What’s included? Physical restraint or sedation without anesthesia



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What’s included?

What’re the risks?

  • Patient experiences stress and/or pain

  • Trauma to patient and/or veterinary staff

  • Advancement of dental disease undetected below the gumline resulting in infection, bone loss, etc.

  • If the teeth are not polished after cleaning, the grooves caused by scaling encourages rapid bacterial regrowth

  • Aspiration pneumonia, infection, or death caused by inhalation of plaque/bacteria, water, or vomit

  • Rapid reoccurrence of dental disease and increased frequency of treatment needed


Why to Avoid Non-Anesthesia Dentals

Recently you may have heard of a procedure known as a non-anesthesia dental, anesthesia free dental cleaning, or non-professional dental scaling offered by a groomer, a day care or boarding facility, or even a veterinarian. A non-anesthesia dental involves the scaling of a pet’s teeth without putting the pet under general anesthesia. Although this may seem appealing to owners whom have concerns with anesthesia or those looking to keep costs low, unfortunately it has the potential to cause more harm than benefit to your pet. Before making a decision in regards to your pet’s dental health it is important to understand the difference between a non-anesthesia dental and a professional dental cleaning and know the current recommendations for dental and oral health.

A non-anesthesia dental involves physical or chemical restraint without general anesthesia of a patient while a sharp dental scaling instrument is used to remove plaque from the visible portion of the tooth. Unfortunately this is the entirety of the procedure, lacking essential steps required to properly treat dental disease. The American Veterinary Dental College (AVDC) describes a non-anesthesia dental as “purely cosmetic” and providing “no benefit to your pet and does not prevent periodontal disease at any level.” The AVDC provides resources explaining the harmful effects from missing these essential steps. To begin, a patient that is only physically or chemically restrained without general anesthesia can experience stress, pain, and may cause trauma to themselves or those performing the procedure. Due to the limitations of these methods of restraint a full oral exam cannot be accomplished and only the visible portion of the tooth is able to be scaled. This leaves the other 60% of the tooth below the gumline vulnerable to progressive dental disease, which is where it is most active. Unfortunately the appearance of a clean, visible tooth, lacking tartar gives the impression that the tooth is healthy when in fact it can be decaying beneath the gumline. The only way to properly evaluate and scale beneath the gumline is by using dental probes, ultrasonic scalers, and dental radiographs ---which can only be accomplished while the pet is under general anesthesia. Also, a non-anesthesia dental may not involve polishing of the teeth after scaling. This leaves micro scratches on the surface of the tooth encouraging bacterial regrowth, plaque build-up, and perpetuating oral disease. This means that although the non-anesthesia dental is a cheaper option it will have to be done more frequently alleviating any savings one may think they are getting. Lastly, without an endotracheal tube (breathing tube used during anesthesia), loosened tartar and bacteria in the mouth leaves the pet at risk for inhalation of bacteria/plaque and accidental aspiration which can result in severe pneumonia, and can also be fatal. Given the information provided, non-anesthesia dentals are not recommended due to the associated risks and lack of benefit to the pet’s oral health. Inversely, this is why a professional dental cleaning is recommended and dental care guidelines have been established.



The 2013 American Animal Hospital Association (AAHA) Dental Care Guideline for Dogs and Cats proclaims, “Dental care is necessary to provide optimum health and optimize the quality of life. Untreated diseases of the oral cavity are painful and can contribute to local and systemic diseases”. This is way it is of the utmost importance to provide proper dental care in the form of a professional cleaning versus the inadequate non-anesthesia dental cleaning. As per the AAHA guidelines, the essential steps for a professional dental cleaning are as follows:

  1. Perform a complete oral evaluation

  2. Radiograph the entire mouth for an accurate evaluation and diagnosis of dental disease. If full mouth films are not taken, the client must be informed

  3. Scale the teeth supra- (above the gumline) and subgingivally (below the gumline) using a hand scaler or appropriate powered device followed by a hand instrument

  4. Evaluate the patient for abnormal periodontal pocket depths using a periodontal probe

  5. Polish the teeth using a low speed hand piece running at no more than 300 revolutions/min with prophy paste that is measured and loaded on a disposable prophy cup for each patient

  6. Perform subgingival irrigation to remove debris and polishing paste and inspect the crown and subgingival areas (visible surface of teeth)

  7. Apply antiplaque substances, such as sealants

  8. Provide instructions to the owner regarding home hygiene


What’s included?

  • Preanesthetic physical exam and bloodwork

  • IV catherization and administration of fluids

  • Intubation to prevent aspiration

  • Continuous monitoring of vitals by veterinary professionals

  • Complete Oral Exam

  • Radiographs to assess teeth below the gumline for disease

  • Scaling of all visible teeth and below the gumline of each tooth

  • Polish the teeth using prophy paste and adequate machinery

  • Exam teeth again following procedure and remove any debris from the procedure

  • Application of a sealant to prevent bacterial/plaque regrowth

  • Discuss at home and follow up care

What’re the risks?


Additional steps are required if further therapy is needed including:

  1. Perform periodontal therapy based on radiographic findings and probing

  2. Administer perioperative antibiotics when indicated

  3. Perform periodontal surgery to remove deep debris, eliminate pockets, and/or extract teeth. When either pockets or gingival recession is >50% of the root support, extraction or periodontal surgery is indicated and should be performed by a trained veterinarians or referred to a specialist.

  4. Biopsy all abnormal masses that are visualized grossly or noted on radiographs. Submit all samples for histopathology to be analyzed by a pathologist

  5. Take postoperative radiographs to evaluate treatment applied, especially in extraction cases

  6. Recommend referral to a specialist when the primary veterinarian does not have the skills, knowledge, equipment, or facilities to perform a specific procedure or treatment

Furthermore follow up care is recommended every 6 months to yearly for healthy mouths to mild dental disease and as frequent as monthly for severe dental disease until it is controlled. Client education regarding home dental care, nutrition, and dental chews should also be discussed.

Dental care is extremely important to maintain a happy, healthy life for your pet. All members of the veterinary staff must strive to increase the quality of dental care and oral care education to clients. Based on these principles, a professional dental cleaning is recommended to properly maintain dental care and treat dental disease as outlined by professional guidelines and recommendations.



References:

  1. American Veterinary Dental College. Available at: http://avdc.org/AFD. Accessed July 28, 2015.



  1. Steven E. Holmstrom, DVM, DAVDC, Jan Bellows, DVM, DAVDC, DABVP, Stephen Juriga, DVM, DAVDC, Kate Knutson, DVM, Brook A. Niemiec, DVM, DAVDC, FAVD, Jeanne Perrone, CVT, VTS (Dentistry). 2013 AAHA Dental Care Guidelines for Dogs and Cats. J AmAnim Hosp Assoc 2013; 49:75–82. DOI 10.5326/JAAHA-MS-4013. Available at: https://www.aaha.org/public_documents/professional/guidelines/dental_guidelines.pdf. Accessed June 28, 2015.


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