Dentistry training can yield incredible clinical and financial rewards for general practitioners.

In the last 10 to 15 years, dentistry in veterinary medicine – both the awareness and ability to do it at a high level – has grown tremendously. Yet Jodi Reed, DVM, believes the number of general practitioners who possess the training, knowledge, equipment and staff that can deliver high-quality dentistry is still relatively low.

Part of that is because of the time involved. It’s a steep learning curve to learn how to do it, and most practitioners must get that education beyond veterinary school, “because unfortunately, in the vast majorities of veterinary schools, the education that we get as general practitioners on performing really good, high-quality dentistry is still quite lacking,” she said.

Dr. Reed herself is a case in point. She graduated in 2001 from veterinary school with almost zero dentistry education. There was only one rotation at her school at the time. It was taught by a human dentist, and out of her class of 90 veterinary students, only eight were able to take the elective. While she graduated from school with very little training in dentistry, there seemed to be an expectation of veterinarians being able to practice dentistry at a high level. “That was clearly not happening,” she said. “Most of us, when we graduate from vet school, have to find a path to be able to learn how to do it outside of our traditional education.”

Dentistry as a team sport

Dr. Reed’s desire to provide better care for her patients eventually led her to the International Veterinary Dentistry Institute. Founded by Brett Beckman, DVM, FAVD, DAVDC, DAAPM, the IVDA provides general practitioners RACE Accredited Veterinary Continuing Education. More than 10,000 people have taken the IVDI’s live and online courses since it was established in the early 2000s.

At the core of the training are wet labs. Students are taught things like extractions, how to recognize disease, when to treat and when to refer. Yet after years of providing these wet labs, Dr. Beckman discovered a missing element. To truly provide excellent dental care, the entire dentistry team needs to receive training, not just the veterinarians. So, he created the Veterinary Dental Practitioner Program to enhance the effectiveness of the entire team from the moment the patient is put under anesthesia to the moment the patient wakes up. The program is flexible and virtual, including once-a-month wet labs that remain pivotal to enhancing the veterinary team’s knowledge and skill set with a mentor watching and offering instruction as they go through the dental procedure they’re being trained on.

While some oral care cases require a specialist, extractions are the No. 1 thing that general practitioners should be able to do. To that end, the VDP taught Dr. Reed how to efficiently, effectively, and successfully do extractions for animals who have painful diseases related to either fractured teeth, periodontal disease or other things that cause pain and inflammation and infection in their mouth. “The program is for veterinarians who like dentistry, but need more training, and really want to be doing it at the top of their game,” she said. “It changed the way that I did things, and it elevated my ability to offer my patients a higher level of experience in treatment than most other general practices could do.”

Clinicians and technicians who go through the training become more valuable to their veterinary practices and sought-after service providers in the marketplace, Dr. Beckman said. “There are not a lot of people that have had training to that level that are able to walk into a veterinary practice and really impact that practice from day one with all of the things that we teach in the program,” he said. “So, the people that go through that program (the veterinarians and the veterinary technician team members) are some of the best in the world in general practice for dentistry. It sets them up to being very successful in not only the provision of the service to the patient, but also for the practice’s success from a financial standpoint.”

Dr. Reed was one of the first students to complete the VDP Program and is now an IVDI instructor. “I love being able to provide better quality dentistry as a result of the program,” she said. “I love surgery in general, and it seemed like a really natural thing for somebody who loves surgery to do a really good job in dentistry.”

Low-hanging fruit

Dr. Reed believes that dentistry presents a largely untapped opportunity for general practitioners.

“It’s really low-hanging fruit, because so many of our patients are experiencing high levels of infection, inflammation and pain in their mouths, but they can’t tell us that,” she said. “When we learn how to diagnose and treat periodontal disease and other dental diseases, it changes these animals’ lives in ways I can’t even begin to describe. To see pets do things that they haven’t done or wanted to do in years, and to see owners that thought that their dogs or cats were just getting older, but were actually in pain from infection that you can treat, it’s beautiful. These clients are just so grateful that their little fur babies are feeling better than they have in such a long time. They just had no idea it was due to pain.”

For example, a young Boxer-Shepherd mix named Jacoby was brought to Dr. Reed’s office because he had been experiencing a foul odor in his mouth. The pet owner had done all the right things. He took Jacoby to another clinic and had his dog’s teeth cleaned, but within a few weeks the smell was back. Meanwhile, Jacoby was in tremendous pain. Although his breed is traditionally very rambunctious, he wouldn’t play with his toys or run around. When the client brought him into Dr. Reed’s office, she immediately did an oral exam and diagnosed him with a condition called chronic canine ulcerative stomatitis. Unfortunately, the treatment required a full mouth extraction of all 42 teeth. But a couple weeks after the extraction, the 3-year-old, 100-pound dog was back to his normal self, bouncing around and wanting to play with his toys.

“I’m so thankful that his owner recognized something was really wrong, and he came to somebody who focuses on dentistry,” Dr. Reed said. “We were able to diagnose it and thankfully treat it, and he is absolutely living his best life right now. I am still in contact with this owner, even though his dog doesn’t have teeth. I still get letters and pictures and messages about how great Jacoby’s doing.”

Tools of the trade

More practices are investing in new technology that provides diagnostic advantages over traditional X-rays. For some specialty providers that includes cone beam CT. General practitioners may not want to purchase a piece of equipment that expensive, but digital radiography has become the standard of care in recent years.

Specialty practices are investing in Cone Beam CT which provides diagnostic advantages over traditional X-rays. This technology is very helpful in discerning questionable lesions like a periapical bone loss for a non-vital tooth, but it is something that only some larger practices with multiple use cases will likely consider, Dr. Beckman said.

Dental health care chiefly involves trying to slow or prevent periodontal disease, and that starts with plaque. “It’s why you and I brush our teeth twice a day, it’s why dentists recommend for us to floss our teeth every day, and why we go get our teeth professionally cleaned every six months,” Dr. Reed said.

Plaque is the combination of minerals and bacteria in saliva. It creates tartar and calculus that forms on the teeth and harbors a lot of inflammatory responses and bacteria that get under the gumline. “So, anything that we can do to prevent plaque is what we recommend doing at home,” Dr. Reed said.

At-home, plaque prevention products include:

Pet-safe wipes with a cleaning agent that can be used to wipe off plaque
Dental chews
Diets specifically formulated for oral care
Toothbrushes to use on pets

In-practice, veterinarians can offer more thorough clinical options, including teeth cleaning. But because it involves general anesthesia, some pet owners will be hesitant to agree to it. “Veterinarians cannot do a thorough, good job cleaning teeth without the patient being under anesthesia,” Dr. Reed said. While anesthesia is not 100% safe, the monitoring and ability to perform it safely has come leaps and bounds. The chance of losing a patient under anesthesia is extremely slim.

“These are not procedures we’re doing just because we want their dogs or cats to look pretty,” she said. “I genuinely want to have their mouths feel good. Just like in people, having infection, inflammation and pain in your mouth will influence not only your quality of life, but your longevity. It can cause problems with your kidneys, heart, brain, liver, with all sorts of things, if you have nasty things going on inside your mouth.”

Putting it all together

Practicing excellent dentistry involves three key tenets, Dr. Beckman said. The first is training. A veterinarian and technician must undergo significant training and incorporate those learnings into the veterinary practice. “This goes back to the VDP Program,” he said. “It provides an ongoing basis for mentors, instructors and colleagues to provide continual feedback on a student’s progress and help foster success. So training is No. 1.”

Number two is having the proper products and equipment. The instrumentation portion is important for the veterinarian to perform procedures efficiently, confidently and correctly. So too is the dental radiography and software used to capture images and data. Having members trained on how to handle these pieces is key as well. Distributor reps can play a key part here in consulting with the veterinary practice on the latest products and equipment (see this month’s Product Roundup).

Finally, the entire veterinary team must understand the timing and flow of the dental procedure from induction to recovery. “Know when to take the X-rays, when to do the charting, when to call the owner, when the nerve blocks wear off – all those things that result in the success of that practice being one of the best in dentistry,” Dr. Beckman said.

A rewarding contribution

Veterinary medicine will continue to push dentistry to higher levels with more education in veterinary schools, more access outside of veterinary schools for continuing educations, and more innovations on the product and technology side in the coming years. Dr. Reed is on the front line of instilling that higher caliber of dental care as an advocate and an IVDI instructor.

“I am a general practitioner,” she said. “I run two separate hospitals – a general hospital and a dental-focused one. I know what their real world looks like. I know what it’s like to not be a specialist and to have clients who are trying to pressure you into doing things that you’re not comfortable with. Teaching students how to honor their own comfort levels while serving their patients the best way they can is one of the most rewarding things I do.”

The Vet Dental Show

Dr. Beckman (drbrettspets.com) is host of the Vet Dental Show, available on YouTube and several podcast channels. During the weekly show, Dr. Beckman and his guests discuss everything a general practice veterinarian needs to know about dentistry in a fun and engaging format. Each episode is around 15 minutes so it can be listened to while driving, during a workout or taking a break from work. “We’ve gotten great responses from it and built quite a following on YouTube,” Dr. Beckman said. The podcast is available on Apple, Google or Spotify. Or, to watch an episode, visit youtube.com/@VeterinaryDentistry.

Photo credit:

istockphoto.com/Kateryna Kukota

Veterinary Dentist Training: Something to Smile About