Monday, March 7, 2016

Why do we anaesthetise patients for veterinary dentistry?

Periodontal disease
This patient is anaesthetised with an endotracheal tube placed to protect the airway from fluids and debris during the dental procedure.

A few years ago an Australian journalist wrote an article suggesting that veterinarians who perform dental cleaning under general anaesthesia are ripping clients off. Why not, she argued, just chip off the tartar? 

There are very sound reasons for anaesthetising animals for dental cleaning which I’d like to discuss.

Unlike you and I, companion animals can’t consent to treatment nor can we explain that “if you just hold still, I will put these instruments in your mouth, they will make a lot of noise but it won’t hurt”. [I do know people who, because of severe dental anxiety, require heavy sedation and in one case general anaesthesia to cope with dental examination and treatment].

Anaesthesia allows us to keep patients still so we can thoroughly probe and clean the teeth.

Just “chipping off the tartar” can be painful, particularly where roots may be exposed underneath. This is not accepted as the standard of care.

Most of the structures we are interested in are actually below the level of the gum line. Probing can be uncomfortable and occasionally painful, and I’ve not met an animal that could tolerate probing when awake.

To scale teeth below the gum line, on both the outside (the buccal side) and inside of the mouth (mucosal side), from the very front incisors to the very back molars, requires a wide open, relaxed mouth. General anaesthesia helps achieve this.

In addition, general anaesthesia enables us to place an endotracheal tube to maintain a patent airway. Importantly, a snug-fitting or cuffed endotracheal tube also prevents fluid and debris (like plaque fragments) from entering the airway.
We need to remember that because we can’t explain what we’re doing to animals, the veterinary visit can be quite scary. Fear is worsened by restraining animals so we can perform a procedure. I have always anaesthetised patients, including those who live with me, prior to performing dental probing, radiography (x-rays) and cleaning.

It also means that if you have to perform extractions or oral surgery (such as a gum flap) you can do so without causing pain or distress to the patient.

In short, it’s better for the welfare of the animal to have a general anaesthetic if the animal is a suitable anaesthetic candidate. You can read more on the standards here.