Dentistry in Companion Animals-Living Healthy

Dentistry in Companion Animals-Living Healthy

Anesthesia Free Dental Care is: NO DENTAL CARE!

DH DeFORGE,VMD

Fellow of the Academy of Veterinary Dentistry

The purpose of Dentistry in Companion Animals is to preserve a quality of life and remove pain.  As pet advocates, veterinarians and pet owners, must work as a team to assure that no animal lives in pain.  The Human-Animal Bond has this as its focal point.  The companion animal provides unconditional love and the pet advocate returns this love with compassionate care for a life time.

Veterinary dentistry has two important components.  The first is prevention of disease and the other is diagnostics to discover and remove those factors that can lead to pain and discomfort.  To achieve both of these objectives a thorough intra-oral exam with dental x-rays is needed under general inhalation anesthesia.  This anesthesia should be gas inhalation anesthesia.

To properly clean the teeth and prevent disease sub-gingivally [i.e. below the gum-line], root planing is necessary under general inhalation anesthesia.  If root planing is attempted without anesthesia, the patient can move causing pain or result in the the creation of a periodontal pocket.  I have witnessed, over the years, many human dentists and human hygienists who have attempted to clean their dogs and cats teeth at home without anesthesia with terrible results.  The patients, their beloved pets, present with advanced periodontal disease.  There is no effective periodontal care in companion animals with the pet awake.  It is impossible to take quality diagnostic digital oral x-rays with the patient awake.  Slight movement will distort the radiograph leading to an erroneous diagnosis.  The bisecting angle technique which is needed for the x-ray visualization of all of the canine teeth, incisors, and maxillary dentition is impossible to project without the patient being anesthetized.

The argument that it is better to do a sub-par teeth cleaning with the animal awake than to perform no teeth cleaning at all is fruitless.  Advocates of non-anesthesia dentistry state that the cost of the anesthesia and the risk of anesthesia makes clients refuse dentistry.  Both discussions do not hold water.  Will a client refuse to repair an ACL rupture in their pet's knee because of the cost of anesthesia?  Will a client refuse to have a bladder cystotomy to remove cystic calculi [i.e. bladder stones] because they fear anesthesia.  The answer is no in both cases.

Client education is the key to the acceptance and completion of proper veterinary dentistry under general inhalation anesthesia. Thorough pre-anesthesia testing is a requisite to allow the client to know the condition of their pets cardio-pulmonary systems [i.e. heart and lung function] prior to utilizing anesthesia.  Veterinarians have to step up to the plate and take an hour in the exam room to explain why the older pet needs more than just blood work for anesthesia.  The necessity, prior to anesthesia in aged or sick pets, for Chest X-rays; the ECG; blood pressure; and possibly an Echocardiogram must be reviewed and explained.  

Safety is the issue! This testing does alter the cost of the total procedure.  Very few clients will turn down a procedure because testing allows greater safety.  Veterinary medicine is an inexact science.  There are no guarantees with any procedure[s].  The greater we can expand the safety net with pre-anesthesia testing the less risk is involved.  Everyone wants less risk! 

Cat dentistry to check for the very painful cat resorptive lesions can only be done under general anesthesia.  Cat stomtatitis and dog stomatitis both need dental x-rays and biopsy for diagnosis and treatment. Dogs commonly have periodontal disease; endodontic disease; fractured teeth; and painful mouths that need dental x-rays under anesthesia to identify. The American Animal Hospital Association-2013 AAHA Dental Care Guidelines for Dogs and Cats outlines the importance of dental-x-rays. The guidelines state "that full mouth dental x-rays are necessary for accurate evaluation and oral diagnosis."

Read the guidelines at aahanet.org/Public Documents/Dental_Guidelines.pdf 

We have teeth cleanings on ourselves without anesthesia.  We have oral x-rays on ourselves without anesthesia.The companion animal is different. We tolerate having this done. If we cannot, we are given local anesthetics. Sometimes humans need IV and gas anesthetics for periodontal diagnostics and treatment.  Local anesthetics on an awake animal patient are not possible to administer. The positioning that we accept after dialogue with the dentist or hygienist is part of the "human" condition.  To force conditions that are non-applicable on the animal companion we love, is a violation of the Human-Animal Bond.

Non-anesthesia dentistry can produce aesthetic crown appearance but it is not dentistry.

A client once came to me with their dog, that had experienced ten years of non-anesthesia dentistry, who stopped eating at home. After a series of tests to eliminate other causes of inappetance proved negative, general anesthesia was utilized to achieve dental x-rays.  Twenty seven "hopeless teeth" were identified with radiographic changes representative of end stage periodontitis.  With informed consent, these teeth were removed.  The patient did excellently post surgery.  Unfortunately, 27 teeth were lost that would not have been lost with the proper exams and treatment under general inhalation anesthesia from puppyhood to the time of geriatric presentation.

Veterinarians must become better trained in periodontal diagnostics and oral radiology or seek out those individuals [i.e. veterinary dentists] who are trained to provide preventive and diagnostic oral care.  Once a patient undergoes veterinary diagnostics and treatment under general inhalation anesthesia [Comprehensive Oral Health Assessment and Treatment] there must a a detailed homecare program to assist in the prevention of recurrence. Follow-up out-patient exams to monitor the progress of the homecare program is essential.  

Anesthesia Free Dentistry is NO Dental Care!  Do not get trapped into believing it will help your pet.  Please read below the American Veterinary Dental College Position Paper on Dental Scaling Without Anesthesia. 

AVDC Position Statement:

Dental Scaling Without Anesthesia

In the United States and Canada, only licensed veterinarians can practice veterinary medicine. Veterinary medicine includes veterinary surgery, medicine and dentistry. Anyone providing dental services other than a licensed veterinarian, or a supervised and trained veterinary technician, is practicing veterinary medicine without a license and is subject to criminal charges.

This page addresses dental scaling procedures performed on pets without anesthesia, often by individuals untrained in veterinary dental techniques. Although the term Anesthesia-Free Dentistry has been used in this context, AVDC prefers to use the more accurate term Non-Professional Dental Scaling (NPDS) to describe this combination.

Owners of pets naturally are concerned when anesthesia is required for their pet. However, performing NPDS on an unanesthetized pet is inappropriate for the following reasons:

1. Dental tartar is firmly adhered to the surface of the teeth. Scaling to remove tartar is accomplished using ultrasonic and sonic power scalers, plus hand instruments that must have a sharp working edge to be used effectively. Even slight head movement by the patient could result in injury to the oral tissues of the patient, and the operator may be bitten when the patient reacts.

2. Professional dental scaling includes scaling the surfaces of the teeth both above and below the gingival margin (gum line), followed by dental polishing. The most critical part of a dental scaling procedure is scaling the tooth surfaces that are within the gingival pocket (the subgingival space between the gum and the root), where periodontal disease is active. Because the patient cooperates, dental scaling of human teeth performed by a professional trained in the procedures can be completed successfully without anesthesia. However, access to the subgingival area of every tooth is impossible in an unanesthetized canine or feline patient. Removal of dental tartar on the visible surfaces of the teeth has little effect on a pet's health, and provides a false sense of accomplishment. The effect is purely cosmetic.

3. Inhalation anesthesia using a cuffed endotracheal tube provides three important advantages... the cooperation of the patient with a procedure it does not understand, elimination of pain resulting from examination and treatment of affected dental tissues during the procedure, and protection of the airway and lungs from accidental aspiration.

4. A complete oral examination, which is an important part of a professional dental scaling procedure, is not possible in an unanesthetized patient. The surfaces of the teeth facing the tongue cannot be examined, and areas of disease and discomfort are likely to be missed.

Safe use of an anesthetic or sedative in a dog or cat requires evaluation of the general health and size of the patient to determine the appropriate drug and dose, and continual monitoring of the patient.

Veterinarians are trained in all of these procedures. Prescribing or administering anesthetic or sedative drugs by a non-veterinarian can be very dangerous, and is illegal. Although anesthesia will never be 100% risk-free, modern anesthetic and patient evaluation techniques used in veterinary hospitals minimize the risks, and millions of dental scaling procedures are safely performed each year in veterinary hospitals.

To minimize the need for professional dental scaling procedures and to maintain optimal oral health, AVDC recommends daily dental home care from an early age in dogs and cats. This should include brushing or use of other effective techniques to retard accumulation of dental plaque, such as dental diets and chew materials. This, combined with periodic examination of the patient by a veterinarian and with dental scaling under anesthesia when indicated, will optimize life-long oral health for dogs and cats. For information on effective oral hygiene products for dogs and cats, visit the Veterinary Oral Health Council web site (www.VOHC.org).

For general information on performance of dental procedures on veterinary patients, read the AVDC Position Statement onVeterinary Dental Healthcare Providers.