The case for anesthesia
To evaluate and clean teeth properly, general anesthesia is mandatory. Some veterinarians and non-veterinarians advertise anesthesia-free dentistry. This is a disservice to the patient, client and our profession.
The American Veterinary Dental College (AVDC) developed a position statement for veterinarians and the public. The AVDC prefers to use the more accurate term non-professional dental scaling (NPDS) to describe anesthesia-free dentistry.
Naturally, owners of pets are concerned when anesthesia is required. However, performing NPDS on an unanesthetized pet is inappropriate for the following reasons:
- 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. The operator is also exposed to unnecessary bites.
Anesthesia-free dentistry does not allow scaling beneath the gum line (where periodontal disease is active) which results in purely cosmetic cleaning of the teeth and doesn't allow for a complete oral examination. Removal of dental tartar on the visible surfaces of the teeth has little effect on a pet's health, and it provides a false sense of accomplishment.
Anesthesia provides three important advantages: Cooperation of the patient, elimination of pain resulting from examination and treatment of diseased or injured dental tissues, and protection of the airway and lungs from accidental aspiration.
Choose the correct patient
Clients often ask whether their dog or cat is too old for anesthesia...but remember that age is not a disease! Clients with older pets who are sometimes most in need of dental procedures, often quickly decline dentistry. The problem with this is that no amount of antibiotics or teeth brushing is going to help a companion animal suffering with mobile teeth and/or later stage periodontal disease. Letting the periodontal syndrome rage on is far more dangerous than professional oral hygiene care performed under general anesthesia.
Every patient must be evaluated before anesthesia. The patient history is a vital part of the preoperative process, which paired with bloodwork and digital dental radiographs, will allow your veterinarian to evaluate your pet's health and provide the best treatment. Much like a pilot performing a pre-flight checklist, we run through a list of critical systems beforehand.
Anesthesia protocols vary by patient age, condition, co-morbidity factors, length of and type of procedure. Local anesthetics are used on all operative dental procedures where tissue is incised. There are many anesthesia protocols; the best one is the one that you are most comfortable with.
The third leg of the anesthetic safety trilogy is evaluating the patient during and after anesthesia. American Animal Hospital Association (AAHA) anesthesia guidelines (which we adhere to) require that one or more of the following monitors must be used on the anesthetized patient:
- Electronic respiratory monitor
- Pulse oximeter
- Blood-pressure monitor
- Continuous electrocardiograph (ECG) monitor
- Esophageal stethoscope