by Timothy Hodge, DVM
Dental disease in dogs is one of, if not the most, common disorders affecting our canine friends. By the age of three, 80% of all dogs have sufficient dental disease that warrants professional dental cleaning.
Unfortunately, that doesn’t occur with enough regularity to maintain good oral health. Many dogs suffer in silence as a result dental disease. Dental disorders, including plaque, tartar, gingivitis, periodontal disease, infections, cavities, and tooth trauma, all affect the oral cavity. Dental disease also has significant implications for the rest of the body. The heart, kidney, respiratory system and brain are all impacted by diseases of the teeth and oral cavity. Professional dental treatments not only provide for a healthy oral cavity, but also the health of the body as a whole. So, the benefits of proper dental care far outweigh the risks.
All major veterinary organizations that provide treatment guidelines and recommendations have established that professional anesthetic dental cleanings are considered standards of care. To not use anesthesia with dental treatments is considered to be below the minimum appropriate level of care. Anesthesia is the only way a comprehensive oral health assessment and treatment can be performed.
Many dog owners are aware of the importance of proper oral health and the need for dental treatments, but acceptance and compliance is low. Why is this?
In my experience, the fear of anesthesia is the number one reason why dogs, especially older ones, do not have proper dental treatments performed. While it does affect all dogs and all breeds, dental disease is prevalent primarily in older toy breeds. Costs and fees are generally less of a concern as most pet parents know how important this treatment is and plan accordingly. The key to preventing tooth loss is assessment and treatment. This is greatly limited with non-anesthetic dental treatments.
Non-anesthetic dental cleanings give pet owners a false sense of security into believing that they are doing what is best for their pet. However, in many cases, disease is left undetected and untreated. The pet suffers in silence until they can no longer tolerate the pain. By this point, the disease has progressed to where extraction of teeth is the only alternative. Other organs may now also be affected.
If disease is found early enough, treatments other than extractions are among available options. Tooth loss can be avoided with early, proper assessment and treatment, only achieveable if the pet is under anesthesia.
For non-anesthetic dental procedures, pets have to be restrained. This increases the risks that the pet may be injured by the restraint. Dental instruments can also cause mouth, head trauma or injury. It is most important to realize that the majority of dental disease lies below the gum line. This cannot be addressed effectively with non-anesthetic cleanings.
Cleaning only the surface of the tooth crown is a cosmetic procedure that offers no health benefits for the pet. Non-anesthetic dental cleanings are not in the best interest of your pet’s health and well-being.
Age Is Not A Disease
Many pet parents become more concerned with anesthesia in their older dogs. This is especially true of small breed dogs. The time under anesthesia can be longer for older pets due to the level of disease and the necessity for more dental work. Treatment, early and often, is the key. Repeated anesthesia over the life of the pet does not impact longevity as was once the case with older anesthetic medications. Dental disease is not curable with a one-time
treatment. The disease is recurrent and progressive. Regular anesthetic dental treatments and cleanings can manage and stall dental disease.
Ensuring a safe and effective anesthetic dental cleaning and reducing the fear of pet parents, requires screening pets and providing individualized care. This allows us to ensure the safety of the pet and limit the time under anesthesia. We start with pre-anesthesia testing. At a minimum, a physical exam and lab testing to assess organ function are required. Pets with possible or known heart/lung disease may also need an EKG, chest radiographs and echocardiogram.
The anesthetic protocol is tailored to meet the needs of the individual pet. This will mean choosing the pre-anesthesia medications, drugs to induce anesthesia and maintenance gas that meet the needs of the pet. Each pet is an individual and needs to be treated as such.
Light Plane Of Anesthesia
The depth or level of anesthesia is kept to a minimum. The pet should be in a shallow plane of anesthesia as opposed to a deep plane of anesthesia. Local nerve blocs, just like with humans, can allow for better pain control, but still allow the pet to be as minimally sedated as possible. Light planes of anesthesia improve heart and lung function and blood pressure. Effective pain management, nerve blocks, injectable and oral pain medication allow for a lighter plane of anesthesia, reducing the risk of complications and speeding the recovery period. These are major factors in minimizing anesthesia concerns.
The concerns with anesthesia are greatly reduced with today’s modern ability to monitor the pet. Monitoring by an experienced and attentive technician or veterinary nurse is paramount. Monitoring machines are also very helpful. All pets will have pulse oximetry (oxygen levels in the blood), EKG, respiratory monitor, temperature monitor and blood pressure assessed during their entire time of anesthesia.
An IV catheter is always in place for fluid administration, helping maintain proper blood pressure, but also to flush drugs, medications and toxins via the kidneys, which also supports proper kidney function. As previously mentioned, anesthesia, by nature, can lower blood pressure. It can also lower body temperature. To address this, the pet must be warmed while under anesthesia. This requires external warmers such as blankets and warmed IV fluids. When the body temperature is kept as close to normal as possible, the rest of the body functions better, and recovery is quicker. An endotracheal tube with cuff is used on every patient to maintain an open airway and prevent water and debris from entering the trachea and lungs.
Recovery from anesthesia is one of the most important times of the entire procedure and is critical to a successful outcome. The pet is to be monitored until able to sit upright and breathe without the need for the endotracheal tube and swallow appropriately. Body temperature is monitored and the pet is warmed to maintain normalcy. While the pet is being monitored, any additional support is provided, if needed, such as additional pain medication, warming support, and nausea control.
The Big Take Home Message
First, talk to your veterinarian and veterinary team about their protocol for pre-anesthesia evaluation, lab testing, and treatment. Ask them how your pet will be monitored, what steps will be taken to adequately monitor your pet, and control pain and discomfort. Ask how your pet will be supported to limit
anesthetic complications and allow for safe, effective and proper dental care.
Timothy Hodge, DVM is the owner/practioner of Harbourside Animal Hospital and Cross Creek Animal Medical Center. Having completed his training at the Chi Institute, he provides acupuncture and herbal therapies in addition to traditional medical care.