The Truth About Non-Anesthetic Dentals (Gentle Dentals)

Dental care is extremely important for the long term overall health and function of our pets. Periodontal disease, which is irreversible damage of the gums and structures below the gums, can have many negative effects on the animal. First and foremost, pain and inflammation in the mouth can lead to a poor appetite, weight loss, and lower quality of life. Infections in the mouth can travel via the bloodstream to organs such as the heart, liver and kidneys. Dental disease is just as important as other diseases and deserves to be treated.

A new trend that has emerged in pet care is the non-anesthetic dental cleaning, or gentle dental. I suppose this came about as a way to capitalize on people's fears about anesthesia and as a "cheaper" alternative to a professional dental cleaning. Basically, as I will discuss, it is a quick and easy way to make a buck. There is no benefit for the pet and it can actually be detrimental to the animal in a few ways.

Gentle dentals:
- are generally not performed by anyone with any actual training (in fact in California, it is illegal to perform this procedure without a veterinary license)
- do not allow the lingual surface of the teeth to be cleaned or evaluated (the side of the teeth touching the tongue)
- scratch the enamel and damage the gums
- cannot be used to extract teeth
- give owners a false sense of security
- Most importantly: can not clean under the gum line which is where the problems lie!

Anesthesia is required to properly evaluate, clean, probe, and polish a pet's teeth. No cat or dog, no matter how cooperative, will hold its mouth open for a long period of time so a person can perform necessary dental procedures, which may include extractions. This is why we must anesthetize them for the procedure.

Anesthesia is safe, and actually it is generally safer to fully anesthetize a pet for a dental than to give "twilight" or light sedation. Pre-operative bloodwork is routinely performed to assess organ function prior to anesthesia. Appropriate pain control medications are given before anesthetizing. In a properly anesthetized patient, the pet is intubated (a tube is inserted into the trachea) to ensure oxygen is getting to the lungs and to prevent water or rinse from going down the trachea. The pet is monitored by the anesthetist (nurse or doctor) and has its temperature, blood pressure, oxygen tension, and pulse rate measured by a machine.

Rarely, a complication may arise that could not have been predicted or avoided by the doctor or pre-op bloodwork. With our safe medications, proper precautions and careful monitoring, this is rare.

Once under anesthesia, a veterinarian or nurse will remove all the tartar and plaque from all surfaces of the teeth (inside, outside and in between). All teeth will be probed for pockets, areas of infection, loss of enamel or nerve exposure, broken teeth, and root exposure or resorption. Any teeth that are non-viable (dead) or freely mobile in the socket will be extracted using proper procedures and often a nerve block to reduce pain sensation to the area. Dental x-rays may be performed to evaluate roots and bone structure.

The remaining teeth will be cleaned and polished. The teeth are cleaned on the visible surface and under the gum line. This is where the bacteria mainly reside and most "bad breath" comes from bacteria hiding out under the gum line. Periodontitis (irreversible gum damage) starts here. This is why many people who had a non-anesthetic dental done on their pet still report bad breath, even though the teeth may look very nice. If the teeth are not cleaned below the gums, the whole procedure is basically worthless. Anesthesia is necessary to clean under the gums in our pets.

Polishing is a very important step in a dental cleaning. The polisher is a not just a fancy toothbrush. It actually is meant to help smooth the microscopic scratches in the enamel that were inevitably created by the other instruments. It is a vital step to maintaining a healthy tooth and preventing new bacteria and plaque from attaching to the tooth and possibly penetrating the enamel to the underlying structures in the tooth. Polishing cannot be performed in a gentle dental.

Here is a picture of the lower incisor teeth of a dog who had two recent non-anesthetic dentals. All of them had to be extracted.

Note the tartar, recessed gum line, bleeding and root exposure of the incisors. 

The money (not a small amount either) that the owner spent on the gentle dentals would have been much better spent on a professional cleaning earlier in the course of disease. 

Nearly all pets will need at least one, if not more, professional cleanings in their lifetimes. Home care is possible, and daily brushing of a dog or cat's teeth will most certainly prolong the healthy lives of the teeth and the pet and increase time between professional cleanings. Dental care is extremely important for any pet.

Update: A video on how to brush your dog's teeth
http://www.youtube.com/watch?v=wB3GIAgrTPE

Resources

The American College of Veterinary Dentistry position statement: 

http://www.avdc.org/dentalscaling.html

Ten Steps to Dental Health

http://www.aspca.org/pet-care/dog-care/ten-steps-your-dogs-dental-health

Dangers of Anesthesia Free Cleanings

http://wellpets.com/anesthesia-free-vet-dentistry/