It is a relatively simple thing to do a “dental cleaning,” right? Wrong! In fact, a dental cleaning is as complex as any other procedure that requires general anesthesia. Here is a discussion of what is involved.
Before the dental procedure:
All dental procedures in animals require general anesthesia. Prior to any anesthetic procedure, pre-anesthetic blood tests must be performed to ensure that organ functions are satisfactory for anesthesia. Under some circumstances, additional tests might be recommended, such as chest x-rays (for any dog over 6 years old or any cat over 8 years old), ECG (if any heart murmur, abnormal rhythm, or changes in the appearance of chest x-rays are present), or urinalysis. Sometimes antibiotic treatment is instituted before a dental procedure is performed, in some cases as much as 2-3 weeks prior to the dental procedure. Your veterinarian will discuss the specific pre-dental recommendations for your pet.
Do I have to make an appointment for my dog to have a dental cleaning?
Yes. Your veterinarian will perform pre-anesthetic tests, examine your pet for any other underlying disorders prior to the procedure, and determine if antibiotic treatment should be started in advance. This is best accomplished by scheduling a pre-anesthetic exam, during which time an awake oral exam will be performed, and preoperative tests will be performed. Then the dental cleaning procedure must be scheduled on a specific date. On the day of the procedure, your pet is not allowed to eat anything. Your pet can have dinner the night before, but any remaining food should be taken away from the pet by midnight before the procedure. However, your pet is allowed to have water throughout the night.
If you are unable to bring your pet in for a pre-operative exam, the exam and pre-op laboratory tests can be done on the day of the procedure. However, be aware that the procedure may need to be postponed or cancelled if there are any significant abnormalities in the test results.
What is done during the dental cleaning?
The goal of dental scaling and polishing is to remove the visible tartar and invisible plaque, both above and below the gumline. Dental cleaning is a 10-step process.
Step #1) Awake examination of the head, face, neck, eyes, cheeks, jaws, mouth, and teeth. This helps to identify problems that may not be obviously visible inside the mouth.
Step #2) Anesthetized examination of the structures noted above, in addition to a complete exam of the mouth , teeth, and inside the throat.
Step #3) Supragingival cleaning (above the gumline). The tartar and plaque are removed from the tooth surfaces by use of an ultrasonic scaler, as well as with hand instruments that allow access to difficult spaces.
Step #4) Subgingival cleaning (below the gumline). A special periodontal ultrasonic scaler and specialized hand instruments are used to remove the tartar and plaque that have accumulated below the gumline. The tartar beneath the gum line is the most significant cause of gum disease.
Step #5) Polishing. This removes any fine scratches left on the tooth surface. Leaving scratches or roughened tooth surface promotes more rapid recurrence of plaque and tartar.
Step #6) Irrigation. The sulcus between the tooth and gum is flushed with sterile saline or antiseptic solution to remove any loose particles of tartar or debris that could contribute to gingivitis.
Step #7) Fluoride treatment. Fluoride helps to strengthen the enamel and reduces sensitivity of the teeth.
Step #8) Post cleaning exam and diagnostics. During this part of the procedure, the depth of the pockets around each tooth is checked to look for periodontal disease. In many cases, we also use disclosing solution to detect any hidden plaque or tartar that remains. During this step, most patients will also get full-mouth dental x-rays. Dental x-rays will often reveal problems that cannot be seen on visual examination alone.
Step #9) Charting is performed. Charting allows for better communication in and between offices, as well as providing a record that can be used for future comparisons.
Step #10) Specific dental therapy. This is often the most involved part of the dental procedure. This includes tooth extractions, the creation of gingival flaps in order to do a deep cleaning of teeth with periodontal disease, placement of an antibiotic gel, called Doxirobe, which helps treat periodontal disease, root canal therapy, restoration of damaged teeth, applying sealants to exposed dentin, etc.
These procedures will be fully discussed prior to your pet’s dental cleaning procedure. Since it can be difficult or even impossible to predict the extent of dental disease prior to anesthetized exam and x-rays, it is imperative that your veterinarian is able to reach you during the procedure to discuss any additional treatment that may be necessary.
Dental sealants (OraVet or Sanos) are an optional addition. These are products that are applied to the tooth surface at the time of the professional dental cleaning, in order to help reduce the rate of bacterial colonization and plaque buildup on teeth. Cost and required follow-up is different for each of these products.
How long does a dental procedure take to perform, and when can my pet come home?
The length of time that it takes to perform dental cleaning, evaluation, and treatment is extremely variable depending upon many factors. Some of those factors are: how heavy the tartar deposits are, how many teeth there are, the size of the teeth (cats are easier than dogs because of less tooth surface area), how severe the dental disease below the gumline is, what additional procedures (such as extractions) need to be performed, and how many procedures need to be performed. Certain procedures, such as root canal therapy, take much longer than others. The entire procedure could take as little as 30 minutes or as long as 4 hours to complete. In rare severe cases, it is not practical to keep a pet under anesthesia as long as it would take to do all that is necessary, and we will do the dental work in 2 separate procedures, 1-4 weeks apart. This is not a procedure to rush through, and if not done properly is of limited benefit to the pet, and is unfair to both the pet and the owner.
On any given day, we potentially have several dental procedures and other surgeries scheduled. Typically, all patients are dropped off in the morning, and we will assess each patient‘s needs. Patients that are higher risk (especially very young, very old, or sick pets) are typically done first, followed by procedures that may require a longer anesthetic recovery. In most cases, we cannot guarantee that a specific pet will be done at a specific time. Special requests based on the owner’s schedule, etc. will try to be met if possible. We will call you when your pet’s procedure has been completed and give you a time when your pet can be picked up. Please be aware that some pet has to be first and some pet has to be last on the schedule, and that there are very good reasons for the order in which pets are anesthetized. Please be understanding if your pet happens to be the “last” one of the day. Each pet is given our full care and attention no matter what time their procedure is done. In rare cases, procedures take longer than anticipated, and you may be given the option of picking up your pet after the hospital has closed to regular business or for your pet to stay the night in the hospital. If your pet stays the night, he or she will be monitored until he or she is recovered from the anesthetic and is stable to be settled into a place for the night. On even rarer occasions, when we know that we will be very late, you may be asked to reschedule your pet’s procedure.
I am concerned about the risks of anesthesia and I have heard that dental cleaning can be performed without anesthesia. Is this true?
There are unlicensed practitioners, and even some licensed veterinarians that offer dental cleaning without anesthesia, or with just sedation (see next item). This is ineffective and can be dangerous.
The most important parts of a dental cleaning include the cleaning below the gumline, probing around the teeth to detect hidden periodontal disease, and x-rays if there are any problems suspected. None of these can be adequately performed on an awake animal, either because they are painful or because the animal must hold completely still for the procedure. An awake dental cleaning only allows for removal of the tartar above the gumline, which makes the teeth look nice, but does almost nothing to improve the health of the mouth. In fact, removing the tartar above the gumline gives the owner a false sense of security that the mouth is healthier than it actually is. Lastly, the polishing step can rarely be performed. Scaling the teeth without polishing leaves a rough surface, and results in more rapid recurrence of plaque and tartar.
Can a dental cleaning be done by just using a heavy sedative, rather than general anesthesia, to make it safer?
The concept that sedation for dental cleaning is safer than general anesthesia is absolutely false. While sedation may make a patient quiet enough to allow better ability to clean below the gumline, probe the teeth, and even take dental x-rays, it is actually less safe to do this, than to do general anesthesia. Why? There are 2 primary reasons:
– First, sedation leaves the airway in the throat open to aspiration of saliva or with the water that is used during the cleaning process, resulting in aspiration pneumonia. In addition, there are bacteria that are aerosolized during the cleaning process, and these bacteria can also contaminate the airway, resulting in bacterial tracheitis or even pneumonia. During general anesthesia, an endotracheal tube is placed in the airway which protects the airway from contamination with fluids or with bacteria.
– Second, when a pet is sedated, we have no control over the pet’s response to the anesthetic. Once the injection is given, our only option is to wait until the drug wears off. The exception to this is that there are certain drugs that can be reversed. However, the sedation with these drugs cannot be regulated, and it “all or none,” regarding the level of sedation. During general anesthesia, the pet is given a gas anesthesia that can be adjusted up (if we are doing something painful, and the pet needs to be deeper under anesthesia) or adjusted down (if we are doing non-painful procedures, or we are near the end of the anesthetic procedure, and we want to speed up the wake-up time).
How much does a tooth cleaning procedure cost?
It is impossible to determine the exact cost of the procedure because we do not know the status of your pet’s teeth and gums, until we are able to do a complete exam under anesthesia. Your veterinarian can give you the cost of the required pre-op testing, anesthesia/exam/cleaning, and dental x-rays. If the teeth and gums are healthy, then this will be the only cost. Additional fees are based on costs of additional anesthesia, necessary therapy, and medications. The doctor or staff will provide an estimate for the initial anticipated treatment plan based on exam room findings and can call you at the provided contact number with a final treatment plan and total cost after a tooth-by-tooth exam is conducted under anesthesia.
How often does my pet need to have teeth cleaned by the veterinarian?
It depends on the degree of plaque and tartar accumulation. The rate at which plaque/tartar develop is determined by multiple factors, including the type of food your pet eats (dry vs. wet, and if there are additives to aid in dental health), your pet’s breed (smaller breeds and certain specific breeds develop problems more rapidly), how well your pet’s mouth is formed, and whether or not your pet is getting home dental care (also how often and what type of home care will influence this).
Look for an accumulation of yellow or brown material at the area where the tooth meets the gumline, especially over the cheek teeth and canines. Attached to the tartar are bacteria, which irritate gum tissues, causing gingivitis. When treated with professional cleaning, the inflammation of gingivitis will resolve. When gingivitis is left untreated, it will progress to periodontitis, which is non-curable.
Once you notice plaque or tartar accumulation, it is time for a professional cleaning. Do not wait. The intervals between teeth cleaning procedures will depend on how often you can brush your pet’s teeth and/or provide other home dental care. Once or twice daily brushing is best, and three time weekly (every other day) is still very effective. Once weekly is still of benefit to the pet, but less often brushing makes it less effective. If you cannot brush the teeth, then use other forms of home dental care as discussed. Some pets will need two or three teeth cleaning visits yearly, especially if there is no home dental care, and/or your pet is predisposed to dental disease. Other pets, especially larger breeds and pets getting aggressive home dental care, only need a professional cleaning every 2-4 years.
Make sure to examine your pet’s teeth monthly, and if you are uncertain whether or not your pet should have a dental cleaning, please schedule a dental examination with our office, so that we can advise you of the best approach.
How can I tell if my pet is suffering from periodontal disease?
The leading sign is bad breath. Dogs and cats should not have disagreeable mouth odor. Bad breath typically comes from diseased or infected teeth. There are other causes of bad breath, including oral tumors and certain disease conditions. If your pet has bad breath, let us examine his/her mouth and advise care.