physical exams (including the morning of the procedure, even if they were just seen for vaccines earlier in the week), are up to date on vaccines, and that any comorbidities have been resolved or managed. For example, if a heart murmur is detected, a cardiac work up must be performed before putting the animal under anesthesia for any elective procedure. If the pet has a higher American Society of Anesthesiologists (ASA) status but has severe dental disease that is impacting its quality of life, serious precautions need to be taken. However, that does not necessarily mean that the pet cannot undergo anesthesia and it just needs to suffer with its dental disease. Tailor the drugs to the individual—do not use the same blanket procedure for everyone. If you always use dexmedetomidine as part of the pre-op sedation, for example, it would be a good idea to find an alternative with a dog with a heart murmur. Also, consider the following steps to increase anesthesia safety: 1. Pre-oxygenate before inducing anesthesia. 2. Have your technicians pay close attention during anesthesia monitoring. They should notify you early of any changes, even those that may be considered subtle or benign. 3. Keep anesthesia time as short as possible. If there is a lot of work that needs to be done, it is better to stage it into two sessions a month apart than have a perfect mouth on a dead pet that underwent a three-hour procedure and did not wake up. Pay attention to the most pertinent problems and save the rest of the pet’s dental care for another day in the near future. Key point : If you find something concerning on a pre- anesthetic exam or blood work, trust your gut. Dentals are typically elective procedures, so if you have a bad feeling, postpone the procedure, and recommend pursuing the other problem. The owners may be annoyed but will understand, and they will be grateful in the long run. The benefits to general anesthesia are numerous and include: ● Less stress and no pain to the pet (that is worth repeating—no pain to the patient!) ● A protected airway with the cuff of an endotracheal tube ● Diminished chances of aspiration ● Ability to perform a thorough oral examination ● Ability to obtain a dental radiograph, which may uncover significant periodontal disease under what may seem to be perfectly healthy crowns. (RSPCA, 2019) Performing dentistry under general anesthesia allows for a more accurate assessment of the true status and classification of disease and allows for a more targeted treatment approach to be made, yielding the best outcome. Uncovering unforeseen problems not only improves the pet’s well-being but is good for hospital revenue as well. That is revenue gained that would have been missed without anesthesia. Additionally, all surfaces of the teeth can be scaled and polished when under anesthesia. In the case of gingivitis, sometimes getting an ultrasonic scaler under the gumline is all you need to do to resolve the problem. When talking to clients, it’s important to emphasize that anesthesia allows for a more complete and accurate assessment of the level of disease (including what cannot be seen by a naked eye), a more thorough cleaning in a pain- free way, and a greater understanding of what treatments (if any) need to be recommended in the greatest interest of the pet’s health.
significant underlying periodontal disease and providing a false sense of security or health to the owners? Does the benefit of a lower cost outweigh the risk of knowing the pet is not receiving thorough dental care? Some people believe that anesthesia is risky, and there are some pets that will sit for a veterinary dental hygienist to scale their teeth without a need for anesthesia. In addition to avoiding the risks of anesthesia, the owners also avoid the cost of anesthesia, making anesthesia-free dentals less expensive than traditional dentistry. Providers of anesthesia- free dental services often believe that some owners just will not commit to full anesthetic dentals. After the owners see (and smell) the difference in their dog’s mouth and breath associated with anesthesia-free dentistry, however, they may start understanding and appreciating the importance of dental health. Additionally, these providers may argue that lesions detected during an anesthesia-free dentistry may encourage owners to pursue a full anesthetic dental assessment, treatment, and prophylaxis (ATP). Finally, these providers may believe that some owners cannot afford full dental ATPs and an anesthesia-free dental is better than counterarguments. An animal undergoing anesthesia-free dental treatment does not understand what is happening. They do not understand why someone is holding them down and sticking sharp objects in their mouth. They cannot understand “Relax” or “This might pinch,” as we are told by our dentists. This procedure is often associated with at least some level of stress and discomfort. Furthermore, some anesthesia-free dentals still do receive mild sedation. This decreases the pet’s ability to swallow as fluids are sprayed into their mouths. Their airway is not protected with an endotracheal tube. They most likely do not have all the proper vital monitoring equipment that they would need under anesthesia. Beyond that, they still receive the same subpar cleaning as if they are fully awake. Pets are not necessarily safer without anesthesia. nothing—at least it is removing some plaque. While these may be valid points, there are valid Let us say we have the world’s most cooperative dog. They will let you do anything to them while awake, and they just sit on the hygienist’s lap while he or she scales their teeth. Even then, the hygienist will still be only cleaning the outside surface of the teeth. They still are not cleaning under the gumline, where most of the diseases that cause bone loss and abscesses exist. They still will not be able to take oral radiographs, which means that many of the significant signs of periodontal disease may be missed, allowing it to go untreated and progress into more serious diseases. However, pet owners often do not truly understand the difference in quality between anesthetic and anesthesia- free dentals. They come in with their dog for bad breath or trouble chewing, just a couple of months after receiving an anesthesia-free dental. “What do you mean he needs another dental procedure? He just had one. Why didn’t you find that problem the first time? So now you are telling me you are taking more money because it is more advanced disease than it would have been if it was found several months ago?!” I am sure you get the point. The bottom line is that clean teeth are not necessarily healthy teeth. Of course, there are downsides to general anesthesia. Yes, it is more expensive for the owner, and that is something a lot of owners have trouble getting past. And there is always some risk associated with anesthesia, no matter how routine the procedure. Serious adverse events are rare, but statistics mean nothing to the individual. Risk can be minimized, however, by ensuring that dentistry patients have recent
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