Published by: Ingrid King. Last Updated on: June 28, 2023 by Crystal Uys
Written by The Animal Medical Center
When people go to a human dentist, we sit in the dentist’s chair, often time grasping the armrests tightly with white knuckles in anticipation of the procedure about to happen. When the dentist or hygienist tells us to say “ahhhhhhhh” or turn our head, or open our mouths, we may be reluctant, but we can follow their directions to facilitate their work. When they place x-ray films or digital sensors in our mouths and tell us to hold them while they walk out of the room, we do as they say.
February is Veterinary Dental Month. Our pets need the same dental care as we do; maybe more, since they don’t brush or floss twice a day. Our pets are not as cooperative when it comes to saying “ahhhhhhhh” or when it comes to following directions, yet they often experience the same anxiety as their owners when a stranger is poking and squirting things around their mouths.
There has been recent movement to perform anesthesia-free dental cleanings on veterinary patients. The rationale for performing dentistry on awake dogs and cats is that it will be cheaper for the client and safer for the patient. This movement is in direct opposition to the American Veterinary Dental College’s position statement entitled, “Companion Animal Dental Scaling without Anesthesia.”
I understand that many people are reluctant to perform proper dental procedures because of the need for general anesthesia, especially in the older patient. I am a firm believer that “age is not a disease,” and age should not be the deciding factor in determining the safety of general anesthesia for any patient. Pre-anesthesia testing can help determine the risk associated with general anesthesia and aid in the decision whether or not to perform a dental procedure. These tests help determine the function of the internal organs such as the liver, kidneys, heart and lungs, which are necessary to help the body safely handle anesthesia.
Proper anesthesia starts with the pre-op testing but also involves choosing the proper anesthetic drugs safest for each pet. The Animal Medical Center’s Dental Service always places an intravenous catheter to administer drugs, fluids and emergency drugs if needed. We also place an endotracheal, or breathing, tube to protect the airway and deliver the anesthetic gas and oxygen mixture to the lungs. Anesthetized dogs and cats at the AMC are connected to various monitoring equipment to measure the vital signs such as pulse rate, blood oxygen levels, blood pressure, electrocardiogram, and carbon dioxide levels. Finally, we monitor at regular intervals to make sure the vital signs are stable. If any painful procedures need to be performed, we also have the ability to utilize local anesthesia to minimize the amount of general anesthesia needed.
There are many advantages to performing any dental procedures under general anesthesia. First, when we scale the calculus (also known as tartar) off the teeth, there are often large or small pieces of calculus removed. If an animal is properly intubated with a breathing tube, then this calculus cannot be aspirated into the lungs or “swallowed down the wrong pipe.” The biggest advantage to working on a patient under general anesthesia is the ability to work around every side of every tooth. In the awake patient, the veterinary dentist has a very limited view of most of the teeth in the mouth. It’s easy to see the outside of the front teeth, but virtually impossible to evaluate the inside surfaces of many teeth and impossible to see many of the back teeth. A proper cleaning involves cleaning off all of the calculus from every surface of every tooth, both above and below the gum line. In the awake patient, the area below the gum line cannot be seen, yet under anesthesia it is much easier to fully visualize this area.
Once the teeth are cleaned, they need to be evaluated for periodontal disease. This involves gently probing under the gum line in several areas around each tooth in the mouth to measure periodontal pockets, or separation of the gums from the tooth root surface. Imagine trying to do this in an awake dog.
Approximately 75% of cats presenting for dental procedures have a decay of their teeth called tooth resorption. These are holes or decay in the teeth that often start at the gum line. They are quite painful and diagnosed by probing along the gum line with an instrument called an explorer. Again, this is not the type of procedure that could be tolerated by a cat without general anesthesia.
Proper dental procedures require intra-oral x-rays to make a diagnosis. A piece of film or a digital x-ray sensor is placed in the pet’s mouth. The person taking the x-ray steps out of the room and exposes the film or sensor and then walks back in the room. Not too many awake pets will tolerate this type of procedure.
Finally, with 75% of cats having tooth resorption and 80% of all dogs over the age of 5 years having periodontal disease, most veterinary dental patients need some type of surgical procedure to correct the abnormality. Finally, it is much easier to perform oral surgery when I’m not working on a moving target.
Given the complexity of the procedures necessary to clean, diagnose and treat a pet’s mouth, it is easy to understand why general anesthesia is so vital to performing proper veterinary dental care. My recommendation to anxious pet owners over the years is to use a little general anesthesia every year in order to maintain a healthy mouth, rather than wait until the mouth has severe disease and needs several hours of surgery to clean up a messy and painful mouth.
For over a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit www.amcny.org. To make an appointment, please call 212.838.7053.
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About the author
Ingrid King is an award-winning author, former veterinary hospital manager, and veterinary journalist who is passionate about cats.
My healthy young (3 y.o.) cat died last week after having anesthesia for a dental cleaning. He never woke up from the anesthesia. The techs tried all afternoon to wake him up. It was awful. (Ten years ago an older, frailer cat of mine died similarly. I thought I was going to spare this young guy a lifetime of dental problems.
Never again.
I can’t remember the last time my dental hygienist put me under to have my teeth cleaned. In fact, with a regular maintenance program getting my teeth scaled is a breeze. Same for my 5 yr old westie, and countless other pets I know who have had the same amazing results from non-anesthetic cleaning. Not all companies are the same. Mine, in Barrie Ontario, does not use a heavy blanket to restrict the pet as I’ve seen some American companies use. They spend the first 15 min gaining the dog’s trust, and 45 min later it’s done! I never would have believed that my hyper, nervous pup, who trembles every time we enter the vet’s office, would have allowed this. She was calm and relaxed. This is how it should be. Yes, I understand that there are some more critical situations that would require the use of anesthesia, but a general cleaning? Give me a break. Did I mention the cost is around $200 vs the outrageous quotes I was given of up to $900???? Use your common sense, and do your research. At the end of the day, it’s always going to be about money.
Anesthesia-free dental is essentially a cosmetic procedure, Kim. While some dogs may agree to it, I’ve yet to meet a cat who will allow it. And while these procedures may be less costly, they do not address problems that can’t be seen without a thorough look at what’s going on underneath the gum line. Here’s more information on why it’s not a good idea: https://consciouscat.net/2011/12/05/this-trendy-dental-procedure-may-do-your-cat-more-harm-than-good/
I definitely understand how scary it is to have your pet put under anesthesia, but what you see on the outside doesn’t necessarily reflect what’s truly going on inside.
One of my boys had sparkling shiny teeth at first glance, but ended up having six extractions with one being particularly nasty. There were no signs of dental issues, and not even any bad breath.
Another one of my boys underwent countless diagnostics in an attempt to find out why he was losing weight when I finally scheduled an oral exam under sedation for him. When it was all said and done, he had 5 procedures with 4 surgeries. He currently has no teeth, and is gaining his weight back. While he is FIV+, not even the Vet thought that his mouth could have been to blame. That was based on an oral exam (awake) with a very laid back and cooperative cat.
I would definitely recommend dental x-rays if it’s determined that your cat needs any work beyond an exam and cleaning. My boy endured so much that he didn’t need to because x-rays weren’t performed at the immediate onset of issues following extractions.
Thank you for this post. This week, my (almost) 4 year old cat Shadow will be having his first dental. The vet says he has feline herpes and that has caused the condition of his gums. My other cat Bella (also almost 4) has great teeth. They both eat wet food only and some raw for treats.
I have tried to brush his teeth, but I can’t because he bites and scratches me too much. I can barely get his claws trimmed.
I just had my cats teeth cleaned (her once a year check up that is included in her pet plan I pay for) and urine testing was also done. It was found that she has a urinary infection. I was given pills to give to her twice daily. She does NOT like taking pills at all!! I read on the internet that you can crush the pill (which my vet said was OK) and mix it with cream cheese, and then smear it on the cats paw, or wherever and they lick it which gets the pill into them.
I only had that “Laughing Cow” brand of spreadable cheese, so I crushed the pill and mixed it into a small portion of the cheese and spread it on her paw. It DID work and she licked every bit of it off. I was wondering if you thought that this was okay to do. Will the cat still get the full effect of the antibiotic and is that cheese harmful in any way. I just love my cat with all my heart so an answer would be greatly appreciated!
Sincerely,
Maccamare
Maccamare, hiding your cat’s antibiotic in some cheese is not going to affect the medication – she’ll still get the full effects while she feels like she’s getting a treat. Since this works for you, I’d stick with it. If you’re looking for an alternative, you can also try Pill Pockets – they’re cat treats that are designed to hide pills inside. Most pet stores carry them.
I know I would hate to have dental work done without anesthesia, so there’s no way I would put my cat through that unnecessarily!
The anesthesia does worry me and I’m a nervous wreck until I know my cats are okay. However, I really can’t imagine being able to properly clean a dog or cat’s teeth without using it. One thing I do that dramatically lessens the need for teeth cleanings is to feed my cats raw organic chicken necks once a week.
Julia, I haven’t tried the organic raw chicken necks, but I’ve heard that they can help keep teeth clean and healthy.
They do!! Some people refer to them as “nature’s toothbrush” because they really scrape away the plaque and tartar. I have an 11 year old cat who has never needed to get his teeth cleaned. He gets regular vet checkups and they always marvel at the condition his teeth are in.
No one has mentioned the use of antibiotics involved in dental cleaning. Vets can legally administer needed antibiotics, where–say a groomer doing a teeth cleaning–cannot. I think that’s something to be considered too.
That’s a great point, Debbie.
I wonder if there is something in between full and anesthesia-free cleaning? My vet feels the risk is too high for anesthesia for Merlin at age 16.
Layla, it’s always difficult to weigh the risk of anesthesia in an older cat vs. the benefits of keeping his teeth healthy. Anesthesia can be tailored to the needs of senior cats, but short of full anesthesia, there’s probably not much that can be effectively done. With a cat Merlin’s age, chances are that once they get in there and take a closer look, they’ll find problems that require more than light sedation.
I’ve been a licensed vet tech for 3 years. I have seen thousands of animals and have yet to meet one that would tolerate a dental without anesthesia. I can’t comprehend who has suggested such a thing. If they are practicing anesthesia free dentistry, they are either ripping off the client by not really doing anything, or they are putting the animals through an incredible amount of stress that is likely much more dangerous than the risks incurred with proper anesthesia.
DesC, I’ve always wondered about the level of stress these animals go through during these anesthesia-free “dentals.” In all my years in veterinary medicine, I just haven’t met a lot of pets that would willingly lie there and allow their teeth to be scaled and polished without anesthesia. Most pet owners are barely able to brush their pets’ teeth!
It would be nice if we didn’t use anesthesia for dentals, but it’s unrealistic to think we can do this. What I often encounter is that when the cat needs a dental, it’s not just due to some simple situation where the cat could tolerate the cleaning while awake. They usually need a tooth removed or on the brink of having a resorption problem.
What I’d love to see is a discussion about DIET and the effects on a cat’s teeth. My guess is we’d avoid a lot of these problems by putting the cats on a raw diet and removing dry kibble from their bowl.
Robin, I just had this discussion about the connection between dental health and raw feeding with a holistic vet last week. When she pronounced Allegra’s gums and teeth super healthy, I asked her whether she thought they’d stay that way now that Allegra is eating raw food. Allegra is my first raw-fed kitty. All my other cats have had varying degrees of dental issues, and have always had to have their teeth cleaned at least once a year.
The vet said that at Allegra’s age, if she had a genetic predisposition to dental disease, we’d probably be seeing some early signs by now. In her experience, if there’s no genetic component that affects dental health, the raw food contributes considerably to keeping teeth healthy.
I can’t imagine having a dental procedure done on my cat without anesthesia. Like the article says, I’m a human being and I’ve learned that despite the fact that dental cleanings are uncomfortable at times, the hygienist isn’t doing this uncomfortable stuff just to hurt me. But if I were going to have serious dental surgery like, say, a root canal or one of those tooth scalings that goes down below the gum line, I’d darn well want a lot of novocaine–at the very least!
I don’t know how dentists deal with little kids who need serious dental work (they do exist), but they probably sedate them and give them lots of local anesthetic. Why should it be any different with animals?
Janea, I’m with you on wanting my novacaine for any dental procedures that might cause even minor pain! I’ve often thought that it might actually be kind of nice to be knocked out even for my regular cleanings – I just hate the sensation of the scraping, polishing, and all that comes with it.
That is some really good information. It is really scary to have your cat put to sleep for surgery. But it has to be done and the teeth do need looking after. I cannot imagine doing a cat or dog’s teeth without anesthesia.
Marg, I agree, it’s always worrisome when we have to put our cats under anesthesia for any surgery. It’s a case of weighing risk vs. benefit, like so many things when it comes to health.