Q: Is it is possible to perform dental cleanings without anesthesia?
A: Concerns about anesthesia are probably the most common cause of anxiety in the clients who present their pets to me through our Dental Service with their pets. Certainly I understand this, but I believe dental procedures without anesthesia are not in the best interest of our patients’ health or safety. This is supported by the American Veterinary Dental College (our professional organization) as well.
As compared to sedation dentistry general anesthesia is much safer and better controlled than ever before. We have an intravenous catheter in place to provide fluids or drugs. The patient is intubated so that we can provide oxygen or breathe for the patient. We are closely monitoring and can improve any parameter including blood pressure, heart rate, oxygenation and temperature. Sedated patients may not breathe well or could have a low heart rate but there is less control over the outcome. Most importantly, without a cuffed endotracheal tube, patients can aspirate the fluid from the cleaning and may develop pneumonia. Especially in in sick or older patients, I believe general anesthesia to be much better controlled and safer than sedation. Sedation should also legally only be provided under the direction and care of a veterinarian.
Also, dental cleanings can not be done in a safe or thorough way with sedation alone. Very sharp instruments such as curettes or ultrasonic scalers are used, and in sedated and moving patients these instruments can cause injury. Xrays cannot be done with sedation, so many problems are missed. I often find missed problems in patients who have had multiple or recent cleanings under sedation. We cannot clean between teeth, on the inside surfaces of the teeth, or behind the teeth without sedation. Periodontal probing cannot be performed. After scaling the teeth, a rough surface is left behind and without proper polishing (which can’t be done in a moving patient), plaque and calculus will accumulate more quickly. Most importantly, no cleaning or scaling can be done under the gum line. This is the source of periodontal disease. Cleaning the crowns of the teeth may provide temporary cosmesis or improvement in odor, but it creates the illusion that we are treating the source of disease. I compare this to washing a car which isn’t running well. It seems as if the situation is improved but nothing has been done to determine the source of the problem. I think there is no place in our profession for anesthesia-free dental cleaning. I do strongly believe that treatment of periodontal disease is one of the best ways to improve our pets’ health, comfort, well being and longevity.