In one year it has led participating practices to treble the numbers of patients receiving dental x-rays.
Dental radiography is a key tool for clinicians to accurately examine teeth. Research has highlighted that 42% of cats and 28% of dogs have lesions[i] which are only detectable on x-ray. Failing to identify teeth with root lesions can have a significant negative outcome for patient welfare, causing ongoing pain and eventual tooth loss.
The CVS clinical improvement project was voluntary for practices to enrol and its first priority was to review how effective its first opinion small animal practices were at using radiography in dental examinations. In July 2021, only 16.2% of dental cases had radiography performed. Clinicians were mostly using visual examination to guide decision making.
The project then investigated the common barriers to clinicians using dental radiography. These were identified as a lack of dental radiography equipment in a practice; a lack of clinician confidence in taking and interpreting the radiographs; and a belief that pet owners would not want to pay for this valuable service.
To support its practice teams, CVS installed new dental radiography machines. Over 104 sites had new generators installed, with a total of £615,000 being invested by the group during the year. This means nearly one quarter of CVS’ first opinion small animal practices now have dental X-ray equipment, with a further tranche of practices scheduled for installation in 2023.
The project then sought to upskill both its vets and nurses in dental radiography – looking specifically at getting good quality radiographs and interpretation. Working as a team, a veterinary nurse can conduct all initial dental radiography work, whilst a vet can then perform all dental extractions.
During equipment installations, induction training was conducted for clinicians by the manufacturer. CVS’ Hub Clinical Leads also visited each participating practice to conduct face-to-face training. In addition, the Hub Clinical Lead team held off-site training for over 50 colleagues in multiple UK locations to train colleagues on equipment software, radiography positioning, image interpretation and treatment planning, and how to have client conversations.
In addition to this, a dedicated dental radiography area was created on CVS’ unique Knowledge Hub learning and development platform to house all training materials. A series of short micro-videos was also produced focusing in on individual dental radiography tasks, to upskill both vets and nurses.
An audit of each participating practice’s dental radiology data was conducted at the start of the project. Results were then shared with each practice every month. One year on, data shows that 43% of dental cases in project practices are now using dental radiography as part of their consultation. In the best cases, some practices have been in 100% of cases.
Hub Clinical Leads Deborah Komianos, Lisa Baker and Ceri Owen, who designed and led the CVS dental radiography clinical improvement project, said:
“When you open a patient’s mouth and look inside, seemingly normal teeth are oftentimes not normal. So vets and nurses can risk missing periodontal disease.
“Dental radiology has historically been underutilised but we believe it adds valuable information to dental consultations and is an important decision-making tool.
“We’re thrilled with the early results in our practices. It shows there’s been a real change of mind-set and behaviour towards using X-rays in dentistry – as well as increased confidence in execution. We strongly believe that this work will help us to provide the best dental care for feline and canine patients.”
The CVS dental clinical improvement project has been enhanced to include other aspects of dentistry and will continue for another year. It will be offered to other CVS Group practices as a voluntary project. Focusing on dentistry more widely, it is expected to include new modules on nerve blocks, extraction techniques and surgical flap techniques – where wet lab courses will be run at CVS’s own veterinary training centre. Additional CPD days and clinician and practice resources will also be created.
CVS Group operates across small animal, farm animal, equine, laboratories and crematoria, with over 500 veterinary practices and referral centres in the UK, the Republic of Ireland and the Netherlands. In the last five years the company has invested nearly £80 million in its sites, facilities and equipment, in addition to industry leading training and support, to give the best possible care to animals.