Monday, August 22, 2011
Biting down on anesthesia-free pet dentistry, By Christie Keith, Special to SF Gate
You've probably seen it advertised on a flyer, pinned to a pet supply store bulletin board: "Anesthesia-free dental cleanings for dogs and cats." You looked at it with interest, maybe even some excitement. Who doesn't want to avoid the risks of anesthesia for their pets, especially older or sick pets? After all, we don't need full anesthesia to get our teeth cleaned, so really, why do our pets? And wouldn't it be nice to get all that nasty tartar off your dog's or cat's teeth and have a fresh, clean mouth breathing in your face first thing in the morning again?
If you look into it a little further, what you'll discover is that during "anesthesia-free dental cleaning," tartar is removed from the visible part of your pet's teeth. The teeth are brushed, then rinsed, and sometimes the mouth is given a visual examination and the teeth polished to the extent the pet allows. After this cleaning, the mouth looks and, at least for a while, smells a lot better. This service is usually offered in grooming shops, sometimes by the owner or staff of the grooming business and sometimes by individuals who visit the shop on a periodic basis.
Dig a little deeper and you might find out that the person offering the service calls him- or herself a "pet dental hygienist" or "pet dental technician." But since there are no recognized licensing, training, certification or registration programs to back them up, those titles are just marketing slogans. Even if the person offering this service is a human dental technician or registered veterinary technician, California law requires that dental operations be performed by or under the direct supervision of a licensed veterinarian. State courts have found that "Without question, the techniques of anesthesia-free teeth cleaning ... fall within the definition of a dental operation."
Where the procedure is done or by whom or even its legality aren't the most important issues, however. "Periodontal disease is a disease of the teeth that occurs below the gum line," says Dr. Steven Holmstrom of the Animal Dental Clinic in San Carlos. "The calculus and tartar that 'anesthesia-free' procedures attempt to remove is above the gum line, on the crown of the tooth. It completely misses the plaque and calculus that are doing the damage below the gum line."
Isn't some cleaning better than none at all? Holmstrom says no: "The teeth can visually look great on the crown. This gives a false sense of security, because, meanwhile, the disease is silently progressing below the gum line."
He expressed concern over serious dental and other health issues that can easily be missed when exams -- even exams done by veterinarians -- are conducted without anesthesia. "All too often we have patients come in that have had repeated, even monthly [anesthesia-free] dental cleanings,'" he said. "We do a clinical exam, correctly anesthetize the patient and take dental radiographs. I've had many patients where multiple extractions were necessary to treat the advanced disease. What might have been easily treated, now was untreatable, except by extractions."
If all that's true, why are so many pet owners afraid to let their pet be anesthetized for a procedure that has so many benefits? The answer is that, just as with humans, anesthesia carries some risk to animals. Respiratory and heart problems can occur and, in rare cases, even death.
Holmstrom, who is a board-certified specialist in veterinary dentistry, agrees that concerns over the safety of anesthesia are the biggest selling point of these procedures. "The chief reason these 'anesthetic-free cleanings' are popular is the public fear of anesthesia," he told me. "But over the past two decades, veterinary anesthesia protocols and drugs have improved dramatically. Anesthesia done properly is much less risky than people imagine, and they should be encouraged not to fear it. They should ask questions, naturally, to ensure their pets will receive optimum care, but as we all know, even very elderly and very young patients can be anesthetized safely."
Nancy Campbell, RVT, DVT, is a registered veterinary technician in the Seattle area. She has been specially trained and certified in advanced dentistry and anesthesia techniques, and maintains a popular Web site devoted to educating pet owners to better understand veterinary medicine and procedures.
"It infuriates me to see the way so many people who perform this procedure use the fear of anesthesia as a marketing tool," she said. "Instead of educating pet owners, they frighten them, then offer something that will supposedly allay their fears. But it doesn't. There's not only no benefit, there's real risk. Worst of all, by intensifying the owner's fear of anesthetizing the pet, they don't only discourage owners from getting proper dental care, but make it harder for the owner to consider letting their dog or cat be anesthetized for other procedures, as well -- even life-saving surgery."
Dental procedures themselves might be considered "life saving." The American Veterinary Medical Association says that "80 percent of dogs and 70 percent of cats show signs of oral disease by age three, often indicated by bad breath, a change in eating or chewing habits, pawing at the face and mouth and depression. Besides causing receding gums and tooth loss, the infection may enter the bloodstream, potentially infecting the heart, liver and kidneys." The AVMA calls oral disease "the most frequently diagnosed health problem for pets."
Although some pet owners might be unaware of the need for pet dental care, they aren't the main market for anesthesia-free dental cleanings. It is, in fact, those pet owners who are most concerned about their pets' health who are drawn to what they perceive as a safer way to get needed care for their dog or cat. What they don't realize is that it's not possible to properly examine and clean a dog or cat's teeth without anesthesia -- and that's something a lot of pet owners find extremely confusing. Why do we anesthetize pets to do dental procedures that in humans are usually done without anesthesia?
If we could explain to the pet what we're doing and that they need to hold still, if we were able to put equipment in their mouths to prevent them from inhaling dental debris, if we could be sure they wouldn't move during the procedure, then there would be no more reason to anesthetize them for a dental examination and cleaning than there would be for a human being. But that isn't the case. Animals who are appropriately anesthetized are not afraid, not in pain, and are completely restrained, permitting an unrestricted dental examination and cleaning.
There is an even greater benefit to doing dental cleanings on an anesthetized pet: protecting the lungs. Campbell explained that, during cleaning, tartar and other debris from the mouth can be inhaled by the pet, which can lead to pneumonia and other respiratory complications. "This is why we use a cuffed endotracheal tube," she said, "which can only be used if the pet is under general anesthesia: to protect the airway and the lungs from accidental aspiration during a dental cleaning."
Of course, knowing all this, many pet owners will just feel more uncertain about what to do. Sure, dental disease is scary. So is anesthesia. What can pet owners do to minimize the risks of both?
While some of the tendency to poor dental health in pets is due to genetics, some of it is due to things we can control. Daily brushing of your pet's teeth really does make a difference in their dental health. You can ask your veterinarian about new products that help prevent dental disease in your pets. And you can think about diet and how it might impact their oral health. While wild animals eating their natural, wild diet can suffer broken teeth and other dental problems, they rarely have problems with tartar.
The other way to minimize the risk of anesthesia is to get truly expert veterinary care for any procedure requiring anesthesia. Anesthesia protocols, for dentistry or any other procedure, should be individualized and state-of-the-art. Your dog or cat must have an IV catheter inserted; this isn't optional. Make sure that there is a trained staff member whose only task during your pet's procedure is monitoring his or her body temperature, heart rate and rhythm, respiratory rate, oxygen levels and other important vital signs. During anesthesia, your pet should be kept well hydrated and warm.
Talk to the veterinarian doing the procedure about pain control and treatment. Analgesia -- the control of pain -- has advanced enormously in recent years in veterinary medicine and has been shown to reduce the stress of anesthesia and surgery and to improve recovery rates. Proper pain control can also reduce the amount of anesthesia used during the dental procedure.
While there are fewer than a hundred board-certified veterinary dental specialists in the United States, several of them practice in the Bay Area, including Holmstrom. You can locate a diplomate of the AVDC by searching on their Web site.