Ep 150- How can technicians and veterinarians collaborate effectively to transform your dental practice and deliver exceptional patient care?

So enjoy this episode and we'll be back the following week with episode two. We're privileged with having my long time veterinary dental technician. and specialist in dentistry on the technician side, Annie Mills, who is, in my opinion, the most amazing instructor and the most amazing right hand that I can imagine having in veterinary dentistry. So Annie, welcome. Thank you so much. I'm excited to be here. This is actually my very first podcast.

This should be fun and just looking forward to talking about dentistry. Excellent. I'm definitely going to put you to the test, so we'll see Alrighty. No pressure at all. All right. Just to give you a little idea of my background I'm a, an LVT originally from Michigan and have been in the veterinary field almost four decades now.

And the last almost 13 with Dr. Beckman, but the majority of my career has been in general practice and doing dentistry in general practice and facing all of the challenges that you guys face. And I also received my specialty in dentistry, BTS. in 2008, so have been on that track.

And so this is all I do, but still remember those days in general practice and hopefully we can address some of those challenges and frustrations that you guys are facing today. Excellent. Annie brings a tremendous perspective, not only from general practices, she said, but She's been my specialty technician for 13, 14 years. And so she sees the patients as they come in from general practice, plus leading up to that point where we became a team.

She's seen everything in general practice, plus she teaches general practice dentistry to veterinarians and technicians, both practically live and in the virtual setting. So Annie, let me start off by asking, what is the importance of having a mindset of a team structure when it comes to dentistry in general practice. Yeah, that's actually absolutely the approach that needs to happen. And for many years, it was always on the shoulders of the technicians, unfortunately.

And I know that for many years I did extractions. oral surgery. And that's still happening today. And we know that we're not unrealistic, but what we need to do is move forward and establish a team that has appropriate skill sets for each team member and work together to complete that case but each using their strengths in completing that case and providing optimal care. Obviously, technicians should not do extractions and we like to call it oral surgery.

Surgery is right in the name that says technicians don't do it, but technicians are a huge part of the dental team and the veterinarian should be. skilled in oral surgery. That's what we need them to know. So education of course is key and we want to make this as appropriate care for these patients. If you think about it, when you go to your own dentist, who do you have more contact with?

The dentist or the dental hygienist and it's mostly the dental hygienist, but the dentist is there or the oral surgeon is there for any treatment that's going to be performed on that patient. And then the dental hygienist pretty much rounds out everything else as far as completing the procedure. that case. And so that's our approach when we teach that dentistry is absolutely a team sport. This should not fall on any one person.

And ideally, the dental team that we would recommend is one person monitoring anesthesia, the dental technician, and then a skilled general practice oral surgeon. And that's ideal, and we know that can't happen in all the practices, but if if we can put a team together that way, and then when we teach, we address all of those skill sets for all three people. Excellent.

You mentioned the oral surgeon only being the one to do extractions, but there's a lot of things that technicians can do as well. What are some of those things that the technician can do directly with the patient that make a huge impact in not only the speed, but in the functionality and the patient outcome? Aside from of course, the anesthesia and inducing that patient and getting that case started with dental x rays, that's where we start to get our diagnosis first.

And a skilled technician in taking dental x rays can help. shorten that anesthesia time significantly. When we get our time in a reasonable amount of time, getting a complete full mouth series, which is what we recommend is standard of care for every patient, full mouth x rays.

And then once we get those x rays we teach our technicians to be able to recognize obvious pathology and get that dental chart started put those nerve blocks on board and knowing Essentially what the treatment plan is going to be, getting

that instrument tray set up and ready to go so that when that veterinarian comes in, we confer and talk and have her or him confirm that treatment plan and then we can just jump right into surgery. Moving that case along. Whether the veterinarian is ready or not and in general practice, that's a real life thing because veterinarians are doing multiple different things as is technicians. But we just tend to have more time in that dental suite than than our veterinarians.

And so we want to make sure that we're doing everything we can to move that team forward. That case forward and prepping that patient up until the time that oral surgeon jumps in the chair and picks up that scalpel and we're ready to go. So all of those skills, charting regional nerve blocks, recognizing pathology, getting those dental x rays and being able to put together an estimate.

And communicating with the clients and educating the client as to what we found, what the treatment plan is and what that cost is going to be. Because we don't ever want our veterinarians to have to talk about estimates that's not in their wheelhouse. But a confident, knowledgeable dental technician is absolutely capable of jumping on the phone, getting that permission, and then we can move forward.

What do you feel is your ability to talk to the client and the touch points that you have with the clients when they are not only calling initially to talk about the dentistry service and decide whether they want to maybe come to that practice, let's say. And then how many touch points do you have with that client traditionally? And should it be you? Should it not be the receptionist? What are your thoughts on that?

Anytime we're talking to clients about dentistry, we have to remember that dentistry is an elective type of procedure. And they're typically very nervous, very reluctant, and unfortunately, some of these patients, we don't get to treat until they're very clinical and it motivates that client to finally call and say, I've just got to do this.

And we also have to keep in mind that most of what The general public knows and the veterinary community as a whole, I think too, doesn't know a whole lot about dentistry or what we know is is maybe not correct information. And so we want to be able to educate that clients, give them the. The key points like Dr. Beckman mentioned, number one being, we are going to clean the teeth, but that's more or less incidental. Our main focus is to assess and get a definitive diagnosis.

And we need to do that via dental x ray and assessment under anesthesia. That's key because we know that. The majority of patients, especially those patients under 15 pounds, have some degree of disease.

So we have to let our clients know that, yeah, we're going to clean the teeth, but we really need to diagnose so that we can treat appropriately and then move on from there and hopefully prevent further disease because that's what dentistry is all about is treating and preventing hopefully we can find stuff early enough that we can still intervene where Our only option is, if it goes too late, our only option is extraction.

So we want to reiterate that to our clients and educate correctly that it's not about the cleaning. It's about the assessment. It's about the treatment, the appropriate treatment. And prevention moving forward. That's how I approach clients anytime they call. And then, of course, we have to address the anesthetic concerns that a lot of these clients have as well.

And the way that we teach our anesthesia, just jumping over to that component of the dental procedure the anesthesia protocols need to be a little bit different for those dental patients because they tend to be older. These Procedures tend to be a little bit longer and we want these patients to be as little compromised as possible, especially those little ones that sometimes can become hypothermic for long procedures. And so our protocols are going to be different.

The main one being we keep these patients really light because we're only working in the mouth. And so my specific verbiage when talking to clients. We need to do the assessment to get an appropriate diagnosis so we can do the appropriate treatment. Our anesthetic protocols are a little bit different for our dental patients. We use agents that metabolize quickly. We can keep them very light.

We're only working in the mouth and because of the pain management that we do even if we have to do oral surgery, we can still keep them very light. And most of my patients are recovered and ready to go home within about an hour. And that gets them to jump over that hurdle of, I'm scared to death to put my dog under anesthesia, because that is a huge hurdle to get over. And so with those, key points in educating that client.

Most most will schedule and feel much more confident and much more comfortable, but there's gotta be that confident technician. There's gotta be that that knowledgeable technician that, that is confident in talking to those clients and can convey that over the phone. So a couple of points. One, I want to clarify when you're talking about diagnosing, you're talking about preparing. the chart, the radiographs, making your observations, and then allowing the veterinarian to do the final diagnosing.

Is that correct? Absolutely. Absolutely. This is again, a team, I when Dr. Beckman and I do cases I'll get that dental chart started looking at those x rays and very obvious pathology. If I'm looking at x ray for a second and that pathology just slaps me in the face, that's how obvious. That's what I mark. And then he comes in and looks at the x rays again. And then we also do a gross examination as well to complete that dental chart.

So it's definitely a team sport to get that dental chart completed which should take just minutes to put together. So ideally this is the trained technician that takes the initial inquiry call from, let's say a new client. Is that accurate? Yes. Rather than a receptionist. Yeah, definitely. Unless you've got a really sharp receptionist who is knowledgeable. But in most cases it's best to have a contact person at the hospital. Even when I was in general practice before.

Way before dentistry we did a lot of orthopedics and any orthopedic procedure or case management, I was the contact person for that particular case from when they came in for their first exam to scheduling the surgery and then post op so that they could talk to one person that was. Deeply involved and firsthand. Of course, I assisted in surgery as well. And then post op care so that clients number one, doesn't speak to multiple people and get multiple answers.

That happens quite frequently, especially in dentistry, because there is so much to know. So many different areas to have. information. And you've seen this, I know in general practice, if we get different questions about vaccine protocols or heartworm protocols or, blood work protocols, sometimes they'll get different answers from different staff members. That creates not only confusion for the client, but a little mistrust. And it will lower the client compliance.

from moving forward and scheduling as well as being comfortable during the procedure and after the procedure, if they can have a contact person to know they can get a hold of, talk to, know that they're, they know about their pet specifically and and can answer those questions appropriately and help that client. Because we have to remember with dentistry, unlike.

Spays or neuters where spays or neuters it just has to be done one time and no matter how badly it goes They don't ever have to do it again Dentistry has to be approached with the mindset that we need To exceed expectations of the client because we need these patients to come back, especially those perio patients. And some of these patients we need to see every 3 months under anesthesia for assessment and treatment. Typically, it's at least twice a year.

If not more, perio patients should not go longer than six months and that's the majority of what you're seeing. And so if we have components to that procedure before, during, and after that don't sit well with the client, it's unlikely that they're going to return. And the only one that suffers is the pet, because they're going to be back in the same boat, and the client will not move forward until that pet is clinical again.

And we know that by the time they're clinical, showing signs, drooling, bleeding, not eating, scratching their face, whatever it is, it's past the points of being able to treat. And all we're doing is extractions and we want to catch stuff early. So we've got to promote early and we've got to do it well and make the client feel comfortable so that there's not that high anxiety to get that pet back when we need them to come back. Great.

So multiple touch points for the client with The person that's in general practice that is tasked with the education, the updates, the follow up, everything

that has to do with that patient. And that starts from the first phone call until the scheduling of the recheck to come back for the perio case. And that may be multiple times a day when that patient's there. including letting the owner know any updates in the estimate after the initial estimates given and the cleaning and the probing and the charting is done, when the procedure starts, how the patient's doing during anesthesia, all those times.

Can be opportunities for that veterinary technician just hop on the phone and increase that bond with the client. And then certainly postoperatively a call letting them know that the patient's fine. And then certainly at discharge there's that one-on-one where the technicians got the opportunity to sit down with a client, talk to them. And show them pictures of the procedure, images of the x rays, and answer any questions that they have.

And if you can carry through with all that protocol step by step, you're going to find that your patients are going to be more likely to come back to you, like Annie said. Because the client knows the value, they see what is going on, they understand what's going on. And they have that relationship with the technician that. is super important. So thanks. Thanks for that. And that's a really important topic.

That concludes part one of the two part series of my interview with Annie Mills, DTS in dentistry and world class instructor in veterinary dentistry. Stay tuned for next Wednesday when we'll conclude the series with part two. I hope you enjoyed that episode. If you'd like more information about the veterinary dental. Practitioners program, please submit to request an invitation at I V D I. org slash I N V.