01:04:26.480 --> 01:04:28.880
That's we're not gonna talk about that at the staff meetings.
01:04:29.119 --> 01:04:33.440
We we've got to troubleshoot all the other million things that are happening right now.
01:04:33.599 --> 01:05:00.000
But if you can maybe set aside every couple of months, or maybe after a doctor has gone to a CE or something where you just have one little meeting of just a core group of people in the practice that you say, these people, we're gonna sit down and we're gonna meet, and then we're gonna write out a plan, just like a like this is a three-month plan of how are we gonna incorporate what we just got excited about and learned, how are we gonna incorporate this into our day-to-day practice?
01:05:00.239 --> 01:05:10.639
Take small bites, change one thing in a period of time, and then get really good at doing that, and then go back and say, what was that that I just learned?
01:05:10.800 --> 01:05:17.519
And change something else, and be able to, if you don't have that plan of here's what we're gonna do.
01:05:17.599 --> 01:05:19.920
And I look at it just like triaging a patient.
01:05:20.079 --> 01:05:24.960
We've looked at our patient, we've said, okay, these are all of the health issues that we're concerned about.
01:05:25.119 --> 01:05:26.320
What's top priority?
01:05:26.480 --> 01:05:27.920
Okay, the dog's vomiting.
01:05:28.000 --> 01:05:29.360
Okay, let's address the vomiting.
01:05:29.519 --> 01:05:32.239
Great, let's figure out what we need to do to fix the vomiting.
01:05:32.400 --> 01:05:34.639
Okay, now we also notice that there's a broken tooth.
01:05:34.719 --> 01:05:35.840
He's no longer vomiting.
01:05:36.000 --> 01:05:37.840
Great, let's address the broken tooth.
01:05:37.920 --> 01:05:52.639
And so stage it out, triage it out, but have a written plan that you want to take away from whatever learning that you did so that you can go back to it when life gets in the way and practice gets in the way.
01:05:52.800 --> 01:05:59.599
You can circle back around to it and say, Hey, yeah, when I was at that CE last summer, I really learned that I.
01:06:00.159 --> 01:06:02.239
Want to learn how to do a better nerve block.
01:06:02.320 --> 01:06:03.760
Now I'm ready to do that.
01:06:03.920 --> 01:06:12.239
And so those are the types of things that I think is really important to find a way to make a good plan for how you want to improve.
01:06:12.400 --> 01:06:24.239
And if it's important to you to incorporate something that have a technician do something that maybe they didn't know how to do or train the receptionists in something, then make a plan for how you're going to have that happen.
01:06:24.320 --> 01:06:28.159
Are you going to bring somebody like us in that is going to train your team?
01:06:28.320 --> 01:06:30.960
And we would love to come talk to your receptionist.
01:06:31.199 --> 01:06:35.119
Maybe you don't have time or you don't really not understand what the receptionists need to know.
01:06:35.360 --> 01:06:41.360
Plan a time where you can figure out, okay, who do I call to train my reception team to do a better job?
01:06:41.519 --> 01:06:46.960
I may not know that right now, but I'm going to write down in a month that I'm going to go figure out how to do that.
01:06:47.119 --> 01:06:47.920
And that's great.
01:06:48.079 --> 01:06:49.519
That's absolutely fantastic.
01:06:49.840 --> 01:07:02.559
That's important because we talked about dentistry being a team sport here, but you need to identify maybe some key players on your team that could help drive forward some of your goals for dentistry.
01:07:02.800 --> 01:07:09.679
And so you mentioned having your hospital manager, a doctor, and a technician, a CSR.
01:07:09.920 --> 01:07:19.599
Those people are going to be the ones that have a lot of ideas and can help to not only brainstorm out ideas, but also drive those ideas forward.
01:07:19.760 --> 01:07:29.599
So something as simple as, hey, let's start evaluating occlusion and let's actually start documenting that in photographs and in words.
01:07:29.840 --> 01:07:33.920
That could be a huge difference that you could make for your patients.
01:07:34.079 --> 01:07:37.760
It's not super complex, but it does take some planning.
01:07:37.840 --> 01:07:42.480
And then to execute the plan, the most important thing is to create a habit, right?
01:07:42.639 --> 01:07:49.039
So getting a habit going really requires buy-in from all of your team members that are involved with that patient.
01:07:49.199 --> 01:07:52.880
So that way they're actually doing the thing that you want to do, right?
01:07:53.360 --> 01:08:05.199
So I feel like there's a lot of layers to this, but it's all super important because we often think about things that we'd like to do better, that we want to change, but then we just don't know what to do to make that actually happen.
01:08:05.280 --> 01:08:15.199
And we're so caught up in just survival mode versus thrive mode in our practices because of all the things coming at us that it's really hard to make these changes happen.
01:08:15.440 --> 01:08:15.840
Perfect.
01:08:15.920 --> 01:08:16.399
I love it.
01:08:16.560 --> 01:08:42.079
That's great advice so that the listeners can take away some ideas that they can actually use to create this team effort that will really be successful and really help to improve not only the care that we can give these patients, but honestly, I would say our team satisfaction because working in a team where you feel like everyone has a voice, communication will improve, which can really affect patient safety.
01:08:42.159 --> 01:08:46.319
If you ask me, when we're communicating much better, patients are a lot safer.
01:08:46.560 --> 01:08:53.520
And we'll also increase our client confidence because they will trust us more if we're better at communicating.
01:08:53.680 --> 01:08:59.359
And they can also see that we all have a plan and we're all working well together.
01:08:59.600 --> 01:09:17.840
If we communicate well, I really feel like our clients can see that and they want to trust us more because they feel like we do have our communication down and we do know what we're doing, and then they feel like they want to entrust us with their pets well-being and their pets' life and something as scary as anesthesia.
01:09:18.239 --> 01:09:24.079
So, as we wrap up our episode here, did you happen to think of a question for the next guest?
01:09:25.039 --> 01:09:30.720
My question for the next guest is so how you have to hear the whole question.
01:09:30.880 --> 01:09:43.520
So, yes, how wealthy would you be if you had a nickel for every time you were asked, oh my gosh, he needs how many extractions?
01:09:43.680 --> 01:09:45.920
How will he be able to eat?
01:09:46.159 --> 01:09:57.520
Okay, how wealthy would you be for every time you've been asked if you were receiving a nickel for how many extractions and how will my pet ever be able to eat?
01:09:57.680 --> 01:09:58.319
Yes.
01:09:59.119 --> 01:10:00.159
Okay, great.
01:10:00.319 --> 01:10:00.800
I love that.
01:10:00.960 --> 01:10:02.880
That is such a common question, right?
01:10:03.119 --> 01:10:07.439
And I always say way better because he's gonna feel so much better.
01:10:07.600 --> 01:10:19.600
You're gonna have to be careful he doesn't overeat because you haven't realized how he's been suffering and just eating because he's hungry and not being able to accomplish that task very easily.
01:10:19.920 --> 01:10:21.439
Very relevant, great question.
01:10:21.680 --> 01:10:22.560
So thank you, Dr.
01:10:22.640 --> 01:10:24.560
Bannon, so much for your time today.
01:10:24.720 --> 01:10:40.640
I feel like this information is really valuable and I appreciate you sharing your knowledge and passion for veterinary dentistry and also really just bond with you on the love of getting out there into the world and laying down some foot tracks and doing some running.
01:10:40.880 --> 01:10:45.119
Thank you for listening today to the Positive Veterinary Dentistry Podcast.
01:10:45.279 --> 01:10:54.079
If you enjoyed this episode, please be sure to subscribe, share it with your colleagues, and help us continue spreading better dentistry for veterinary patients everywhere.
01:10:54.319 --> 01:11:04.479
Until next time, keep elevating patient care through Positive Dentistry, and I will catch you at the next episode of the Positive Veterinary Dentistry Podcast.
