Pawsitive Veterinary Dentistry “The podcast for veterinary dental teams—hosted by Benita Altier, LVT, VTS (Dentistry).”

 On the Front Lines of Periodontal care, Why Veterinary Technicians Have a Critical Role.

• Benita Altier • Season 1 • Episode 6

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In this episode of the Pawsitive Veterinary Dentistry Podcast, host Benita Altier, LVT, VTS (Dentistry) sits down with Heidi Olivier, CVT, VTS (Dentistry) to explore the essential role veterinary technicians play in the treatment of periodontal disease.

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SPEAKER_00

Welcome everyone to the Positive Veterinary Dentistry Podcast, a podcast dedicated to helping veterinary professionals elevate patient care through better dentistry, better diagnostics, and better decision making. I'm your host, Bedita Altier, licensed veterinary technician, veterinary technician specialist in dentistry, and the founder of Positive Dental Education. Today's episode is one I'm really excited about because it speaks directly to the heart of what we do every single day in practice. Periodontal therapy and the critical role of the veterinary technician. This episode on the front lines of periodontal care, why veterinary technicians have a critical role, is one that will help you in your general day-to-day practice of veterinary dentistry. Peridontal disease is the most common disease we see in our canine and feline patients, and I did say the most common disease. And yet it is still one of the most underestimated, underdiscussed, and sometimes undertreated conditions in veterinary medicine. Veterinary technicians are often the first to recognize periodontal disease and the ones performing comprehensive periodontal therapy. And we can be the strongest advocates for our patients because we talk to clients so much and we really need to get them on board. So they're a part of our team. We want to do this long before disease becomes severe because unfortunately we wind up treating a lot of patients that the disease has progressed so far that we can't actually be in tooth saving mode. We're actually having to advocate for tooth extractions, which isn't really the goal. We want to have animals keep their teeth their whole lives. Today I'm joined by Heidi Olivier, a certified veterinary technician and veterinary technician specialist in dentistry like myself. Her career spans general practice. She was in a veterinary university teaching hospital, specialty dentistry and emergency. Her work has focused on dental diagnostics, paridental therapy, oral pain management, and dental education. So, like me, she's really passionate about educating professionals like you in a general practice setting so that we can all help more animals together. Heidi is a national speaker on veterinary dentistry. She is an executive board member on the Academy of Veterinary Dental Technicians. So I get to see her every month. She is an amazing secretary. I will definitely tell you, Heidi has been really organized. I'm so impressed how organized you are, Heidi. And she just took on a new role as chief education officer at PerioVive. She is deeply dedicated to mentoring veterinary technicians, advancing dental standards, and empowering veterinary teams to advocate not only for their patients, but also for professional growth, fair compensation, and a healthy work-life balance, which I love that, Heidi. I definitely want to ask you more about that. I'm really excited to dive into our conversation today. So welcome, Heidi.

SPEAKER_01

Thank you so much for having me. I'm excited.

SPEAKER_00

So what we do on this podcast to have a little cliffhanger at the end and something fun at the beginning is the last guest leaves a question for the next guest, and you'll have one to give at the end for my following guests after you. And it's meant to be fun, but it's also helping us to learn more about each other and what we do in our real lives or veterinary dentistry. So, what is the most unusual case or patient you have ever worked on?

SPEAKER_01

Okay. I have a really good answer for this. I think.

SPEAKER_00

Okay, perfect.

SPEAKER_01

Mostly because it was my very last patient that I worked on in specialty practice. And his name is Quasimodo. And he is just like the name, he has short spine syndrome. And so if you've ever seen, he's actually kind of um famous, I guess you could say, for a dog. He has his own little following. If you follow him online, his name is Quasi the Great. You should check him out because he's adorable. He's like a really good, like feel good material if you ever need to find something online to relax. But um, Quasi the Great has short spine syndrome. So he was born that way. And because of that, he is incredibly difficult to manage, not only in his periodontal disease and dental disease, as well as anesthesia. And so we got on kind of a routine with him where we saw him every six months. And it took a combination of a board-certified anesthesiologist, a board-certified dentist, a guest and anesthesia, and myself every six months would see him because of his short spine syndrome, sometimes he required endoscopic intubation because he couldn't move his neck. And so we had to, over the years, we discovered the best way to intubate him, which was like in a lateral recumbency versus the sternal recumbency. We figured out what size, what side was better over the other. And of course, he had different challenges with anesthesia as well, his lung capacity and all that. And so I think that is just a really good example of how all of the departments can come together to work on a very special case and make sure one, that he's safe and two, that he keeps his teeth. Because another thing we were very scared of is because he couldn't really open his mouth very wide. So cleaning his teeth was very difficult. We had to contort into all different positions, taking x-rays was very difficult. But we really didn't want to have to extract any teeth in the back of his mouth because that would involve probably a very large extraoral surgery, like opening up his cheek. And so his owners, I give them a lot of credit, are so dedicated to his care. And really, we saw him every six months. And so that's one sad thing about leaving general practice is that I won't be seeing Quasi anymore, but I know he's still gonna get the dental care he needs. I know he'll be there every six months.

SPEAKER_00

Oh gosh, wow. Yeah, that's a case that sounds like it has so many complexities that it takes the whole team. So amazing. So he's doing okay now though, right? As far as you check him out online.

SPEAKER_01

He's wonderful, he's the best little guy.

SPEAKER_00

He's got a following on his Instagram and TikTok.

SPEAKER_01

He does a pretty big one. Yeah, he's like the most famous patient we see or so. Which is silly to say, but it's kind of like a little celebrity that walked in the door every every six months.

SPEAKER_00

Oh, yeah. Oh my goodness, that's really exciting. Well, we do sometimes see famous patients or they become famous to us, so that's super cool. So, yeah, thank you for that. And yeah, be thinking about a question for the next guest. So, my first question, we're gonna talk about how periodontal disease has a start, and we want to really figure out how we can advocate for patients. So when we think about it being the most common disease we see in our patients, yet it's often not addressed until it's advanced. Why do you think it's so important that we really start that conversation early on in a patient's life at a puppy or kitten visit?

SPEAKER_01

Yeah, I think it's essential to start that conversation on day one. So, you know, if you're in a general practice setting, would you see that puppy or kitten at eight weeks, at 12 weeks, at 16 weeks? We just need to supply them with little nuggets of information. And I think it's important to set the standard in the beginning so that when you see them back at one year and you say, Hey, it's time for your first dental cleaning, they're like, ah, I've heard this before. You told me I was gonna need to be back in a year to do this. And they hear it from you every single time they come to visit, usually regardless of any reason, right? Usually asking them what's going on with their mouth. If does that patient's breath smell? Do they have any concerns that way? Let's take a look in the mouth. Because then the unfortunate thing is in my specialty practice, I saw the worst of the worst. And so we were often seeing 13, 14, 15-year-old dogs and cats that at that point needed full mouth extractions and for a whole host of reasons. One is a blind neglect. Maybe they just didn't realize that dental care was important. And I think that has a lot to do with us as the veterinary professionals, is we need to keep that at the forefront in our daily conversation with them. And so the guilt that they would feel at the time that they saw me and their pet is in pain, they're suffering, maybe they have an abscess, maybe they have a pathologic jaw fracture, the guilt they feel is horrible and it's something you have to walk them through. You know, I'm sorry this happened, but you're here now and we're gonna fix it. And so I think we can kind of we can't always prevent that type of thing from happening. But if we start it on day one when we see them as puppies and kittens, again, the front line of periodontal disease is the technicians in the room every single time.

SPEAKER_00

Yeah. I think that it's really important that we don't make them feel guilty, but they're so excited about those new puppy or kitten visits that they want to just be like a sponge. They want to take in all the information we're trying to give them. And if the receptionists, when they schedule the appointment with them, and also us as technicians in the room, and then the doctors talking to them, if we all have a touch point with the client, we can really make a difference, I think, in their understanding of how we all think this is really important. And the cool thing about periodontal disease, it's actually preventable, right? And so, you know, when we're in the room and we're talking to the owners, I've definitely heard people say things that sort of backpedal really good recommendations. Sometimes we've said things like, Well, I think it can wait, or it's not that bad yet. Why do you think that kind of language is so damaging to advocating for our patients? And what would you say to the client if they say, Well, can't it just wait, or I don't think it's that bad yet? If the client is saying that, like, how can we change the script a little bit just to make it so that the clients understand that this is going to be a part of their wellness care throughout their life?

SPEAKER_01

Yeah, I think that sometimes we put our own fears and our own perceptions on what an owner is willing to do. Um, you know, as technicians, some sometimes we're very cost focused, we're money conscious. And so sometimes it's very difficult to recommend a very expensive procedure because maybe you think they can't afford it. But I was continuously surprised in my experience by the people that went for the procedure and didn't go for the procedure. But it was my job, regardless of how much it costs, regardless of how sick the patient was, of their anesthetic concerns, to offer the gold standard of care and then alter based on their needs. And so I'm always gonna offer you, you know, the gold star, and then we're gonna discuss together what seems reasonable for you. Maybe you can't get your pet in every single year for a cleaning, but maybe we could talk about every other year or every third year, and we're gonna talk about really good home care in between so that maybe we can stop the progression of periodonless disease. I think that sometimes we take a one-size approach and it's not right for every single patient and every single owner and what they're capable of. And so I think having um an honest conversation with them as far as, hey, it's not ideal that we can't get fluffy in every single year for a cleaning, but I hear that maybe you can do it every second year. But here's what we can do in between those things. And so I think being honest with them and letting them know what could happen or what might happen, it may be, hey, we're gonna expect some extractions next year. But if you're willing to accept that risk, if you're willing to provide some home care or be in contact with me, if you're you seeing something that is concerning, I think it all just really boils down to good good communication. Because I think if an owner feels heard, that's first and foremost, because they don't want to feel like you're just selling them something. They want to know why you're recommending it and the and the data, the science behind it as and ultimately they want to do right for their pet, right? They want to, they want what's best for their pet and they want them to be happy and comfortable. So if you come at it as an approach like that, I think it's much more palatable for owners.

SPEAKER_00

Yeah, I think that's true. One thing that I would say is that when we think about talking to them, we want to come across as we are pet owners ourselves. And we can even share some stories or testimonials about how we've been able to incorporate home care in between the professional visits. Because I think what overwhelms owners is thinking about having their pet go under anesthesia every year. But unfortunately, if we don't do home care, we don't do professional care, that's when the periodontal disease really takes hold. And once it does, we can't really go back to where it was before it happened. So, like you said, we really just gotta somehow figure out the right words to use to appeal to their logic, but also their heart because they're very concerned about taking good care of their pet, but then they're also very concerned about the scary thing we know as death, and we think it's anesthesia, but it's really death. People are so afraid, and dentistry shouldn't be fear-inducing, we hope, right? People might also have fear because they don't like going to the dentist, right?

SPEAKER_01

Right, yeah, exactly. I think it it all boils down to just being empathetic with owners, like that is something I've spent a lot of time in rooms with owners, and no matter what the problem was, if you can just boil it down to some empathy, like hey, I can relate, I had an XYZ situation that happened similarly, and I'm gonna help you through it. I think it is it's hard sometimes because sometimes when you've been in vet med long enough, you can sort of jump to being defensive if somebody doesn't want to do something or if they're kind of giving you pushback. But I think if we just boil it back down to, hey, this person's here and they're asking for help, and it's my job to figure out what kind of help to give them.

SPEAKER_00

Yeah, I love that. So I feel veterinary technicians play a really huge role in recognizing periodontal disease before anesthesia even happens. So, what should technicians be looking for during those conscious oral exams that may indicate periodontal disease is present or potentially progressing?

SPEAKER_01

Well, the first thing I pay attention to is the smell. Sometimes I, you know, even before you enter the room, sometimes you say, whoa, okay. And if you've done enough dentistry, if you've been enough around enough mouths, you know the smell of dental disease and you know if something nefarious is going on. And so there's a very particular smell to a very infected mouth. So that's the first thing I pay attention to is um, you know, before we go in the room, or once I'm in the room, how does the room smell? Two, I'm gonna ask the owner what they feel is going on. And so obviously that can be we're gonna ask some good questions to the owner. Secondly, I'm gonna just look at that patient from across the room. Maybe they're drooling, maybe their eye is wink squinting, maybe they have nasal discharge, maybe they have a swelling, or maybe they have nothing going on at all. But if you're gonna do a good conscious oral exam, you're gonna palpate our structures, you're gonna feel for swelling, you're gonna feel for atrophy, you're gonna feel for things like that. And then if your patient allows, if they have a good temperament, you're gonna flip the lip and try to take a look inside. Um, you're gonna assess for, I think gingivitis is much more important to assess versus a calculus index. I mean, I know calculus can be very um misleading sometimes. And sometimes we have really terrible calculus, and sometimes we have no calculus at all. So I try to pay attention to if things are bleeding, if they're smelly, if they're red and inflamed, if there's bone loss. And then any sort of obvious pathology, if there's a tumor hanging out, if there's a fracture, if there's missing teeth or extra teeth, I try to get a really good visual of that, you know, in our limited, what do we have, 20 to 30 seconds? Right. Very long. Taking all of that to in together to kind of give us the best clue we have going forward into our procedure, our anesthetized oral exam.

SPEAKER_00

Okay. Yeah, I was teaching with a veterinary dentist recently, and she was telling the doctors, do not write calculus. I do not want you guys to even write calculus down in your medical record because it really doesn't have bearing on the outcome. So when we think about looking at that genital health, I feel like that's one of the most important points that you made there. You know, we think about periodontal disease. I mean, even just defining that when we think about staging periodontal disease, like what do you think about when it comes to the conscious oral exam and how you would potentially imagine what the stage of periodontal disease is? Because we clearly can't actually stage it until we have dental radiographs. So with the patient awake, is there anything that you have as a tip or trick to help the veterinarian or technician understand potentially what stage we're at?

SPEAKER_01

Well, I always say we're like a little detective, right? We have to take all of our clues and do our best guess to what's going on and tell they're under anesthesia. So what does it smell like? What am I seeing? What's my past experience like? You know, if I've seen patients like this before. We got really good in my specialty practice where we could look at something and say, this is probably two to three hours of extraction time. Or also on the other end of that, we would say, Oh, this doesn't look so bad. Maybe it's just an hour of an extraction time. And then you get them under anesthesia and you're completely surprised because every single tooth in the mouth has resorption or something else going on under the gum line that you didn't anticipate. So I think sometimes we can do everything right and still be completely surprised. And so that's to your point about calculus not being a real indicator of um the stage of periodontal disease, because I've seen the the most pristine mouths be atrocious under anesthesia, you know, the worst pockets, the worst bone loss, that things like that. So it it can be very difficult, but I think it comes with time and experience mostly.

SPEAKER_00

Yeah. Funny thing, teeth are like a box of chocolates. You don't know until you get to the inside. That's true.

SPEAKER_01

That's true.

SPEAKER_00

And sometimes a coconut flavored and you might not be your favorite flavor there for sure. So, how as a technician do you feel like you can help communicate that properly and document that to the veterinarian so that we can schedule those patients properly and get them treated when they're under anesthesia? Is there any tips or tricks that you have in regards to how you would document that conscious oral exam to help us understand better how to actually place that patient in our schedule?

SPEAKER_01

Sure. I think you as a team, you should probably have a standardized way that you report things. I know in my practice, we hack our standard SOPs for our oral exams. And so you're gonna take note of the gingivitis, you're gonna take note of the pathology, you're gonna take note of what the owner says, very importantly, because if the owner's telling you like they're not eating, they're dropping food, that kind of stuff, that's gonna be a clue that something else is going on. And then I think too, we have to um just assume that things are gonna take longer than than you think they are, and then just be happy when they're shorter. And so I don't I don't know that you can ever just say, oh, this is a stage or a level one or a stage one dental procedure, because we just don't know until they're under anesthesia. So I don't know that I have like the magic bullet there for how to better communicate that, other than just one having understanding between your team on what's acceptable in your medical record, and then having a really standardized way that you report it.

SPEAKER_00

Yeah. I feel that if they have a full set of dental radiographs from last year, it's way easier to determine what we may be up against this year. Is that something that you guys would normally do? Is if they're here, go back and review their images from last year and their chart.

SPEAKER_01

That's a really good point. Is if they are repeat patients, which if you're in a general practice, you probably are getting those annual patients. This is a really good reason to do really accurate charting, right? So take a look at your chart from the previous year. Maybe you had on your K98th, you had some mid-level pocketing that you did some root plating on. And this year, you're gonna like, ooh, okay, we might be in a position where those are gonna be okay, or we're gonna have to extract them. So it could go both ways. So I think that's a really, really good point is looking at what was done last year, and that's gonna clue you in. Maybe that patient had 25 extractions the the year before and they've been really diligent about home care. So maybe this year it's just a straightforward cleaning.

SPEAKER_00

That would be nice. I love it when that happens. And I feel that if we can really get them on that plan of doing this on some sort of routine basis and establish a baseline by taking full mount dental x-rays earlier in their life to assess, to make sure that the roots formed normally, that we have normal root morphology, we have strong, healthy bone. Let's keep it that way. But if we don't have that information from them visiting us or even visiting another veterinarian where they've done that before, we just are really in that box of chocolate situation where we don't know what we're up against. And when we think about how much time it's gonna take, I am totally with you about just adding on more time for those patients when we don't have that prior information to look back on, right? So when we think about periodontal therapy, I feel that technicians have a really strong role to play. And I feel that this is where people go wrong in the veterinary profession. They just don't really think that there's an option to save teeth sometimes, and they don't really have the skills or the knowledge to actually do that properly. So we're gonna talk now about when we have a patient under anesthesia, what exactly does it mean to do periodontal therapy? And how do technicians truly shine in this particular part of the dental procedure?

SPEAKER_01

Sure. I think periodontal therapy is doesn't I think it's just simplifying. I think we overcomplicate things. I think if you with a really good thing over reading, it's going to be really important. As a technician, learn how to probability. And look at what it means. Learn everything x-ray. Then you're going to be like a doctor. And so I think it's it's really just comes down to educating yourself and then getting the confidence and the tools and support to help you succeed.

SPEAKER_00

Exactly. When we talk about hand instruments specifically, because that is one of the places where a lot of hospitals may have some hand instruments, but they don't necessarily know how to identify what is a current and what is a hand scaler. And even understanding how to adapt those instruments properly to the two circles, as well as understanding how important it is that those instruments are captured. We do have any tips for tips for practices and regards to how to call the infrastructure.

SPEAKER_01

I think we have three are couple instruments to say that we treat our instruments. If you have one, you've had it for thirty years. Um again because we have to overcomplicate things. A lot of times there's a number on that instrument. Just Google it. I can tell you, oh, you gotta use it this way.

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Benita Altier

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