A disturbing e-mail arrived the other day: Hello, Dr. Bellows: I have a 5-year-old yellow Labrador Retriever that I have routinely cleaned her teeth (with enzyme toothpaste and a brush, recently using Sonicare). Despite all best efforts, she is building up tartar and I think may have a dark spot (cavity on a rear molar).

I appreciate your time and hope you can provide some insight. Our Labrador has had general anesthesia several times, but I'm a bit skeptical to put her under anesthesia unless it is absolutely necessary.

I have seen some advertisements for non-general dental cleaning and was wondering if you are familiar with other anesthesia options? Can cleanings be done with IV sedation or simple acepromazine? Or do you intubate to protect the airway from debris?

Photo 1: Technician cleaning a dog's teeth under general anesthesia

Client anxiety about anesthesia for dental procedures is a concern that practitioners face every day. Choosing the correct patient, anesthetic protocol, as well as intra- and post-operative monitoring allows the most favorable anesthesia outcome. How can you convey that anesthesia is necessary to perform dental procedures, and that it is well worth the smallest risk as long as precautions are taken?

Client anxiety about anesthesia is similar to dread of flying — fear of the unknown. To allay this trepidation, we take time to explain what happens and what we do to make the experience as safe as possible.

Case for anesthesia

To evaluate and clean teeth properly, general anesthesia is mandatory. Some veterinarians and non-veterinarians advertise anesthesia-free dentistry. This is a disservice to the patient, client and our profession.

The American Veterinary Dental College (AVDC) developed a position statement for veterinarians and the public. The AVDC prefers to use the more accurate term non-professional dental scaling (NPDS) to describe anesthesia-free dentistry.

Naturally, owners of pets are concerned when anesthesia is required. However, performing NPDS on an unanesthetized pet is inappropriate for the following reasons:

• Dental tartar is firmly adhered to the surface of the teeth. Scaling to remove tartar is accomplished using ultrasonic and sonic power scalers, plus hand instruments that must have a sharp working edge to be used effectively. Even slight head movement by the patient could result in injury to the oral tissues of the patient. The operator is also exposed to unnecessary bites.

Professional dental scaling includes scaling the surfaces of the teeth above and below the gingival margin (gum line), followed by dental polishing. The most critical part of a dental scaling procedure is scaling the tooth surfaces that are within the gingival pocket (the subgingival space between the gum and the root), where periodontal disease is active. Because the patient cooperates, dental scaling of human teeth performed by a professional trained in the procedures can be completed successfully without anesthesia. However, access to the subgingival area of every tooth is impossible in an unanesthetized canine or feline patient. Removal of dental tartar on the visible surfaces of the teeth has little effect on a pet's health, and it provides a false sense of accomplishment. The result is purely cosmetic.

• Inhalation anesthesia using a cuffed endotracheal tube provides three important advantages — the cooperation of the patient with a procedure it does not understand, elimination of pain resulting from examination and treatment of diseased or injured dental tissues, as well as protection of the airway and lungs from accidental aspiration.
• A complete oral examination, which is an important part of a professional dental scaling procedure, is not possible in an unanesthetized patient. The surfaces of the teeth facing the tongue cannot be examined, and areas of disease and discomfort are likely to be missed.

What can you do?

Choose the correct patient

When a client asks whether his or her dog or cat is too old for anesthesia, remember age is not a disease. However, older patients often are discriminated against that need urgent dental care to decrease pain and improve quality of life. No amount of antibiotics is going to help a companion animal suffering with mobile teeth secondary to Stage 4 periodontal disease. My point: Letting the periodontal syndrome rage on is far more dangerous than professional oral hygiene care performed under general anesthesia.