Dental cleanings for pets can be more extensive than cleanings on ourselves due to our inability to ask our pets to “say ah” and keep still! A pet must be under general anesthesia in order for us to fully evaluate their teeth and do a thorough and complete cleaning. This will be a blog post to explain what happens with your pet from start to finish when they see us for a dental cleaning.
Step One: Drop off and Evaluation
When you drop your pet off, we will ask if there has been any change in their history since we last saw them. For you to schedule a dental cleaning with us, we will need to have seen the pet within the last six months. We need an initial exam to ensure there aren’t any abnormalities or contraindications to anesthesia. The doctor will do an examination on the pet before starting the procedure.
Step Two: Pre-Op Blood work
We recommend blood work within the last month prior to anesthesia. Your pet may have already had blood work at a visit within the last month, but if not, we will draw a preoperative panel at this time. Bloodwork will help us see if there is an underlying disease that is undetectable on physical exam such as early stage renal disease, signs of endocrinopathy, anemia, immunosuppression, etc.
Step Three: Procedure Prep
Here at DVC, we recommend IV catheters and intraoperative fluids during anesthetic procedures. Anesthetics can cause patients’ blood pressure to drop. If blood pressure is low, the organs and tissues will not receive as much oxygenated blood as they would in a pet with normal blood pressure. This puts the pet at higher risk of having an adverse event during the anesthesia. IV fluids help to maintain blood pressure and keep the vital organs well perfused. Your pet will also receive a sedative, or what we call a pre-medication. The pre-medication will relax your pet, making the placement of the IV catheter easier and much less stressful for your pet. The pre-medication also decreases the amount of gas anesthesia required during the procedure, decreasing the likelihood of adverse effects to the cardiovascular and respiratory systems. The IV catheter is also a great safety net, although highly unlikely, should your pet need emergency medication during the procedure, medications are much more effective and more quickly effective when given intravenously. Hitting a vein in an emergency can be very difficult if the pet is small and the blood pressure is low. If the catheter is in place prior to the procedure, it allows us to act quickly and effectively in case of any emergency.
Step Four: Anesthetic Induction
At this point your pet has been examined, their blood work evaluated, pre-medication given, and catheter in place. It is now time to induce anesthesia and begin the actual procedure. A medication is given to get your pet to an anesthetic plane. Now there will be no jaw tone, meaning we can open your pet’s mouth and place an endotracheal tube. This is a tube in the trachea, keeping the airway open, and protected from fluids or bacteria going down the airway during the procedure. The endotracheal tube and the anesthesia machine become a closed system. There is a cuff that is carefully inflated around the bottom of the tube to secure it. The end of the tube coming out of the pet’s mouth is connected to the anesthesia machine. Through this tube, your pet will be receiving 100% oxygen and isoflurane, a gas anesthetic. Gas anesthesia is much more easily manipulated than long acting injectable anesthetics. The goal is to use just enough pre-anesthetic and induction agent to get the pet relaxed, intubated and hooked up to gas anesthesia, so we can then maintain anesthesia using anesthetic that is short acting and easily increased or decreased as needed during the procedure.
Monitoring equipment is hooked up to measure heart rate via ECG, respiratory rate, oxygenation levels, temperature, and blood pressure. The doctor and a technician will be present with your pet throughout the procedure closely monitoring physical indicators of how your pet is doing under the anesthesia as well as the values obtained by the monitor. Again, having this comprehensive monitor helps us catch any issues occurring under anesthesia early and to address them.
Step Five: Dental Radiographs
As mentioned in previous posts, dental radiographs are highly encouraged but if cost is prohibitive, they are not required. Dental radiographs can show disease beneath the gum line that may be undetectable just by visualizing the crown of the tooth. The radiographs can show tooth root abscesses, bone resorption, fractured tooth roots, periodontal disease, and can be used to ensure that no roots are left behind when extracting teeth. Periodontal disease is the most common disease affecting dogs and cats today. When bacteria is built up beneath the gum line, it can lead to damage of multiple organ systems. At each dental cleaning, we recommend performing a set of full mouth x-rays.
Step Six: Evaluate and Scale the teeth
The doctor first looks at the teeth to see what abnormalities are present. Things he looks for are gingivitis, fractured teeth with pulp exposure, deep gingival pockets, freely moveable teeth, masses or abnormal growths, and more. Dr. Chris will take note of his findings and his plan to address them prior to cleaning the teeth. We use an ultrasonic scaler to clean the teeth or may occasionally use a hand scaler, similar to your dentist. It’s extremely important to us to make sure to scale beneath the gum line. This is crucial to preventing periodontal disease. In order to do the exam thoroughly, be able to clean all sides of every tooth, and to be able to clean beneath the gumline, general anesthesia is a necessity.
Step Seven: Dental Extractions
Should there be any diseased teeth that the veterinarian feels cannot be saved, they will be extracted. Root canals and advanced dentistry are performed by veterinary specialists. Pets do remarkably well even if every one of their teeth needs to be extracted. Generally, owners see a remarkable difference in their pet’s comfort level, appetite, activity level, and overall demeanor when diseased teeth are extracted. Even if that means they don’t have many teeth left at the end of the procedure. Depending on how many extractions are needed, Dr. Chris may recommend postponing some to a future procedure to shorten the time under anesthesia.
Your pet may not require any dental extractions! If you brush your pet’s teeth daily and have veterinary dental cleanings performed yearly, there is a very good chance your pet will never need to have teeth extracted. Small dogs are much more predisposed to periodontal disease than larger dogs and are much more likely to require extractions. Staying on top of your pet’s dental health is crucial for all pets, but especially for toy breed dogs.
Step Eight: Polishing
Dr. Chris will address any other issues as needed such as suturing gingiva where teeth were extracted or removing other masses if necessary. Finally, we will polish the teeth. This creates a type of sealant and will prevent bacteria from accumulating in any microabrasions caused by scaling the teeth.
Step Nine: Recovery from Anesthesia
Once the procedure is complete, we will turn off the gas anesthesia and let your pet remain intubated on oxygen for a brief amount of time to ensure the pet is well oxygenated prior to disconnecting them from the machine. Pets wake up remarkably fast from gas anesthesia. We wait until the pet can swallow, meaning they are able to control and protect their own airway again, before we pull out the endotracheal tube. We are able to pull this tube in most pets within minutes of turning off the gas anesthesia. The pet is then placed under a warming device while they continue to recover from the anesthesia. Most pets go home the same day.
As you can see, we put a lot of time, energy, thought, and care into making sure your pet has a clean and healthy mouth in order to improve their overall health and comfort. To those of you living in Louisville and Prospect, Kentucky, we would love to give you a tour of our dental suite and answer any other questions you may have. Call Dogwood Vet Clinic today at 502-710-0170 to set up an initial consultation to discuss your pet’s specific needs.