Dropping Off
When you bring your pet in the morning to drop them off for a dental, the first thing we do is discuss your options with you. You can choose to have additional services completed while your pet is under anesthesia, such as a nail trim, ear cleaning, and other services. These can be done while your pet is getting their teeth cleaned and will not increase their time under anesthesia. We will also discuss if your pet needs pre-anesthetic labwork, what you would like us to do if we find something that needs to be treated, and what we should do in the event that we cannot contact you for approval (this rarely happens, but if your phone dies or if you’re in a meeting where we can’t reach you, then we need to know how to proceed). Once we have your instructions and we’ve answered any questions you have, we will take your pet inside.
Pre-Anesthetic Exam
After we take your pet inside the clinic, their doctor will greet them! We take a couple of minutes to help them feel a little more at ease with affection and praise. Your veterinarian will do a physical evaluation of your pet, which includes listening to their heart and lungs, before the procedure. We do this, even if we have seen your pet the day before, to make sure that your pet is healthy enough for anesthesia. If your pet is 7 years or older, then we will also collect a small blood sample in order to run some in-house pre-anesthetic lab work. If your pet is under 7 years of age, you can opt-out of this additional wellness check.
Light Sedation & Resting
After we have confirmed your pet’s weight and have completed their exam, your pet will receive a pre-medication injection. The purpose of this injection is to provide a mild sedative effect and it usually helps provide some pain relief as well. This helps relax your pet, making IV-catheter placement less stressful for them, and allows us to use a lower volume of induction medications later. After the pre-medication injection, your pet will be put into a quiet monitored area to relax while the medication takes effect. Each kennel has comfortable bedding, is species-specific, and is pre-sprayed with a synthetic calming pheromone (Adaptil for dogs & Feliway for cats). If your pet gets nervous in a kennel we will work with them. Every dental has one doctor and two techs assigned to your pet so that we can help them be as safe and comfortable as possible.
Induction
Once your pet is lightly sedated, we will place an IV catheter. This is important as it allows us to have immediate intravenous access throughout the entire procedure. Initially, this IV catheter is used to help administer the induction medications. As you can see, we use several different medications at different times. This allows us to use less of the gas anesthetic (the gas that keeps them maintained under anesthesia) and lower volumes of each medication, thus decreasing the chance of negative side effects from any one drug. The induction agent also allows us to immediately place an endotracheal tube. The endotracheal tube does several things. It helps us administer oxygen and administer the gas anesthetic accurately so that your doctor can control how much of each is given and adjust as needed. The endotracheal tube also creates a seal around it, which keeps water from the dental cleaning out.
Dental Radiographs (X-Rays)
X-rays are done of every tooth to help find any cavities, periodontal disease, fractures, “dead” teeth, unerupted teeth, FORLs, abscesses, or other abnormalities. Dogs & Cats are less likely to get cavities and more likely to have periodontal disease (bone loss, abscesses, etc. underneath the gum-line). These things cannot be fully evaluated without dental radiographs. The radiographs, coupled with the oral probing and evaluation, tell us the whole story.
The Cleaning
This is the most dramatic visual change that you can see after a dental COHAT. We use an ultrasonic scaler to quickly remove the plaque and tartar on the teeth and underneath the gumline. Once the scaling has been completed, your pet’s teeth will be coated with a substance, called ICPlaque, which allows us to easily see if there are any areas of plaque (the white substance that later hardens and turns into tartar) that need to also be removed. Once the teeth are completely clean, they are polished. Polishing them will make the surface of the tooth smooth. A smooth tooth makes it harder for plaque and bacteria to adhere to. This will help maintain your pet’s dental health.
Below you can see a before and after dental picture of a dog with dental calculus. For this pet, the calculus did not progress enough yet to cause gingivitis or periodontal disease to set in, which means it was a great time for a dental! This dog’s mouth had two small fractures, but we were able to determine with dental radiographs and probing that the fractures did not compromise the pulp chamber inside the teeth, so they were healthy enough to stay.
*A quick note about “anesthesia-free dental cleanings”. This is a term that some facilities use, but it is very misleading. It is impossible to clean and evaluate the entire tooth, especially underneath the gum-line where periodontal disease begins, while the pet is awake. This is not only a dangerous practice but can also be traumatic for your pet. A professional dental cleaning (COHAT), done under anesthesia, includes all of the services listed below and should only be done by veterinary professionals. Please visit AFD.AVDC.ORG to learn more about why anesthesia-free dental cleanings are NOT recommended by the American Animal Hospital Association, the American Veterinary Medical Association, the Veterinary Oral Health Council, and us.
Their Oral Exam
The doctor will evaluate each tooth to identify any crown fractures, mobility, large pockets, or other abnormalities. The doctor will also do a complete oral evaluation. They will make sure that your pet’s tongue, cheeks, hard palate, soft palate, tonsils, frenulum, and facial structures are normal.
Extractions/Periodontal Treatments
We are in the business of saving teeth. However, sometimes a tooth is compromised enough that it is recommended to be extracted. We will follow your instructions on the drop off form concerning extractions, and we can always give you a call and discuss this recommendation with you mid-procedure.
Sometimes a tooth looks like it’s on it’s way to being removed, but doesn’t have enough bone loss to warrant extraction. These teeth typically have large pockets but are otherwise healthy. Here at Midtown, we are able to usually save these teeth with a Periodontal filler that contains an antibiotic. This filler hardens to form a seal between the tooth and gum. This protects the pocket from further infection and helps facilitate gingival growth so that the affected tooth is no longer in danger of extraction.
Oravet
Once everything is completed, we are excited to be able to apply Oravet to your pet’s teeth! Oravet works as a barrier that basically coats the tooth surface and makes it slicker, so that plaque and tartar cannot adhere as easily. The initial application lasts 2 weeks. After that, you can keep it up with either an Oravet chew once a day or a swab on the teeth once a week.
Waking Up
When your pet’s dental team has completed the cleaning and any necessary treatments, we will gently turn off the gas anesthetic and wake them up. They are very closely monitored throughout the procedure, and waking them up is no exception. Our goal is to keep your pet healthy, safe, and to give them the best experience possible. To the left is a patient being held and closely watched by her veterinary technician. Usually, they will wake up to voices asking them if they want to go on a walk, or if they want some treats! You will receive a phone call once we get an idea of how quickly your pet will be on their feet. You can pick them up once they’re awake, or you can leave them to recover with us throughout the day. Once they are awake enough, they will promptly receive a small food snack and will be taken outside for a walk.
Dental Care at Home
Your pet’s clean teeth can be maintained using a variety of methods. The gold standard is teeth brushing once daily. We are happy to demo this for you at any time! The trick to compliance is finding a pet toothpaste that they enjoy (we have a chicken flavor that is very popular!), giving lots of praise, and following it up with a high-value treat! You can also give dental treats, the Oravet and CET treats/products are our favorite. There are many oral pet health products out there that the Veterinary Oral Health Council approves. Visit http://vohc.org/all_accepted_products.html for a list of all products that have been proven to benefit your pet’s oral health.