If you have ever tried to open your dog or cats mouth, you probably have an idea of why it is difficult to properly examine the oral cavity even if your pet has been trained to accept mouth handling or is used to having their teeth brushed.
During your pets annual physical (or if your pet is in specifically to assess the mouth), the oral cavity is given a cursory exam. This exam lasts only a few seconds, depending on what the patient will allow. At this time the Veterinarian can briefly observe the overall appearance of the teeth. Is there tartar accumulation? Is there gingivitis? Can we identify teeth that have gum recession? Are there teeth with obvious breaks/fractures/chips? Is the odour from the breath foul? Are there missing teeth or obvious mobile teeth? Are their obvious resorptive lesions (cavities)? This is a lot of information to obtain in a brief window of time.
If we identify any of these problems, a dental procedure will be recommended, and this is performed under general anesthesia. To better explain why this requires anesthesia, lets first talk about what happens during a dental procedure.
First, your pet has their blood, and urine tested to assess whether they are a safe anesthetic candidate. Sometimes other tests may be required depending on the health status of your pet.
Once we have these results, an anesthetic protocol is planned to best suit your pets needs. This will include the type of intravenous fluids administered during and after the procedure. The rate at which the fluids are administered, a combination of drugs given as a pre-medication injection before inducing general anesthesia. The type of intravenous induction agents given to facilitate placing an endotracheal tube. The type of maintenance anesthetic drugs administered to keep the patient asleep, local freezing drugs, and post-operative pain medications.
Once your pet is under general anesthetic, a complete oral health assessment and necessary treatments are performed. It starts with an examination of the oral cavity, including the appearance of the gums, back of the throat, roof of the mouth, tongue, and underneath the tongue. The purpose of this to ensure there are no abnormalities like growths or lesions. Next, each tooth is probed at the gum-line, all around the circumference of each tooth. It helps us identify any sub-gingival pockets, beyond the normal, acceptable depth. Pockets tell us that infection has advanced below the gum-line, indicating the periodontal disease is present. During this time we are also assessing each tooth for the following: fractures, breaks, chips, wearing of the crown, enamel defects, discoloration of the tooth, gum recession and degree of gingivitis, degree of tartar accumulation, if the tooth is loose, cavities, missing teeth, extra teeth, and intra-oral x-rays of each tooth to assess what is occurring below the gum-line.
All findings are charted on a dental record. Then, in conjunction with the x-rays, each tooth is evaluated for the degree of pathology and treatment plan is initiated. As you can see, this degree of thoroughness would be impossible on awake patients, resulting in missed abnormalities and reduced standard of patient care.
The next step is scaling and polishing each tooth’s entire surface. The back of the throat is packed with gauze to prevent debris (tartar that is being cracked off), water (from rinsing the mouth), blood (from irritated gums) and polishing paste from going down the throat or pooling where the endotracheal tube was placed. At the end of the procedure, the mouth is thoroughly lavaged with clean water, the gauze at the back of the throat is removed, and the back of the throat is checked to ensure all fluids/debris have been flushed away. Any fluid or debris that makes its way to the back of throat, unchecked, has the potential to be swallowed or aspirated by the patient once awake.
Not including any teeth that may require extraction, the entire procedure up to this point will have taken 1 to 1 and ½ hours, on average. Unfortunately, our canine and feline companions can not comprehend why we need them to lay still, with their mouth open, not swallowing, for this amount of time. It is especially the case if they have a painful mouth due to dental disease.
If teeth require extraction, dental nerve blocks are performed to freeze the area. It allows us to use less gas anesthetic to keep them asleep. Even though our patients are unconscious, their bodies still register pain and will react under anesthetic. Thus, causing us to have to increase anesthetic drugs if we do not use local freezing agents.
During tooth extractions, the gum around the tooth is often cut and flapped to allow easier access to the roots of the teeth. Once the tooth is extracted, the gums are then sutured shut. It is a delicate procedure, which requires the patient to be perfectly still. Any patient movement could result in a scalpel blade or extraction instrument slipping and causing unwanted injury to other parts of the mouth. Post-extraction x-rays are then done to ensure the entirety of the tooth has been removed. Without this tool, roots tips or tooth fragments could be left behind. It can result in continued infection and pain within the mouth.
How would this type of procedure be done on an awake patient? It would be impossible. Anesthetic-free dental cleanings will involve physical restraint of the patient, likely in excessive force, which can result in physical injuries to the patient. It is unlikely that the proper scaling technique of the teeth can be performed, due to patient movement. Polishing of the teeth cannot be done, as the patient would end up swallowing the polishing paste. The proper examination of each tooth, including probing under the gum-line could not be done. X-rays of the teeth could not be done, as the x-ray films are placed in the mouth, requiring no patient movement.
In conclusion, dental procedures under anesthetic allow your veterinarian to provide the safest and best standard of care to your pet.
Written by: Christine Strang, RVT