10-Step Pet Dental Care Program

Anesthetic risks, cost and potential pain for your pet are on everyone’s mind when we discuss pet dentistry. Veterinary dental care has come along way in recent years and today is a major part of pet wellness.

As a preventative wellness practice for over 25 years we have sometimes seen clients wait too long to have dental problems addressed related to these concerns. We recommend consideration of the following vital components to allow optimal pet dental care and overall pet health & vitality.

The primary health benefits for pets are:  preventing pain, tooth loss, and internal disease.

The primary benefits for the family are: peace of mind knowing there are no painful conditions in the mouth, less breath odors, and potential cost savings compared to waiting.

The primary concerns are anesthetic safety, adequate pain control, how to prevent recurrence and cost.

To provide the above benefits and address the major concerns we have developed these 10 considerations of optimal dental care for your pet.

An optimal dental program for your pet should:

(   )  1.  Be comprehensive and follow established guidelines within the veterinary profession (AAHA & AVDC)

(   )   2. Include dental x-rays in all pets.

(   )   3. Pre-emptively address concerns about pain

(   )   4. Take into account breed specific conditions.

(   )   5.  Completely address home care & a strong preventative approach.

(   )    6.  Be cost effective in these tough economic times

(   )    7.  Detect “surprises” to help  avoid an additional anesthetic episode.

(   )    8.  Include special training & equipment to perform additional procedures identified after cleaning & dental x-rays performed

(   )    9  Address anesthetic risks & concerns completely

(   )    10. Include referral to a dental specialist or telemedicine consult if needed/desired

A brief explanation of the importance of each of these follows

1)  Be comprehensive and follow established guidelines within the veterinary profession

Dentistry Guidelines have been established by the American Veterinary Dental College (AVDC) and the American Animal Hospital Association (AAHA) since 2005.  Not all pet dental health care is equal. We need to keep evidence based information at the top of all our pet dental care recommendations.

Link to AAHA Dental Care Guidelines

Link to American Veterinary Dental College AVDC

12-step teeth cleaning at Westside Family Pet Clinic  includes:

1)  Pre-surgical exam with Dr and informed consent consultation
2)  Pre-medication/pain relief before anesthesia (we encourage you to be present)
3)  Ultrasonic cleaning using Chlorhexidene (antiseptic rinse)
4)  Hand scaling using a sterilized pack
5)  Subgingival curettage (under gum debridement if advanced disease)
6)  Root planing (if advanced disease-Grades 3 & 4))
7)  Slow speed polishing
8)  Complete oral charting
9)  Oral Exam by Dr (including oral cancer)
10)  Fluoride application
11)  Oravet ® barrier sealant applied
12)  Personalized Dental Home Care Plan with samples

NOTE Steps 3 through 11 and dental X-rays (see below) can only be done thoroughly and safely while your pet is under general anesthesia. Many or all can not be safely or adequately performed under sedation only.

AAHA Article  that addresses need for anesthesia & limitations of  “sedation dentistry”

2) Include dental x-rays in all pets

The AAHA guidelines for dentistry specifically state that dental x-rays should be taken in all pets as part of their dental care. Just like human dentistry dental cleaning is incomplete without the “look below the gum tissue” that dental x-rays give us.  The only difference from human dentistry is that they cannot be taken while pets are awake.

•    Over 25% of dogs with normal oral exams have 1 or more problems that are only evident on radiographs
•    Over 50% of cats the age of 5 or older have abnormal x-rays
•    Chipped and discolored teeth often abscess and cause pain
•    Before any teeth are treated oral pathology needs to be identified
•    Missing teeth can develop bone destructive cysts
•    “look into future” gives us ability to prevent unnecessary emergency dental visits or painful episodes

3) Preemptively address concerns about pain

A proactive, multi-modal approach to pain needs to be taken to insure no dental procedure is painful to the pet.

•    Local pain blocks for any procedures
•    Non steroidal anti-inflammatories (NSAIDS) like Rimadyl ®
•    Narcotic pain injections
•    Constant assessment (before, during & after procedure)
•    At home pain relievers

4) Take into account breed specific conditions

Breed specific dentistry is becoming much more advanced and now that rescues, “designer” and mixed breeds are more prevalent it is important to know the genetic background so that we can be more proactive as to what dental conditions a pet might be “at risk” for.

WFPC has practiced breed specific dentistry for over 5 years (the following breeds need a different dental prevention and treatment focus)

• Retrievers (chipped teeth, discolored teeth)
• Pugs, Bostons, Boxers, Shitzus, Lhasas,  Bull dogs (missing teeth, crowded, partially erupted, deciduous canine teeth)
• Yorkshire terriers, Miniature poodles, Chihuahuas and many other toy breeds retained deciduous (baby) teeth
• All small dogs less than 20 lbs (prone to periodontitis & teeth loss)
• Greyhounds (genetically prone to periodontitis)
• Brachycephalic (short nosed) breeds have slightly higher anesthetic risk
• this is a very partial list and rapidly expanding

5) Completely address home care with a strong preventative approach

A comprehensive personalized home care plan can provide you with many tools to help prevent too frequent dental cleanings include:

See veterinary oral health council (VOHC) for complete list

• Periodontal vaccine
• VOHC approved foods
• Oravet ® barrier sealant
• Evidence based tooth brushing pastes & rinses
• Evidence based treats & water additives
• Recommendation of “teeth safe” toys

Link to Pet Dentistry Library Great articles on all types of care

6) Be cost effective in these tough economic times

Preventative pet dental care is cost effective. Not only is pet teeth cleaning more costly than teeth cleaning in people (the need for anesthesia is the biggest difference) procedures are now done that can save important teeth and treat pain just like in people. If done before problems develop, the cost can often be greatly controlled.

The early preventative approach is also the most cost effective approach.
Grade 1 & 2 dental cleanings typically costs $150 to $250 but Grade 3 & 4 stages can be from $500 to over $1000 to include the full mouth x-rays, perform extractions of “end stage teeth”, anesthesia and pain medications it takes when disease is advanced and bone around the teeth has been lost.

7) Detect “surprises” to possibly avoid an additional anesthetic episode

•    Deep periodontal pockets
•    Missing teeth (dogs should have 42 and cats 30)
•    Chipped or fractured teeth
•    Resorptive lesions
•    Apical abscesses
•    Malformed teeth
•    Discolored teeth

Many of these teeth can be saved by applying sealants, below gum time released antibiotic (perioceutic), performing a root canal (if an important tooth) or extracted via oral surgery techniques. These decisions will be made on a tooth by tooth basis fully involving you in the decision making process.

8)  Include special training & equipment to identify & perform additional procedures after cleaning & dental x-rays performed

Because veterinary dentistry is performed in a single session (under anesthesia) detection of problems is ideally followed immediately by the correction of those problems which can involve special diagnostic and therapeutic skills

The American Veterinary Dental Society has sponsored a 3 day educational conference yearly for the past 23 years that includes everything from home care to root canals. The Dr Lambrecht has attended this conference since its inception in 1986 and in the past 5 years staff Drs & Certified Veterinary Technicians have attended as well.

See the latest information that has come from that meeting including breed specific dentistry, and new home care products, and the use of fish oils in preventing & treating periodontitis and more in Dr Lambrecht’s new blog.

http://breedspecificwellness.blogspot.com/

Oral surgery in pets is now as common in people. WFPC has been performing root canals pets and oral surgery in pets since 1991. Sealing chipped teeth, the application of a time released antibiotic as well as advanced periodontal therapy is practiced on a daily basis often avoiding an additional anesthetic episode

9) Address anesthetic risks & concerns completely

Anesthetic safety is addressed at our clinic by the following

•    Our staff is well trained to be able to safely induce & monitor anesthesia
•    We have “state of the art” monitoring and warming units
•    We have an AAHA accredited hospital and follow AAHA protocols
•    Drs & Certified veterinary technicians work as a team
•    We place IV catheters in all pets
•    We practice balanced anesthesia by using local blocks, premeds etc

Note: Sedation dentistry does NOT allow the complete visualization, charting and staging/documentation using x-rays that can be obtained by our 12 step cleaning.  Placement of an endotracheal tube is paramount for a thorough cleaning and anesthetic safety.

We have a board certified anesthesiologist available (by appt) for high risk, long or complicated anesthesia or just for extra “peace of mind”.  Please ask for details.

10) Include referral to a dental specialist or telemedicine consult as needed or desired

While an additional anesthetic procedure to address a severe problem is not ideal it sometimes happens. With additional training and equipment we are able to correct dental related problems in approx 99% of cases we see.

For unusual cases we can take photographs digitally which then along with digital dental x-rays can then be sent to specialist as needed. Procedures like root canals, crowns, cancer involving the mouth, even orthodontics can be performed by board specialized veterinary dentists at the U of WI (they currently have 3-the most at any veterinary teaching hospital in the world!)

We hope you find this useful for your pet’s dental health!

Dr Ken Lambrecht & the patient care team at WFPC