Anaesthesia-free dentistry involves restraining an animal to remove tartar from the surface of their teeth. This may be done manually with instruments or using an ultrasonic scaler. It’s often offered as a cheaper or easier alternative to professional dentistry under anaesthesia. But it doesn’t prevent or treat dental disease, can cause significant pain and distress to the animal and is often carried out by people not trained in dentistry.
The Royal College of Veterinary Surgeons (RCVS), our governing body, say anaesthesia-free dental procedures for cats and dogs are not in the best interests of the health and welfare of patients. They also say:
“If anaesthesia-free dentals are performed under the guise of a “dental treatment” it could be considered misleading unless the owners are made aware of the inadequate and potentially injurious nature of the procedure.”
Studies show 70% of cats and 80% of dogs suffer some form of gum disease before three years old. So it’s clear that looking after your pet’s teeth is important. Studies also show that nothing beats daily brushing to keep the teeth healthier for longer. Chews, washes, and diets can reduce plaque build-up but are not as effective.
What is a ‘dental’?
Dental work carried out under anaesthetic isn’t a replacement for prevention. An anaesthetic is needed to examine the mouth thoroughly, find out the extent of the problems, and implement treatment. This can be loosely termed a ‘dental’. The examination is vital to pick the correct treatment, and a scale and polish often performed during a dental cannot be done effectively awake.
What is gum disease?
Plaque is a sticky, constantly forming bacterial film which hardens into tartar (or calculus) and is difficult to remove. Toxins produced by the bacteria attack the gums causing inflammation known as periodontal disease. Early periodontal disease, gingivitis, is an inflammation of the gums and can be reversed. It can progress to periodontitis, an inflammation of periodontal tissues, including the bone around the tooth, and the soft tissues that anchor the tooth in the mouth, causing loosening of teeth.
Why can’t a full examination be done awake?
Problems can only be diagnosed and investigated after a thorough dental examination which is just not possible in a conscious animal. Even if you get a good look, studies have shown that 28% of normal looking teeth in dogs, and 42% of normal looking teeth in cats, had important findings on X-rays. Without a general anaesthetic many issues will be missed. This is because:
- Parts of the mouth cannot be seen without anaesthesia. The back of the mouth must be accessed to check each individual tooth and evaluate the tissues surrounding it, which is impossible in a conscious animal. Some early oral cancers can only be seen when the pet is asleep. A delay in diagnosis may mean the disease that was treatable, no longer is.
- Probing the periodontal area is essential to check for disease but can be painful. Humans may tolerate this pain and keep still, but animals will not. Without probing early dental issues that can be reversed may be missed, leading to chronic pain and eventually loss of teeth.
- We use sharp instruments which could easily damage periodontal tissue and cause pain if there is too much movement.
- X-rays may be indicated but cannot be performed in a conscious patient due to movement.
Why can’t the scale and polish be done consciously?
Even if a scale and polish is the only recommended treatment, it’s impossible to do it effectively. This is because:
- The most important area to clean effectively is the periodontal pocket, the area below the gum line around the teeth. Cleaning below the gum line is uncomfortable. While humans grin and bear it, pets will not. Simply removing the visible tartar above the gumline improves cosmetic appearance, but it’s not useful in tackling dental disease. This creates a false sense of confidence and security for owners, unable to see the more important build up below the gum line.
- It can take 20-40 minutes even in an unconscious patient. It’s unrealistic and unfair to expect animals to remain still for that long. Pets would need to be tightly restrained which would be traumatic and stressful. It’s unlikely your pet will allow you near their mouth for routine vital preventative brushing afterwards and it may lead to behaviour issues. The person carrying it out would be at high risk of bites.
- Scaling requires the use of sharp instruments. Uncontrolled movements could easily lead to periodontal damage, significant pain, damage to major blood vessels, and possibly loss of the tooth.
- If used correctly ultrasonic scalers produce jets of water at the tip to reduce thermal damage to soft tissues. It’s not possible to protect an animal who isn’t anaesthetised from inhaling bacteria and fluids present in the fluid during dentistry.
Is an anaesthetic not dangerous?
Modern anaesthetic protocols and monitoring means anaesthesia carries a low risk. Screening methods can pick out and manage pets with increased risks. Animals are intubated protecting the patient from inhalation of dental fluids created during dentistry. Sedation does not give you the same amount of control, or intubation, so is not a viable option for this job.
So, Myth or Fact – anaesthetic-free is safe and effective?
To summarize, a professionally performed dental examination and cleaning procedure, carried out under anaesthesia, is usually the recommended approach for dental disease. At best, anaesthesia-free dentistry is a cosmetic activity delivering no healthcare benefits. At worst it has the potential to mask underlying dental pathology resulting in delayed treatment of dental disease.
People providing anaesthesia-free dental services could be liable to actions under the Animal Welfare Act if any harm is done. Plus performing sub-gingival scaling which is necessary for proper oral hygiene, and extraction of teeth using instruments can only be legally be performed by vets. Owners allowing someone to perform an anaesthesia-free dental on their pet should be aware it may cause harm to their pet. Owners also have a responsibility under the Animal Welfare Act to avoid harm.