Anesthesia-free dentistry, or nonprofessional dental scaling (NPDS), is becoming more common, particularly in dogs and cats. Anesthetic concerns, monetary issues and the desire to maximize
the health and welfare of a beloved pet by providing some form of dental care all play a role in the onset and proliferation
of this practice. But are we helping, hurting or working somewhere in between when we clean pets' teeth without adequate anesthesia?
Case example 1: A history of inadequate care
To avoid administering general anesthesia in a 10-year-old dog, at the client's request, the choice was made to provide regular
dental cleaning with hand curettes and polishing on the awake patient. Although this dog also received excellent homecare,
including brushing daily, profound disease below the gum line was the disastrous result of failing to undergo a thorough dental
examination and cleaning that would have required anesthesia (Photos 1 and 2).
Photo 1: This 10-year-old patient has undergone several sessions of anesthesia-free dental cleaning.
Numerous ineffective cleaning procedures were performed on this patient, but the end result was still multiple extractions
for dental disease that should have been addressed years earlier. The remainder of this patient's oral cavity had similar
pathology. This case is, unfortunately, the rule and not the exception.
Photo 2: A radiograph of the region shows profound stage 3 and 4 periodontal disease as evidenced by the arrows at the apical
extent of bone destruction.
Case example 2: Disease that could be missed
Photo 3: This patient has an oronasal fistula that was created when tooth extraction was not followed by proper closure of
the defect. The arrow points to the exposed nasal mucosa.
A second patient represents a situation that is commonly missed if anesthesia-free dentistry is performed. This middle-aged
dachshund has an oronasal fistula due to periodontal disease associated with the loss of the maxillary right fourth premolar
(104). Improper closure resulted in a defect exposing the nasal cavity (Photo 3). The opposite canine tooth (204) demonstrates
no visible pathology (Photo 4); however, a periodontal probe placed on the palatal aspect of this tooth reveals an 8-mm periodontal
pocket where bone has been destroyed. In time, this will result in a similar outcome.
Since anesthesia-free dentistry does not allow for probing or thorough examination, this finding would have been missed. Because
of the client's inability to brush this patient's teeth, the tooth was extracted rather than trying to grow new attachment
with periodontal regenerative therapy (Photo 5).
Photo 4: The opposite tooth in the same patient looks to be relatively normal. However, probing reveals an 8-mm pocket that
is close to producing a similar fistula.