DENTAL

Proper dental care is an essential component of a preventive health care plan for your pet.  This client handout is designed to help you understand the dental cleaning procedure by providing some general information to assist you in making informed decisions regarding your pets’ dental health.

  • Dental procedures must be performed by a licensed veterinarian or by a licensed or trained veterinary assistant under the supervision of a veterinarian in accordance with the state veterinary practice act
  • An oral exam performed on a conscious patient allows the veterinarian to make a visual assessment of the degree of dental disease.  Only when the patient has been anesthetized can a complete and thorough evaluation can be made with the combination of tooth-by-tooth visual exam and probing.
  • Cleaning your pet’s teeth without general anesthesia is considered below the standard of care.
  • We utilize state of the art guidelines on anesthesia, antimicrobial use, fluid therapy, and pain management for all pets undergoing a dental procedure.
  • If left untreated, diseases of the oral cavity are painful and can contribute to local or systemic diseases.

Where Do We Start?

A proper dental cleaning is a two-part process involving a pre-operative patient evaluation followed by a diagnostic dental cleaning. This involves both an awake component and an anesthetized component for a complete evaluation. It is not until the patient is evaluated under anesthesia that a full treatment plan including costs of the anticipated procedure(s) can be successfully made with any degree of accuracy.

Evaluation of a patient for dental disease begins with an awake oral examination.  Preoperative evaluation includes a preanesthetic physical examination and laboratory testing based on the patient’s life stage and any existing disease. Although many problems may be seen at this point, an accurate diagnosis and treatment plan cannot be determined until a tooth-by-tooth examination of the anesthetized patient has been completed.

A pre-anesthetic examination is required for all pets.   Pre-operative lab work is recommended for all pets and required for all pets over 7 years of age.  After the examination, your doctor will discuss the results of any diagnostics performed and schedule your pets’ dental cleaning as soon as possible.


Dental cleaning day, what should I expect?

As your pet will be undergoing general anesthesia, an 8-12 hour fast is required. You can feed your pet dinner the night before the procedure but then remove access to food overnight.  Water is okay. Please arrive between 8:00-8:30am. Arrivals beyond that time may not provide us enough time to safely clean your pets’ teeth and will be rescheduled. General anesthesia with intubation is necessary to properly assess and treat your pet. It is essential that aspiration of water and debris by the patient is prevented through endotracheal intubation. Your pets dental cleaning will be completed in the early afternoon, and you will be contacted when your pet is awake from anesthesia.  We prefer to keep all anesthetic patients for several hours post-operatively to assess their full recovery. If for any reason you are unable to come in for your pets scheduled dental cleaning, please let us know as soon as possible in consideration of other pets requiring similar procedures.


Why can’t you tell me what the dental will cost before you start?

The basic dental cleaning price includes the anesthetic cleaning, and medications to go home.  However, if there is extensive dental disease the cost can vary significantly. A periodontal probe is used to measure the depth of the gingival sulcus and periodontal pockets in millimeters to help evaluate the extent of periodontal support.  The percentage of support loss, plus clinical and intra oral examination findings, contribute to the creation of a treatment plan. Teeth affected by periodontal pockets composing less than 25 percent of the root height (stage 2 periodontal disease) can be treated with a locally applied antimicrobial or antibiotic. Teeth affected by 25 to 50 percent pocket probing depths (stage 3 periodontal disease) can be treated with extraction or open flap surgery to clean the accessible root surface and, hopefully, save the tooth. Teeth affected by more than 50 percent support loss should be extracted.  

Extractions will increase the cost of the procedure significantly as it is a delicate and time-consuming procedure. We always try to preserve teeth where indicated but extracting diseased teeth will remove a source of chronic pain and contamination and often help pets chew their food without pain. If extractions are indicated, we will call you to discuss what is recommended with the estimated cost prior to proceeding. As your pet will be under anesthesia at this time, it is EXTREMELY important that you be readily available by phone during the day. If you are unavailable, we cannot perform additional procedures without your express permission and will not risk keeping your pet under anesthesia longer than is necessary. If you know ahead of time that you will not be available, please let us know your wishes if troublesome teeth are found.


What do I do now? Will my pet be in pain?

Please review your post-operative handout for specific recommendations. All pets receive peri-operative antibiotics and analgesics which will last 24 hours.  If your pets’ dental was routine, they should be comfortable at time of discharge and often do not require additional medications. If extractions were performed, your pet will likely be sent home with additional oral antibiotics and pain medications that can be given the following day.  We will discuss administration of these medication with you at discharge. Often patients feel much better right away, as the cleaning and/or extraction has removed their source of pain. Soft food for 7 days is necessary to allow for the gums to heal. Any oral sutures are absorbable and will not need to be removed. Signs that your pet is having complications with the procedure may include; drooling, foul breath, a poor appetite or pain when eating.  As always, we are a 24-hour facility and will be more than happy to assist you with your concerns any time. Below are some useful links with additional information.

Links:

5 Signs of Dental Pain in Pets
A Cat’s Mouth Handout
A Dog’s Mouth Handout

Does your hospital offer anesthesia-free teeth cleaning?

We are against non-anesthetic teeth cleaning, as it is an illegal practice when not performed by a licensed veterinarian in California and potentially dangerous to your pet.  Anesthesia-free dental cleanings unfortunately give many pet owners a false sense of security.  The pet’s teeth may appear cleaner and whiter, but that does not mean periodontal disease and any other underlying oral issues are gone.  Imagine going to your local nail salon or hairstylist to have your teeth “professionally” cleaned.  Is it the same procedure if you go to an actual dentist?  Think about it.

The Pet Hospital of Peñasquitos in San Diego, CA offers valid points about non-anesthetic teeth cleaning on their website.  Here is the excerpt:

“First of all it is difficult, if not impossible, to properly clean the teeth in an awake animal. It takes us about 45 minutes to clean, polish and seal the teeth after the patient is anesthetized, all our monitoring equipment is attached and we are ready to start cleaning. No animal wants to be forcibly held down while you work in their mouth for 45 minutes, that’s why we use anesthesia! Second the most important part of the teeth cleaning is to clean below the gum line. Numerous scientific studies have shown that cleaning only the visible surface of the teeth does not cure or prevent oral disease. The public may not understand that the procedures offered by unlicensed or unregulated persons are only cosmetic and do not improve tooth health. Thirdly, the California Veterinary Medicine Practice Act requires that an unlicensed person must be under the direct or indirect supervision of a veterinarian or under the direct supervision of a registered veterinary technician when performing tasks, such as a dental cleaning, and it must be in an animal hospital setting. There is no question cosmetic teeth cleaning is illegal in California unless done in a veterinary hospital under veterinary or veterinary technician supervision. Furthermore without ultrasonic scaling and polishing cosmetic teeth cleaning is not cleaning to improve tooth health even though it may look good.”

You can read more at their website: http://www.pethospitalpq.com/wedonotrecommendanesthesiafreetreethcleaning.pml

Here are a few links that discuss the issue at hand:

http://www.avdc.org/dentalscaling.html

https://www.avma.org/News/JAVMANews/Pages/111215j.aspx

http://www.vmb.ca.gov/about_us/agenda_items/vmbagenda_20120424_12.a.v.1.pdf