Let’s talk about anesthesia and veterinary dentistry!

One of the most common reasons pet parents do not pursue regular dentistry for their cats or dogs is due to the fear of general anesthesia and the lack of understanding as to why it is necessary.  When people get their teeth cleaned and assessed we are not undergoing anesthesia, right?  Why can’t we do dentistry on animals without general anesthesia?  Aren’t the risks of anesthesia too high to make it worth it?  Well, let’s talk about those questions and more.

One of the biggest differences between human and animal dentistry is communication.  We cannot explain to an animal what we are doing and have them comply in a way that will allow proper and quality dentistry.  An animal will not hold their mouth open to have each of their teeth cleaned and assessed inside and outside.  They do not know that we are trying to help them. All they see is someone trying to torture them with instruments in their mouths.  You may be able to remove some of the tartar build-up on teeth on a well-behaved awake animal. However, it is impossible to fully assess, clean above and below the gumline and polish every tooth properly with an awake animal in a manner that is both safe for the animal and the veterinary staff.

Not to mention, tartar is not the direct cause of dental disease. The cause of dental disease is harmful bacteria in the biofilm near the gumline.  You cannot remove this biofilm layer completely on an awake animal.  Animals tend to have a lot more tartar on their teeth than people since most pet parents do not brush their pet’s teeth.  For this reason, we use an ultrasonic scaler to clean the teeth, which uses a lot of water.  We must protect your pet’s airway with an endotracheal tube so that they do not accidentally inhale a lot of water into their lungs. Additionally, when an animal’s teeth are scaled, we cause micro-abrasions in the enamel which need to be properly polished to prevent more calculus from building up.

Another reason anesthesia is necessary in veterinary dentistry is that 2/3^rd of the tooth is below the gumline. We need dental x-rays to fully assess these teeth.  An animal cannot tell us when a tooth is bothering them, so we need dental x-rays on a regular basis to look for problems.  This requires that we put a very expensive x-ray sensor plate in their mouth and that they be very still to take precise x-rays of each tooth in the mouth.  Even with minimal tartar and gingivitis, we often find problems that would not have been evident without an x-ray.  If not treated properly, simply cleaning the teeth is not going to correct that animal’s dental disease and it will likely get worse.  These x-rays cannot be taken on an awake animal, but it is the first thing we do when they are under anesthesia, so we know what we are treating.

There are some services out there that will offer anesthesia-free dentistry. For the above reasons, we do not recommend this. Lots of disease and bacteria will be missed, not to mention the stress it causes for your dog. Devices are often used to pry the animal’s mouth open, which not only causes pain and distress but can lead to injury. The picture below is of a patient who came to a veterinary hospital after having an anesthesia-free dentistry procedure. Not only did the patient have lots of dental disease that was undiagnosed and untreated, but it also had this terribly painful laceration on its tongue from forces the animal’s mouth open.

With the reasons why we use anesthesia in mind, do the benefits outweigh the risks?  With current anesthesia protocols and risk management strategies the answer is absolutely, for most animals. Some of the risks of dental disease include pain, systemic infection, jaw fracture, and slow changes to the heart, liver, kidneys, and brain.  These things can shorten an animal’s life span and significantly impact their quality of life as well as the human-animal bond. The risks of anesthesia can be mitigated with the use of pre-anesthetic bloodwork and a full exam including listening to the pet’s heart and lungs.  For animals with heart murmurs, ultrasounds of the heart often clear these animals for anesthesia with certain additional safety measures or medications. When anesthesia is properly monitored with EKG, blood pressure, heart rate, oxygen levels, respiratory rate, CO2 levels and temperature, problems can be caught early and corrected. In extreme cases, the animal can be woken from anesthesia quickly if needed.  The risks of dental disease far outweigh the risks of proper anesthesia. Below is a picture of our anesthesia monitor and chart as well as a patient being pre-oxygenated prior to anesthesia. Every patient is pre-oxygenated while getting pre-anesthesia vitals and has chart-based anesthesia recorded by a dedicated anesthesia technician.

Additionally, general anesthesia for dentistry can look very different than general anesthesia for something like abdominal surgery. Animals undergoing dentistry can be maintained on a lighter plane of anesthesia than an animal with an open abdominal cavity.  Furthermore, dental nerve blocks prevent the animal from feeling areas of the mouth when oral surgery is required. Nerve blocks allow us to keep anesthesia levels lower and reduce the risk of complications such as low blood pressure and hypothermia. Patients with these protocols wake up very quickly from anesthesia but are still given a dedicated technician in recovery to ensure the smoothest and safest recovery possible.

Finally, age is not a disease.  Just because an animal is older, does not necessarily mean they cannot undergo anesthesia. More extensive bloodwork is warranted to ensure their safety, but as long as this and their physical exam is normal, they can absolutely be anesthesia candidates.  It may be best to keep these anesthesia events shorter, which is another reason to do regular routine dentistry to prevent the need for extensive oral surgery which makes anesthesia events longer.

If we wait to do dentistry until an animal has significant signs of dental disease such as an abscess or pain in their mouth, we are often looking at prolonged anesthesia times in addition to tooth loss.  Alternatively, if preventive annual dentistry is pursued, anesthesia times can be much shorter and complications and risks even lower.  Preventive dentistry means COHAT procedures annually starting at 24 months for medium and large breed dogs and cats and 18 months for small breed dogs.  Animals with increased risk of periodontal disease often need COHATs every 6 months to prevent infection and tooth loss.

We hope this article can help clear up some fears and misconceptions about anesthesia and veterinary dentistry.  Mainely Veterinary Dentistry’s mission is to improve and maintain the overall health and well-being of pets and the human-animal bond by addressing the oral health of dogs and cats. MVD provides high quality and compassionate veterinary dentistry services and education to small animal pet owners as well as training and education to general practitioners and their support staff in New England. Mainely Veterinary Dentistry provides preventive dental cleanings, oral exams, full mouth x-rays and oral surgery services. If you would like to learn more about your pet’s oral health or if they are an anesthesia candidate, fill out our referral form to schedule your consultation today.