In the last article, we discussed different options for dental homecare. Eventually, however, regardless of how diligent you have been about brushing every day, you will find that dental tartar – that nasty, yellow/brown hard buildup – is starting to accumulate. If this process continues, plaque and tartar will start to invade underneath the gumline, causing gingivitis, and eventually periodontal disease, which can lead to pain and tooth loss. It is at this time, before irreversible damage has been done, that your veterinarian may recommend a dental cleaning procedure.
These procedures are sometimes called “prophies” or even just “dentistries”, which are a bit of a misnomer. A “prophy” is a procedure meant exclusively to prevent disease, but by the time we veterinarians have the opportunity to do a cleaning, our patients are almost always already exhibiting some degree of dental disease. If the disease is mild enough, as with gingivitis, a cleaning followed by good homecare can reverse the process, and the mouth may be as good as new afterwards. If the problem is more progressed, as with periodontal disease, then the changes that have been done are irreversible, and we can only help to prevent things from getting worse. We will discuss more about periodontal disease in the next article, and concentrate on what a dental cleaning procedure involves today.
The first, and probably most important point to discuss is that a proper dental cleaning always involves a general anaesthetic. There is absolutely no other way to do what we need to do without doing any harm. There are some people out there that claim that a dental cleaning can be done on an awake animal, or just under light sedation, but they are WRONG. To do so is negligent, and the practice has been strongly disapproved of by every reputable veterinary dental organization around. It may be possible to scrape off tartar from the crown (the visible part of the tooth) in a very good, compliant, awake animal, but it is impossible to clean adequately underneath the gumline without the animal asleep. Underneath the gum is where the action is – it is infection here that causes gingivitis and periodontal disease, and this can continue no matter how white and sparkly a pet’s teeth may look after having had only the crowns of the teeth cleaned.
Although some veterinarians may do things slightly differently, here are the basic steps involved in a complete dental hygiene procedure:
1. Anaesthesia
Firstly, the patient is examined, and sedated. Once he or she is sleepy, we will place an intravenous catheter to inject the drugs and give intravenous fluids during the procedure. The patient is then given drugs to induce anaesthesia, a breathing tube is placed into the trachea, and the patient is placed on oxygen and a maintenance gas anaesthetic. During the procedure, a staff member will monitor the patient’s heart, respiration, oxygen levels, and blood pressure. At our hospital, we always perform pre-anesthetic bloodwork prior to anaesthetizing our patients, as we feel this helps minimize any risks associated with the procedure, although this requirement may differ from clinic to clinic.
2. Dental examination
After the patient is anaesthetized, a complete oral examination is conducted. The space between the teeth and the gums is probed with a dental instrument at several spots around each tooth, and the results are recorded on a dental chart. Any abnormalities such as missing or fractured teeth, overgrown gums, receding gums, deep pockets around teeth, and cavities are charted and recorded.
3. Dental Radiographs (Xrays)
If a clinic has a dental Xray machine, then Xrays are usually taken at this time. There have been many instances where a tooth looked healthy to me on examination, but had significant disease occurring underneath the gums, which I didn’t realize until I had seen the Xrays. Without dental Xrays, we may be missing a lot of dental problems that could be causing infection and pain, and it is almost impossible to be able to correctly diagnose dental problems and develop a proper treatment strategy.
4. Formulate a treatment plan
Once the examination and Xrays have been completed, we will have a very good idea of what kind of shape the mouth is in, and be able to formulate a treatment plan for our patient. This can make things difficult for veterinarians – with humans, we have a treatment plan already in place when we go to the dentist. With pets, we don’t know what exactly we’re going to find until we have them anaesthetized and are able to do a complete examination. For this reason, it is important that an owner can be contacted during the procedure so that we can discuss any problems and their potential treatment, and proceed to correct them while the animal is asleep.
5. Supragingival plaque and tartar removal
Visible tartar is removed from the crowns (the exposed part of the teeth) with a variety of hand instruments or ultrasonic scalers, just as when we go to the dentist. Usually, an antibacterial solution is flushed into the mouth before cleaning begins to help reduce the population of bacteria present. This is the part of the cleaning that will leave your pet’s teeth pearly and white, but it is not the most IMPORTANT part of the cleaning…
6. Subgingival plaque and tartar removal
THIS is the most important part of a dental cleaning procedure. The plaque and tartar that have accumulated underneath the gumline is what causes dental disease, and it must be thoroughly removed using hand instruments called curettes and ultrasonic scalers. If any significant pockets are present around the teeth exposing the roots of the teeth, then the roots must be scraped completely free of any plaque, tartar, and inflamed gum tissue. Occasionally, this may involve surgery to open up a flap of gum tissue to allow better access to deep pockets.
7. Specific therapy to treat problems
It is not uncommon to find lesions (diseased areas) during the dental examination, Xrays, or even during the cleaning procedure itself. These problems need to be specifically addressed and treated. Treatment may involve periodontal surgery, extractions, instillation of medications around the teeth, or more advanced procedures such as root canals.
8. Polishing
When the teeth are cleaned, tiny little grooves are created in the enamel (outer hard layer) of the tooth. These tiny grooves make it easier for bacteria and plaque to attach to the tooth later, and must be removed. Polishing is a procedure whereby a dental instrument is used to smooth out the surface of the enamel. Earlier, we mentioned why “awake” dental cleanings are a bad, bad idea – here is another reason. If the teeth are scraped in an awake animal to remove the supragingival tartar, it leaves these tiny grooves, which cause the teeth to develop tartar more quickly following the procedure, which could lead to further dental disease. Polishing avoids this problem in the anaesthetized patient.
9. Irrigation
Loose debris in the pockets around the teeth is removed by flushing with a water spray, which may contain an antibacterial solution.
10. Fluoride application
Sometimes, a veterinarian may choose to place a fluoride product on the teeth after the cleaning is complete. In humans, fluoride is used mainly to prevent caries (cavities). As cavities are very uncommon in dogs and cats, fluoride use in veterinary medicine is controversial, and is not always used.
As you can see, a complete dental oral hygiene procedure, when properly performed, is a quite complex and time-consuming task. These procedures may take anywhere from 40 minutes to several hours, depending on the size of the patient, and the amount of tartar and disease present. Along with good home care, these procedures are an indispensable part of keeping our pet’s teeth healthy.
If you think that your pet may be suffering from dental problems, please see your vet. Caught early, a cleaning procedure can alleviate all discomfort and signs of disease. If performed later, there may already be irreversible dental damage that has occurred, which may warrant more extensive surgery or extractions. As always, prevention is the best medicine.
For more information on complete dental hygiene procedures, along with cool step-by-step pictures, click on the following link to Dr. Gignac’s website: http://www.yorkvilleanimalhospital.ca/index.php?view=pageView&pageid=209
