The American Animal Hospital
Association (AAHA) recently made a requirement that all of its member
hospitals only perform dental cleanings under general anesthesia with an
endotracheal tube in place, AAHA Dental Guidelines. This decision has come under fire from groups who perform dental cleanings
without anesthesia. Fairly, we should look at each side’s concerns.
The groups who perform dental
cleanings without general anesthesia argue that their trained staff can safely
and completely clean the teeth without general anesthesia. They also
correctly state that there is an inherent risk whenever general anesthesia is
performed. Some of these groups only recommend non-anesthetic dental
cleanings (NADs) in between complete cleanings under general anesthesia as
preventative maintenance. Some believe general anesthesia is only
required if there is a need for extractions or other involved treatments.Those who believe general anesthesia is required state that scaling of all the teeth surfaces and cleaning below the gum line is not possible when a patient is awake. Additionally complete diagnostics including periodontal probing and dental x-rays cannot be adequately performed in an awake patient. One group taking this stance is the American Veterinary Dental College, who are the only group of veterinary dental specialists recognized by the American Veterinary Medical Association. The College’s position can be found here, Dental Scaling Without Anesthesia.
I believe that some of the
groups supporting NAD do have the pet’s best intention in mind. Their
thought is that the risk of an adverse reaction under general anesthesia is too
high to justify an anesthetized cleaning. I agree that if general
anesthesia is not properly performed,
the risk of a problem occurring is high. However if the right precautions
are made, the risk of an event under general anesthesia is minuscule in a
healthy pet.
Adequate dental care can not be
provided on an awake patient in the vast majority of cases. Most of the
patients I see have some degree of gum recession and bone loss which requires
more than simple scaling and polishing. As well, a number of patients I
see who have had a recent anesthetized dental cleaning have large
amounts of dental tartar left behind. If dental tartar is left behind in
some anesthetized patients, how can it be completely removed in an awake,
uncooperative patient?
In conclusion, adequate dental scaling and polishing does require balanced and monitored general anesthesia. It is my opinion that cleaning teeth without general anesthesia is simply cosmetic and not therapeutic. It is a disservice to the pet and client.
