Steps to a Dental Cleaning

           

1            Ever wonder what we are doing when your pets come in for a dental? Here are the steps that are taken at West Ridge when we perform a dental cleaning on your pet.

     

      First the “pre-dental “portion where the level of your pet’s dental disease is determined by a veterinarian.  This diagnosis is given on a grading scale of one through four.  Dental grade 0: No sign of plaque or tartar. Grade 1 disease/mild gingivitis: Margin of attached gum is inflamed and swollen. Plaque is covering teeth. Grade 2 disease/moderate gingivitis: Entire gum is inflamed and swollen, mouth is painful and odor is noticed. Grade 3 dental disease/severe gingivitis: Cherry red and bleeding gums - destroyed by infection and tartar. Sore mouth and bad breath odor is evident. Grade 4 dental disease/severe gingivitis: Chronic infection is destroying the gum, tooth and bone. A bacterium is spreading through the body via the bloodstream and may damage the kidneys, liver and heart. During this initial appointment, we will also run a complete blood chemistry on your pet.  We are checking to ensure that your pet’s kidney and liver functions are adequate for anesthesia, as these are the organs that process that drug.

            Once the dental grade has been given and the bloodwork comes back perfect; it is time to admit on your pet on the day of their dental.  Once we have taken your pet into our inpatient area the Veterinarian performs their pre-anesthetic exam while a certified veterinary technician checks your pet’s temperature, heart rate, and respiratory rate. Our ultimate goal is to keep your pet as safe as possible while they are with us, as well as ensuring that no last minute infections or problems have cropped up.

Then when it is time for the procedure to begin, an IV catheter is placed, allowing IV fluids to be running during the procedure to help control blood pressure and to allow emergency access to life saving drugs if needed. Then all of our patient are placed under general anesthesia and are intubated to protect the air. All patients are set up with heart monitoring, blood pressure monitoring, oxygenation monitoring, and CO2 monitoring. They are also manually monitored throughout the procedure by a trained technician, with a DVM always standing by for support.

All of our veterinary technicians follow strict guidelines during the dental procedure; these steps are as follows:  

            1.  A visual evaluation of plaque and/or tarter as well as gingivitis is performed. This is grading the degree of plaque or tarter on each tooth in your pet’s mouth. It is also an evaluation of the amount of gingivitis of the gums around each tooth. At this time we also determine if any teeth that should be visible above the gum line are missing, fractured, or have any physical changes.

Ultrasonic Scaler

      2. Next is ultrasonic scaling. We use this tool as the vibration and water break up, or pulverize, calculus on the surface of each tooth without scraping them thus preventing cracks in the enamel of the tooth, which causes more dental infections later in life. The ultrasonic scaler is used on all surfaces of the teeth and below the gum line as well; effectively cleaning the teeth.

3.  After your pet’s teeth are cleaned, we check for sulcus depth; or pockets, holes, or possible separating of the gums from the tooth. We use a very small 1mm instrument and check both the front and the backs of all present teeth. All measurement are recorded.

            4. Then it’s time to polish! The polishing head removes any remaining plaque and smooth’s the tooth’s surface. A product called prophy paste is used which is similar to the toothpaste used by dentists. Once all the teeth are clean, we rinse out the mouth removing excess prophy paste and any debris from the teeth.

 

Polishing of the Teeth

            5. Dental radiographs are an essential part of any dental procedure and are one huge item missing from anesthesia free cleanings. This allows us to view what cannot be seen of the teeth because it is under the gums.  Like people, most of our pet’s teeth actually reside beneath the gum line.  With radiographs we can evaluate if teeth are truly missing or broken off, the degree of tooth damage due to fractures or feline oral resportive lesions (FORL), or any other abnormalities. These will also show is if a tooth is abscessed or if there is bone loss in the jaw which is an effect of dental disease.  When extracting teeth we also use dental radiographs to determine that all pieces of the root have been completely removed. If these pieces remain in the gum or bone they can cause further abscesses.

6. Once all cleaning and dental radiographs are completed, the veterinarian will make their final assessment of the teeth. They will evaluate the radiographs and physically check any problem areas. If further dental treatment is needed such as extractions, bonded sealants, or clindoral

Full Mouth Digital Radiographs

application, you will be contacted for approval and to answer any questions you might have.   

Once the first side is completed, your pet will be turned to the other side and steps 1-6 will be performed again.  Once all treatments are completed your pet will be woken up from anesthesia in the arms of one of our loving veterinary technicians. They will be consistently monitored during this time as well to ensure that their transition is smooth and easy.

Getting your pets teeth evaluated, cleaned, and treated is essential to your pet’s life time health and longevity.

Additional reading on steps to a dental procedure:

1. http://davisonvethospital.com/dentals.html

2. http://www.avds-online.org/info/dentalcleaning.html

3. http://www.catclinicofcobb.com/dentistry.pml

4. Veterinary Dentistry for the Technician and Office Staff.  Written by: Steven E. Holmstrom

 

What You Can't See

                While most people begin thinking about their pet’s dental health when they start smelling their breath it is important to note that dental disease does not just affect the outside part of the tooth and the gums in our pets. There is also damage to the internal organs and systems.

Red and Swollen Gums

                In addition to bad breath, we also can see a loss of appetite due to irritated and bleeding gums and inflammation and reddening of the gums.  When your pet’s gums become inflamed it is  The disease continues to spread from the surface and outside of the tooth to under the gum line. Toxins are secreted into the bloodstream and the bacterium stimulates our pet’s immune system into action; causing white blood cells to trigger the inflammatory chemical signals to move into the space between the gum or bone and the tooth (observes as swelling in the gums). Bacteria from dental disease can enter the bloodstream; this is called sepsis, and can be carried throughout the body. This can lead to serious and potentially fatal problems. Sinus infections can be caused when the disease progresses into the sinus cavities. As the dental disease progresses there are several changes in your pet’s mouth that can be observed both visibly and with radiographs, including loss of the jaw bone around the teeth and loss of the soft tissue (or gum); this is called periodontist.

Loss of jaw bone can be seen in this X-ray

                 Diabetes is another major health concern with dental disease. Deep periodontal pockets, tooth root abscesses, and severe gum inflammation often occurs with poor oral hygiene. Diabetes is a systemic disease caused by increased blood glucose levels due to absence or decreased levels of insulin. The body organs and their functions are affected either directly or indirectly. Periodontal disease can lead to increase susceptibility to infections.

                Good dental health, including home care and routine anesthetized cleanings, is just as important for our pets as it is for us.  With proper dental care, including home care and regularly scheduled anesthetized dental cleanings, our pets can live longer less painful lives.

Why Anesthesia is Necessary for Dental Cleanings and Treatments

                Any time our pets have to undergo anesthesia, we naturally get worried.  General anesthesia comes with inherent risks including minor reactions such as vomiting while anesthetized or during recovery, to more serious risks that can be life-threatening.  West Ridge Animal Hospital takes every precaution possible to reduce risks associated with anesthesia by performing pre-anesthetic exams and blood work to identify any possible problems before the animal is under anesthesia.  Examination by a veterinarian can identify conditions that may put your pet at risk while in surgery.  Risk factors include but are not limited to: heart disease, obesity, advanced age, and dehydration.  Blood panels allow the veterinarian to “take a look inside” the animal to be sure of their health prior to surgery.  They look for signs of infection; kidney and liver disease, as these organs are where the body metabolizes the gas anesthesia; or any other health conditions that may compound the risks associated with general anesthesia.  Owners are also asked to fast their pets before anesthesia, and while anesthetized, patients are intubated, just like humans are for procedures.  Fasting and intubation reduces the risk of patients vomiting and aspirating on food, which can cause aspiration pneumonia. 

A Veterinary Technician shaves the
leg prior to placing the IV Catheter

                While under anesthesia, patients are closely monitored by a trained technician.  Vital signs including heart rate, blood oxygen levels, and blood pressure are monitored and recorded.  These records are kept in the patient’s chart for future reference.  Patients also have an intravenous catheter placed to safely and efficiently deliver fluids to keep them hydrated, and medications for pain and antibiotics if necessary.  Waking up from anesthesia can be disorienting for some patients, which is why every patient has a trained technician dedicated just to helping that patient recover from the effects of anesthesia. 

                The risks of general anesthesia on a healthy pet are generally outweighed by the health benefits your pet will receive from a professional anesthetized dental cleaning.  Removal of plaque and tartar not only make teeth look nice and their breath smell better, but reduces the risk of progressive periodontal disease, which can cause abscessed teeth and jaw bone loss.  Bacteria allowed to flourish in the mouth can easily enter the blood stream and cause other systemic infections of the lungs, heart, kidneys, liver, and neurological systems.  According to an article from the American Veterinary Medical Association (AVMA): "Untreated periodontal infections often lead to more serious health problems because of chronic pain and infection, and subsequent stress on the immune system," says Dr. Carlson. "These untreated conditions can then lead to heart valve disease, kidney disease, and even diabetes and cancer, not to mention the significant discomfort associated with dental infections.”

                Some pet owners who are not comfortable with anesthesia opt to give their pets what are called “anesthesia-free” dental cleanings.  During these types of cleanings, pets are sometimes sedated and sometimes left fully conscious.  Metal dental tools are then used to scrape the plaque and tartar off the teeth.  There are however, problems with this method of cleaning.  The first is that conscious or semi-conscious animals may not tolerate having their mouths handled and may attempt to struggle.  This is not safe for the pet or the people handling the pet, especially since most dental tools are sharp; they could end up injuring the pet or themselves.  During an anesthetized cleaning we

Ultra Sonic Scaler

have the ability to use an Ultrasonic Scaler to remove plaque and tartar build-up.  This special tool uses pressurized water and vibration to clean, rather than scraping with metal tools.  Scraping the teeth with something harder than the surface of the tooth can actually create scratches and cracks in the tooth’s enamel.  These spaces will weaken the tooth and also create the perfect place for even more bacteria to thrive. 

Radiograph of Canine Teeth

These anesthesia-free cleanings only allow the tops, or crowns, of the teeth to be cleaned.  This is more cosmetic than it is therapeutic, or for the benefit of the pet’s health.  Anesthesia is also required to probe each tooth, remove debris from below the gum line, and to take intra-oral radiographs.  At least 60% of the tooth is located below the gum line.  Radiographs allow the veterinarian to evaluate this section of the tooth, check for fractures, bone loss, and abscesses.  Occasionally, a pet may need to have a tooth extracted.  This can only be done safely and pain-free with the use of general anesthesia. 

                For these reasons, the American Animal Hospital Association (AAHA), which sets the standard for veterinary practice and care, recently updated their guidelines for veterinary dental procedures.  According to another article from the AVMA, “The guidelines state that cleaning a companion animal’s teeth without general anesthesia and intubation is unacceptable and below the standard of care.”  While there are always risks associated with general anesthesia, in healthy animals that have received the proper pre-anesthetic examination and lab work the benefits of receiving a professional anesthetized dental cleaning far outweigh the risks.  Contact your veterinarian today about scheduling a cleaning for your cat or dog!