As a pet owner, you always want what is best for your pet family member. Occasionally circumstances arise where there may be conflicting advice from different directions. It can be difficult to know who to believe in such a situation.

You may have seen advertising for anaesthesia free dental cleaning. There are a few organisations now offering this service locally. We always want to provide you with as much information as possible to help you make informed decisions regarding your pet’s care. So – read on and we will discuss!

 

In a healthy mouth…

 The periodontal structures are those that support the teeth. These include the gums (gingiva), periodontal ligaments, and the bone of the jaw in which the teeth are embedded. The visible part of the tooth is the crown. Every tooth has roots that hold it in place. These are not visible in a healthy mouth – they are covered by bone and gum.

What is plaque (and tartar)?

 Teeth are essentially modified pieces of bone that allow an animal to process food. The mouth has a large bacterial population, which is constantly pushing the boundaries for more territory. Plaque is the manifestation of this bacterial “biofilm”. Tartar (and calculus) is the solid form of plaque that forms on the surface of the tooth.

What is periodontal disease?

 Periodontal disease is disease of any (or all) of the tooth support structures.

Periodontal disease is very common in both people and animals. Over time, as food is caught in narrow areas and bacteria (and plaque) build up, periodontal disease spreads unseen beneath the gum line. If left unchecked, this ultimately leads to bone loss and mobile, painful teeth which may require removal. Diseased teeth can also shower inflammatory and infectious debris into the bloodstream, which can have implications on other organs (e.g. kidneys, liver).

 

How can I tell if my pet has periodontal disease?

In the very early stages of periodontal disease, you will not be able to see anything when you look at your animal’s teeth. At such a moment, damage may be occurring underneath the gum-line which is impossible to see with the naked eye. It is for this reason that most human dentists recommend six monthly dental checks and tooth cleaning.

In more advanced cases, your pet may have obvious signs of dental disease. These include calculus on the tooth (a solid form of plaque), smelly breath and, in advanced cases, loose teeth or even tooth loss. A dental abscess may also develop. This often causes painful and sudden facial swelling. By the time these changes can be identified unfortunately the periodontal disease is often quite advanced, and significant and frequent intervention will be required to limit further periodontal disease and keep the teeth as healthy as possible.

 

How can I prevent periodontal disease?

 Like in humans, good dental hygiene prevents periodontal disease. There are two factors to consider with dental hygiene – annual professional dental care and at home care. It is recommended that every small animal (including guinea pigs and rabbits) have a twelve-monthly dental assessment. In most cases this may require general anaesthesia. Adequate and full assessment in all instances requires probing (and cleaning) under the gum-line. Pending on this assessment, dental radiographs may be recommended. At your annual or six monthly check up your veterinarian will discuss dental hygiene and an individual plan with you. Periodontal disease is by far the most common cause of disease and ill health in animals, and as such we consider it a top priority.

Also like in humans, the gold standard of dental hygiene at home is tooth brushing with an animal toothpaste. There are also excellent commercial diets, treats and water treatments available that can be an excellent adjunctive support.

 

Why does dental assessment cleaning require general anaesthesia?

 Most importantly, it is impossible to adequately assess the degree of periodontal disease without anaesthesia. Dental radiographs are a baseline minimum for full assessment of the oral health of a patient. Such radiographs cannot be safely or adequately completed without proper positioning of the patient. In a human this is easy – they will hold still! We can’t ask our pets to open wide, so to reduce their anxiety and allow us to examine and xray the mouth we require them to be absolutely still.  Unfortunately there is no way we can rationally explain that absolute stillness is necessary!

A visit to the vet always creates a little bit of fear and discomfort, and we cannot rationally explain that absolute stillness and “open wide” is important.

In addition to dental radiographs one cannot get a full assessment of the true degree of dental health without probing underneath the gum-line. If periodontal disease is present, the veterinarian can safely clean in this area. This allows the periodontal structures to heal and helps prevent or minimise further gum, ligament or bone loss. This part of the procedure is often uncomfortable or even painful for the animal. In a conscious patient it can therefore simply not be completed.

Additionally, the teeth cannot be properly polished without general anaesthesia. Both scaling and polishing require the use of an ultrasonic scaler and distilled water. The equipment causes some noise and sensation (just like at the human dentists) and can cause anxiety in an awake patient. The water used can be inhaled. To make the process as fear free and safe as possible, it is therefore imperative that the animal is nice and still with a safely maintained airway. This is only possible with general anaesthesia.

 

But what if my animal lies extra still?

 Even the best of animals can’t lie still enough for the above procedure. In some instances, very well-behaved animals may appear to be still when held down in an “anaesthetic free” procedure. This degree of restraint is often very frightening for an animal, as they (just like us) perceive the loss of autonomy and control. Where at all possible we try to avoid restraining any animal, and certainly not to the degree required for full dental assessment. Such restraint can also provoke such anxiety that they may be extra fearful for other, urgent veterinary visits in the future.

 

General anaesthesia for my pet is scary, should I not avoid it?

 Every anaesthetic is not without a small degree of risk. That being said, anaesthetics as they are currently used are very safe provided certain standards are met (see below). We would never recommend an anaesthetic unless we deemed it absolutely necessary. As periodontal disease is so common, on a risks/benefits analysis the risk of the ongoing and deteriorating dental disease most definitely outweighs the risks associated with the anaesthetic.

Sedation is not sufficient for dental assessment. With sedation often there is no maintenance of the airway, which can lead to fluid going down into the respiratory system.

Every patient will also be considered individually, and an individual treatment plan made for every patient. This may require a slightly modified anaesthetic or treatment plan.

 

What should a full dental assessment include?

 A full dental assessment should include:

  • Initial oral assessment of your pet’s oral health at the time of initial consultation
    • Free dental checks are available – please call the clinic to discuss
    • This is also done at the yearly health assessment and is part of a full clinical examination
  • If anaesthesia is recommended, blood and other pathology testing should be completed so that the veterinarian has a full idea of your animal’s inner health
    • Certain problems can be picked up on a blood test prior to any signs being shown in the animal
  • General anaesthesia
    • General anaesthetics for pets are now very safe
    • Your pet will be maintained on intravenous fluids for blood pressure support and intra-venous access
    • Your pet will have a leak proof tube inserted into the airway to ensure only gas and oxygen are delivered to the respiratory system (and not liquid from the dental procedure)
    • Your pet will have a dedicated and trained veterinary nurse to monitor and maintain the anaesthetic, ensuring that no problems arise. The parameters the technician will monitor include:
      • Blood oxygen saturation
      • Heart rate
      • Breathing rate
      • Degree of anaesthesia
      • Body temperature
      • Blood pressure
    • Pain relief
      • Every pet receives pain relief before the dental procedure as part of the pre-anaesthetic regime. This ensures a smooth and safe anaesthetic.
      • Pain relief may be required after the procedure if there has been significant gum irritation or tooth removal.
      • Just like at the human dentist, the veterinarian may also administer local anaesthetic numbing injections directly to the mouth
    • Assessment under general anaesthesia
      • Visual assessment with probing underneath the gum-line around every tooth
      • Full oral assessment to look for any other problems (e.g. gum lump, oral ulcers, soft palate problems)
      • Dental radiographs
      • Full ultrasonic scaling (cleaning) including underneath the gum-line as well as the crown of the tooth
      • Polishing of every tooth (all surfaces) to remove the biofilm and ensure a smooth surface which bacteria cannot cling to
      • Removal of any diseased teeth (this will be discussed with you prior to removal)
    • Full report of dental health and ongoing dental hygiene plan upon collection of your pet

How often is a full dental assessment required?

 Just like in humans, a full dental assessment is ideally completed every year. The veterinarian will probe around every tooth, clean every tooth, and radiograph any teeth to get a clear idea of what the tooth’s supporting structures are like. All of this information will be recorded for future reference.

Whilst we understand that this can be quite a financial commitment, it is important to realise that regular treatments can help prevent the progression to more serious and painful dental disease requiring extractions which can be costly.

Anaesthesia free dentals may appear cheaper than a standard dental assessment. You may find that the difference in cost is less than expected, however. There is the risk that significant disease will be missed. This can cause pain to the animal, but also lead to greater expense when full dental treatment under anaesthesia is required.

We believe the risk of missing significant disease and the increased fear and anxiety for your pet strongly favours dental assessment and treatment under anaesthesia as the best dental care for your pet.

What happens during an anaesthetic free dental?

 It is important to note that the technician who provides an anaesthetic free dental is not a trained veterinarian. As of the time of writing, there is no regulation for such a service, and great variability amongst training institutions. In such a service, even with the best-behaved animal, all the technician can aim to do is scrape the obvious plaque and calculus from the tooth surface. They cannot adequately assess the degree of periodontal disease, and thus this can continue unabated even if the crown of the tooth looks clean (above the gum-line).  An ultrasonic scaler that provides a superior clean cannot be used. It is also very difficult for the technician to assess the tongue (medial) side of the tooth.

Additionally, this scraping of the tooth surface without adequate polishing can actually cause enough change to the tooth surface that bacteria and plaque find it easier to adhere. Polishing cannot be completed due to the risk of water or other material going down into the airways when the animal breathes in.

Proponents of anaesthesia free dental will have you believe that a visibly white tooth (the crown of the tooth) is a healthy tooth. This is not the case, as it misses the other side of the tooth and most importantly the parts of the tooth that sit under the gum-line. This can also give you as the pet owner a false sense of security that you have your pet’s oral health completely under control.

In conclusion

 Hopefully this helps clarify some of the issues around “anaesthetic free” dental cleaning for pets. Please do not hesitate to contact the clinic if there is anything you would like to discuss in more detail, or to create a treatment plan for your pet.[i]

[i] http://avdc.org/AFD/category/veterinarians/

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