Anesthesia Free Dental Cleanings
At ADOS we are more frequently encountering dogs that have had “Anesthesia-Free Dental Cleanings” or what has been termed “Non-professional Dental Scaling” (NPDS). The alternative is professional dental scaling that require general anesthesia. There are a few reasons for this notable increase. 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, Anesthesia Free Dental Cleaning 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 structures, periodontal probing and dental X-Rays. In spite of claims some individuals make, it is technically impossible for anyone to perform a “complete, comprehensive and thorough” oral assessment on our companion animal patients without the assistance of general anesthesia. As a corollary, proper treatment of any oral problem is even less possible to perform in a conscious patient.
Unfortunately, without the benefit of general anesthesia, pets most often do not receive the proper and timely preventative (maintenance) care, diagnosis and treatment of oral problems. 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”. This is a service whose marketing sounds appealing and logical on the surface, however, it promises a lot more than can be delivered. Non-Anesthetic Dentistry is essentially a cosmetic procedure that addresses only the visible surfaces of only some of the pet's teeth. 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.
As previously noted, not all surfaces of a pet’s teeth are even visible in a conscious patient. The palatal and lingual aspects of the dentition are simply not visible on an awake patient. Periodontal disease affects surfaces for 360 degrees around the teeth. Even in human patients, most periodontal infections start in locations between teeth where the toothbrush does not reach. The bacteria that cause periodontal disease are especially biologically active subgingivally (below the gumline). Subgingival biofilm bacteria and infection (if developed) is not addressed with Non-Anesthetic Dentistry and a false sense of accomplishment is conveyed. These pets continue to be affected for years with chronic oral infection (and associated inflammation) which progresses to the point of potential pain, tissue loss and eventually tooth loss. When infections are finally recognized, the patients are usually older, often have additional health related problems that increase the risks of anesthesia. Instead of treatment being an elective procedure on a relatively healthy patient, there is often urgency to treating the problem on a less healthy patient. The problems become not only more urgent to treat, but treatment costs are then often greater.
Although there is always some degree of inherent risk, most major anesthetic risks are associated with two things: 1) the general health of the patient. When appropriate preanesthetic health screening have been performed, the risks associated with anesthetic management are markedly lower. This same holds true for most of our patients with other existing health related problems. The more we know the details of your pet’s health, the safer we can deliver anesthesia and effective oral health care. 2) the level of training, knowledge, caring and skills of those individuals administering and monitoring the anesthesia itself; this of utmost importance for anesthetic safety. This arena of care is behind the scenes, and is not the same in every veterinary (or human) facility. It’s what goes on behind the scenes that counts. ADOS maintains among the highest standards for anesthesia and anesthesia related care. At ADOS, we are located within The Life Centre campus and we have the benefit of collaborative expertise, knowledge and support of other AVMA board-certified specialists. This includes cardiology, internal medicine, emergency/critical care, ophthalmology, oncology, and surgery. Please refer to the preanesthetic risk assessment page on our website for information on proper preanesthetic risk assessment and required testing.
In California, a recent (2012) case of a fractured jaw led to a ruling against the party preforming anesthesia “Anesthesia Free Dentistry”. Subsequent to this ruling, the Board of Veterinary Medicine of the State of New Jersey banned Non-professional Dental Scaling as practicing veterinary medicine without a license. Veterinarians who support individuals involved with “Anesthesia-Free Dentistry” should consider the professional, ethical and potential legal considerations.
The Following Is The American Veterinary Dental College (AVDC) Position Paper on Companion Animal Dental Scaling Without Anesthesia
In the United States and Canada, only licensed veterinarians can practice veterinary medicine. Veterinary medicine includes veterinary surgery, medicine and dentistry. Anyone providing dental services other than a licensed veterinarian, or a supervised and trained veterinary technician, is practicing veterinary medicine without a license and shall be subject to criminal charges. Recently (2012, in the state of California) an individual who was performing anesthesia free dental cleanings on pets, was convicted of practicing veterinary medicine without a license.
This position statement addresses dental scaling procedures performed on pets without anesthesia, often by individuals untrained in veterinary dental techniques. Although the term Anesthesia-Free Dentistry has been used in this context, AVDC prefers to use the more accurate term Non-Professional Dental Scaling (NPDS) to describe this combination.
Owners of pets naturally are concerned when anesthesia is required for their pet. However, performing NPDS on an unanesthetized pet is inappropriate for the following reasons:
1. Dental tartar is firmly adhered to the surface of the teeth. Scaling to remove tartar is accomplished using ultrasonic and sonic power scalers, plus hand instruments that must have a sharp working edge to be used effectively. Even slight head movement by the patient could result in injury to the oral tissues of the patient, and the operator may be bitten when the patient reacts.
2. Professional dental scaling includes scaling the surfaces of the teeth both above and below the gingival margin (gum line), followed by dental polishing. The most critical part of a dental scaling procedure is scaling the tooth surfaces that are within the gingival pocket (the subgingival space between the gum and the root), where periodontal disease is active. Because the patient cooperates, dental scaling of human teeth performed by a professional trained in the procedures can be completed successfully without anesthesia. However, access to the subgingival area of every tooth is impossible in an unanesthetized canine or feline patient. Removal of dental tartar on the visible surfaces of the teeth has little effect on a pet's health, and provides a false sense of accomplishment. The effect is purely cosmetic.
3. Inhalation anesthesia using a cuffed endotracheal tube provides three important advantages: a) the cooperation of the patient with a procedure it does not understand, b) elimination of pain resulting from examination and treatment of affected dental tissues during the procedure, c) and protection of the airway and lungs from accidental aspiration.
4. A complete oral examination, which is an important part of a professional dental scaling procedure, is not possible in an unanesthetized patient. The surfaces of the teeth facing the tongue cannot be examined, and areas of disease and discomfort are likely to be missed.
5. Hand scaling alone (without polishing) can make the tooth surface even more plaque retentive. The metal scaler is harder than the surface of the tooth and it can microscopically etch the surface. These microetchings create a rougher and larger surface area where plaque bacteria can attach to the tooth. This actually accelerates plaque (bacteria) and calculus reaccumulation and fuels gingivitis and periodontitis.
Safe use of an anesthetic or sedative in a dog or cat requires evaluation of the general health and size of the patient to determine the appropriate drug and dose, and continual monitoring of the patient. Veterinarians are trained in all of these procedures. Prescribing or administering anesthetic or sedative drugs by a non-veterinarian can be very dangerous, and is illegal. Although anesthesia will never be 100% risk-free, modern anesthetic and patient evaluation techniques used in veterinary hospitals minimize the risks, and millions of dental scaling procedures are safely performed each year in veterinary hospitals.
To minimize the need for professional dental scaling procedures and to maintain optimal oral health, the AVDC recommends daily dental home care from an early age. This should include brushing or use of other effective techniques to retard accumulation of dental plaque, such as dental diets and chew materials. This, combined with periodic examination of the patient by a veterinarian and with dental scaling under anesthesia when indicated, will optimize life-long oral health for dogs and cats.
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). Please feel free to also visit a website put together by the AVDC Public Relations Committee (www.AVDC.org/AFD/) for more helpful information for veterinarians and pet owners. For information on effective oral hygiene products for dogs and cats, visit the Veterinary Oral Health Council web site (www.VOHC.org).