The perils of anesthesia-free dentistry in pets

The perils of anesthesia-free dentistry in pets

Nonprofessional dental scaling misses serious disease below the gum line and can damage teeth
Oct 01, 2011

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

Photo 1: This 10-year-old patient has undergone several sessions of anesthesia-free dental cleaning.
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 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.
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.

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.

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.
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).