Dr. Katie Kling joins Dr. Andy Roark on the Cone of Shame Podcast to discuss the importance of working with pet owners on dental disease prevention without risking their human animal bond in the process. Together they go over what to do when pet owners bring in their favorite dental products and how we as veterinary professionals can guide them to the right resources.
This episode is brought to you by Hill’s Pet Nutrition and the Hill’s Veterinary Academy
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LINKS
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More information on Hill’s Prescription Diet t/d
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ABOUT OUR GUEST
Dr. Katie Kling graduated from Ross University School of Veterinary Medicine in 2008 and spent the first 7 years of her career in general practice in Cincinnati, Ohio and College Station, Texas prior to completing her dental residency at the University of Illinois in 2019. She stayed on at the University as an Assistant Professor until 2021 at which time she joined the Veterinary Dental Center in Aurora, IL where she now practices as a part of a dedicated dentistry team. She is happy to serve on the AVDC Diversity, Equity, and Inclusion Committee and the AVDC Exam Committee.
EPISODE TRANSCRIPT
Dr. Andy Roark: Welcome everybody to the Cone of Shame Veterinary podcast. I am your host, Dr. Andy Roark. Guys, I had a great one here with Dr. Katie Kling. Gang, we are doing a ‘How Do You Treat That’ episode with a three year old chihuahua who’s starting to get dental tartar. And mom loves chihuahuas and has had them in the past and they all had trench mouth and she’s like what can I do?
She’s got some products she bought off of instagram that she’s rolling in with. This is a great conversation. I get Katie to help me to talk to this person, to lay down for me her thoughts on supplements on nutrition for dental health, on what ages we start to have these conversations and things like that.
We talk about toothbrushing. We talk about relative importance of toothbrushing versus like dental chews and diets and things like that. And it is really a very cool conversation to sort out kind of the, all the different stuff that people can do. And I’ll be honest, like there are so many products around dentistry.
A lot of them I’ve never seen before and pet owners are coming in with stuff. I just never heard of this stuff and there’s nothing, authoritative behind it. I want tips on how to talk to them, how to guide them, things like that. So anyway, this is a really good, really practical episode for maintaining dental health. I hope you guys will like it a lot. This episode is brought to you ad-free by Hill’s Pet Nutrition. Guys, if you have not checked out Hill’s Veterinary Academy for your learning needs, I highly recommend that you do. I’m going to put a link down in the show notes. I mention it when we talk about resources as well, but Hill’s Veterinary Academy is a great place to get some continuing education on dentistry, especially on nutrition.
Go check it out. Have a look. Guys, let’s get into this episode.
Kelsey Beth Carpenter: This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame, with Dr. Andy Roark.
Dr. Andy Roark: Welcome to the podcast, Dr. Katie Kling. How are you?
Dr. Katie Kling: Great. Great. Thanks for having me.
Dr. Andy Roark: I am so thrilled to have you. I love having you on the show. You are one of those people who is amazing because you are a boarded veterinary dentist. You’re a specialist. You have a deep wealth of information and knowledge, and also, you were a general practice doctor for like eight years when you graduated, you went straight into practice, you did that for a while, and then you transitioned over and went back and got your residency, and so you walk in both worlds.
Dr. Katie Kling: Yeah. Thanks. Thanks, Andy. I agree. I have a huge respect for general practice. I think that’s really where a lot of the most important things happen in caring for our pets and that’s a huge vantage point to be in. So I loved general practice. And I think a lot of good dentistry, important dentistry happens at that level too.
Dr. Andy Roark: I’m always interested. I always have to start this conversation when I talk to people who have had a journey like yours, because I think vet medicine is amazing in that you can change up what you do. It’s a– it’s a house with a million rooms. And so, what was it that motivated you after being in general practice for eight years?
How did you decide to go back and become a specialist?
Dr. Katie Kling: Yeah, great point. So yeah, I think a lot of us jump around a little bit or try out different things. And, you know, when I was at U of I, I would say the students like it’s not like everything advances at the same level. So even if you’re not specializing officially, you’re still sort of developing your special interests or your special skill set.
And I think when I worked in practice and worked with multiple colleagues, three or four colleagues, you know, it’s like, okay, Carrie’s good at ultrasound. I’m going to be faster at this surgery. And, and you still, in my experience, at least. Bounce things off of each other and specialize in your own way.
So, definitely I think that starting out in that practice, I felt very hesitant about dentistry, spent a lot of CE and then kind of swung the other way to where I developed a special interest. So I think all of us that like, you know, we’ve been in practice a similar amount of time, you look for the next challenge, the next thing to take on and, and dentistry became that for me.
Dr. Andy Roark: Yeah that’s awesome. I love the fact that it was something that you were not particularly good at or you just felt sort of uncertain about and through sort of learning more about it, you’re like, I really like this and you just kept going. I think that’s great. All right. I have a case that I want to talk with you about a little bit today.
Is that okay?
Dr. Katie Kling: That sounds great.
Dr. Andy Roark: Alright, sweet. I have a three year old female spayed chihuahua named Cece. And so, Cece’s a young chihuahua, and she is here with her mom. And, uh, her mom is her person. Her, she’s one of those chihuahuas, her body has kind of formed to match her mother’s like armpit, you know what I mean? So as she’s being held, her back end just fits right there. Uh, that’s, she doesn’t touch the ground a lot. She lives, lives on mom’s arm. And so anyway, that’s Cece.
Now, I can talk to mom and Cece’s at three years old. She’s already getting some of the tartar that you can see on the outsides of her upper canines, you know, just along the gum line. She doesn’t have gingivitis, anything like that, but she’s getting that.
You can start to see it accumulating. And so I’m doing my physical exam and I just say to mom. Hey, come and have a look at this. You can see we’re starting to get some dental tartar here. And I was just sort of starting to set the stage to talk to her about this and about, you know, our chihuahuas are just classic sort of dental, dental dogs that we have to keep up with.
And I really hit a nerve because mom has had chihuahuas before and she was one of those Chihuahua owners that had this old Chihuahua that had a horrible trench mouth and it was going to be a lot of money to do anything about it. And she was like, Oh, but she’s so old, you know? And it was, it was really that case.
And ultimately I don’t think she did anything about the mouth and of course, you know, her dog ultimately was put to sleep. And in this conversation, it becomes clear that she’s got a lot of guilt. She’s got a lot of guilt that her dog had terrible dental disease and had it for years at the end of her life and she either I don’t know if she’s able to financially afford it if she was it was if it was the risk of you know of putting her under anesthesia.
It’s always hard to tease those things apart about what’s really motivating people. But she definitely had a lot of guilt, and so, when I pointed this out to her in this three year old dog, she was kind of upset, like, what am I supposed to do? And I sort of uncovered that it came from that sort of hardship in the past.
And so, what I want to talk to you about is this. So, I’ve got Cece. She’s young. We’re just starting to see some accumulation of dental tartar. Mom is very aware of this. She’s got, Sparkle Rinse. Sparkle Rinse is an all natural dog mouthwash that she’s pretty excited about. I don’t, this is voodoo. I think it’s got lemon juice in it and, wishes is what I can tell. The primary ingredients are thoughts and prayers for healthy teeth.
Um, Anyway, that’s what she’s got. Katie, how do you treat this? Where do I try to take this conversation? What do you say to the owner of this, you know, relatively young dog, to help sort of get her on the right path? And what tools are even in my toolbox?
Dr. Katie Kling: Great point. Great scenario. I think we’re all familiar with this patient and this owner, right? And then you brought up a couple of different things that I think we all see, right? This is a, this is maybe from a medical standpoint, if we just had the dog in front of us, we kind of all know what to do.
We, we all know the steps. We know what’s going on. We know what this dog is prone to. And so this shifts into like maybe a little bit of a medical challenge, but primarily communication challenge here, and I think we have a lot tied up in this, right? We have this, there’s typically some guilt tied up in dentistry. They feel like they’re bad owners or they’re neglecting something or, the dental health maybe reflects the care of the patient overall, and then also a hesitancy to want to have, you know, I think the, the implicit thing is, is there’s also the fear of anesthesia, probably. And so all those things go into this where we’re coming in and they’re defensive, right? So, so straight off the bat, and then they brought in this product that we’re like, uh, we’ve never heard of this product. Um, and they feel great about it, and so I think, there’s varying opinions on how to approach this. But my opinion is that we want to be on the same side as our clients.
So our clients are at the very least good clients because they’re in front of us. The worst clients have not even shown up to us in the first place. So they’re, they’re trying to do the right thing. And we want to educate if they want to be educated. And so I think laying the groundwork, that’s like, Hey, you want to take care of Cece’s mouth? Me too! We’re on the same page. You brought this product to me. You’re interested in home care. Me too. So let’s figure out where we have common ground and then to alleviate them of that guilt. What I’ll say is, hey, your breed is a chihuahua. You’ve fallen in love with chihuahuas. You’ve always had chihuahuas.
So let’s talk about what we need to think about, in having a chihuahua in addition to all the good things that come with chihuahuas and, and obviously you’re a dedicated mom. So how do we sort of open them up to let them know that we’re on their side? We’re not here to scare them. You know, this, this in my opinion, outdated way of saying, Oh, wow, these are really bad. Or, or did you know this can seed to the liver or cause heart disease or things like that, where we used to try these threats, which it’s like, okay, if you look at the research, the incidence of cardiac disease and liver disease is very rare. That’s not really the highest risk. I think the highest risk is that we could miss providing an even more comfortable and healthier mouth for your pet. And most of our clients are at that level. They’re like, I do want to do the best thing for Cece. and we can share those.
So I can say, I’m on the same page as you. How do we make things easy on Cece when we know Cece is at such a higher risk of dental disease. I usually, depending on how interested people are in talking about dentistry or not, I will sometimes just bring it all down to just dental disease. So you fall in love with a small breed dog, they have a high rate of dental disease.
So, let’s talk about what that looks like.
Dr. Andy Roark: Yeah, I really like that opening a lot. I know at some point she’s going well, I have friends and their dogs don’t need dental cleanings every six months. And you know and, and their Labrador was 12 years old and barely had anything eating on his teeth and no one said anything about him and I go, okay, let’s validate the scenery here.
You’re not in crazy town, but this is, you have picked this wonderful little dog and every dog has their little eccentricities and dental diseases is part of this. I really liked that a lot. Let’s start to talk a little bit about, let’s talk a little bit about this mouthwash. There are so many products that are out there and I swear.
I do Instagram. I don’t do a lot of social videos, but I do, I do do Instagram. I had it off my phone for like two years and I put it back on and I do Instagram. And man, they hit me with great targeted marketing. Like they know my stupid sense of humor, um, and just hit me with these weird products that I’m like, okay, that’s pretty great.
And I know that pet owners are out there looking at, you know, you start looking at dog Instagram feeds and all of a sudden you’re getting all kinds of stuff. And like, I used to feel like if you had a product that just flat out didn’t work, nobody was ever going to hear about it, you know, and that’s not the case anymore because you can, you can target ads and you can, you know, sell just absolute snake oil. And so I’ve got these people and they’re coming in and some of them seem really compelling ads and things like that. What does that conversation look like for you today, given that at least it feels like there’s so many more products being put in front of better owners and the marketing around these products is pretty darn slick.
Help me with that part of the conversation.
Dr. Katie Kling: Yeah, I agree. They’re just swamped with all this information. And some of it, I’m trying to, to kind of come at it from, from what their angle is. So like, let’s say someone’s like, I’m spending all this money on these products and I can’t keep up with this. You know, that comes down to something that’s pretty simple, which is the bottom line is that toothbrushing works and toothbrushing is pretty inexpensive.
But it’s time consuming. And so then we look at these products to say what other products work besides toothbrushing and to try to sort that out. So I’ll typically if they bring in a product I haven’t heard of, or I’m unfamiliar with, or doesn’t have any studies behind, then I’ll, I’ll take a look at the product for them.
I want to look and make sure it doesn’t have xylitol or a whole lot of alcohol or things like that, that we would not expect to be in them. But like you said, anything’s out there. And then from there, if they’re interested, I introduced the idea of a group of products that have been studied, by something that’s not sponsored, like you said.
So for humans, we have the ADA that we can trust and can find on our toothpaste or our toothbrushes. And then the dog version of that is the VOHC.org . So that’s the Veterinary Oral Health Council. And that is the same premise, which is to say, Hey, I’m a vet, I’m going to make my recommendations as research based recommendations.
And these are products that have been through the same standard research and have proven that they help with either plaque, tartar or gingivitis or halitosis. And this is how we can tell that they work. Could there be other products out there that work that haven’t been through this testing? Sure.
But if you want to spend your money on something that has proven to work that’s where you would look. When they evaluated toothbrushing in a whole group of beagles with just saline, right? So no product, that was effective in reducing gingivitis and plaque. And so we look at these other products as sort of supplemental or more inviting or, or more appealing or more user friendly, right?
Maybe Cece’s mom is 85 and she’s not going to be Chasing her chihuahua around with a toothbrush. Similarly, I will say, my pet owners who are holding down their pet to brush their teeth. It’s like well, that’s gonna happen once like my goal is not to disrupt your bond with your pet, right?
Dr. Andy Roark: Yeah. So two questions here. First, I just got to know, have you actually seen, are there actually pet products with alcohol or xylitol in them?
Dr. Katie Kling: Yes, so I have seen xylitol and I think what was it? Well, I’ve been in practice same amount of time as you, but I think that they, justified that it was a small enough amount. But yeah, isn’t that shocking?
Dr. Andy Roark: Well, the alcohol for, I was like, I could see, you know, dental products being like, sure, we’ll just put some alcohol in there. That’ll, that’ll do it. Okay. I was just curious. Okay. So, so that’s, that’s the first part. The other, talk to me a little bit about how much emphasis you put on tooth brushing versus, either supplements or dental nutrition, things like that.
I think a lot of us have kind of settled into this idea that like, we’re going to tell people they should brush their pet’s teeth, but we’ve kind of accepted that the chances of them actually doing it are low. And some of us have just given up even talking about it, but I always feel guilty.
I, and I always wonder a little bit if they go out and they’re like, you know what, I’m going to do the t/d diet or I’m going to do some dental chews, but I’m not going to brush my pet’s teeth. I always kind of wonder, are we spitting in the wind here or are we actually doing good?
Help, help me get my head around, are supplements comparable to teeth brushing? Is teeth brushing really? 85 percent of the battle and supplements are 10 percent of the battle, like, where, where are we? Can they put together a comparable dental plan if they’re like, I can’t brush this pet’s teeth? Do I need to just suck it up and really start trying to talk more directly to them about toothbrushing?
Help me, am I doing a good job? I guess, Katie, is what I’m kind of looking for here.
Dr. Katie Kling: Right. Um, so I agree. And I think, we as vets sort of get trained by our clients, right? You bring up toothbrushing, you get like, uh, or, just like when we bring up a dental procedure, right? We get that, like, kind of bad feedback that makes us, Maybe even subconsciously sometimes not want to bring it up the next time.
When I talk about tooth brushing, and sometimes I talk about tooth wiping instead, which if it’s more realistic for certain pets or certain owners. What I let the owner know, I want to know, where do you stand on that? Is that something that you’re planning on doing so that I can make my plan around that?
So I’m not going to tell you. You need to brush your teeth. And next time that I come in, I’m going to ask you how frequently are you brushing your dog’s teeth? I am going to tell you that the science says that tooth brushing every other day makes a big difference. Every day makes a huge difference once a week.
Not very much. So if you’re taking Cece to the groomer every six weeks, and she’s getting her teeth brushed, I’m gonna tell you, why don’t you stop doing that? That’s just like Cece torture, but it’s not having any benefit. Or, certainly if the mouth is painful and you’re introducing tooth brushing, it’s causing bleeding. You’ve just trained Cece that tooth brushing hurts. So I think that some people are gung ho. They’re like, my whole goal is keeping the teeth. My whole goal is not having what happened to my last dog happen to this dog. Then really, toothbrushing is a great concept, and then maybe you can supplement it with, you know, we, we talk about the t/d, which is great for chewing teeth if they’re chewing it right.
It’s plaque disruptive, just like chewing is. Um, and sometimes, you know, I keep it in my room, my exam room, because I want to see, I want to see how a dog chews. That food sometimes if they’ll chew it, or if they won’t like that can be useful information to know, and then when we think about other supplements, things that are really going to bind up the minerals that are in saliva that cause the plaque to calcify into calculus or tartar.
That can be helpful too. But tartar looks bad and, and really the bottom line is plaque is what’s causing that disease or causing the bone to want to recess away. So we can have, like you said, a lab come in who the owner perceives the teeth are really bad and we know we’re going to get them under, do full mouth rods and we’re going to clean the teeth and Maybe they won’t require any extractions versus our Chihuahua that has, like you said, just a little bit of tartar forming on the canines.
Well, chances are we get in there and one of those 42 teeth, even at two or three years of age or more than that, may already have advanced dental disease.
Dr. Andy Roark: Talk to me a little bit more about your chewing test. That’s not in my playbook. What does that look like? What are you looking for? So you, you give them t/d, which I love as an exam room treat. I like, I like the size, you know, I like the fact that it’s there and it makes the conversation about these, uh, these types of things easier, but you’re, you’re giving it to them and you’re seeing if they’ll chew it. Like what does that look like when you do it in the exam room and what are you looking for?
Dr. Katie Kling: Yeah, so and maybe that is getting off topic a little bit. I have some, I have some patients who come in where they do a little chatter after they chew or they’re hesitant to chew or the owners will say they’re chewing on one side. And so sometimes I can use that for an exaggerated to sort of show me, show me what they’re doing.
I think also if, if I’m thinking about using a treat or a kibble or something like that with a dog as a part of their home care routine. I also want to see if they’re going to swallow that whole. Have you had those dachshunds swallow them whole before? I mean, just impressive.
Dr. Andy Roark: It’s impressive.
Yeah. It’s a skill that I was like, I didn’t, it’s like a snake they just dislocate their jaw and kind of down. Yeah.
Dr. Katie Kling: Right. If you’re chewing a dental treat and you’re giving it one bite and swallowing it, that’s. I mean, but now the, they, they test a lot of those dental treats with beagles and they did go through them in like 15 to 40 seconds, and they’re still having benefit from them. So, but certainly they have to chew them somewhat.
Dr. Andy Roark: Talk to me about when you start to lean into nutrition for dental health. Is it pretty early in your, in your presentation? Is this something with Cece at age three?. Especially since mom is focused on it. I mean, she seems like a good candidate in my mind. Is this early in the game? Is it late in the game?
Are you talking to puppies about or a puppy of visits about it? When do you start to introduce this? And how do you kind of get the clients to start thinking about nutrition? I can tell you that sparkle rinse is probably a lot cheaper than a diet that we buy ongoing and ongoing. Talk to me about sort of how that presentation looks.
Dr. Katie Kling: Yeah, absolutely. So I think that we are looking at sort of trying to get multiple factors in there at 2 or 3 years of age, Cece needs needs a full assessment, right? She needs to go under. She needs to be probed. And we know that 80 percent or higher of dogs are going to have, are going to have dental disease at that age already.
And I think that in a really motivated owner, right? Some owners are motivated to say, I want my pet to be pain free and comfortable mouth. Great. We’re on the same page. Some owners want pain free, comfortable mouth, and to preserve as many teeth as possible. So now that is in a situation where I can’t do that alone without some home care.
And that’s when we pull up, I have them go home with that list, look through that and say, what is realistic for me? I think you’ll be hard pressed to find something better than, brushing once a day with with saline, I mean, I and and sometimes linking that with something that they’re that is positive for them.
So for chihuahuas, for in Cece’s case, right? We also have to take into account, their daily caloric needs. I don’t think any general practitioners going to be happy with me making recommendations to add these three treats. I’m adding 200 calories to their patients diet every day. So now they’re going to have the other the other situation.
In terms of, using a product to, as like a toothpaste, I think they want to think about that more in the sense of bribery. So if the pet likes the flavor of toothpaste, great, that’s an added bonus that they’re going to now have that positive link versus for us when we’re thinking about fluoride or preventing cavities, right?
The incidence of cavities in dogs is 6 percent of dogs will ever get a cavity and, and cats just simply don’t get cavities. So really it’s the mechanical disruption that we’re thinking about. So whether that’s done with tooth brushing or a diet or treats, those are, that’s all the angle of disrupting plaque by the natural way that they’re using their chewing teeth.
Dr. Andy Roark: Gotcha. What are your favorite resources if people are geeking out and they love, you know, dentistry? So, I’ve got to give a shout out to Hill’s Veterinary Academy as, you know, they, we work with them and they’ve, they’ve made this episode possible. What are the, what are some of the resources that you find a lot of value in or that you recommend to people who may be like you or like, hey, I’m in general practice and either I’m weak in dentistry or, this is an area that i’m starting to fall in love with and I would like to read more deeply. Where do you send people?
Dr. Katie Kling: Yeah, great point. So the dental forum is the ABDC’s national, forum. We have people internationally there too. So, and that’s held in the U. S. every year, once a year, usually in the fall. And there’s typically a lot of attendance by veterinarians who have a strong interest in dentistry and veterinary technicians who have a strong interest in dentistry or even specializing in dentistry.
There’s good anesthesia references or resources there too. And then there’s hands on labs, which. For me certainly coming right out of school, that was what I was looking for, right? Like, hands on, let me make my mistakes in a lab and kind of build my confidence that way. So, that would be the route I would go to in terms of making connections and then also just, just all of your, resources and hands on practice.
There is, you know, I don’t know how things are nationally, but around us, our general practitioners are still backed up with, with dentals. I don’t know if that’s ever going to go back to pre pandemic times or not. It’s just, there’s a huge demand for that in patients where people are alerted to that, that that’s going to make such a good, positive impact on their pets.
Dr. Andy Roark: I agree with that. I love the hands on learning idea I think that that is absolutely fantastic I’m such a big believer in you know There’s knowledge and there’s skill and like skill comes from actually doing the thing and so I just I love that. I’ll put links in the show notes.
Thanks so much for being here. Where can people find you online?
Dr. Katie Kling: Definitely Instagram and Facebook. I work at the veterinary dental center in Aurora, Illinois. Great team of dentists there.
Dr. Andy Roark: I’ll put links to those accounts in the show notes. Katie, thank you so much for being here. Hey guys, thanks for tuning in and listen, everybody.
Dr. Katie Kling: Thank you.
And that’s it, guys. That’s what we got. I hope you enjoyed it. I hope you got a ton out of it. Thanks to Dr. Katie Kling for being here. That was a really fun conversation. Thanks, thanks, thanks to Hill’s Pet Nutrition for making this episode possible. Guys, again, if you haven’t checked out Hill’s Veterinary Academy, definitely do so.
I’ll put a link in the show notes. Also, if you have questions specifically about t/d or dental diets, things like that, through Hill’s Pet Nutrition, check out hillspet.com. I’ll put a link to that in the show notes as well. Guys. Take care of yourselves, everybody. Be well. I’ll talk to you soon.
