Prevention – We all know what to recommend when a pet has severe periodontal disease. However, most of us forget that periodontal disease, for the most part, is completely preventable. In your practice you incorporate preventative measures every day. You administer vaccines, heartworm meds, flea meds, supplements, routine lab work – all for prevention. Dental disease is no different and should be treated in the same manner.

• Start early – clients need to be educated about the inevitable periodontal disease their pets will develop (especially the small breeds). Prepare an educational talk with them during one of their puppy/kitten vaccine visits.
• First COHAT – to prevent periodontal disease, dental procedures must start early. Prepare clients that you will be recommending their first cleaning procedure at the age of 2-3 years. 
• Annual COHATs for life – once the first COHAT has been performed, maintaining good oral health is essential. Every 12 months is the goal with some exceptions. Some pets may need every 6-9 months to achieve our goal and some very healthy large breed dogs may only need every 18-24 months.
• Don’t wait for active disease to recommend dentistry. Once disease is present, we aren’t preventing, we are treating. Use human analogies. We brush 1-2 times a day, floss, and use mouth rinses and still go to the dentist every 6-12 months. Why? To prevent disease!
• Many clients want to be part of helping prevent periodontal disease in their pets. Discuss things they can do at home that will slow down the progression of plaque and tartar. Please remember to remind them that at home care does not erase the need for professional dentistry (see above analogy)

At Home Care – this is a very important part of our patient’s oral health. At home care coupled with regularly scheduled COHATs allows us to decrease the number of future extractions as the pet ages. Owners may commit to being very involved to no involvement at all. You need to have recommendations ready.

• Daily brushing with pet-only toothpaste. This is the single most effective and least expensive form of prevention. It is also the most difficult for owners to perform. Regardless, it needs to be presented as the first option to owners. Starting with puppies and kittens allows for the best pet acceptance. It must be performed daily to be effective.
• Diet – two diets are head and shoulders better at prevention – Hills t/D (the best) and Hills Oral Care. This is a very easy and very effective form of preventing plaque and tartar. It is one of my favorites and I practice what I preach. All of my personal pets are on these diets.
• Treats – everyone loves to give their pets treats. We should only be recommending treats that also have the benefit of reducing plaque and tartar. Again, I practice what I preach.
• VOHC.org – this website has a list of all approved diets, treats, and supplements that are proven to reduce plaque and tartar. I only recommend and carry products from this website. It is important to prioritize your recommendations for those products that have been awarded the seal for plaque prevention.

Dental X-Rays – any meaningful dental procedure cannot be performed without dental x-rays. If your practice does not have dental radiology, it should be a priority purchase for 2025. If incorporated correctly in all your dental procedures it will pay for itself in 6 months and generate nothing but profit thereafter.

• You must be able to produce quality x-rays. There is a learning curve, but improper positioning or contrast are not very helpful.
• Skull x-rays are worthless
• Full mouth x-rays for every patient are a must. As a GP, I routinely found pathology that was hidden from my detailed oral exam. It should be part of every dental patient’s medical record.
• Don’t give options for dental x-rays! Owners should not be given the option to decline the most important part of the dental procedure. If you believe additional cost will be an issue, then charge very little for full mouth x-rays. You will recoup the profit with the pathology you uncover with the x-rays. You can also just roll it into a dentistry package. I did it this way as a GP. Let’s say I charged $500 for a COHAT. This included labs, anesthesia, full mouth x-rays, scale, and polish. There were no options to decline.

Old Age – this should never be a reason to not recommend dentistry. Most of our patients with severe periodontal disease are seniors. 70% of my patients are 10-20 years of age. 

• Periodontal disease is progressive. If you diagnose severe periodontal disease in a senior patient, that day is the best it will ever look.
• Advanced periodontal disease creates two conditions that are the worst things a body can deal be forced to deal with – infection and inflammation. In one oral surgery procedure, years of infection and inflammation can be removed and our patients thrive afterwards.
• Co-morbidities – many of our senior patients are also dealing with additional medical issues. While these conditions will increase the risk of general anesthesia, it is still rare to have poor outcomes in my experience. Choosing the correct anesthesia protocol and having a trained team diligently monitoring the patient throughout the procedure and recovery is a must. For heart patients, having a recent cardiology workup with their anesthesia recommendations is very helpful. 
• For many of these patients’ referral may be the best option.

Prevent broken teeth – Broken teeth caused by inappropriate chews and preventable. 

• Broken maxillary 4 th premolars and mandibular 1 st molars are almost always caused by chewing on things the owners give their pets. They see these items at PetsMart, PetCo, and on the internet claiming to benefit oral health. Owners are also looking for things their pets can chew that will last.
• The problem is these items are too hard. Couple that with how our pets chew with their cheek teeth, it leads to complicated crown fractures or worse.
• The most common teeth breaking culprits are – deer antlers, real bones, large, compressed rawhides, cow hooves, nyla bones, and ice cubes.
• When discussing chews with owners, tell them the kneecap rule. If you wouldn’t want me to whack you in the kneecap with a chew, don’t give it to your dog. Also tell them with an acceptable chew you should be able to slightly bend or indent your thumbnail into it.
• Kong chew toys are a good option for most dogs. Also, safe and durable dog chew toys can be found at www.westpaw.com. Understand there are some dogs whose primary goal in life is to destroy whatever toy you give them. They are very good at it and there may not be a single toy that lasts forever with them. That’s okay. If it’s not breaking their teeth the owners can continue to replace the destroyed toy. That is much less expensive than root canal therapy or surgical extraction.

As always, if you need advice or have questions with a case, please feel free to reach out to me.