Dental disease, and the associated pain and secondary health complications that accompany it, plague our companion animals. The first article in this two-part series examined the roles that diet, chewing, home care and professional cleaning all play in slowing the rate of plaque deposition that mineralizes to form tartar, and the ensuing periodontal disease and infections that follow. 

Most advice for pet parents stops at this point. There is another option, considered controversial by many veterin-arians and frowned upon by the American Veterinary Dental College, that is worth evaluating. 

“Open Wide!”

Think about the process that happens during a typical visit to the “people” dental hygienist. First there is a conversation about any problems that have been noted since the last visit (typically six months earlier), and then the hygienist examines each tooth, sometimes measuring the periodontal pocket depths and noting any pathology. Each tooth is scaled above and below the gum line, then polished and flossed. The teeth are rinsed, and there is an exam by the dentist. The whole process can range from mildly unpleasant to quite uncomfortable, depending to the degree of oral health or disease. 

The veterinary profession has struggled with incorporating the concept of biannual cleanings for pets, which would help to significantly decrease periodontal disease. The financial cost and risks (although typically small) of anesthesia twice a year need to be weighed against the benefits of slowing the progression of disease and decreasing the necessity of extracting decaying teeth. 

Many cats and dogs are simply not candidates for even considering anesthesia-free cleaning, due to temperaments that would not allow extended cleaning and probing of the mouth. Another group of companion pets has an oral pathology that is too extensive to be addressed without anesthesia and likely oral surgery. But what about the Goldilocks pets that fall into the sweet spot of early dental disease and agreeable personalities? Why do veterinarians shy away from anesthesia-free cleanings? The answers are complex, and many concerns have merit. Let’s examine the two most common objections.

1. Anesthesia-free cleanings are performed by unqualified individuals. 

This is absolutely valid in many cases. Anyone considering an awake dental procedure for their pet should ask about the credentials of the person performing the procedure. She needs to have specialized training and be working under the on-site supervision of a licensed veterinarian. Typically, these cleanings should be performed by a licensed veterinary technician with advanced schooling in oral health and disease, as well as the unique techniques and skills needed for anesthesia-free dental cleanings. This is not a procedure that can be performed by a pet groomer or inexperienced technician.

2. Anesthesia-free cleanings may miss more serious disease.

Again, this can be a valid concern. When a pet is examined by a veterinarian prior to an anesthesia-free cleaning, she will note in the medical record a level or “Grade” of disease, on a scale of one to four, with four being the most severe. Only Grade 1 and some Grade 2 pets should be considered as candidates for awake cleanings; Grades 3 and 4 require additional diagnostics and interventions under anesthesia. A qualified technician should be able to scale above and below the gum line during an awake cleaning, just as during a human dental cleaning. However, dental radiography can be performed only with anesthesia, and some periodontal disease can be diagnosed only with the help of X-rays. Common sense dictates that for human dental care, X-rays are taken on a schedule appropriate for each individual, with cleanings at least every six months. Why not follow these same guidelines for companion animals?

In an ideal world, all pet parents would brush their pets’ teeth twice daily, feed a species-appropriate diet and provide ample opportunity for chewing that acts as a natural disruptor of the plaque and biofilm that accumulate on teeth. Even if all of these good habits are deployed, dogs and cats will still develop periodontal disease. Instead of dismissing all non-anesthesia dental cleaning as inadequate, a more responsible and thoughtful approach is to tailor the appropriateness of the procedure to each individual pet. Holistic medicine shines in recognizing that the “one-size-fits-all” approach of much of conventional medicine results in suboptimal outcomes. Awake dental cleanings can be a part of superior oral care for some pets.

Dr. Laura Weis and her husband, Dr. Ransome Weis, own and operate Doylestown Veterinary Hospital & Holistic Pet Care, and Holiday House Pet Resort & Training Center, in Doylestown. She focuses on homeopathy and nutrition counseling for her clients within the full-service veterinary practice. Call 215-345-6000 to request an appointment. See ad, page 31.