Anesthetic vs Anesthesia-Free Dentals for Dogs
This quandary can be answered by a simple risk vs benefit analysis. Do the risks of anesthesia outweigh the benefits of a good thorough oral exam, with oral x-rays, multi-surface scaling and polishing, and deep under-the-gumline cleaning?
Or do the benefits of avoiding anesthesia outweigh the risk of potentially missing significant underlying periodontal disease and providing a false sense of security/health to the owners? I think you can see where I’m going with this, but let’s probe this a little more (pun intended).
There is a wave of popularity among pet owners for anesthesia free dentals, AKA non-anesthesia dentals. The belief is that anesthesia is risky and there are some pets that will sit for a veterinary dental hygienist to scale their teeth.
In addition to avoiding risk of anesthesia, the owners also avoid the cost of anesthesia, making anesthesia free dentals much cheaper too.
Why Some Vets Offer Anesthesia-Free Dentals
I spoke with a veterinarian, whom I respect greatly, who recommends anesthesia-free dentals to select clients/patients. It was explained to me that there are some owners that just will not commit to full anesthetic dentals, who will go for these anesthesia free ones.
After the owners see (and smell) the difference in their dog’s mouth and breath, they will start understanding and appreciating the importance of dental health.
Also if while the pet is undergoing the dental procedure awake, and the hygienist finds a lesion, such as a loose tooth, the owners are typically more willing to approve the full anesthetic dental than they would have been without at least trying it without anesthesia first.
Lastly she explains that some owners just cannot afford full dental evaluations and an anesthesia-free dental is better than nothing—at least it is removing some plaque.
Risks of Anesthesia-Free Dentals for Dogs
While my colleague does make some good points, here are my counterarguments. An animal undergoing anesthesia free dentals does not understand what is going on.
Dogs don’t understand why someone is holding them down and sticking sharp objects in their mouth. They cannot understand “relax” or “this might pinch” as we are told from our dental hygienists.
Secondly, they need to be restrained for this procedure, some more than others. Excessive restraint can be stressful and even harmful.
Furthermore, some dogs undergoing non-anesthetic dentals still do get some medications for sedation. Now they have a decreased ability to swallow as fluids are getting sprayed into their mouths, they don’t have their airway protected with an endotracheal tube, and they most likely do not have all the proper vital monitoring equipment that they would have under anesthesia.
Keep in mind, sedation is not without some risk too, and warrants proper monitoring. And beyond that, non-anesthesia dentals, with or without sedation, get a subpar “cleaning”. Safer without anesthesia? I don’t think so.
More than Meets the Eye
Okay, so let’s say we have the world’s most cooperative dog that will let you do anything to it awake, and he just sits on the hygienists lap while she scales his teeth. They are still only going to be cleaning the outside surface of the teeth.
The hygienist will not be able to effectively scale the crown tips or the inside surfaces. They still are not getting under the gumline where the majority of the disease that causes bone loss and abscesses exist.
They still won’t be able to take dental x-rays, potentially allowing significant disease to go untreated and progress into more serious disease.
However now you have owners that might not truly understand the difference in quality between anesthetic and anesthesia-free dentals.
This can give owners a false sense of security, giving them the impression that their pet just had a dental cleaning and is therefore healthy. Clean does not equal healthy.
The Downsides of General Anesthesia
Of course, there are downsides to general anesthesia. It is more expensive for the owner, and that is something a lot of owners have trouble getting past. But you do get what you pay for.
More importantly, there is always some risk of anesthesia, no matter how routine the procedure is. Seemingly normal pets can have a tragic response to a commonly used sedative or anesthetic without any warning. Now ,that is very rare, but statistics mean nothing to the individual.
I always tell my clients that, while there is a risk, we do everything we can to minimize that risk as much as possible. That involves making them as healthy as possible before the procedure.
That includes recent physical exams, up to date vaccines, and resolving or controlling any other current illnesses. For example, if a heart murmur is detected, a cardiac work up is to be performed and disease is to be managed before putting them under anesthesia for any elective procedure.
If the pet has a high anesthetic risk, but has severe dental disease that is impacting its quality of life, serious risk vs. benefit analysis needs to be taken under consideration.
That does not necessarily mean that the pet cannot undergo anesthesia and it just needs to suffer with its teeth rotting inside its mouth.
Precautions should be taken to help minimize risk and get the dog through the anesthetic event as quickly and uneventfully as possible. This includes managing other illnesses, tailoring the anesthetic protocol to the individual, and minimizing time under anesthesia.
Sometimes in order to limit time, the procedure needs to be staged in two sessions a month apart.
Now, there are some pets that are in such bad shape that no precaution taken could lower the risk enough to allow them to undergo anesthesia for an elective procedure.
It is ultimately up to the owner and the doctor to decide if the risk is worth the benefit on an individual level.
The Benefits of General Anesthesia
The benefits of general anesthesia are less stress and no pain to the dog (that is worth repeating…no pain), a protected airway with the cuff of an endotracheal tube, thus diminishing the chances of aspiration, and obtaining a much more thorough oral examination.
Dental x-rays can be taken, which may uncover significant periodontal disease (disease of the structures under the gums) under what may seem to be perfectly healthy crowns.
This allows for a more accurate assessment of the status and classification of disease and allows for a more targeted treatment approach to be made, yielding the best outcome.
Additionally all surfaces of the teeth can be scaled and polished when under anesthesia. This also allows the technician to get underneath the gumline to remove the plaque and bacteria that have accumulated, which left untreated, would progress to periodontal disease if it has not already.
In the case of gingivitis, sometimes getting an ultrasonic scaler under the gumline is really all you need to do to resolve the problem.
Key take away points are although there is some risk, anesthesia allows a more complete and accurate assessment of the level of disease (including what cannot be seen by a naked eye), a more thorough cleaning in a pain-free-stress-free way, and a greater understanding of what treatments if any need to be recommended in the greatest interest of the pet’s health.
Video on Anesthesia-Free Dental Cleaning in Dogs by Dr. Eric Weiner