It can be nerve-wracking dropping your pet off for a procedure at the vets. Most pets will require dental treatment at some point in their lives to keep them healthy: we thought perhaps you might like to know a little bit more about the procedure, and what actually happens to your pet during the day.
Before the procedure, you will be advised to fast your animal overnight. This means that after their supper the night before the procedure, they shouldn’t have any more food. They shouldn’t have breakfast on the morning of the procedure. However, it’s important that they have free access to clean fresh water. The reason we fast animals before anaesthesia is because they may regurgitate their stomach contents under anaesthetic. As they are unable to swallow, they would be at risk of inhaling or aspirating this material. An empty stomach reduces this risk.
Upon your arrival at the practice, once you have checked in with our reception staff, you will usually see one of the nurses for your pet to be admitted to the clinic for the day. Sometimes, if there is something more complicated to discuss, your admit appointment may be with a vet. At the appointment, your pet will be weighed, and the nurse will take a brief history to find out how their general health has been recently and if they are on any medications. This is to ensure we select the right anaesthetic drugs for your pet to be as safe as possible, or to determine if we advise any other investigations be carried out before hand. Often, our dental patients are more senior pets. Anaesthesia isn’t inherently more dangerous for older pets, but they may be more likely to have other underlying conditions we need to be aware of and manage. For that reason, we often advise a blood test be carried out before their procedure, or that they receive IV fluids.
After being admitted, your pet receives a physical examination by a vet. This is to determine that they are fit and healthy enough to go ahead. If they are having a blood test, the sample is usually taken now, and checked in our in house laboratory. The vet then calculates the dose of pre-medication the pet will receive. A pre-med is a combination of pain relief and a sedative, which prepares them for anaesthesia.
Once their pre-med has taken effect, an IV cannula is placed into your pet’s vein. We use this to deliver the anaesthethic induction drug into the vein, as well as any other drugs that might be required. We start the anaesthetic, and place an endotracheal tube into their airway. This allows us to administer oxygen and anesthetic gas, and keeps the airway clear while we work in the pet’s mouth. A throat pack is placed at the back of the throat to catch any water, saliva or other debris that might enter the airway. We are then ready to start cleaning your pet’s teeth.
First, a complete examination of the mouth and throat is carried out. We make a note of any damage or inflammation of the soft tissues such as the tongue, back of the throat, lips or gums. It’s very difficult to examine these fully in animals when they are awake. We examine the teeth using a dental probe. We use this to look for any loss of attachment between tooth and gum. If this has occurred, the probe slides under the gum next to the tooth. The depth of this attachment loss helps to determine how healthy the tooth is. We use a sharp probe to check the enamel for any defects. All our findings are recorded on a chart.
Next, the teeth are cleaned using an ultrasonic scaler. This vibrates at very high speed to break up the hard mineralised tartar on the tooth. The most important part of this process is to clean under the gum line. This cannot be done effectively and safely when the animal is awake, as it is uncomfortable; it also involves the use of sharp instruments that can damage soft tissues if the pet were to move. This is the reason that conscious dental cleanings are ineffective and widely considered unethical by veterinary organisations such as the Royal College of Veterinary Surgeons, British Veterinary Dental Association, and the European Veterinary Dental Society, as well as the American Veterinary Dental College, American Veterinary Medical Association and Australian Veterinary Association. You can read the RCVS statement here.
Once the tartar is removed from the teeth, they may be checked again with the probe; damage might have been hidden under thick tartar. This is also the stage when x-rays are taken. About 50% of the tooth structure is actually the root sitting within the jaw. The only way to assess this is with radiographs. Dog and cat teeth have much longer roots than human teeth. In cats, full mouth radiographs are advised (just like you have when you go to the dentist). This is because problems with the enamel and roots are very common. In dogs, generally only teeth that are damaged or have marked periodontal disease will be radiographed, to help us decide if the teeth need to be extracted.
If any teeth are badly damaged, they are then extracted by the vet. Did you know that nurses can carry out scaling of the teeth, as well as take the x-rays, but removing a tooth is legally an ‘Act of Veterinary Surgery’? To remove a tooth, we use a sharp tool called an elevator which is inserted into the tiny gap between the tooth root and the gum. This is then used to gradually tear and break down the periodontal ligament holding the tooth in place, and the tooth is removed. Many teeth in dogs and cats have two or even three roots. In these cases, we use special instruments to lift up the gum overlying the tooth. We then use a high speed drill to cut the tooth into sections, and remove some of the bone on the outside of the tooth socket. This allows us to remove the individual roots one by one without damaging them. The gum is then stitched back into place with special suture material that dissolves once the gum heals.
Once their procedure is complete, your pet is monitored by one of our nurses until they have recovered fully from their anaesthetic. They then return home later that afternoon. We like to keep our dental procedures until a little bit later in the day than other surgeries, as they will often have been under anaesthetic much longer than other routine procedures, so can take a bit longer to recover.
Three days after the procedure, they will have a check up with the vet. We check that their extraction sites are healing as expected. They will then have a check up with the nurse a week later to discuss ongoing homecare with you. After a cleaning under anaesthetic, plaque and bacteria will start to build up again almost immediately; in order to make the most of the care they have received, ongoing regular cleaning of some sort should be started as soon as the mouth has healed enough.