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Sunday, June 27, 2021

Doggie Dentistry: Is Non-Anesthetic Better?

     More than ever, owners are taking proactive initiative in their pet's oral health as veterinarians recommend annual comprehensive dental care for both dogs and cats. The health of the teeth and gums is incredibly important; periodontal disease is the most common disease of companion animals! Disease of the mouth can have downstream effects on other organ systems. While we can often be reasoned through our fear of the dentist, a proper oral exam for dogs and cats requires anesthesia-- this allows the veterinarian to fully open, examine, and radiograph the pet's mouth, which is a very stressful experience for an awake patient. However, anesthesia is equally stressful to many owners, and the combined use of anesthesia, radiographs, and dental care can make the appointment rather pricey. This has led to a rise in "non-anesthetic teeth cleanings" offered by groomers and other pet care professionals. This alternative appeals to a number of pet owners, for good reason! It costs less, it doesn't involve anesthesia (so it's perceived as safer) and in many cases, it's quicker, too. Unfortunately, non-anesthetic cleanings are not a safe or reliable alternative to ensuring dental health in your dog or cat. They offer essentially no benefit other than cosmetic, and may even be dangerous or painful to your pet. The individuals offering these services often have the best of intentions, and simply do not realize the immediate and indirect risks associated with the procedure. 

    The American Veterinary Dental College is a professional organization that oversees the residency and board certification of Veterinary Dentists. They have a strong position statement on their website addressing these services, which they term Non-Professional Dental Scaling (NPDS). They raise the following (paraphrased) points: 
  • A pet may be injured by the ultrasonic scaler if they make even a slight sudden movement while the tool is in their mouth, and the use of sprayed water in the mouth can lead to aspiration and pneumonia.
  • The superficial scaling accomplished by these procedures is cosmetic, failing to address disease-causing bacteria in the sub-gingival pocket. 
  • Inhaled anesthesia allows for stress-free cooperation, pain-relief, and intubation reduces the risk of aspiration (inhaling water from the scaling instrument). 
  • A complete oral exam cannot be performed without anesthesia, and areas of significant disease (and pain!) may be missed without anesthesia

    These points are an excellent outline of the problems with these advertised "non-anesthetic dentals" and why they're not only a waste of money, but potentially dangerous to your pet. The World Small Animal Veterinary Association has also discussed and condemned such procedures in their Dental Guidelines

Stress and Pain

    Anyone that has ever had dental work done can likely attest: it hurts! Periodontal disease can be very painful, and that pain can be amplified by the probing done to assess pockets in the gum, or manual pressure on the teeth to assess mobility. Cleaning the teeth can also be stressful for a dog or cat that cannot receive an explanation of what is being done; think of the tools, sounds, physical sensations, and even smells that are involved in a dental procedure. These things are very stimulating to a pet and can cause stress and anxiety, especially when done by an unfamiliar individual. Multi-modal anesthesia provides unconsciousness, analgesia (pain-relief), and amnesia (interrupts memory formation). This creates a more stress-free experience for your pet. 

Undiagnosed (Untreated) Disease

    Anesthesia-free scaling of the teeth does make them look cleaner! However, these pearly whites confer a false sense of security to pet owners and may result in delayed treatment of existing periodontal disease. This is because a significant amount of pathology (disease) exists below the gum-line in cats and dogs. Studies conducted in 1998 sought to determine the diagnostic value of dental radiographs. What researchers found is that radiographs revealed clinically significant findings in nearly 30% of dogs that did not have any visual evidence of significant disease on examination. In dogs with clinical lesions, radiographs added relevant information over 70% of the time. In cats, those numbers rise to ~40% and ~85% respectively. 
    There can be severe consequences for untreated periodontal disease in companion animals. Beyond the pain that accompanies dental disease, fractures of the jaw can occur secondary to bone loss around the teeth. Systemically, the bacterial burden of the mouth and chronic inflammation can negatively impact other organs:
  • Periodontal disease is correlated with an increased risk of chronic kidney disease
  • Dogs with periodontal disease face a greater risk of endocarditis, inflammation of the heart
  • Anecdotal reports from veterinarians managing diabetic dogs and cats suggest improved control of blood sugar with routine dental care

Risk of Injury 

     One of the greatest risks of dentistry is aspiration, or inhalation of liquid into the lungs, which can result in pneumonia. The tools used during dental procedures require a constant stream of water to prevent the ultrasonic instruments from overheating. Additionally, water may be needed to rinse away blood, debris, or polishing material. During an anesthetic dental procedure, the animal is intubated with an endotracheal tube that has an inflatable cuff, sealing off the airway and minimizing risk of aspiration. Additionally, the mouth is packed with a removable sponge gauze material. Neither of these can be safely used on an awake patient. 
     On top of the risk of aspiration, a conscious patient may make sudden movements. Some of the tools used for dental procedures are sharp, and even the blunted instruments can cause damage if applied too forcefully in a single motion. The gingival tissues of the mouth are fragile and any injury caused by movement during a non-anesthetic scaling can result in long-term disease within the mouth.  

Recommendations for Your Pet's Oral Health

     In order to keep your pet's mouth healthy, you can try gentle brushing at home if your pet is amenable to it. A Fear Free trainer focused on cooperative care may be able to provide recommendations on how to improve this experience for you and your pet. Dental chews with a Veterinary Oral Health Council seal can also be used to reduce the speed at which periodontal disease develops. There are also several diets on the market that slow the formation of dental calculus, which can trap bacteria against the surface of the tooth. Most importantly, your pet should receive anesthetized oral care from a veterinarian throughout their life. 

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