Anesthesia Free Dentals – Why Doesn’t My Vet Recommend Them?
I find it very interesting that at a time when sedation dentistry is all the rage in human medicine, anesthesia-free dentistry is growing in popularity in veterinary medicine. So many people hate going to the dentist, become anxious about the procedures and find the overall experience uncomfortable and sometimes even painful. As humans, we at least know what is going on and why it is necessary. If this is so with us, why do we then somehow think that it is kinder to put our pets through this stressful and possibly uncomfortable experience wide awake when they don’t have any concept of what is happening or why we are doing it? Have you ever had sore gums from gingivitis? Was that dental cleaning comfortable or pain-free when the dental hygienist probed up under your gums to get all the tartar? Now imagine that gingivitis multiplied – because most dogs and cats have far more dental inflammation than we do. Why would we force our pets to endure this?
Now, I certainly understand the appeal of the anesthesia-free dental. Allowing your pet to be placed under anesthesia is a nerve-wracking experience for many owners, filling a day with worry and anxiety. This is even more true if you have had to endure the loss of a beloved pet during an anesthetic procedure. However, anesthesia, when proper precautions are taken, can be very safe and is certainly kinder for pets (alleviating anxiety, restraint, and potential pain) and, as I will describe below, is actually the only way a full dental prophy is possible.
ANESTHESIA: First, at Cambridge Animal Hospital, we use the following protocols to ensure that the risk to your pet from anesthesia is minimized as much as possible:
· All pets receive a full physical examination so that we can assess for any heart murmurs, masses, heart arrhythmias, etc. that might affect anesthesia. We strongly recommend bloodwork, especially in patients older than 6 years of age, prior to anesthesia to help detect any underlying medical conditions that might affect our choices of drugs or even affect our decision to proceed with anesthesia (ie – underlying kidney disease, anemia, elevated liver enzymes, etc). A normal exam and bloodwork helps doctors and owners know that the risk of anesthesia is as minimal as possible.
· We use a type of anesthesia called “Balanced Anesthesia”. This involves using smaller doses of several drugs in combination rather than using a large dose of a single medication. This helps to offset potential side effects from any one drug. We start with an injection prior to anesthesia that usually includes a narcotic pain medication, a tranquilizer and an anticholinergic to help support heart function during anesthesia. Anesthesia is then induced with an injectable, short-acting medication or by using a mask with an inhaled anesthetic. Finally, a tube is placed in the trachea (airway) and your pet it placed and maintained on an inhaled anesthetic (isoflurane – which is much safer than previously used anesthetic gases). Such inhaled gas anesthetics can be lowered so that only the minimal amount of drug needed to maintain sleep is used – this is individualized for your particular pet. The importance of the tube in the trachea is that it allows protection of your pet’s airway from the bacteria and water that are spread in the air during the cleaning (why we don’t swallow when our teeth are cleaned, but we cannot tell veterinary patients to not swallow). It also provides a way for us to control and ensure adequate breathing while your pet is asleep.
· All patients have an IV catheter and receive IV fluids during the dental procedure. IV fluids help protect the kidneys and liver during anesthesia and help maintain good blood pressure. IV fluids also help your pet clear the anesthetic medications faster and allow for smoother, more rapid recoveries. In addition, having an IV catheter in place allows for access to veins for injections in the rare event of an emergency during anesthesia.
· A veterinary technician is with your pet at all times monitoring his/her vital signs. We use advanced monitoring equipment to continuously monitor: oxygen levels (pulse oximetry), EKG, respiratory rate, end tidal CO2, blood pressure, heart rate and temperature. This helps us to know how to adjust the anesthesia for your pet and alerts us to any problems early so that we can address them immediately and prevent complications from occurring with anesthesia. Your pet’s technician stays with them and continues monitoring them until they are fully awake and recovered.
THE DENTAL PROPHY ITSELF: Sure, after an anesthesia-free dental, the teeth may look pretty, but the tartar and the crown of the tooth (the part we can see outside of the gums) is actually just the tip of the iceberg. It is just an indication of what might be going on with the more important structures of the teeth – the roots and the bone surrounding the tooth.
During a proper dental, the tartar is removed using the same scaler that is used in human dentistry. It is very important that not only the visible tartar is removed, but also the tartar in the pockets under the gums (and with inflamed gums, an awake pet is not going to allow you to do this because it can be uncomfortable or even painful, as we ourselves know). All sides of the teeth need to be cleaned – not just the side of the teeth we can see, but in between the teeth, the side that faces the tongue and the very back teeth that are hard to see, much less reach, without the mouth wide open.
After the tartar is removed, the teeth must be polished. The scaler leaves microscopic scratches on the surface of the teeth which can act as scaffolding for bacteria to rebuild tartar even faster than before. Polishing removes the scratches and helps to slow down re-colonization of the oral bacteria on the surface of the tooth.
Next, every surface of each tooth needs to be probed to ensure that there are no abnormal pockets underneath the gumline where we cannot see. Pockets can indicate loss of bone structure holding the tooth in place (periodontal disease). Any teeth that are missing or any teeth that have lesions or where an abnormally large pocket is found need to be radiographed so that the severity of the disease can be determined as well as a treatment plan can be developed – whether this is medically treating the infection or extracting the tooth. The findings of the probing, visual inspection and radiographs are then recorded on a dental chart so that we can accurately follow your pet’s dental health. Unfortunately, this probing, radiographs and most treatment protocols are not possible in an awake patient.
Though on the surface, the idea of doing a dental cleaning without anesthesia sounds wonderful, it is just not possible to accomplish all of these steps in a conscious pet. Again, the outside surface of the teeth may look pretty when it is done, but were scratches left from the scraping? Were all sides of the teeth probed, including the very back teeth to ensure there are not pockets? Was it truly pain-free and anxiety-free for our pet? Do we really know what is going on underneath the gumline where the vital structures really are? Were appropriate treatment plans made and completed? It is for all of these reasons, that we do not recommend anesthesia-free dentals and why not a single member of the American Board of Veterinary Dentistry performs dentals without anesthesia . We truly want the best preventative health care for your pets and honestly feel that the only way to get the full health benefit, and not just the cosmetic appearance, from the dental cleaning is for a full dental prophy to be performed under anesthesia.
If you have any questions or concerns about this topic, please feel free to contact the clinic. Any of our doctors or staff would be more than happy to continue this conversation with you.
