In my last column, I reminded you that February is National Pet Dental Health Month and many veterinarians are offering deep discounts. I also explained that dental disease is a common and major pet health problem with a prevalence of 80-90% in all dogs and cats three years of age and older. Dental disease primarily causes oral infection that results in significant pain and discomfort and puts the major organs at risk of infection. Studies have shown that pets with dental disease have shorter lifespans on average of two years.
These sobering facts suggests pet owners should be eager to follow any reasonable guidelines to assure their pets do not have dental disease or infections. Professional dental cleanings are an essential component of effective pet dental care. The routine use of home dental care products can delay the first one and reduce the frequency of subsequent dental cleanings, but it is exceedingly rare that a pet never requires professional dental cleaning procedure. There are two main objections that cause some pet owners to refuse this essential health service. Both objections and concerns are valid and need to be fully understood. The two key issues are costs and safety.
For one to fully understand the costs of professional dental cleanings you have to understand what is involved. Although it varies somewhat from one veterinary hospital to another, the standard of care includes the following: pre-anesthetic assessment, premed injection (mild sedation), IV catherization and fluids, IV induction anesthetic, intubation, and gas maintenance anesthesia. Older pets or ones with significant health issues may require pre-anesthetic blood work and an ECG to minimize anesthetic risks. Anesthetic monitoring equipment is vital and typically includes constant readings of ECG, blood pressure, blood oxygen and CO2 levels, respiratory rates and body temperature. Concerns about anesthesia related hypothermia requires convection warming system to maintain normal body temperature. Full mouth radiology (x-rays) are included by veterinarians that offer full service level of dental care. The dental cleaning aspect includes ultrasonic scaling just like in human dentistry, and all the related equipment. If the patient is a Grade 1 case of mild gingivitis, then the next steps are the last ones and include fluoride treatment, polishing, and a protective sealant applied at the tooth gum line. For every dental, all teeth are carefully checked for periodontal disease by using calibrated probes; and antibiotics and analgesics are routinely provided to treat infection and to minimize pain and discomfort. Grade 2 cases indicate early periodontal disease that can be successfully treated by thorough scaling of the deep pockets and application of long acting antibiotic fillings. Grade 3 and 4 cases are characterized by established and progressive periodontal disease that typically require oral surgery to resolve. The next phase of dental care involves anesthetic recovery that includes ongoing monitoring and extubation. Then the pet is transferred to intensive care that allows ongoing observation to assure no complications. The final part of the professional dental cleaning service appointment is the discharge process where the service and outcomes are fully explained and the necessary home care options are discussed and an effective preventive strategy is implemented. As you can see, there are many steps and a lot of sophisticated equipment.
The other important objection and concern is safety. The reason for this concern is the use of anesthesia. This became such a concern that “anesthesia free” dentals came to the marketplace, which initially seemed like the best solution until you consider the pathology of gingivitis and periodontal disease that indicate 90% of dental disease is below the gum line. This means that the intricate and delicate process of doing a thorough dental cleaning must include the tiny areas below the gum line that can only be effectively addressed with complete immobilization that only anesthesia provides. This led to a serious ethical question regarding those veterinarians that were charging for a service and claiming a benefit that was not being realized by “anesthesia free” dentistry. Therefore, the AVMA was compelled to use their authority to declare “anesthesia free” dentistry as a form of malpractice.
It is wise to be concerned about anesthesia. However, with today’s improved and reliable monitoring equipment and the ability to successfully screen patients pre-emptively, I firmly believe the benefits of necessary professional dental cleanings far outweigh any perceived risks. Furthermore, the necessary level of dental anesthesia does not always reach the level of surgical anesthesia, and with inhalant anesthesia the ability to precisely control the level of anesthesia provides another layer of enhanced safety.