Dental Care: Three Veterinarians' Perspectives
All veterinarians agree on the importance of dental care for our dogs. There is, however, some controversy over the methods of non-anesthesia dental cleanings vs. cleanings while under anesthesia. We invited three veterinarians to submit articles on the issue of dental care. As with many healthcare topics, this is an issue each individual must research independently, discuss with a trusted veterinarian, and decide personally which approach works best for you and your dog.
The Importance of Dental Care
By Dr. Nicola Mohr, DVM
There is evidence that over 80 percent of adult dogs by two years of age have diseased teeth and gums.
This is mostly a result of civilization and modern lifestyle. In the wild, carnivores use their teeth to cut and rip prey into chunks of a size that can be gulped. This involves cutting tendons, hide, muscle and bone – for which domesticated dogs are perfectly adapted by having a set of shearing and pinching teeth. Modern dogs and cats, however, often receive small, concentrated kibble to eat, and as a result rarely use their teeth in any mechanically engaging way.
Despite common belief, commercial kibble has no protective effect on teeth at all. Most pets swallow it whole, and those kibble that do end up between two teeth tend to shatter and crumble, at best touching the tips of teeth. Calculus, however, builds along the entire crown of a tooth, first along and beneath the gum line. Imagine going years without brushing or having a single cleaning at your dentist’s office?
Unfortunately, the outward signs of dental problems may be subtle, including slowed eating, reduced excitement at meal times, a preference for soft foods, or bad breath. In severe cases, decreased social interaction, no longer playing with/tossing toys, snapping at people or other pets, and generalized withdrawal from normal activities may be observed. Most of the time, though, the onset of dental disease is so gradual that our pet can compensate and outwardly appear completely normal to us. While we might think that our friend would stop eating if in dental pain, this is usually the last thing to happen.
By the time plaque and gingival disease is usually noted, a thorough professional cleaning is the only thing that will reverse the disease. Unfortunately, this can only be done under general anesthesia. In order to correctly evaluate and treat the teeth of any dog or cat, we need to be able to inspect and chart them, and probe under the gum line on all sides of each tooth. Frequently, sub-gingival pockets and disease are found that require taking intra-oral x-rays. Fractured crowns and abscessed roots are often discovered that had no outward sign. Simply scraping off the calculus on the outside of teeth will miss the full extent of the disease and lead us to erroneously believe that we have just taken care of the problem. While we all worry about anesthesia, especially when pets reach older ages, the procedure can be done very safely today. It does mean taking precautions in the preparation and treatment. All patients undergoing anesthesia need to have a prior physical exam and lab work to assess their overall health. On the day of the dental therapy, IV fluid support and careful monitoring are required. Only the safest anesthetic protocol should be used (the same as is used for people).
With careful and thorough therapy, a painful and infected mouth can become clean and healthy once again, and the overall health of our friend is enhanced. Non-anesthesia “therapy” can never provide any of the above. At best, calculus on the outside of a tooth can be scraped while the dog is struggling to free herself from a completely unnatural, not-to-her-explained procedure. More likely, the scraping misses sub-gingival disease, causes injury to the gums, and potentially leads to aspiration of liquid and calculus that can culminate in potentially fatal pneumonia. It cannot be done safely, no matter how much we wish for it.
Following treatment, the long-term dental health of our pets can be maintained by regular home care. The cornerstone of this is daily brushing of the teeth using a pet toothbrush and veterinary toothpaste, perhaps complemented by dental diets, chews, and rinses.
Dr. Mohr completed her DVM degree at the University of California, Davis, in 1996. She worked as a general practitioner in Sonoma before joining Santa Cruz Veterinary Hospital in 2001. Her specialties include pediatrics, dental medicine, reproductive care, geriatric care, and comprehensive, preventive well-care of dogs and cats. Santa Cruz Veterinary Hospital is located at 2585 Soquel Drive in Santa Cruz, CA. (831) 475-5400 or www.santacruzveterinaryhospital.com.
The Benefits of Non-Anesthesia Dental Cleaning
By Dr. Annette Richmond, DVM
Non-anesthetic teeth cleaning offers a safe and affordable alternative to standard anesthetic-based cleanings. By combining extensive training with gentle handling techniques, it is possible to thoroughly examine the mouth and effectively clean the teeth while pets remain alert and comfortable. This safe technique can be used on animals of all ages and in varying stages of health. As people become aware of the risks and adverse effects of anesthesia, they are choosing this alternative.
To begin with, a pet must have a thorough physical examination by a veterinarian to assess eligibility before proceeding. If the level of dental and periodontal disease is too severe, the animal may require anesthesia. Precautions must be taken if an animal has a heart murmur or other disorder, and occasionally animals require antibiotics before and after the procedure. Temperament also is assessed. If a cat or dog exhibits aggression upon being handled and examined, then they may not be eligible for this procedure.
As with any medical procedure, it is imperative that the dental technician has been properly trained in both the technicalities of cleaning, as well as proper animal handling. The steps for cleaning are similar to traditional cleanings. First, an ultrasonic cleaner or a standard dental hygiene scaling instrument is used to clean both the crown of the tooth and the area under the gum line. A probe is used around the teeth to check for disease below the gum line. Next, the teeth are polished, which removes any remaining tartar and staining on the teeth. To complete the procedure, the mouth is rinsed with a natural antiseptic to help clean out debris loosened during the procedure. Animals are often held in the lap of the technician and feel little discomfort during the cleaning. After the cleaning is finished, it is recommended that the veterinarian recheck the mouth.
The frequency of cleanings depends on many factors, including the condition of the teeth and the gums, the breed of the animal, the type of diet, and the intensity of home care. In general, cleanings are recommended one or two times per year. A strong home care program is encouraged, and guardians are taught to properly brush and care for the teeth.
This alternative cleaning can benefit animals of all ages. Incorporating routine prophylactic dental cleanings into the care of very young animals can help prevent periodontal disease as they age and in turn prevent possible secondary organ dysfunction. Geriatric animals, who normally have slower anesthetic recoveries, can finish the procedure completely alert and with little risk. Patients with organ dysfunction including a heart murmur, liver dysfunction, or kidney disease have a greater risk with anesthesia. For these animals, anesthesia is often not advised.
When considering your pet’s dental health, remember the option of non-anesthetic teeth cleaning. Without this alternative, some animals may never get their teeth cleaned and continue to succumb to the adverse effects of the periodontal disease and its secondary effects.
Dr. Annette Richmond is a doctor of veterinary medicine, earning her degree from UC Davis in 1997. She is also a certified veterinary acupuncturist, trained through the International Veterinary Acupuncture Society and is currently being certified as a canine rehabilitation practitioner. She opened Natural Veterinary Therapy in Pacific Grove, CA in 2007. Natural Veterinary Therapy offers non-anesthetic teeth cleaning by Barbara Sargent of Poochie Smiles. With ten years of technical experience and many relaxing techniques, Barbara continues to help many pets with different levels of dental disease and temperaments. Natural Veterinary Therapy is located at 510 Lighthouse Ave. in Pacific Grove, CA. (831) 655-0501 or www.naturalveterinarytherapy.com.
The Dangers of Non-Anesthesia Dental Cleaning
By Dr. Tom Boekbinder, DVM
As a veterinarian committed to natural, non-invasive techniques, with thirty-two years experience, I feel compelled to add my thoughts to the anesthesia/no anesthesia dental debate.
There is a question that needs to be considered. The question is: Why don’t all veterinarians offer non-anesthesia tooth cleanings? We can all do it. It takes less equipment and staff and is far simpler. And, frankly, it is more profitable to do the simpler procedure.
A simple answer, in several parts. There have been numerous documented cases of severe injuries in animals struggling while getting the non-anesthesia procedure. The misconception is that it is a gentle procedure. They are lovingly wrapped in a towel or blanket to hold them. In fact, it is more like a straight jacket. The pets are completely restrained and then subjected to a stressful and, yes, painful procedure, fully awake and aware. We have one patient in the practice who has permanent spinal damage from such
a process performed in Los Angeles several years ago. There has been legal action regarding this procedure, with findings against it.
The second part is that it is extremely difficult – nearly impossible - to do a good job without anesthesia. The animals move and will not open their mouths sufficiently to allow for a complete and thorough cleaning. With anesthesia we use non-damaging sound waves to gently clean the tooth surface on all sides, and under the gum line. With awake procedures, teeth are scraped with sharp instruments, which damage the enamel and cut the gums. Also, because the teeth cannot be properly polished, the surface is left rough, and build-up of new tarter is actually faster. One recent case in my clinic had just had the awake procedure done, and was bought to me about eight weeks later. This was a seven- pound little sweetheart of a dog. On examining him, I found that the rearmost molars still had a lot of thick, hard tarter on them, leading me to the conclusion that it had been impossible to get to those teeth because he was awake. When we cleaned his teeth with anesthesia, we found that the insides of most of the teeth were also not clean.
The bottom line, in my opinion, is that to perform non-anesthesia dental cleaning in pets is unkind (if not even cruel in some cases), and leads to poor-quality care and results. I feel this is why most veterinarians choose to offer high-quality, anesthesia-based dental cleanings.
Dr. Tom Boekbinder graduated from the Ontario Veterinary College, Canada, in 1977. Dr. Tom arrived in Carmel eleven years ago and founded the Carmel Holistic Veterinary Clinic (CHVC). CHVC is an Integrative Medicine practice utilizing holistic and alternative practices with state-of-the-art modern medical and surgical services. Dr. Tom has increasingly turned to natural diets and supplements to support his patients’ bodies in healing and was a pioneer in introducing the Monterey Peninsula to raw food diets. Dr. Tom is joined by Dr. Shannon Hudzik as associate and partner. CHVC is located at 26135 Carmel Rancho Blvd., Carmel, CA. (831) 620-0115.