Sunday, November 16, 2008

Holly Goes to the Dentist

Your friendly neighborhood veterinarian is probably a general practitioner, like me. That means that we perform multiple functions in the course of our day. We are surgeons and internists, pediatricians and geriatricians, dermatologists and anesthesiologists. And, we are dentists.

Canine and feline dental patients will not sit quietly in a chair, with a bib around their necks, calmly opening wide and letting us mess around in their mouths, like human patients do. And, their teeth are usually a whole lot dirtier than ours are, and require much more work. That means general anesthesia is required to clean their teeth. It also means that the bill may be more than it is when the dental hygienist cleans your teeth.

To help you understand what all is involved in canine dentistry, here is my dog, Holly, undergoing a routine teeth cleaning.

After a complete physical exam and pre-anesthetic laboratory testing, Holly has an IV catheter placed in the vein of her front leg. With rare exceptions (cat neuters, abscesses, simple lacerations), every patient that undergoes general anesthesia at our practice receives IV fluids from prep through recovery.

Fluid therapy supports the pet during anesthesia, keeping the blood pressure up and perfusing the vital organs. Low blood pressure during anesthesia can lead to kidney damage. Also, if anything were to happen during anesthesia, like a slow heart rate or low blood pressure, we have immediate access to a vein to administer needed medications. Without a catheter, treatment would be delayed.

Many practices only use IV fluids during prolonged or complicated procedures or on elderly patients, perhaps offering it as an option for younger animals. I have practiced that way in the past, but now, it would be hard for me to go back. It is an added expense, but the benefits and the peace of mind is worth the cost.

Sedated, IV catheter in place, Holly receives an intravenous anesthetic induction agent, making her very sleepy.

"Whoa, wha's happening? I feel very weird."

A tube is then placed in her trachea, allowing us to administer oxygen and an inhalant anesthetic agent. The tube also protects her airway, so that she doesn't aspirate ("breathe in") the fluids and debris from the teeth cleaning process.

A tiny balloon on the tube is filled
with a small amount of air, creating a seal.

Next, a blood pressure cuff is wrapped around Holly's rear leg.

The Doppler probe is taped to the underside of her foot and connected to this machine, which allows us to hear her heart rate continually, and to measure her blood pressure every 5 to 10 minutes.

Blood pressure, heart rate, respiratory rate and mucous membranes are checked regularly throughout the procedure. A pulse-ox probe, to assess blood oxygen level, is used in other surgeries, but because it attaches to the tongue, we don't use it in dental work.

Holly is ready to go.

Wow - my baby looks old in this photo.

Look at those dirty teeth! Yuck!!

The teeth cleaning process starts with an antibacterial mouth rinse. Then a pliers-like tool is used to remove large chunks of tartar.

Tartar, sometimes called calculus, is calcified plaque. Basically, the soft film that is in your mouth when you wake up every morning (plaque) hardens and becomes permanently attached to the tooth enamel. Plaque can be removed with tooth brushing and certain dental chews, but once it hardens to tartar, nothing except hard work and dental instruments can remove it.

After the bigger pieces are removed, an ultrasonic scaler is used to clean every surface of every tooth, top and bottom. Depending on the amount of debris, this step may take twenty or thirty minutes.

This machine provides water and power for dental procedures. The various handles include an ultrasonic scaler, a polisher, air and water jets, a drill, and suction.

The polishing or "prophy" paste comes in individual, disposable cups, just like at your dentist's office.

Polishing is an essential step in a teeth cleaning procedure. If you tried to use hand-held metal instruments to "scrape" the teeth during an examination, a grooming appointment, or at home, not only would you risk injury to the pet or yourself, but you would put a series of fine scratches on the enamel. This creates a foundation for more plaque and tartar to attach, speeding up the process. Polishing the surface smooths the enamel, and keeps it healthy.

Finally, the vet (me) inspects the mouth, looking for oral pathology, like masses, broken teeth or periodontal pockets. Fluoride is applied and ...

Pearly whites again!

Holly recovers in a hospital cage.
"Mom! You're NOT going to blog this, are you?
It's embarrassing!"

Within two hours, she is up and walking, looking for a late breakfast. You can't keep a Lab down for long!


nina said...

This is really something I've wondered about and your description and pictures explain it well.

That final photo of Holly--so like I feel afterward, too!
(I am the definition of the stressed-out dental patient!)

Susan Gets Native said...

Your teeth look great, Holly!

But your mommy is bad for showing all this...very embarrassing for you!

bruss1510 said...

Wow - impressive....


cestoady said...

I always thought that the teeth of dogs and cats ( i.e. carnivores in general)were naturally cleaned by the chewing on bones and having a varied diet so that tartar did not have a chance to build up -- not so ?? What happens to the teeth of wild animals -- foxes,raccoons, etc. do they have a tartar problem ?? Or is this just a problem with civilized animals ??

Mary said...

Thanks for sharing this, Kathi. Holly looks great and I can see the different in her smile :o)

Chloe had her first teeth cleaning under general anesthesia two years ago and is going again later this month. During the first cleaning, Doctor removed several loose teeth. I hope he doesn't need to remove any this time...

Bella will go in February for her first cleaning - it's Dental Month and I'll get a discount, I hope.

KatDoc said...


I haven't examined the mouths of wild carnivores, so I can't speak from personal experience.

A few Google searches on wolves (or coyotes) and periodontitis indicates that wild canids do develop dental disease, including fractures and tooth abscesses.

What do wild animals with dental disease do? The same thing they do when they contract viral infections, parasites, or are injured. They either recover or die, depending on how severe the problem is, and how hardy the individual is.

From my brief reading, the average lifespan of a wolf or coyote in captivity is roughly 1.5 to 2 times as long as in the wild. Better veterinary care is probably a big part of it. Longer lifespan would give more time for dental disease to develop, although I suspect that a "civilized" diet may contribute as well.

denapple said...

My vet used to suggeset brushing the dog's teeth to delay the need for heavy duty dental hygiene - and to get rid of doggy breath. But we just couldn't get him to rinse and spit!