Tooth or Dare: Taking the Scary out of Dentistry in General Practice
Dental Conversations
There is so much to explore during a physical exam. Depending on the presenting complaint, it’s easy to develop tunnel vision and narrow our focus. This is why we’ve all heard the importance of performing the physical exam in the same order every time. It helps ensure nothing gets overlooked. It helps ensure that nothing is missed. This blog highlights an early but important stop along the way—the oral cavity, which should always be examined in its entirety at every visit.
When a patient presents for concerns unrelated to the oral cavity, we as veterinarians often mention any visible oral disease but may hold off on having a full dental conversation. However, when the opportunity arises to provide valuable information, it is our responsibility to educate owners on the details of dentistry. Even if dental disease isn’t the reason for the visit, skipping a conversation that could improve a pet’s long-term health is a missed opportunity.
General Dental Talk
When the oral cavity appears healthy on exam, I provide a basic dental discussion that includes a recommendation for toothbrushing. Most clients are intimidated when I tell them daily brushing is ideal. While brushing every other day or a few times a week can still be effective, daily brushing is considered the gold standard for maintaining optimal oral health. I usually aim for a few times a week with pet-safe products that are approved by the Veterinary Oral Health Council, also known as VOHC. I explain that using products recommended by the VOHC ensures they have been tested for safety and effectiveness.
Introducing pets to toothbrushing early in life —ideally as puppies or kittens—helps normalize the routine. This makes it easier to maintain the habit as they grow. It’s all about desensitization and creating positive associations. When working with older pets, I always emphasize that old dogs can absolutely learn new tricks. It’s never too late to begin a new oral hygiene routine. If behavior or training presents a challenge, VOHC-approved water additives or dental chews can serve as helpful alternatives.
How to answer: Why do I need to clean my pet’s teeth?
Oral health is not always intuitive for our clients. It’s our job not to judge but to educate. I explain that the dental calculus visible on their pet’s teeth can’t be removed with regular toothbrushing. That is why we recommend brushing early to prevent buildup.
I explain how tartar forms and how it becomes a reservoir for oral bacteria. When tartar and gingivitis are present, pets are continuously exposed to bacteria, which they swallow—potentially leading to systemic infections, including serious conditions like endocarditis.
The goal is never to fear monger. The intention is to educate and empower clients by giving them the tools they need to help their pets thrive.
Explaining the Comprehensive Oral Health Assessment and Treatment (COHAT)
The at-home dental care conversation naturally leads into a discussion of the COHAT. This is a professional dental cleaning performed under general anesthesia. It is important to help clients understand that while tartar is visible above the gumline, most dental disease lies beneath the surface. This disease cannot be identified or treated without anesthesia, which includes dental radiographs—and certainly not with home care alone.
In my experience, the majority of clients express concern about anesthesia. This is completely understandable if they do not have education on the topic. It is important, again, to listen without judgment. Here is a communication example I use with my clients:
“I completely understand your concerns about anesthesia for [Pet’s Name]. Your worries are valid, and it is important to feel confident in the care your pet receives. Before we move forward with a dental cleaning, we always perform a thorough physical exam and pre-anesthetic bloodwork to make sure [Pet’s Name] is a safe candidate for anesthesia. These labs help us assess internal organ function and catch any underlying issues ahead of time. That’s why we require lab work within 30 days of the procedure.”
Additionally, many clients express concern about the financial aspect of dental care. It is important not to treat this as a sales opportunity. Instead, I return to education, always centering the conversation around the pet’s health. I have a technician provide an estimate the same day so clients can plan for the recommended procedure.
I’ll admit that I didn’t anticipate how many financial conversations I’d be having when I entered this career. I remind myself often that I am not a salesperson. I am a veterinarian. It is my duty to inform clients of their pet’s health and disease status and to give them the tools to make informed decisions. That’s a grounding reminder I return to often.
New Vet on the Block
As a veterinarian only one year into practice, I feel most comfortable discussing client communication. That is why I chose this topic for the blog. I am not a dental expert, and dentistry was never my favorite subject in school. However, I have learned valuable techniques as an AIV mentee that have helped me feel much more confident when performing dental cleanings and basic extractions (and now I secretly kind of love dentals). Here’s a list of the tips I have picked up so far:
- Managing Anesthesia
- Adjust protocols for every patient. Each animal is unique and deserves an individualized approach based on age, health history, and physical exam findings.
- Always have a reliable dosage calculator available. I recommend this free tool.
- Local Blocks
- Review your block techniques using a skull model or anatomical diagrams from textbooks or trusted websites.
- Bupivacaine or lidocaine can be effective on their own. When appropriate, combining buprenorphine with bupivacaine can enhance and extend analgesic effects. This study provides helpful insight.
- Extractions
- Take your time. That is the most important lesson. *Drops microphone*
- Avoid atomizing roots inside the canal and try filing on the bony side under the elevated mucosa. Be slow and deliberate.
- Postoperative Care
- Pain management should be provided, especially after extractions.
- Antibiotic use should be determined on a case-by-case basis. Responsible antibiotic stewardship is essential.
- Always clean your patient’s face and fur after a dental procedure to support a comfortable and hygienic recovery.