Dentistry – What a Pain! Part 1
By Erika Ball, DVM
If I were to ask you what you thought was the most common surgical procedure that I perform at my hospital, what would you guess? I’ve already given away the answer, but without that hint you likely would have guessed spays and neuters, am I right? The fact is, the number of dentistries I do far exceeds the number of spays, neuters, and all other procedures that I do combined! Pretty much all pets would benefit from dentistry at some point(s) in their lives. I am specifically a cat vet, but most of the principles I am about to discuss apply to both dogs and cats.
How much training in dentistry do you think veterinarians get in veterinary school? Quite a bit, right? That would be a logical answer, considering we do more dentistry than any other procedure. I hope you didn’t bet any money on your answer, because you would lose. The answer is, with few exceptions, little to no training at all in dentistry. I think I watched a dental cleaning once in vet school. We spent more time on diagnosing oral tumors than routine dental cleanings and extractions. Now Imagine you have a toothache. Do you go to your primary care physician? Would you let them extract it or would you rather be sent to a dentist or oral surgeon for that? The human dentistry field originally developed as an off-shoot of general medicine as it required a considerable amount of training above and beyond what is taught in medical school. The same applies to veterinary medicine. If you are a graduate of veterinary school, and want to perform dentistry properly, you must seek additional training. There are boarded veterinary dentists, for sure, but they are few and far between, and may not be an feasible option financially or locally for many pet owners. It is up to veterinarians to seek that additional dental training post graduation in order to do right by our patients. Everything from recognition of various dental lesions and diseases, taking and interpreting dental x-rays, performing nerve blocks, to proper treatment and oral surgery techniques needs to be learned, as none of this is even discussed in most veterinary schools let alone practiced. Unfortunately the majority of vets never seek out that training, and more concerning is that they may not even realize that they need it.
Let’s talk a little about anesthesia first. In order to properly clean a pet’s teeth, measure periodontal pockets, clean out bits of tartar that have extended underneath the gingiva, take x-rays, and ultimately perform extractions, the pet MUST be under general anesthesia. This is for the safety of both your pet and the personnel performing the cleaning, as well as for the thoroughness of the procedure. Don’t be fooled when your groomer tells you that they’ve cleaned your pets teeth. They may look nicer externally, but ultimately hasn’t doesn’t your pet any good. They are most certainly not cleaning up under the gumline, nor are they cleaning the inside surfaces of the teeth. In addition, sometimes removing that tartar exposes painful and diseased teeth which can cause further pain. Sharp instruments are frequently used to clean teeth, and if your pet moves during this process it can result in a laceration of the gums or worse. Many people are afraid to put their pets under anesthesia, which is understandable. Anesthesia is not without risk, and should always be taken seriously. Prior to anesthesia your pet should have a thorough exam, have a blood work panel performed to screen for diseases that may increase the risk of anesthesia. I also routinely recommend running a relatively new test that can screen for hidden heart disease, which can be a big problem in cats and can significantly impact your cat’s risk for anesthesia. In some cases an ultrasound of the heart should also be considered prior to anesthesia. Anesthesia, when performed properly, especially with the appropriate pre screening tests, is actually quite safe. In order to induce and maintain anesthesia safely each pet should have an IV catheter through which fluids, and emergency drugs (if needed) can be administered. The administration of intravenous fluids during anesthesia is essential for maintaining a normal blood pressure to protect your cat’s vital organs. They should have a preanesthetic mixture consisting of small amounts of several different sedating medications, as opposed to a large amount of a single drug. Pain medication should always be included in this combination, as preventing pain is much more effective than trying to address that pain once it arises. Next an inducing agent is given. Once anesthesia is induced with this fast acting and rapidly eliminated agent, a breathing tube should be placed and your cat is maintained on gas anesthesia. This breathing tube also allows administration of oxygen and prevents the debris, fluid and bacteria from the mouth from entering the airways. There should be a dedicated and properly trained technician present to monitor the anesthesia at all times. Monitoring equipment should include multiple factors and parameters, including ECG readings, temperature, oxygen saturation of blood, blood pressure, heart and respiratory rate, etc. This should not be the same individual that is cleaning the teeth and taking x-rays. You cannot effectively monitor anesthesia while simultaneously performing these other tasks. Anesthetic emergencies and death rarely occur without some advanced warning, but you need to be actually monitoring the anesthesia in order to pick up on these warnings. There is so much more about dentistry that I want to discuss with you, so this article will be a two-parter. Stay tuned for part 2.