The
and American Animal Hospital Association recently stated that dental cleanings should be performed under anesthesia. According to the 2013 AAHA Dental Care Guidelines for Dogs and Cats, “General anesthesia with intubation is necessary to properly assess and treat the companion animal dental patient.”
Dogs must be put to sleep before having their teeth cleaned because they “do not sit still and open wide,” as we frequently remind our readers. In fact, we stated as much in our July issue.
Pamela Skinner, a reader from Goshen, Massachusetts, wrote to Your Dog about it. She had already had anesthesia-free dental cleanings performed on a couple of her own dogs, and she was pleased with the results.
She announced that “our veterinary practice has started utilizing an outside service for routine cleanings.” “The benefits include being quick (30 minutes), less expensive (since anesthesia is not required), and effective for many dogs,”
We recently scheduled cleanings for two of our dogs, and we were thrilled with the results: sparkling, stain- and tartar-free pearly whites!
We followed up with Ms. Skinner stated over the phone that “the back story is really interesting, too.” It appears that our business has resigned from the AAHA (American Animal Hospital Association). The association had been credentialing them for 30 years. They sent a lengthy letter to the AAHA, which opposes this practice. ”.
Standards and “best practices” for small animal veterinary clinics are established by the American Animal Hospital Association. Based on a set of roughly 900 standards for veterinary excellence, it certifies animal hospitals. It turns out that one of them is not brushing a dog’s teeth without anesthesia.
Arguments against anesthesia-free teeth cleanings… In an email correspondence with us, Katherine Wessels, senior communications manager for the American Animal Hospital Association, noted that the AAHA Dental Care Guidelines for Dogs and Cats state that “cleaning a companion animal’s teeth without general anesthesia is considered unacceptable and below the standard of care.” The justification for this is that in order to properly evaluate and treat the companion animal dental patient, general anesthesia with intubation [which protects the trachea and prevents aspiration of water and oral debris] is required. The use of general anesthesia makes it possible to immobilize patients as needed without any pain. ”.
Additionally, she stated that it enables the required mouth x-rays, which can see what the naked eye cannot and require a dog to be completely still, as well as the removal of plaque and tartar both above and below the gum line, “to ensure patient health and safety.” Gum disease is the most prevalent clinical condition affecting adult dogs. At least 60% of a dog’s normal tooth structure is below the gum line, she continued, so only partially removing plaque and tartar from the exposed crown—the visible part of the tooth—is more cosmetic than therapeutic. Plaque and tartar removal from above and below the gum line requires general anesthesia and has both therapeutic and cosmetic benefits. She continued, “General anesthesia also protects practice teams from potential bites.” ”.
The American Veterinary Dental College weighs in The American Veterinary Dental College, the organization that awards board certification to veterinarians who have chosen to specialize in dentistry and have successfully completed both the necessary training and a qualifying exam, concurs with the American Animal Hospital Association. In fact, on its home page (AVDC. org), and even includes a section titled “Anesthesia Free Dentistry; Know the Facts.” ”.
The AVDC lists one of them as follows: “At the conclusion of the anesthesia free dental procedure, the outside surfaces on your pet’s teeth may appear noticeably whiter. However, there is much more than meets the eye. ”.
The group continues, “Scaling (instrumentally scraping the tooth’s surface to remove plaque and tartar) does not remove the bacteria and plaque from below your pet’s gum line and does not reduce the likelihood that your pet will develop periodontal disease. Think about it: the same type of “gross” buildup you see on your pet’s teeth is also active below the gumline, where you can’t see it or the harm it’s causing. Because periodontal [gum] disease is most prevalent below the gum line, cleaning and scaling there is of utmost importance. This can’t be done without anesthesia. The group explains that extensive harm to tooth roots and the supporting bone structure can result from improper gumline cleaning.
According to the American Veterinary Dental College, “White teeth do not necessarily indicate a clean and healthy mouth.” “Many devoted pet owners hold this unfortunate misconception about the potential oral health issues that may exist beneath their pet’s gums. ”.
The American Veterinary Dental College also emphasizes the discomfort that a dog may experience during teeth cleaning without anesthesia. On its website, it states that although some animals may seem to tolerate this restraint better than others, “your pet is still being restrained for a considerable amount of time with no ability to understand why or what is happening to them.”
Imagine how a pet who is unable to communicate feels when the provider holds open their mouth and tries to do the same for them: “How many people actually enjoy sitting in the dental chair, holding their mouth open while a dental hygienist scrapes mineralized tartar from their teeth? We can be asked to hold still and relax because we can understand what the dentist or hygienist is doing, but because our pets cannot, we must frequently restrain them in a painful manner.
“The next step is to remove plaque from the visible part of the tooth using a sharp instrument…
“Take into account your dental visits and the minor scaling that is occasionally necessary to remove some of the tiny spots of plaque build-up.” Now consider your pet’s teeth and imagine how it would feel to have that much plaque removed from your teeth. It could undoubtedly cause your pet a great deal of suffering. ”.
Ellie Shelburne, DVM, a veterinarian and co-owner of the Northampton Veterinary Clinic, the facility where Ms. Skinner agrees that cleanings while the dog is awake have a number of limitations and brings her dogs in for anesthesia-free dental cleanings. “We have not substituted this for dentistry,” she says. “It’s more of an addition, a tool in our arsenal to help us deliver excellent dental care,” We do full-mouth dental x-rays and extensive dental work here. ”.
It’s not even for all routine cleanings, Dr. Shelburne says. Tartar [hardened plaque that causes gum disease] is rated on a scale from one to four, with four being the worst. Dental cleanings without anesthesia are only advised when there is just a millimeter of tartar below the gum line and the technician can reach it without anesthesia, according to clinical experience. This is not for a dog with overt periodontal disease. ”.
If a dog does have a “one,” a technician from a different business who visits the office occasionally is tasked with cleaning the pet’s mouth of tartar. The price is significantly less than what it would cost a veterinarian to sedate a dog and perform the cleaning themselves.
We have successfully applied it to high-risk anesthesia patients, according to Dr. Shelburne says. “Tartar removal can take 45 to an hour while under anesthesia.” If we can begin without it and then have the client return in a few days, we’ll finish the cleaning under anesthesia but shorten the total amount of time under anesthesia. She continues, “Once the dog is asleep, my office will take some x-rays and do some deeper probing under the gum line to look for issues that the technician wasn’t able to find while the dog was awake.
But sometimes, Dr. Even the technician cleaning the dog’s teeth without general anesthesia will discover issues, such as a tooth coming loose due to gum disease or another problem, requiring dentistry under general anesthesia, says Shelburne. “Then we convert to full dental with anesthesia,” she says.
She or another veterinarian in her practice can take full-mouth x-rays once the dog is sedated, and from there they can decide what to do. She explains, “We might need to remove a tooth, or we could apply an antibiotic under the gum to help fill pockets and regenerate bone. The cleanings performed without anesthesia thus become “an ancillary tool for us. They don’t replace full dentistry. ”.
The advantages of anesthesia-free dental cleanings are also lauded by Kate Knutson, DVM, whose practice is almost entirely restricted to dental patients. When a mutt named Sydney, 15, was being checked for gum disease, the dentist noticed a significant change in one of her teeth while she wasn’t under anesthesia. The “pocket” between the gum and the tooth was significantly larger than it had been recently. That was a red flag that led Dr. Sydney underwent anesthesia so that Knutson could take a closer look, and it was discovered that the change near the tooth was caused by “a tumor in the bone around the tooth—melanoma, a very aggressive and serious tumor.” ”.
Dr. Without the dental procedure performed without anesthesia, according to Knutson, “we never would have found” the tumor in time to remove it. “But the tumor would have been much bigger by then” and very likely unable to be successfully treated, “and it would have been two or three months later when she came in for her routine dental cleaning and examination under anesthesia.”
Anesthesia-free cleanings “can be used as early detection” in this way, says Dr. Knutson says. “In our toolbox, we need to have a variety of different modalities.” ”.
Dr. Knutson has changed her mind about anesthesia-free dental cleanings because she feels so strongly about them. She formerly served as the president of the American Animal Hospital Association and insisted that dogs undergo general anesthesia for dental cleanings if only so the veterinarian could take full-mouth x-rays. But one of the two big companies in the U. S. American Dental Care, a company that trains technicians to perform anesthesia-free cleanings, invited her to come see one in action, and she admitted that she briefly felt queasy. Oh my God, they are so good at what they are doing that I would hire them for my own hospital, I thought. Then, she continues, “I visited other veterinary clinics across the nation and realized that my stance had been incorrect. The fact that I served on the AAHA board when it was decided to make mandatory anesthesia for dental work the norm makes me feel bad even as I write this. ”.
Today, Dr. Knutson is on the board of American Dental Care. She feels that strongly about the value of their work.
American Dental Care is the company that Dr. Shelburne uses in her own practice. Additionally, she points out that anesthesia-free dental cleanings increase the amount of dentistry her patients do receive under anesthesia because owners who may not have been comfortable letting their dogs undergo anesthesia will be more willing to do so if the veterinarian informs them of a specific issue that was discovered rather than just recommending anesthesia for a standard cleaning and exam. She claims that it “brings dentistry into the forefront a little more.” Finding a problem and having a client respond, “No, we can’t do it,” is extremely uncommon. ’ We actually do more anesthesia dentals because of this. We end up providing better care to more” dogs.
I’m happy that anesthesia-free cleanings “help clients feel comfortable with veterinary dentistry,” but I’m also glad that they Shelburne appreciates the fact that the outside company’s technicians “do an outstanding job of teaching people how to do home care.” ”.
The doctor continues, “what I’m hearing mostly from veterinary dentists is that when you have anesthesia-free cleanings, you’re missing things under the gums, and I don’t entirely disagree with that.” However, based on dogs she has put under anesthesia after having their teeth cleaned without it, she hasn’t noticed many things the technicians have missed in their work. She requests statistics on what is missed during cleanings performed without anesthesia, saying that “nobody has them.” ” Studies need to be done.
Even with that, Dr. Shelburne emphasizes that when it comes to dogs who require dental cleanings, she “is not trying to replace anesthesia.” In her office, “a very small portion of supportive care for dental work” includes anesthesia-free dental cleanings. Clients typically choose these in between actual dental treatments, according to her. ”.
Another perspective William Rosenblad, DVM, a member of the editorial advisory board for Your Dog who completed a residency in veterinary dentistry and is on the dental team at Angell Animal Medical Center in Boston, is categorically opposed to the practice despite the positive experiences some veterinarians have had with anesthesia-free cleanings. He declares, “I completely concur with the American Animal Hospital Association and the American Veterinary Dental College.”
He lists the fact that “even in cooperative patients, even slight head or mouth movements could lead to damage to the gum tissue from dental instruments, and then the gingival [gum] recession is permanent, potentially increasing future periodontal disease” as one of the reasons for this. ”.
He adds that “having an intubated patient [under anesthesia] is a great advantage because improper irrigation during and after cleaning and polishing could lead to aspiration (not to mention the possibility of pieces of calculus [tartar] ending up in the respiratory tract) ”.
Dr. Rosenbald is also concerned with the education of the workers’ technicians. “These technicians are trained to use specialized patient-holding techniques, according to a leading proponent of anesthesia-free dental procedures, which “include complete control over the gag reflex.” I have worked in the veterinary field for 40 years, first as a technician and then as a veterinarian, and I cannot believe that there are safe ways to hold veterinary patients that I am not aware of. “That should frighten any veterinarian and pet owner,” he says. No method I’ve ever learned or practiced involves taming a pet’s gag reflex!
Adds Dr. According to Rosenblad, “the worst aspect of these procedures may be the false sense of security they give. When they discover disease, some of the businesses that offer this service claim to refer patients for a dental procedure under anesthesia. He adds that there are studies showing that more than 25% of dental pathology goes undetected until noted on radiographs (x-rays), so how much can we rely on disease “detected by a technician trained for several months” as opposed to a veterinarian trained for many years? The majority of patients would simply benefit from getting a proper dental procedure done under anesthesia at regular intervals, with daily tooth brushing, dry food, and the right crunchy treats in between procedures, according to the study’s findings. ” For dog owners afraid of anesthesia, Dr. According to Rosenblad, “properly administered anesthesia is safer than the progression of [dental] disease,” which can result in tooth loss, bone loss, and other issues.
Take-away points As Dr. According to Knutson, the debate over whether to support Trump or Clinton “is mild compared to” the debate over whether to support anesthesia-free dental cleanings. The agreement is not universal, even among those in the same camp. For example, she thinks anesthesia-free cleanings can reach worse tartar cases that are deeper under the gum line than Dr Shelburne acknowledges this, but notes that in order to conduct a thorough scientific comparison between cleanings done under anesthesia and cleanings done without it, peer-reviewed studies are generally required.
Here are some points veterinary dentists on both sides of the debate agree on to help put things in perspective for how to think about your dog’s oral health in the here and now.
1. Dental exams carried out while the dog is sedated cannot and will never be replaced by anesthesia-free cleanings. A dog can only undergo dental x-rays under anesthesia, which are the only way for a veterinarian to see beneath the gum line and ascertain whether a problem needs to be addressed. (Unfortunately, says Dr. According to Knutson, fewer than 9% of veterinary hospitals in the United S. have the capability to take full-mouth x-rays. ).
4. While some dog owners may feel more at ease getting their pets’ teeth cleaned without anesthesia (and that’s certainly not a bad thing), appropriate health screenings for a dog also include routine oral exams by a veterinarian and, as the dog ages, routine cleanings while the dog is under anesthesia.
Step 4: Dental charting and assessment
Since your pet is completely asleep, it is simple for us to check each tooth for indications of illness, infection, or fractures. We also keep track of teeth that are loose or missing, as well as teeth that may cause issues in the future.
Thorough Removal of Tartar and Dental Plaque
Tartar scaling above and below the gum line, measuring the depth of the pocket, and polishing are all parts of a comprehensive dental cleaning. If your dog isn’t under anesthesia, the procedure to remove tartar from their teeth by a veterinarian will require them to insert dental instruments below the gum line.
During general anesthesia, pets will enter an unconscious state, so they are unable to move and won’t feel any pain. The American Animal Hospital Association states that dogs need anesthesia to allow a thorough evaluation of the mouth, clean teeth above and below the gumline, and treat painful dental conditions.
Step 2: Anesthesia induction
Despite the inherent risks of anesthesia, we take all necessary measures to perform your pet’s procedure safely. In order to always have access to your pet’s vein to administer life-saving medications in an emergency, we first place an intravenous (IV) catheter. Additionally, we administer fluids throughout your pet’s procedure to maintain blood pressure and aid in the kidneys’ ability to eliminate the anesthetic medications. We are prepared to use an anesthetic agent to completely put your pet under anesthesia so she is unconscious and unaware once the IV catheter has been inserted and your pet has been premedicated with a sedative and pain medication combination. We give her a breathing tube to protect her airway and to deliver oxygen and anesthetic gas to keep her asleep. We keep an eye on your pet’s vital signs while she’s sedated using equipment with cutting-edge technology that quickly notifies us of any problems.
FAQ
Are dogs intubated during dental surgery?
The regulation calls for intubating animals during dental procedures. Intubation involves placing a tube into the trachea. This protects the airway. Through this tube, additional oxygen can be given to the animal if necessary.
What kind of anesthesia is used for dog teeth cleaning?
Pets must be put under general anesthesia in order to properly complete dental radiographs, charting, cleaning, polishing, and any treatments that may be required.
Why is it important to intubate an animal during a dental prophylaxis?
Intubation enables the administration of anesthetic gas, oxygen, and manual ventilation. To prevent the airway from being damaged by dental fluids that could enter the lungs, intubation is necessary during all dental procedures.
Are dogs catheterized during teeth cleaning?
Dental Preparation An IV catheter is inserted so that fluids can be given throughout this protracted procedure to keep the patient hydrated, to maintain normal blood pressure, and to flush the kidneys and liver of the anesthetic drugs.