Unexpected findings, like fractured teeth and oral tumors, can be encountered during routine dental cleanings and typically require immediate attention; however, communicating the need for these extractions to anxious clients can be difficult. The following sample dialogues and strategies for prevention and collaboration offer guidance for having these conversations.
Setting Up for Success
Proactive strategies can minimize surprises during routine procedures and avoid keeping patients anesthetized longer than necessary.
Provide clear initial communication. Establishing expectations with the client from the start is critical. Informing the client that awake examinations do not provide all the necessary information and they will receive a call from a team member to discuss radiographic findings and sedated examination results can be helpful. This approach gives the client a sense of partnership and control and may contribute to a better outcome.
Perform a comprehensive examination and diagnostics. Clients may not be aware that dental radiographs often reveal hidden problems. Providing specific examples of what is being assessed can be beneficial. For example, Fluffy appeared to be missing his premolars, but we learned from the radiographs that those premolars are present, growing dangerously below the gumline, and in the early stages of dentigerous cyst formation.
Develop a protocol for authorization. Some clinics adopt a protocol in which the client is asked to approve unforeseen extractions up to a specific dollar amount, meaning clients agree in advance to the possibility of additional dental work. A consent form can specify that although extractions or other procedures may be anticipated; whether extractions are needed will depend on findings while the patient is anesthetized.
Communicating Effectively Over the Phone
In cases in which unexpected extractions are deemed necessary, the client must be informed over the phone. Clarity, compassion, and transparency are the best tools for these conversations. The following 5 key points should be considered when approaching these conversations:
Present the situation clearly. Findings should be explained in simple terms using language the client can easily understand. For example, Max has an abscess at the root of one of his upper premolars that is probably causing some pain and needs to be extracted.
Be transparent but compassionate. The conversation should be approached as a partnership rather than a sales pitch. For example, instead of focusing on cost, the reasons why additional extractions are essential should be explained by saying something like, “I know it’s not what we were hoping for, but it looks like we can make Max a lot more comfortable with this extraction.”
Empathize and offer support. The emotional aspect of the situation should be acknowledged. Clients are often anxious when their pet is under anesthesia, and the discovery of unexpected issues can be upsetting. Clients may also worry about their pet’s ability to eat or drink normally after extractions, and the team should take care not to minimize or dismiss these concerns. For example, although the extracted tooth is one dogs normally use when chewing, Max has likely been avoiding chewing on that side for some time because of the infection. Once his mouth is healed, he will be able to eat and drink normally and without discomfort.
Offer options, but be clear about what is recommended. Alternative treatment plans should be offered when available, but the recommended treatment that is best for the patient’s long-term health should be emphasized. It is important not to pressure the client, but they should understand that their pet could face serious health risks. Clients have various financial and personal situations, so offering a range of care options that can accommodate their needs and budget is important. For instance, root canal therapy may be an alternative to extraction for a canine tooth, but cost can be a significant barrier for some clients, making extraction the more affordable option. In severe cases involving extensive bone loss or disease, extraction may be the only viable treatment.
Avoid additional surprises. It is important to update clients on changes to their estimate before they check out. For example,because this removal changes your estimate, I want to make sure you are comfortable with moving forward. I can transfer you to a team member who can provide you with the updated estimate.
The following scenarios provide examples of conversations with clients.
Unexpected Dental Extractions
Situation: During a dental cleaning with planned extraction of one fractured tooth, additional teeth are found to be severely compromised and require extraction. The client is not expecting this.
Scenario 1: Concerned Client
Veterinarian: "Hi, Mrs. Thomas, this is Dr. Wilson. I wanted to give you an update on Bella’s dental procedure. We cleaned her teeth and performed radiography. While we were working, we discovered a few teeth that were in worse shape than we expected. They’re quite infected below the gum line, with significant bone loss, and we recommend removing them (in addition to the fractured tooth) to prevent further pain or possible worsening infection. Because this changes your initial estimate, I want to make sure you are comfortable with us moving forward.”
Client: “Oh no! I wasn’t expecting that. Is she in pain? How serious is it?”
Veterinarian: “I completely understand. It can be a lot to hear, but this is a common issue we find once we examine the radiograph. If we don’t remove these teeth, Bella could develop painful abscesses, and it could lead to further complications down the line. She is probably already in some discomfort due to the severity of the dental infection. We’ll ensure she’s comfortable throughout the process and keep you updated, but I believe this is the best option for her long-term health.”
Client: “Okay, I trust you. Go ahead and do what’s best for her.”
Veterinarian: “Thank you, Mrs. Thomas. We’ll take good care of her. I can transfer you to a team member who can give you an updated estimate, and we will call you again once the procedure is complete.”
Scenario 2: Resistant Client
Veterinarian: "Hi, Mrs. Johnson, this is Dr. Rosenblatt calling about Buddy's dental procedure. We've completed the cleaning and taken some images. We found a couple of teeth, besides the one we discussed, that are severely infected and need to be extracted to prevent further pain and infection."
Client: "Oh? I thought we were just doing the one. I'm not sure about more extractions. That sounds expensive, and I'm worried about him."
Veterinarian: "I understand your concerns. I know it's unexpected. The images show significant bone loss and infection in these teeth, which means they're likely causing Buddy discomfort. Without extraction, the infection could spread and lead to more serious health issues."
Client: "But he seems fine. He's eating okay. Can't we just wait and see?"
Veterinarian: "While he might seem okay now, animals are good at hiding pain. The infection is already present and will likely worsen. Waiting could lead to more extensive and costly treatment down the road. We want to prevent Buddy from experiencing more pain and ensure his long-term health. We can also discuss pain management options to keep him comfortable after the procedure."
Client: "I'm not sure. I really wasn't prepared for this."
Veterinarian: "I completely understand. How about I send you the images so you can see what we're seeing? We can also schedule a brief video call so I can explain it in more detail and answer your questions. Would that help you feel more comfortable?"
Client: "Yes, that would be great. Thank you."
Veterinarian: "Of course. Once you see the images and we talk further, I think you'll understand why this is the best course of action for Buddy. We'll take good care of him."
Scenario 3: Unwilling Client
Veterinarian: "Hello, Mr. Davis, this is Dr. Patel calling about Daisy's dental procedure. We found that several additional teeth have significant issues and require extraction."
Client: "No, absolutely not. We discussed one tooth. I can't afford any more than that."
Veterinarian: "I understand your financial concerns; however, these teeth are severely infected and causing pain. Leaving them untreated could lead to serious complications."
Client: "I don't care. I can't pay for it. Just do the one tooth we talked about."
Veterinarian: "I hear you. I do need to inform you that only addressing one tooth and leaving the others could lead to further infection and pain for Daisy. It's not ideal, but we can proceed with the single extraction you authorized. We do, however, need you to understand the potential risks."
Client: "Fine. Just do the one tooth. What are the risks?"
Veterinarian: "The remaining infected teeth could cause Daisy ongoing pain, and the infection could spread to other areas of her mouth or even her body. This could lead to more expensive treatments down the line. We'll provide you with pain medication and a follow-up plan, but it's crucial to monitor her closely. We can also discuss options for future dental care when you're able to budget for it."
Client: "Okay, I understand. Just do the one tooth for now. We'll figure out the rest later."
Veterinarian: "Alright, Mr. Davis. We'll proceed with the one extraction and make sure Daisy is as comfortable as possible. We'll also give you a detailed care plan and follow-up instructions."
Conclusion
Unexpected findings during procedures can be stressful for the veterinary team and the client, but clear communication, transparency, and empathy can help make these situations manageable. Preparing clients in advance, setting realistic expectations, and offering information for informed decision-making are the keys to managing these challenging moments successfully. When handled correctly, these conversations can strengthen the bond with clients and ensure the best possible patient care.