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Health & Fitness

Anesthesia Free Dental Cleanings: Fact Vs Fiction

In this blog post Dr. Pattie will discuss the risks of such dental practices as well as the benefits to traditional dental cleaning.

Veterinarians, including those at Aldie Veterinary Hospital, are more frequently encountering cats and dogs that have had "Anesthesia-Free Dental Cleanings" (AFDC) or what has been termed "Non-professional Dental Scaling" (NPDS).  The alternative is professional dental scaling & polishing with a licensed veterinarian, which is exactly the same procedure you do at your dentist checkups.  The only difference is that animals don’t “open up and say ahhh”, therefore a professional veterinary dental cleaning requires general anesthesia.

There are a few reasons for this notable increase of AFDC/NPDS. Fortunately, this is primarily the result of more owners being aware of the importance of oral health care for their pets. These owners also have natural concerns about the risks of anesthesia and the associated costs. Unfortunately, AFDC/NPDS has been marketed as an attractive alternative that touts the same benefits as professional scaling without the cost and risks. By definition, a complete and comprehensive oral exam includes a complete visualization of all dental/oral structures, probing the gum-line, and may include taking dental X-Rays. In spite of the claims, it is IMPOSSIBLE for anyone to perform a "complete, comprehensive and thorough" oral assessment on companion animal patients without the assistance of general anesthesia. 

The reason for this impossibility is because not all surfaces of a pet's teeth are even visible in an awake patient. Periodontal disease affects the surfaces 360 degrees around the teeth (just like humans). Most periodontal infections start in locations BETWEEN teeth where the toothbrush does not reach. The hidden bacteria that cause periodontal disease and infection is NOT addressed with AFDC/NPDS, and a false sense of accomplishment is conveyed. These pets may continue to be affected for years with chronic oral infection which progresses to the point of pain, gum recession, and eventually tooth loss. When infections are finally recognized, the patients are usually older, and often have additional health related problems that increase the risks of anesthesia. Instead of treatment being an elective, preventive procedure on a relatively healthy patient, there is often urgency to treating the problem on a less healthy patient.  Additionally, the problems become not only more urgent to treat, but treatment costs are then often greater.

As for general anesthesia, no one should ever say it is without risk; however, it can absolutely be approached safely with appropriate pre-sedation screening and trained professionals.  Most major anesthetic risks are associated with two things: 1) the general health of the patient (young & healthy vs. older & existing problems), and 2) the level of training, knowledge, caring and skills of those individuals administering and monitoring the anesthesia itself.  Bottom line: risk of sedation must be outweighed by the potential benefit (pain relief, etc.).  The more we know the details of your pet's health, the safer we can deliver anesthesia and effective oral health care.

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Furthermore, with AFDC/NPDS, proper treatment of any oral problem is even less possible to perform and can even be dangerous.  In California, a recent (2012) case of a patient’s fractured jaw led to a ruling against the party as practicing veterinary medicine without a license.  The reason this accident happened was due to the non-sedated animal struggling against attempts to perform oral work.

It is acceptable for well-meaning clients to decline professional treatment because of their fear of anesthesia or if they cannot afford it.  However, it is another thing to be fooled by the marketing of untrained individuals that target this fear and offer an alternative that is "just as good". AFDC/NPDS is a service whose marketing sounds appealing and logical on the surface, however, it promises a lot more than can be delivered.  It is essentially a cosmetic procedure that addresses only the visible surfaces of only some of the pet's teeth. Unfortunately, without the benefit of general anesthesia, pets most often do not receive the proper and timely preventative care, diagnosis and treatment of oral problems. What results are pets that are not receiving thorough preventative care, and some have serious dental problems that go undiagnosed and/or are improperly treated.

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For general information on performance of dental procedures on veterinary patients, please read the AVDC Position Statement on Veterinary Dental Healthcare Providers, which is available on the AVDC web site (www.AVDC.org). For information on effective oral hygiene products for dogs and cats, visit the Veterinary Oral Health Council web site (www.VOHC.org).

 

Caroline Pattie, DVM, CVA
February 2013

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