The American Animal Hospital Association (AAHA) made a bold move recently in mandating that all pets undergoing dental procedures, including dental cleanings, require anesthesia. AAHA believes that anesthesia-free dental procedures do not meet their high standard of care and are not in the best interest of the animals undergoing these procedures. AAHA guidelines, says AAHA, must reflect the best practices. And when it comes to dental procedures, these best practices include anesthesia.
The mandate has drawn a great deal of criticism from groups that promote anesthesia-free dentistry. According to these groups, some dental procedures can be done without anesthesia.
So, is anesthesia necessary to carry out a dental procedure properly? Obviously, there will be those who disagree with me. But, yes, I believe that anesthesia is necessary to perform any dental procedure properly. I don’t believe that these procedures can be performed properly in an animal that is awake.
There really isn’t such a thing as “just” a dental cleaning, or at least there shouldn’t be. Any time a pet’s teeth are cleaned, the entire mouth should be evaluated for signs of disease. This means examining each individual tooth. During the examination, all surfaces on each tooth must be accessible for probing, all the way around the tooth. In addition, dental radiographs are especially important for cats, where dental disease may be present below the gumline but not visible above it. Only radiographs can accurately detect these lesions, which can be very painful for affected cats.
The cleaning process involves not only cleaning above the gumline but also below the gumline. Most dental disease starts below the gumline and if that area isn’t addressed, the dental cleaning is little more than a cosmetic procedure without any medical benefit.
None of this can be done properly without anesthesia. In cases where dental disease is present, trying to do so would be painful and inhumane. There’s also the fact that we cannot always tell without evaluating dental radiographs whether dental disease is present or not. That doesn’t mean that the teeth aren’t still painful though.
The mandate also requires intubation of animals anesthetized for dental procedures. Intubation involves placing a tube into the trachea. This protects the airway. Should the animal need supplemental oxygen, it can be administered through this tube. The tube also prevents the anesthetized animal from inhaling blood and/or dental debris into the lungs.
AAHA is not alone in believing that anesthesia is necessary to carry out dental procedures thoroughly and painlessly. The American Veterinary Dental College, the group that is recognized as the expert voice in pet dental care, endorses this standard as well.
This mandate is required only for hospitals accredited by AAHA. Hospitals not accredited are not subject to the guidelines. However, hospitals failing to follow the guidelines cannot be approved for or maintain their AAHA accreditation.
I understand that many pet owners are frightened of anesthesia. I can’t say that there is no risk involved with anesthesia. But I can assure you that the risk for most animals is minimal. We’ll talk next week about modern anesthetic practices and the precautions that your veterinarian takes to make sure that your pet is safe while anesthetized. In the meantime, if you’re concerned about anesthesia for your pet, my advice is to have a frank discussion with your veterinarian about your pet’s risk.
Some people may wonder why people can have dental work done without anesthesia but pets cannot. To address this issue, I’ll quote AAHA:
“People don’t usually have to be anesthetized because we understand what is going on during a dental procedure — we understand when someone asks us to keep still in order to avoid being hurt. However, even some people react so strongly to dental procedures that they need to be sedated. In people, a trip to the dentist most often means cleaning clean teeth; with dogs and cats, painful periodontal disease is commonly present, which needs to be treated with anesthesia.”
For more information about AAHA’s new dental guidelines, please see AAHA Standards: Anesthesia and intubation for dental procedures.
Dr. Lorie Huston