Although dental extractions are a common, everyday procedure in many veterinary practices, they are also a frequent source of frustration for vets, vet techs, and clients. Learning to communicate with clients about extractions more effectively can help alleviate at least a portion of this stress, improving client compliance with these procedures.
Thoroughly Explain the Extraction and Why It’s Needed
Too often, the busy pace of practice leads to a rushed client phone call that goes something like this:
“Hey Mrs. Smith. We have Fluffy under anesthesia and the doctor found a few teeth that need to be extracted. It’s going to cost around $500. Is that okay with you?”
I’m not blaming anyone for those phone calls… in fact, I’ll admit that I’ve made a few of them myself! I understand all the reasons that these phone calls occur: we’re trying to get through multiple scheduled dentals in the span of just a few hours, we’re trying to avoid keeping the pet under anesthesia for longer than necessary, we’re trying to get back to monitoring the patient as soon as possible, etc. Try to envision it from the client’s perspective, though. Would a rushed phone call like that convince you to unexpectedly spend $500? Maybe not.
When you’re recommending a dental extraction to a client, whether the pet is already under anesthesia or the conversation occurs during a pre-surgical consultation, describe everything to the owner in detail. Start out with an explanation of what abnormalities have been found on exam and what could happen if those abnormalities go untreated. Next, discuss the extraction treatment plan, step by step. After explaining why extraction is recommended, talk to the client about the local anesthetic that will be administered prior to the extraction, the mucoperiosteal flap that will be created, the use of a drill to section multi-rooted teeth, the way the flap will be sutured closed, and any pain medications or antibiotics that will be sent home with the pet. This explanation will help the client appreciate that the vet is performing a necessary surgical procedure, not just “pulling a tooth.”
Once the client understands why an extraction is needed and exactly what a dental extraction entails, they are more likely to see value in the procedure.
Discuss Potential Complications
Unfortunately, dental extractions do carry a risk of complications. It’s important to discuss these potential complications with clients, so that they can provide truly informed consent for their pet’s extractions. If the owner has concerns, this can provide you with an opportunity to highlight steps that your practice takes to reduce the likelihood of these complications.
Retained tooth roots: While these are a common complication of dental extractions, pre-extraction radiographs can reduce their likelihood (by allowing detection of dilacerated roots and other abnormalities) and post-extraction radiographs can allow the detection of retained root tips so they can be addressed prior to discharge.
Hemorrhage: Excessive bleeding can be addressed with pressure, hemostatic agents, or electrocautery. However, a small amount of bleeding from extraction sites is normal and to be expected.
Surgical site dehiscence: Dehiscence is more likely to occur when extraction sites are sutured closed under tension. This is part of what makes dental extractions more complex than they might seem at first glance; the veterinarian typically must create a gingival flap to allow for a tension-free closure.
Severe complications: While uncommon, more severe complications, such as mandibular fractures or oronasal fistulas, may occur. In many cases, the veterinarian is aware that a pet has a heightened risk of these complications before beginning the extraction, based on radiographic findings. If radiographs indicate a heightened risk of significant complications, the veterinarian may want to personally discuss this risk with the owner before proceeding with the extraction(s). In this situation, the vet may elect to refer the pet to a dental specialist.
Provide Post-Surgical Care Instructions
In addition to standard post-anesthesia instructions, you should also give clients instructions related to their pet’s dental extractions. While these instructions may be minimal in some cases (for example, the extraction of a single, highly-mobile incisor), other extractions may require more care.
Common items of discussion during a dental extraction discharge include:
- Sutures: typically dissolve within 1-2 weeks and do not require removal
- Blood in the saliva: may be normal for up to 24 hours
- Pain medication and antibiotics: give as directed
- Feeding instructions: soft food may be recommended for 1-2 weeks
- Home care: consider delaying tooth brushing until the extraction sites have healed
Clients often have questions about what to expect regarding their pet’s anticipated pain level, return to normal eating, etc. These details will vary on a case by case basis; if necessary, offer to call the client back after you have had time to talk to the veterinarian.
Don’t Worry; It Gets Easier!
Like any other aspect of veterinary medicine, your first few conversations about dental extractions may seem stressful. Clients often view extractions as a relatively minor or routine procedure but, in reality, there’s a lot of information to cover! Don’t hesitate to jot down a quick list or outline before talking to the client, to make sure that you don’t miss any important points. Take your time to provide the client with all of the information they need, realizing that these conversations will become easier with time.