Few procedures in veterinary medicine have such a dramatic effect on the quality of a patient's life. We often hear that a client is unaware of their pet’s oral discomfort until they see the improvement in a pet after a dental procedure is carried out. They are then commenting on a pets' increased energy, and that they are eating or playing with toys and food again.
The annual wellness examination is critical in examining areas, like their mouth, to detect areas of concern. Unless a pet’s mouth is regularly handled, the wellness examination is often the first critical step in identifying dental disease. Clients may comment on tartar, bleeding, bad breath and in some cases difficulty in closing their mouth, drooling or pawing at their face.
Diet, dental homecare and even toys chosen can influence an animal's oral care. Please ensure that nothing hard is given to a pet, we often see worn or broken teeth consequently.
When a dental prophy or cleaning is recommended what is involved at Gorham Animal hospital?
Firstly, to perform a pets dental cleaning, the pet MUST be placed under a general anesthetic both to ensure their comfort, as well as to allow for complete examination of the oral cavity. The gold standard is to ensure that dental xrays are done. Dental xrays are critical in ensuring that dental disease is both identified and treated. Almost 40-60% of dental disease is not apparent above the gumline, but identified with oral xrays. We have invested in digital dental xrays to minimize the time required to do so while a pet is under a general anesthetic. Age related dental disease is common. Some breeds of dogs are genetically prone to periodontal disease, and require frequent dental prophys to maintain good health. .
Prior to entering a hospital setting, we ideally want the pet to be up to date on vaccinations to protect them while with us. Although each pet is separated from others, their safety is our foremost concern. It is important that an animal's history is obtained from any previous health care facilities and that they are examined prior to leaving them with us to ensure no concurrent illness or health concerns which should be addressed prior to the dental procedure.
Prior to any general anesthesia, routine blood and urine testing should be performed both to evaluate a pets overall health, address any concerns, and alter protocols to make the procedure as safe as possible. These tests are sent to an outside lab and need to be done between two weeks and two days of the dental procedure so that the results are back before any procedure is carried out.
When the pet arrives at the hospital, we will have recommended fasting overnight. While under a general anesthetic, a pet loses their swallowing reflex. By ensuring that their stomach is empty, they are less likely to aspirate, or have fluids potentially enter their lungs.
The pet is examined; vitals including body weight, blood pressure, temperature and heart and respiratory rates are taken. A pre-anesthetic drug regime is specifically chosen based on the pets overall health, and on any pre-existing health concerns. All of our dental patients are given pain relief prior to even starting any procedures. Studies have shown this leads to both quicker recovery and healing times, and benefits the pets further by requiring less postoperative pain relief to keep them comfortable. The pets are simultaneously given other medications. One reduces their anxiety, further lowering the need for a more anesthetic, another to help regulate their blood pressure and heart rate and rhythm.
All of the patients have an intravenous catheter put in place and are started on an intravenous fluid pump which regulates the rate at which the patient receives the fluids. During the anesthetic, the fluid rate can be varied to ensure that a patient's blood pressure is maintained. By doing so, we ensure that blood flow to the vital organs and extremities are maintained. In the event of an emergency, we already have a catheter in place, allowing for rapid drug administration.
The patients will have an induction agent chosen based on their individual requirements, and once asleep, have an endotracheal tube placed. This tube goes into the trachea, the pathway between the mouth and the lungs. It ensures an open airway, and again, in the event of an emergency, allows for rapid ventilation. The end of the endotracheal tube can be expanded to gently seal the trachea to ensure that no fluids or debris can enter the pet’s lungs throughout the procedure.
The animals are then attached to an isoflurane gas anesthetic machine to ensure a safe and comfortable anesthetic. As a gas, when turned off, the patient rapidly clears their lungs as they breathe.
While under a general anesthetic, a pet’s body temperature can potentially drop. At Gorham Animal Hospital, we have a "hot dog". This specialized mattress has pressure sensors under a pet to keep them warm safely without overheating; it has been made to combat older style heating pads that potentially can burn a pet.
Once a pet is safely sleeping. Their mouth is examined thoroughly. A dental probe is placed around each tooth helping to identify pockets created around teeth from periodontal disease. These form because of tartar build up and bacterial damage to both the tissue and bone around a tooth. Deep pockets reflect periodontal ligament damage, and may lead to the loss of teeth.
Scaling is performed to remove plaque and tartar build up that lead to gum inflammation and subsequent damage. The pet’s mouth needs to be open for quite a while to ensure that all surfaces are examined and cleaned. We use both ultrasonic hand scaling as well as manual scaling. Hand scaling tools are pointy and sharp and should never be used on an awake animal, so even minor movements could lead to damage and pain. Hand scaling is performed beneath the gum line to remove any bacteria and tartar that form with periodontal disease.
Gorham Animal Hospital has a high speed and low speed hand piece dental unit. This allows us to quickly and comfortably scale above the gum line, and in the event extractions are required, we are able to split multi-rooted teeth and then remove the multiple single rooted pieces minimizing both anesthesia time and allows for less traumatic tooth extractions.
In the event that extractions are required, a local anesthetic is administered into the area, ensuring pain relief both during and post recovery. Again, our dental machine aids in removing teeth in a quick and minimally traumatic procedure. Occasionally gingival flaps and sutures are required to ensure the removal of the whole tooth.
Gorham Animal Hospital uses a digital dental x-ray unit to quickly examine 2/3 of the tooth and structures under the gum line and identify any areas of concern. We are able to identify non-erupted teeth, potentially forming cysts within the bones and weakening the jaw. We are able to assess bony involvement and tooth damage associated with periodontal disease or in the event of oral masses. Finally, we can ensure that in the event of a tooth fracture, all the fragments have been removed.
The final step involves polishing the teeth. Polish is applied to the now clean dental surfaces. Scaling results in uneven enamel surfaces where plaque and tartar can reform. Polishing smoothes the surface of the tooth
Clearly, a general anesthetic is essential in providing pets with the best possible dental care and a trauma free experience.
One of the areas of clients concerns pertains to the costing. Thankfully, OHIP hides from most of us the true costs of medical procedures. Surgery requires the monitoring and use of medications, specialized equipment and fluids, local and general anesthetic, scaling, polishing and hand pieces to allow for minimally traumatic extractions and specialized dental x-ray equipment. As well we have Registered Veterinary Technicians devoted and trained to safely monitor a pets anesthesia, as well as the trained veterinary professional performing the procedure. We have a veterinary technician monitoring our patients' heart rate, oxygen level, temperature, C02, and respiration rates. Factor into this cost, the value these procedures and trained staff provide in dramatically improving a pets quality of life, as well as their overall health and comfort. Few veterinary procedures lead to such a dramatic positive change for a pet, often recognized by an owner after the fact.
The benefits of regular and routine dental home care can not be overstated. Plaque buildup can lead to permanent damage of teeth, with oral discomfort and the progression to systemic disease. Please talk to us about preventative measures, and remember not to provide hard objects for chewing, including antlers that have been shown to fracture teeth.
Should you have any questions about dental procedures, please feel free to call us. Look for the VOHC symbol on veterinary products advocated by veterinary dentists in aiding in dental health.