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Why is my vet always banging on about my pet’s teeth?

Written for Bayside Dog Owners Group and Bayside Cat Lovers Melbourne by a highly respected Veterinary Practitioner who, at this stage, wishes to remain anonymous - pen name "The Inside Vet"

Last month under the pen name “The Inside Vet” I wrote an article all about the ins and outs of prescription meds, and very much appreciated the interest it generated. Kate has asked if I would put something together about pet dental care, and options for both surgical and anaesthesia free dental care.

It might surprise pet owners to read this, but dental disease is pretty much the most common problem that your local vet encounters. It certainly is for us! Perhaps around 25 years ago, the veterinary industry began to focus more on the importance of good dental care for their patients.

Just like us humans, dental disease in animals has implications that go way beyond the mouth: bacteria in the bloodstream from tooth decay can cause significant harm to internal organs including the heart, liver & kidneys. We take it pretty seriously; when an owner is discussing a significant surgery and asks “oh, and could you please do her teeth whilst she is under”, it is something to be very carefully considered, due to the risk of releasing a stream of harmful bacteria into the bloodstream that could adversely affect the operation.

We are also careful not to schedule a patient having a dental clean just prior to say, a different patient having a TPLO (orthopaedic surgery to a dog’s knee) in the same operating theatre. The reason: not wanting to cause a cloud of aerosolised bacteria to threaten the outcome of the knee surgery. We are somewhat fortunate as vets in Australia, in that a local company manufactures some of the best veterinary dental equipment in the world (it’s so good and in such demand that Australia is not even its biggest market!) But we, like many many clinics in Australia, are very proud of our high-quality dental base and use it regularly to perform dental scaling, polishing and (when necessary) dental extractions.

Along with equipment manufacturers, pet food giants such as Hills and Royal Canin also invest in developing products to improve dental health in pets. Hills t/d and Royal Canin dental foods use a mix of both chemical and mechanical action to reduce tartar build up in your pets’ teeth. Most of all, we veterinarians encourage owners to brush their pets teeth! And it’s probably about as easy as getting your younger kids to do it! There are some wonderful toothpaste flavours for pets such as beef or chicken flavour….mmmmm….

When teeth brushing, special foods, chews, raw bones and water additives aren’t keeping tartar and plaque at bay, it’s time for the vet to step in. That means a general anaesthetic. “Sleep dentistry” for humans is a relatively new term I have heard advertised on the radio in recent years. Basically, the idea is that for those people who would rather jump off a bridge than visit the dentist, an anaesthesiologist puts them under and supervises their breathing and other vitals whilst the dentist attends to their teeth and gums. Having had a painful wisdom tooth extraction whilst very much wide awake, I can definitely see the appeal! I sometimes wonder if human dentists borrowed the idea from vet clinics and zoos, where a general anaesthetic is the only realistic option if we expect a dog or cat to lay patiently with their mouth open for a vet to scale and polish teeth (let alone perform an extraction or filling.) It also massively reduces anxiety and trauma for the pet, as they are blissfully unaware of the dental procedure.

One of the common concerns of veterinary dentistry is that it’s often the older patients that need the most dental treatment, and the older the patient, the greater the owner’s concern about their pet undergoing a general anaesthetic. How big is the risk? Statistically speaking, the risk of a general anaesthetic with modern medicine responsibly managed is very low; but what do statistics matter when it’s your own pet?

Let’s put those numbers into perspective. In almost 3 decades of working in a vet clinic, I am one of the fortunate vets that have never experienced an unexpected anaesthetic patient death. Many of my colleagues with significant years in surgery have sadly experienced one, and from time to time I might meet a vet who has experienced more than one. What I can definitely tell you is that it is extremely traumatic for the entire team, and even more so for the vet who has to make the very worst phone call of their careers. Some vets never return to surgery. As I say, I am lucky. But the reality is that it might be one unfortunate patient death out of a whole lifetime of performing multiple surgeries on a daily basis. Those are extremely favourable statistics, and what is the alternative for a dog or cat suffering ongoing dental pain?

Leaving any patient with long term dental pain does not sit comfortably with me, and in circumstances like that, I think it is absolutely vital to weigh the risk of an anaesthetic in a vulnerable patient against the the alternative of long term suffering. Is there another alternative?

‘Anaesthesia-free’ dental cleaning has been discussed in previous posts on social media for several years and, in a general sense, is what us vets encourage all owners to do: basically, to clean your dogs’ and cats’ teeth! I think it is important to distinguish between at-home brushing and a dental scale & polish performed by the vets under general anaesthetic. The easiest way to understand this is by drawing a comparison with human dental care.

We brush and floss our teeth at home, and this is often totally adequate to control the tartar, and to keep our teeth & gums healthy. Once calculus (hardened calcium deposits) form on your teeth, it will take a dentist with more advanced equipment to remove it. The human dentist would perform a scale & polish. This is exactly the same for dogs and cats.

Brushing at home by owners, raw bones, chews, water additives and dental food may be all that’s needed. However, if we miss areas of plaque, calculus forms and then it will take a vet with advanced equipment to clean them properly.

There are numerous animal care businesses advertising anaesthesia-free dental cleaning, and promoting their services as an alternative to veterinary dentistry under general anaesthetic. This has caused concern amongst veterinarians, perhaps because it is suggested as a replacement, rather than an intermediate step in a pet’s dental care. Is it a replacement?

As a vet, I always want owners to make informed choices, and whilst I have emphasised my enthusiasm for owners to clean their own pet’s teeth, I am cautious about recommending these types of services unless I am fully aware of their approach.

My personal view as a vet is that I have no objection to these services provided that no sharp instruments are being used and that the patient is not experiencing fear, anxiety or discomfort. What I don’t want to see is a pet’s anxiety increase when being handled or examined by a stranger, possibly to the point that it won’t let us look in their mouth at all?

In regard to sharp instruments, if the patient is awake (as is the case In anaesthesia-free cleaning) it doesn’t take much for a sudden wriggle on the part of the dog or cat for an injury to occur. In addition to this, if used incorrectly, they could cause damage to the enamel. These services talk of ‘swaddling’ and liken it to being wrapped up like a baby. To my mind, it is more a form of restraint that very few patients would find relaxing. Veterinary behaviourists are quick to point out that our aim is to eliminate the fear, rather than to control a reaction to the fear.

Owners should also beware of the “tip of the iceberg”scenario: If we are only cleaning the visible part of the tooth (the crown), which is generally what a conscious animal will allow, we are neglecting the part of the tooth below the gumline, and perhaps on the inside of the mouth. This can promote a false sense of security as “my pet has had a dental and there were no concerns.”

As a vet, am I simply protecting ‘my turf’ ? Absolutely! But I speak from pride in my profession, rather than any concern for income. I am reluctant to see anyone performing dental procedures on a patient without undergoing the formal training that I and my colleagues have undertaken. I also note that we as vets must answer to the board if we cause harm.

So in conclusion, I recommend brushing your pet’s teeth, using chews, water additives and dental food. If you are considering an anaesthesia free dental cleaning service, ensure that they are not using sharp instruments; soft brushing only (and definitely not power tools!), and finally that it is not a traumatic experience that increases your pet’s reluctance to be examined or treated.

I do see a role for anaesthesia free dental cleaning; perhaps for when owners are not confident (or physically capable) of brushing their pets’ teeth themselves. In this situation, someone with more confidence in animal handling may be able to assist.

Perhaps most importantly, to understand that it is an intermediate step, not a replacement for a comprehensive dental examination with subsequent appropriate treatment by a qualified professional. For that, it’s a visit to see me!

Thanks for reading! — The Inside Vet

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