So, your vet has decided that your dog needs dental treatment. Many of you may wonder what will actually happen “behind the scenes” on the day of the procedure…
Partially this will be dictated by the treatment that your pet is undergoing.
This may simply involve a “scale and polish”
This procedure is designed to optimise dental health within the oral cavity by removing calculus (hardened and calcified plaque) on the teeth and alleviating any dental disease – such as gingivitis (gum inflammation) and halitosis (bad breath). Removing such calculus will also prevent detrimental health effects on the heart and kidneys. This is increasingly recognised as a consequence of an increased bacterial load in the mouth when severe periodontal disease (disease associated with the structures around the tooth) is present.
Or, the need for dental treatment may have arisen from your dogs tooth/teeth having been accidentally damaged
This can occur through injury(such as a fractured molar tooth damaged through play or bone ingestion). This may have been noted by you, their owner, in terms of a reluctance to eat on one side of the mouth or eating only with hesitation, or incidentally by your Vet at a consultation.
What else might be found?
Whilst your vet will have communicated the anticipated procedure this to you at the time of the consultation, it is important to appreciate and remember that once anaesthetised, dogs are usually significantly more compliant (!), and a much more detailed and thorough examination of the teeth and oral cavity can be performed. As such, there may be need to be, some modification to the nature of the previously planned treatment.
On the day itself…
Once arrived at the practice, following the completion of one or more consent forms, your dog will likely be admitted by a Veterinary Nurse. Remember that your dog will have been given nothing by mouth (excluding water) overnight. You may be asked about relevant previous medical history, allergies and any concurrent medications being given. Your contact phone number should be confirmed and any concerns that you have should be mentioned at this time. Many practices would have produced an estimate of costs for your information or, if not, could do so at the time of admission. This is helpful and useful to enable both parties to be clear of likely costs. If you have ever needed dental work yourself, you are likely to be aware of the potentially significant magnitude of costs that can be involved relative to the time and experience required!
You may be asked whether you would like your dog to undergo a pre-anaesthetic blood test (designed to identify any problems with the liver and kidneys ahead of the procedure) or whether intravenous fluids are desired. In my opinion and to provide a “gold standard” level of care, I would always prefer my patients to have such fluids, particularly if they are middle aged or older (although in the younger patients it also benefits them as individuals). Intravenous fluids counteract any tendency towards dehydration and support blood pressure during and after the anaesthetic – enabling a smoother anaesthetic.
Once in the “prep” area of the veterinary building, the operating veterinary surgeon will listen to your dog’s heart, check their weight. They will also ensure that they are suitable for the procedure, with a clinical examination. The procedure being performed will be double checked against the clinical records. A consent form and a temporary identification name collar will generally be placed. An area of fur will be clipped off one/two forelimbs and local anaesthetic cream applied to numb the area. A few minutes later, an intravenous catheter will be placed.
Dentistry is “dirty” surgery
Given dental procedures are classified as “dirty” procedures (relative to a sterile surgery, say, such as removal of a lump), they are often performed in the second half of the morning to reduce cross contamination within the building. They may also be done within a separate zone. In the meantime, once any blood results are available, your dog will receive premedication. This is a combination of suitable drugs calculated for weight and age, designed to relax and reduce any anxiety. It will also provide pre-emptive analgesia (pain-relief) that is required for the dental procedure. Intravenous fluids, if being given, will also be started.
The anaesthetic will be induced by the vet (intravenously) albeit also monitored carefully throughout by a veterinary nurse. The main period of anaesthesia is delivered via an inhalational gas diluted in 100% oxygen via a breathing tube (an endotracheal tube or ETT) placed within the windpipe. Typically, similar or identical drugs are used to that which you and I would receive in hospital.
The depth and quality of anaesthesia will be continually assessed using a combination of many parameters. Such as heart rate, heart rhythm, pulse rate and quality, membrane colour, respiration rate, temperature, blood pressure, along with quantities of tissue oxygen saturation and expired carbon dioxide. By monitoring all these levels, a stable and optimal anaesthetic experience is ensured. A “throat pack” (usually a few bound sterile swabs) placed at the back of the mouth prevents any water from being swallowed during the procedure. Importantly, this gives extra protection to the airways.
The dental procedure
When under anaesthesia, the vet will examine the mouth and teeth thoroughly, take any required dental radiographs (which provides vital information about root structure and disease) and perform the treatment required. Small, soft, dissolvable sutures may be placed if extractions have been performed.
Next, the teeth will be scaled free from calculus and the enamel surfaces polished.
Then the recovery phase starts. The anaesthetic gas is turned off and the dog gradually regains consciousness. The ETT is removed once sufficient consciousness has been regained such that your dog is able to swallow. Your pet is carefully monitored in this period to ensure no complications. Typically, it can take anywhere from 30-60 minutes for them to appear more “awake”, then once so, will be fed a light bland palatable brunch and receive much TLC from the nursing team.
Once satisfied with this recovery, one of the veterinary team will give you a call. They will let you know how things have gone and arrange a discharge time for later in the day. Usually post dental care instructions and advice are produced in a written format for you to take home. The team will also talk you through as you collect your dog. Some subtle blood loss or blood-stained saliva can be expected over the next few days; soft foods are also advised. Additional treatments such as analgesia or antibiotics may be prescribed if necessary.
Once recovered from the procedure, longer term the baton is handed over to you the owner, in terms of continued care at home! Tooth brushing will undeniably be the most effective thing you can do to contribute to the continued persistent health of your dog’s teeth. It is the only proven method to prevent gingivitis and progressive gum disease. Specialised enzymatic toothpastes and ergonomically designed brushes are available. Chews, dental diets and food/water additives will help contribute to oral care. However, this is at a much lower level than physically brushing the teeth and should not be expected to provide optimal outcomes.
For more information please visit the British Veterinary Dental Associations web page.
By Rebecca Martin BVSc CertSAM MRCVS