The Team Winter 2013

Winter 2014 | Vol. 11, No. 1

A WealthEnhancing Resource for Independent Veterinary Practices

Wills, Trusts and Guardians 3 | Heartworm Resistance: A Real Threat 8

Tune Up Your Online Brand Reputation 14 | Risks of Anesthesia-Free Dentistry 19

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From the Desk of Dennis A. Nelson, dvm Winter 2014 | Vol. 11 | No. 1

A Wealth-Enhancing Resource for Independent Veterinary Practices Your Veterinarian Pet Care News From ®

11, No. 1 WINTER 2014 | Volume

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Safeguard Your Pet’s Future Breed Diseases: What You Need to Know

The Team is published to complement Pet Quarterly®, an educational resource for your clients. Look for these articles in the current issue of Pet Quarterly: The LowDown on Heartworm Disease; Risks of Anesthesia-free Dentistry; Safeguard Your Pet’s Future; Know Your Breeds.

Visit us on the web at

www.psi-inc.net

Heartworm Resistance: Be the First to Talk about It None of us want to talk about heartworm resistance with clients.

It’s a tough topic to explain, especially after veterinarians have spent decades instilling client trust in heartworm preventives.

Despite everyone’s efforts to head off the spread of heartworm, resistance to medication is now a very Purchasing Services, Inc. announces a new real threat, not just a topic PSI Member Business Symposium to be held discussed in veterinary circles.

Gain your clients’ trust by June 12-15, 2014, in St. Petersburg, Fla. talking about this with them.

Stay tuned for more information.

It won’t be long before the mainstream media reports on the topic, and the last thing you want is for your clients to be blindsided by disturbing news that catches them off guard.

Both Pet Quarterly and The Team tackle the topic in this issue with articles written by scientists on the forefront of events as they develop.

Ask your team to read both articles, and then discuss how you want to educate your clients.

Save the date...

A lso in this issue: • An estimated 500,000 pets face an uncertain future each year when their owners die or can no longer care for them. Trusts and Pet Protection Agreements can help your clients safeguard their pets’ future. Read more about this on pg. 3.

• The Internet is changing rapidly, and these changes can affect reviews about your practice. On pg. 14, Dr. Jed Schaible makes suggestions for how to tune up your online brand reputation.

The Team is an educational resource published by Purchasing Services Inc., St. Petersburg, Fla. Comments are welcome at info@petquarterly.com

• A whole industry is sprouting up around anesthesia-free dental care for pets. As veterinary dentist Dr. Jan Bellows explains on pg. 19, this is likely doing pets more harm than good. Get up to date on the latest developments.

Best wishes for a wealth-enhancing New Year.

Visit us on the web at www.psi-inc.net © Copyright 2014. All rights reserved.

The Team magazine does not make any representations as to opinions or facts as presented. Reproduction of contents in any form is prohibited without prior written permission of the publisher.

Postmaster: Send address changes to: The Team, 2951 34th Street South St. Petersburg, FL 33711

Sincerely,

Dennis A. Nelson, DVM Vice President, Operations Purchasing Services Inc.

www.psi-inc.net | the Team | Winter 2014 1

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*Based on the 2011 Bayer Veterinary Care Usage Study, Bayer HealthCare LLC, Animal Health Division: By John Volk and Dr. Karen E. Felsted (NCVEI) – A comprehensive investigation into reasons for the decline in companion animal veterinary visits over the past several years.

General Wellness

Wills, Trusts and Guardians Here’s how to help your clients answer the question, “What happens to my pet if something happens to me?”

By Mary Scoviak

At some point, your veterinary practice may receive a call like the one placed recently to

the Lake Seminole Animal Hospital in Seminole, Fla. “The client told us he was having a stroke and asked us to take his dog to our facility.

He hadn’t even called 911 yet,” says Michael J. Rumore, DVM, owner of Lake Seminole Animal Hospital.

“We immediately phoned for an ambulance, and then went to pick up his pet. Sadly, the dog’s owner died shortly thereafter. There were no instructions regarding what he

would have wanted for his pet.”

Rumore and his team were able to find a rescue that would take the dog, but that’s not always the case. “Sadder still, this is far from an isolated incident,” he says. “Cases like this show how important it is that veterinary teams talk with clients about what happens to their pets if something happens to them.”

To help clients address this critical decision, review the latest options for pet trusts and other plans.

Have a Plan “It should be a routine procedure that anyone of any age who acquires a pet should think about who will care for that pet if they are unable to,” says Kim Bressant-Kibwe, counsel for trusts and estates and planned giving for the American Society for the Prevention of Cruelty to Animals (ASPCA). Posters, hand-outs and mentions in your newsletter will help to convey the message that this issue is not age-related, nor is it just for the Leona Helmsleys with $12 million to bequeath to their dogs. >> www.psi-inc.net | the Team | Winter 2014 3

General Wellness

Types of Plans An estimated 500,000 dogs and cats face an uncertain future each year after their owners die or become incapacitated, the ASPCA estimates.

Some of the most common include: n Informal oral or written agreements. These arrangements are not legally enforceable. If the designated caregiver no longer wants to care for the pet, there is no protection for the animal. n Wills. Since pets are considered property, they cannot be willed money. A will can include directions for a pet’s care. However, if the will is probated, the pet’s fate may be in limbo for some time. n Pet Protection Agreement®.

Created by animal law attorney Rachel Hirschfeld, this legal document includes a comprehensive list of care instructions for the designated caregiver. It is legal in all states, but it is best used in situations that are unlikely to be contested and do not involve large sums or complex care regimens.

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www.aspca.org/legalzoom. n Pet trusts. “This is a legal technique you can use to make sure your pet receives proper care in the event that you die or becomes disabled,” says Gerry Beyer, Texas Tech University School of Law professor and co-author of Fat Cats & Lucky Dogs, a book about pet trusts. These need to be created by a lawyer with experience in estate planning.

$2,000. Trusts involving multiple pets or complex trusts like those involving boarding horses or care of exotic pets or animals with special needs will cost more.

Funding can range from a nominal amount that is basically a “thank you” to the caregiver to a more typical $15,000 to $25,000.

Experts stress the importance of not overfunding the trust, because

overfunding makes it more likely someone will contest it. The rule of thumb is to calculate the annual amount spent on the pet, anticipate increased expenses as the pet ages and adjust for inflation. Also factor in burial costs.

Keeping Records Beyer recommends asking whether a pet is in trust as part of the intake

>>

How a Trust Works As Beyer explains, the pet owner (the “settlor”) gives enough money or other property to a trusted individual or financial establishment (the “trustee”), who is under a duty to make arrangements for the proper care of the pet according to the settlor’s instructions. The trustee will deliver the pet to the designated caregiver (the “beneficiary”) and then use the property the pet owner transferred to the trust to pay for the pet’s expenses.

The trustee manages the financial aspects of the trust, including getting funds to the caregiver and approving emergency expenses if they arise. The trustee also makes sure that the caregiver is looking after the pet as stipulated by the trust. While the pet owner doesn’t have to hire a professional trust manager (who must be paid a management fee), Beyer suggests doing so if there is no friend or family member who is able or willing to take on those responsibilities. The trustee and caregiver should not be the same person, because of the accountability requirement.

An intervivos or “living trust” ensures the terms will take effect the instant the pet owner becomes disabled.

>>

Cost to Establish a Trust Though some simple trusts can be established for around $500, the average cost is closer to $1,500 to www.psi-inc.net | the Team | Winter 2014 5

General Wellness

Veterinarian as Beneficiary Should the veterinary practice accept the role of beneficiary? That’s an issue each practice needs to decide. If the practice is able to care for the pets in the trust long-term, they need to work out the arrangements with the trustee. One option is to charge the estate as if the pets were being boarded (at a monthly rate). A better option is to try to adopt the pets out, unless they are ill or the owner specifically prohibits it.

“Even if you do care for them at the practice, it will probably be on a case-to-case basis,” says Rumore.

“Some pet owners may not know anyone who will sign on as a caregiver for pets with problems. We encourage pet owners to develop relationships with local breed rescues and humane organizations so that, if their first-choice caregiver cannot fulfill that role, there is a back-up plan.”

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form. Ask that a copy of the dossier outlining the pet owner’s wishes for how the animal will be cared for— including diet, exercise and medical checkups/treatments—be on file at the practice. Adds Rumore, of Lake Seminole Animal Hospital, “It’s essential for the veterinary team to know what the pet’s owner would have wanted. Perhaps that owner would approve of extraordinary measures to save the animal’s life, while a caregiver would see the situation differently.”

Decision-Making Power Will the caregiver have sole decision-making power for the animal’s treatment? Generally, yes, says Beyer. “But it depends on whether the settlor designates the trustee or caregiver as the ‘owner.’”

If the pet is facing a non-routine or very expensive procedure, it may be advisable to notify the trustee.

What if the caregiver does not live up to the terms of the trust?

Beyer notes that a veterinarian can refuse to take any action that would violate the wishes of the owner as set down in the trust. Some veterinarians have even discovered that the animal they’re treating is not the same as the one described in the dossier.

Tackling a Tough Topic Perhaps the strongest argument for taking time to set up some kind of agreement or trust centers on the dangers of what happens if pet owners don’t do it. The ASPCA estimates that 500,000 dogs and cats face an uncertain future each year after their owners die or become incapacitated.

If your team opts to make this topic a regular element in the checkup checklist, make sure to have guidelines on how to open

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the conversation. “Your approach needs to be customized to the client,” says Rumore. “If you have a senior client who has told you his/her pet keeps him or her active, you can raise the issue by saying, ‘What happens if you slip this winter and can’t walk Rover?

Have you thought about naming a caregiver so that Rover will be ready to walk with you when you’re back on your feet?’”

Veterinary teams need to discuss how proactive they want to be in encouraging clients to set up some type of plan in case they can no longer care for their companion animals. There’s no denying it’s a delicate issue. However, many veterinarians now view this as an essential component in ensuring a pet’s quality of life. n Mary Scoviak is a Cincinnati-based writer and editor.

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www.psi-inc.net | the Team | Winter 2014 7

Parasites & Dermatology

Resistance to Heartworm Preventives Get up to speed on the latest research in this important area.

By Dwight D. Bowman, PhD, and Susan E. Little, DVM, PhD, DACVM (Parasit.)

Is your team fully informed about the implications of the latest research on the efficacy of heartworm preventives?

Here’s key information from the Companion Animal Parasite Council (CAPC) to help all your team members understand their roles in protecting pets from this deadly parasite, especially given what we now know about resistance to heartworm preventives.

Recommend yearround heartworm preventives for all of your patients, regardless of where you practice.

Hardier Heartworms Heartworm prevention has long been recognized to be a critical part of basic wellness care for pets. But recent experimental studies have confirmed that some isolates of heartworm (Dirofilaria immitis) are able to develop to adult worms even in dogs regularly treated with preventives. While we don’t know yet the full geographic distribution of these isolates, veterinarians are understandably concerned about being able to protect their patients from heartworm given this troubling finding.

Key areas where resistance have been found include: the Mississippi River Valley south of St. Louis, the eastern Missouri River Valley and the Piedmont Region of Georgia.

However, the reality is that we don’t know the full geographic scope of the problem. As dogs move from one area of the country to another, resistance to preventives may show up in unexpected places.

In response to the most recent research, which was first presented at the annual meeting of the American Association of Veterinary 8 Winter 2014 | the Team | www.psi-inc.net

Parasitologists in July of 2013, CAPC (www.capcvet.org) updated its heartworm recommendations. The revised recommendations address: n questions veterinarians have about best practices in heartworm diagnosis prevention and treatment given our current understanding, including the continued need for year-round administration of preventives to all dogs and cats n the central role of annual testing in monitoring the health of dogs and cats n efficacy of preventives n importance of treating infected dogs promptly with the approved adulticide.

Clients may have heard or read something about a shift in preventive efficacy, and if so, could be understandably concerned that their pets may not be protected.

Some clients may even think they should stop giving the preventives altogether if they “don’t work any more.” Assure them that heartworm preventives remain the cornerstone of protecting their pets from a potentially severe disease, that they are still highly effective, and that they also protect pets from other parasites. Let them know that depending on which monthly preventive is prescribed, >>

The Team Approach Here’s how everyone on your practice team can help educate clients about heartworm and protect and treat patients.

Receptionists/Technicians Make it a habit to evaluate client records at every appointment for compliance with heartworm preventives, regardless of the reason for the visit. Has the dog been tested in the last 12 months? Did the client purchase preventives? Ask about any difficulties with administering preventives.

Some pets are resistant to administration, so make sure you are advocating for the health of your patients by offering advice and tips to pet owners who need your help.

Veterinary Assistants Be familiar with the current Companion Animal Parasite Council (CAPC) recommendations on preventing and treating heartworm disease in dogs and cats, including the need for routine, year-round preventives for all pets and annual testing for heartworm infection. All pets, even those kept primarily indoors, are at risk of heartworm infection. Make sure you are up to date on current recommendations for treating heartworm infections. Practices such as slowkill, which were used in the past, are now known to be problematic and can contribute to selection for resistance.

Practice Managers Adhering to the current CAPC recommendations about heartworm disease is the right decision for patient health and for your practice. Make sure that your practice has clear protocols regarding annual testing for all dogs, regular evaluation of records to ensure preventives are administered, and that when infected dogs are identified, they are treated promptly and appropriately. The protocols should include: n Schedule the full treatment on the day the dog is diagnosed with the infection,

even if time is needed to stabilize the patient before administering the adulticide injections. n Schedule adulticide injections earlier in the week to allow easier in-clinic monitoring for potential adverse events and to be sure that the second and third injections, which are given one month later, do not fall on a weekend. n If dogs will be pre-treated with antibiotics, steroids and a product to eliminate the microfilariae, be sure to build that into the treatment calendar before scheduling the injection and monitoring. n Treatment of heartworm is expensive and medically complex. Evaluate pricing structures to be sure that cost doesn’t inadvertently discourage appropriate treatment of infected dogs. Consider payment plans to aid clients who want to treat their pets but may not be able to afford the full costs of treatment at the time of diagnosis. n Be sure that veterinarians have the products they need to treat their patients promptly and efficiently. Ordering schemes for some products can be complex, and pricing and availability of some compounds has fluctuated dramatically in recent years, so stay informed about what is required to be sure heartworm medicines are always close at hand.

Veterinarians Review and follow the current recommendations for preventing, diagnosing and treating heartworm disease from the CAPC. n Recommend year-round heartworm preventives for all of your patients, regardless of where you practice. Consistent monthly doses of preventives or

the biennial use of the injectable product protects pets much better than protocols that attempt to start and stop prevention by the calendar, and the U.S. Food and Drug Administration recommends year-round administration. n Test dogs and cats annually, regardless of preventive use, to be sure infections are identified early when they occur. n Treat infected dogs promptly and with a protocol that uses the approved adulticide, melarsomine dihydrochloride.

Both the CAPC and the American Heartworm Society specifically recommend against slow-kill, due to concerns about the health of individual patients and increased selection for resistance.

Stay informed about new updates to recommendations about protecting dogs and cats from heartworm.

Parasites & Dermatology preventives may also protect against roundworms, hookworms, whipworms, fleas and mites.

Stress Preventive Measures Keeping pets on year-round prevention is critical. Severity of heartworm disease is linked, in part, to the number of worms present in a given infection, and although undesirable, few worms are better than many worms. The preventives remain heartworm disease preventives, although we now know they are not always perfect heartworm infection preventives.

Direct clients to websites such as www.petsandparasites.org, the CAPC’s educational site for pet owners, or the official FDA website on heartworm preventives. These sites reinforce the message of protecting pets year round (even when pets are kept primarily indoors), testing

Treat dogs infected with heartworms promptly and with a protocol that uses the approved adulticide, melarsomine dihydrochloride.

annually and treating appropriately when infections occur.

Annual testing is also critical to identifying and treating infections as early as possible. In previous years, some veterinary practices would “reward” compliant clients who gave preventives year round by only testing their dogs every two to three years. However, because doses may be missed and preventives may be less than 100 percent effective, annual testing is needed. In regions where preventive breaks are

frequent, twice yearly testing may be warranted. Pathology caused by the presence of heartworms accumulates the longer an adult worm burden is allowed to persist in a dog. Early detection and prompt treatment limit this pathology, supporting the long-term health of the patient.

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Key Points Prescribe year-round preventives for dogs and cats. Although not all preventives remain 100 percent effective against all isolates of heartworm, preventives are still the best strategy we have for protecting pets from this infection.

Encourage clients to give monthly products routinely and on time. Consistent use of the preventives is the single most effective means of protecting pets. Skipped doses allow opportunities for infection.

Test your patients for heartworm infection annually, or twice a year if you are seeing preventive failures in your area. Early detection allows infected dogs to be identified and treated promptly, limiting the degree of subsequent cardiopulmonary damage, and alerts owners of infected cats that they may need to be watched more closely for respiratory disease.

Treat infected dogs promptly with the approved adulticide (melarsomine dihydrochloride). Do not use a slow-kill strategy (maintaining dogs long-term on preventives without removing the adult worms with an adulticide).

Encourage mosquito protection, particularly for kennels, shelters and rescue groups with a large number of positive dogs. While not a substitute for heartworm prevention, screening kennels, keeping dogs and cats indoors and using approved mosquito repellents will help limit the number of mosquito bites pets receive.

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www.psi-inc.net | the Team | Winter 2014 11

Parasites & Dermatology medically indicated given the overall condition of the patient; resistance to adulticide treatment has not been reported, only resistance to preventives.

Delaying treatment for several months allows damage to continue.

When practical concerns interfere with completing a complex, extended adulticidal treatment protocol, this may result in more untreated, infected pets. In addition, because infected dogs should be placed on preventive at the time of diagnosis (to keep them from acquiring more larvae from infective mosquitoes), delaying treatment of adults contributes to selection for further resistance.

In past years, some veterinarians recommended a slow-kill strategy in which dogs were placed on preventive, given antibiotics to kill Wolbachia and then managed conservatively with exercise restriction while waiting for the worms to die. With this method, it may take several years for the worms to die in dogs harboring established infections with adult heartworms. Today this approach is considered very problematic, because it allows selection for resistance to continue.

In addition, because dogs with dead and dying heartworms develop severe pulmonary pathology, they need strict exercise restriction and close observation, which are impractical for the length of time required to eliminate the worms by slow-kill. Both the CAPC and the American Heartworm Society specifically recommend against slow-kill.

Reassure Clients Most importantly, assure clients that, given the rapidly shifting nature of the biology of heartworm and our understanding of this parasite, your veterinary team is doing everything possible to protect pets by recommending annual testing; consistent, year-round preventive administration; and appropriate, labeled treatment. Heartworm is changing, and our recommendations for protecting pets must evolve to keep pace. n

8

8

12 Winter 2014 | the Team | www.psi-inc.net

Dr. Susan E. Little and Dr. Dwight D. Bowman are veterinary parasitologists with the Companion Animal Parasite Council.

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www.psi-inc.net | the Team | Winter 2014 13

Practice Management

Tune Up Your Online Brand Reputation When customers search for businesses online, search engines are basing results on brand reputation. Is your practice ready?

By Jed Schaible, VMD, MBA, CVPM

It might be time to reallocate your online marketing resources. How many marketing

resources are you allocating to Yelp, Yellowpages, Google+, Yahoo Local and all of those other sites that allow users to leave reviews about your practice? How many resources are you allocating to Facebook and Twitter?

If you are allocating more resources toward social media than toward online brand reputation reviews, you are misallocating your marketing resources.

A study by GetListed, an organization that helps small businesses control their online presence, included a report on veterinary practices. The study found that Facebook was far less important than Yelp, Yellowpages and Google+ for search-engine rankings and for influencing consumers. Twitter didn’t even make the list.

New studies in 2013 have shed light on the growing importance of positive reviews that are extremely relevant to veterinary practice marketers. Are you prepared to seize these opportunities to draw in new clients through online brand reputation?

Prepare for Consumers’ Changing Online Behavior Consumers are relying more on online reviews for choosing local businesses. A Local Consumer 14 Winter 2014 | the Team | www.psi-inc.net

Review Survey study from BrightLocal, an Internet research firm, found that 85 percent of consumers say they read reviews for local businesses online prior to making decisions on choosing businesses, up from 76 percent in 2012. The study also found that consumers are making decisions about local businesses in a shorter period of time from online reviews and are reading fewer reviews before formulating a final opinion of a business. This means that local businesses need to manage their online brand reputations more closely, because a few negative reviews on page one of Google+ or Yelp will likely turn away potential customers.

The study also found that customers are becoming more trusting of online reviews and are more likely to use them to form opinions about local businesses.

More than three-quarters (79 percent) of consumers said they trust online reviews as much as a personal recommendation (up from 72 percent in 2012), and the number of people that are giving “word of mouth” referrals to friends about businesses are on the decline. “Word of mouth” referrals are going digital.

Are you proactively encouraging your clients to document their opinions?

What’s Driving Change The way that information is being presented on the Internet is changing rapidly. Google, the dominant search engine with 67 percent market share of all searches, is driving much of this change. In 2011, Google introduced Google+, a social networking platform that competes with Facebook. Google also bought Zagat, the restaurant-ratings publisher, and launched Google+ Local, a platform that uses Zagat’s rating system to blend social networking with reviews of local businesses.

Searches for businesses, directions and social networking are all becoming integrated. Google pulls its rankings for businesses, for instance, from its Google+ Local. Apple Maps pulls most of its brand reputation rankings from Yelp, making Yelp the second most important platform to consider when optimizing your online brand reputation.

Google Maps and Brand Reputation Reviews Google Maps is poised to launch a new interface—it’s now in beta testing—that will put your brand reputation in front of more users. Unlike the current Google Maps, which displays results both on a map and on a list in the left sidebar with pagination, the new Google Maps has no left navigation. Now the business Practices with reputation rankings are front and better online center. Practices with better online brand reputations brand reputations get larger pins on get larger pins on the map. the map. Without the left related

The way that information is being presented on the Internet is changing rapidly. Google, the dominant search engine with 67 percent market share of all searches, is driving much of this change.

search column, one of the only differentiating factors that consumers will have to make decisions are the amount and quality of a practice’s reviews.

The size difference of the pins is dramatic. If you have a poor or non-existent online brand reputation, your pin reflects that with a three-times smaller, less ornate pin. Furthermore, when the pin is “mousedover,” the results are underwhelming when a practice has no reviews. If a practice even has few reviews, the star rating does not appear, because Google has determined the star rating non-significant due to sample size. >>

Relative Size of Pins

Mouse-hover of a small pin practice

Mouse-hover of a large pin practice

www.psi-inc.net | the Team | Winter 2014 15

Practice Management ”Top Reviewers” reviews in the community are given more weight LOTS OF REVIEWS

little or no REVIEWS

Listings displayed by Top Reviewers allow consumers to discover new places based on recommendations from others who are known to have reliable opinions about local businesses.

Business reviews take on even more prominence on mobile devices. The practice with the best reviews in the area pops up with its reviews and the ability to navigate to that practice, call that practice, share the practice, save the practice, view photos of the practice, visit the practice website and more. You better make sure your Google+ Page is optimized! For a refresher on how to do this, review the article about online brand reputations in The Team’s Winter 2013 issue, also available at http://psi-inc.net/brand.

Local Community “Top Reviewers” Yelp was one of the first companies to give more weight to “Power Reviewers,” and now Google is following suit by giving more weight to what it calls “Top Reviewers” in the community.

Listings displayed by Top Reviewers allow consumers to discover new places based on recommendations from others who are known to have reliable opinions about local businesses. Businesses that have been reviewed by people in your Google+ circles will also be displayed—Google is crowdsourcing results based off of your personal relationships. In fact, the maps are personalized to the user— the results are also based off of the user’s search history.

Why Would Google Make These Changes?

Although we can’t know for sure, I speculate that the main reasons are “stickiness” and ad revenue.

The more the consumer relies on Google+ reviews to choose businesses, the more “sticky” the search engine becomes to users who are better able to find businesses with the products and services they desire paired with the customer service they expect.

Making Google more “sticky” to users will ensure increased ad revenue from the Google Adwords platform (Google’s platform of paid 16 Winter 2014 | the Team | www.psi-inc.net

ads that are at the top of searchengine result pages with a tan background). Furthermore, those businesses challenged with forging a positive online brand reputation will likely be forced to purchase sponsored ads from Google to remain competitive, and once again ad revenues increase for Google.

Target Market Your Ideal Customer Demographic The Pew Internet & American Life Project has been collecting information about Internet users and has shown that the percentage of people who get information about local businesses from search engines increases as household income rises. They also found that the 30-49 and 50-65 year old demographics have the highest usage of search engines for evaluating local businesses and that females and college graduates carry out more online brand reputation evaluations. Doesn’t this sound like a veterinary practice’s ideal demographic?

Instead of being terrified that your best potential clients are the ones doing the most brandsnooping online, you should consider this a blessing. You have a super low-cost marketing channel that is locked in to your ideal demographic—the educated, wealthy, 30-65 year old female consumer! That demographic fills practice waiting rooms. n Jed Schaible, VMD, MBA, CVPM, is the Director of Market Communications at PSI and is an expert in search engine optimization, search marketing, digital publishing and veterinary practice marketing. Have questions about this article or automating your online brand reputation campaigns? Feel free to email Dr. Schaible at jschaible@psi-inc.net.

For practice management tips, follow Dr. Schaible on Twitter @ JedSchaibleVMD.

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Dental Health

Risks of Anesthesia-Free Dentistry Talk to your clients about why they may be doing more harm than good if they choose non-professional dental scaling for their pets.

By Jan Bellows, DVM, Diplomate, American Veterinary Dental College and Diplomate, American Board of Veterinary Practitioners

A whole industry dedicated to non-anesthetic teeth cleaning is sprouting up due to pet owners’ fear of anesthesia for dental procedures on their pets. The American Veterinary Dental College has termed the procedure “non-professional dental scaling,” or NPDS. Some groomers offer weekly to monthly teeth brushings that include chipping tartar off the teeth with dental instruments.

In selected cases independent dental hygienists or veterinary

technicians are traveling to veterinary offices to remove plaque and tartar from pets’ teeth while the dogs and cats are awake. There are even national corporations dedicated solely to non-anesthetic dog and cat teeth cleaning.

Because there are no studies showing the benefit of these wholly cosmetic procedures, pet owners may unknowingly be doing their pets more harm than good. Recently, in response to non-professional dental scaling,

the American Animal Hospital Association (AAHA) board of directors voted to mandate that anesthesia with intubation must accompany any dental procedure performed at an AAHA-certified member hospital. The directive is enforceable through loss of certification in hospitals that do not conform. Most of the AAHA hospitals were already in compliance, but AAHA made it clear that those that were not needed to change or lose AAHA hospital certification. >>

Professional dental care under anesthesia

www.psi-inc.net | the Team | Winter 2014 19

Dental Health

The Team Approach Receptionists Since you are the first person to come in contact with a client scheduling an appointment for a “teeth cleaning” or “a dental,” be able to answer all questions about nonanesthetic teeth cleaning.

Know why anesthesia is administered in all dental patients (in order to allow the doctor to fully evaluate each tooth and surrounding gum tissue), and be able to communicate this to clients.

When answering questions about fees, be able to explain that companion animal dental evaluation and care is similar to human dentistry; once the teeth are cleaned, the doctor examines the mouth using a periodontal probe and X-rays, followed by a treatment plan and discussion of additional needed treatment. In most cases, treatment can be performed while the dog or cat is still anesthetized or at a later time. The client must understand that in most cases there are fees for the initial evaluation, teeth cleaning and X-rays, and additional fees to care for pathology found. Be informed about why these fees are worth it for their pet’s overall health and pain-free existence.

Exam Room Assistants You are in a perfect position to explain to clients how veterinarians safely administer anesthesia and carefully monitor pets throughout the procedure.

Recounting an example of a recent patient’s positive experience and even giving a tour of the treatment area will go a long way toward calming even the most concerned client.

Technicians You spend more time with dental patients than anyone else in the office. In many ways, the technician cleaning and probing each tooth needs to be the “eyes” for the practice and advocate for the pets. Bring any abnormal pockets, loose or fractured teeth,

20 Winter 2014 | the Team | www.psi-inc.net

and bleeding gums to the veterinarian’s attention.

Veterinarians Be well informed about the dangers of non-professional dental scaling, and take time to explain this to each client. Let clients know that periodontal disease can take a toll on a pet’s overall health, and possibly even affect its internal organs. Set the tone in your office that dentistry is a priority.

org/dentalscaling.html) and the 2013 AAHA Dental Guidelines for Dogs and Cats published in AAHA’s Trends magazine.

Also, make sure your practice has the proper equipment needed to perform the safest dentistry, including inspected anesthesia delivery systems, patient monitors and temperature control systems.

Dental X-ray systems are also a must to properly evaluate dental patients.

Practice Administrators

Office Managers

Working with the owners of the practice, make a decision not to support nonprofessional dental scaling. If you have questions, consult the American Veterinary Dental College website position statement against this practice (http://avdc.

Proper dental assessment, treatment and prevention practices take time. Make sure staff scheduling allows sufficient time without rushing. Everyone in the office should appreciate the importance of anesthesia for dental care.

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What’s the Big Deal?

Most dogs and cats have their teeth cleaned because they have bad breath related to periodontal disease. When non-anesthetic dental providers remove the plaque and tartar from the exposed crowns of the teeth, the results are mostly cosmetic, even though some may also remove a minimal amount of plaque and tartar from below the gum line. The teeth may look better after the procedure, but no studies have shown any long- or short-term

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Non-professional mechanical tooth polishing without anesthesia

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Wiping the mouth after the procedure

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Normal-appearing cleaned teeth in an 8-year-old dog

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22 Winter 2014 | the Team | www.psi-inc.net

X-rays of the same dog show enlarged pulp chambers and painful tooth abscess related to dead teeth. Extraction or root canal therapy is needed.

Non-professional dental scaling with hand instrument

health benefits of removing plaque and tartar only from the exposed portions of the teeth.

It’s important to let clients know that thorough cleaning of all teeth surfaces—and especially the odor-producing deep periodontal pockets—cannot be performed without anesthesia, nor can uncomfortable periodontal probing.

Additionally, X-rays, which are critical to a thorough dental assessment before treatment, cannot be performed without anesthesia.

If your office is not performing a tooth-by-tooth examination, providing intraoral dental X-rays, recommending Veterinary Oral Health Council (www.vohc.org) accepted plaque/tartar control products, and scheduling follow-up progress visits, then your services under anesthesia may largely be similar to those performing non-professional dental scalings without anesthesia. This should be a big concern.

The largest risk is that non-

professional dental scalings can lull pet owners into believing that they are doing something good for their dogs or cats. Meanwhile, deep periodontal pockets continue to accumulate debris, the bad breath soon returns, and the dog or cat suffers. By three years old, 85 percent of dogs already have gum infections that need immediate care. Small breeds (such as Maltese, Yorkshire Terriers and Miniature Schnauzers) often lose many of their permanent teeth by five years old from

preventable periodontal disease.

Fortunately anesthesia is considered to be safe and effective in allowing the veterinarian to clean, polish, X-ray, probe and treat any abnormalities uncovered. Get everyone on your team in sync with the AAHA Dental Guidelines for Dogs and Cats. (See the Fall 2013 issue of The Team for an overview.) n Dr. Jan Bellows specializes in veterinary dentistry at All Pets Dental in Weston, Fla.

www.psi-inc.net | the Team | Winter 2014 23

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KETAMINE HCI

Quiz TEST YOUR KNOWLEDGE

Quiz questions are based on articles in the current issues of The Team and Pet Quarterly ®

1 What are some of the are as where resistance to heartworm preventives ha s been reported?

A. Delaware Water Gap B. Mississippi River Valley C. Piedmont Region of Georg ia D. Eastern Missouri River Val ley 2 Which statement about tre ating heartworm disease in dogs is not true?

A. Slow-kill is the most eff ective method.

B. D elaying treatment of hea rtworm allows damage to continue.

C. M elarsomine dihydrochlori de is the approved adulticide.

D. Treatment should be sch eduled on the day the dog is diagnosed with the infection.

3 Why is a pet trust more eff ect safeguarding a pet’s future ive than a will for ?

A. Pets are considered pro perty, so they cannot be willed money.

B. A will may go into probat e, leaving a pet in limbo.

C. A trust cannot be contes ted.

D. Both A & B 4 What is a typical cos t to establish a pet trust?

A. $200–$400 B. $1,500–$2,000 C. $5,000–$7,000 D. $8,000–$9,000

5 What are key risks of an

esthesia-free dentistry?

A. The procedures are prima rily cosmetic.

B. No studies support benefit s of these procedures.

C. Pet owners may avoid X-r ays and standard care.

D. All of the above 6 True or false: Anesthe sia with intubation must accompany any dental pro cedure at all AAHAcertified hospitals.

A. True B. False

7 What breed is predis posed A. Boxer B. Rottweiler

to epilepsy?

C. Beagle D. Poodle

8 What breed is predisposed to exocrine pancreatic insufficiency?

A. Golden Retriever C. Bu lldog B. German Shepherd D. Yor kshire Terrier 9 What is the most importa nt Internet platform to consider when optimizin g your brand reputation?

A. Twitter C. Google+ B. Facebook D. Yelp 10 True or false: Business brand reputations are becoming integrated into map searches.

A. True B. False

, 6-A, 7-C, 8-B, 9-C, 10-A

1-B,C,D, 2-A, 3-D, 4-B, 5-D www.psi-inc.net | the Team | Winter 2014 25

It’s the procedure you perform only once in your career.

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We really did write the book on buying and selling your veterinary practice. Scan the QR code or visit our web site to learn more.

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