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Anesthesia-free Dentistry

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According to the American Veterinary Dental Society, up to 85% of dogs and 70% of cats develop periodontal disease by age three. Dental disease (cavitation, periodontal, etc.) is the number one issue facing dogs and cats. As a profession, we are definitely not addressing this issue properly. While anecdotal reports show there is a smaller percentage of pets with dental issues in holistic practices, ranging from zero to 40% for different veterinarians, there is still a need for dental procedures. Since systemic illnesses can be triggered by oral problems, routine dental care by professionals is important. Veterinarians have always performed dentistry, usually under anesthesia, as a routine part of preventative health care. In 1987, dentistry became a specialty and there are now over 100 board certified dentists.

Every conference has dental seminars and practicums. A recent arrival is anesthesia-free dentistry, done either by the veterinarian and staff, or by laypeople trained in this area. Clients are requesting this because of the lower cost and perceived lower risk of no anesthesia. Veterinarians’ opinions range from violently opposed to very positive. Is anesthesia-free dentistry something you want to offer at your practice? Do you want to do it yourself, train technicians to do it, or hire local or national companies who have been doing it for years? This article presents several different views from veterinarians on anesthesia-free dentistry and may help you decide whether or not to recommend or incorporate it into your practice. It will also remind you to query clients about lay dental care along with homecare, as they may be getting the dental at a groomery or pet store.

Anson J. Tsugawa, VMD, DAVDC, emphasizes that the quality of any service varies by the individual providing the service. This is true for the practice of non-anesthesia dentistry as well, whether it is preformed by a veterinarian, technician, or lay individual providing the service. Dr. Tsugawa strongly believes patients must be anesthetized in order to safely and properly perform optimal dental care. He is concerned about patients with a history of nonanesthesia dentistry who have received substandard care, and has treated many patients over the years that should have seen a veterinary professional sooner. He also has seen many clients seek treatment as a direct recommendation of a lay individual performing non-anesthetic dentistry; this is remarkable and noteworthy since these individuals are not veterinary professionals, yet have correctly identifi ed signifi cant oral pathology.

Dr. Tsugawa recognizes one benefit of non-anesthetic dentistry; there are more “eyes” on each animal, and more encouragement for the client to brush. More frequent examination of the patient’s oral cavity will encourage clients to do the same, and to be more aware. Hopefully, this will help gingivitis, oral cancer and other significant oral pathologies to be identified earlier. Finally, Dr. Tsugawa acknowledges there are inherent risks with any anesthesia-related procedure, so a client’s fear of anesthesia should not be quickly discounted. When clients are not ready to pursue an anesthesia dental procedure, education and patience is needed. Usually, a reassuring, guiding and consistent approach leads fearful clients to perform the recommended anesthetized dental work on their companions, though on their terms.

Dr. Jennifer Ramelmeier, who has a homeopathic and house call practice, does anesthesia-free dentistry at her monthly hands-on clinic. She is very pleased with client acceptance and improved dental health. There is no difference in tarter accumulation between dentals, with or without anesthesia. Some patients are scaled every six months. Dr. Ramelmeier can do almost any cat or big dog, though she has diffi culty with small dogs; she uses cat bag restraint. Occasionally, a big dog will put a paw on her arm, but usually there is no reaction. First she chunks off big pieces, then puts the scaler up into the gum to get the tarter off. She polishes the teeth with no problem. She can occasionally pull teeth if they are very loose. She does not use anesthesia-free dentistry when applying sealer, as the teeth need to be dry to apply it. She also cannot remove tartar on the inside. If Dr. Ramelmeier feels an animal is too nervous, she will give him herbal California Poppy (from Animal Apawthecary), Young Living – Peace and Calm, and Bach Rescue Remedy on the ears and sprayed in the room.

Dr. Shawn Messonnier, DVM, author, speaker and owner of Paws and Claws Animal Hospital, has written about the myth that animals cannot have anesthesia for dentistry because of health or aging. He says that regular dental cleanings are critical to keep chronic infections and infl ammation at bay. While many veterinarians discourage this in geriatric patients, he says that with comprehensive physical examinations, laboratory testing, individualized anesthetic and medication, using gas anesthetics (i.e. isofl urane or sevofl urane), any animal can have his teeth properly cleaned under anesthesia, and go home within minutes after waking up. He feels it is impossible to adequately clean teeth without anesthesia.

Dr. Brook A. Niemiec, DVM, DAVDC, FAVD, NAD stated in a recent article that anesthesia-free dental practitioners or companies typically have limited to no training, and are therefore not educated or experienced enough to find and identify dental pathology. In addition, attempting to scale teeth with sharp instruments in awake and moving patients presents many dangers. Furthermore, the most important part of the “cleaning” is subgingival, which means that scaling the crowns is limited to a cosmetic benefit only. Radiographs are critical to good dental care and require anesthesia. Dr. Niemiec states that a proper and beneficial prophylaxis or cleaning includes many steps which cannot be performed without anesthesia. These steps include: supra- and subgingival scaling; polishing; sulcal lavage; and complete oral examination (including periodontal probing). Dr. Niemiec also points out that the financial cost of a proper dental cleaning done annually is comparable to the typical annual frequency of NAD (four times per year or more). And perhaps, most importantly, he and his colleagues have many cases showing NAD to be ineffective and dangerous.

Dr. Shelley Epstein, owner of an AAHA hospital, said that for years she hesitated to use anesthesia-free dentistry because she had been told how inadequate this procedure was. A classmate began working with a company that offers it and raved about the results. After a long, probing conversation with the owner of the company, Dr. Epstein learned the limitations of their work (gingival sulci not more than 2 mm) as well as the benefits. He also detailed the extensive training his hygienists/technicians undergo, as well as their proprietary comfortable restraint techniques. The classmate’s technician came to the practice and did an impressive demo on a clinic. Dr. Epstein’s clinic has been using the company for over a year now, and client satisfaction rate is extremely high.

Dr. Barbara Phillips at the Caring Animal VCA Hospital was initially excited about the gentle handling that allowed for dental care by an anesthesia-free dental service. Over time, though, she found that only the buccal surfaces were being scaled, allowing the lingual surfaces as well as spaces between the teeth to continue to build tartar. The service did not polish the teeth, so repeat visits were often needed at three, six and nine months. Therefore, clients would elect for anesthesia and a more thorough cleaning and polishing that would last one to two years.

Dr. Doug Knueven, owner of the integrative Beaver Creek Animal Hospital, says that the only way to do a complete and proper dental cleaning is with the pet anesthetized, because of the difficulty in properly cleaning the lingual surfaces and subgingival surfaces, and because extractions cannot be done. On the other hand, there are patients for whom anesthesia would pose an unacceptable risk. For these animals, some dentistry is better than none at all. Dr. Knueven states that anesthesia-free dentistry should only be done at a veterinary office by a professional (veterinarian or certified veterinary technician).

Dr. Pema Malu of Veterinary Holistic Care in Maryland reports that their anesthesia-free service does an excellent professional job cleaning teeth and caring for gums both with hand instruments and an ultrasonic scaler. They also use ozonated water on the gums for healing. They properly refer to the veterinarian for antibiotics, extractions, severe periodontal disease, neck lesions and fractures. Many clients opt for regular anesthesia-free dentistry, thus avoiding periodontal disease in the future. The American Veterinary Dental College recommends dentals be done only by veterinarians with the use of anesthesia.4 However, many veterinarians have found great satisfaction in a wellperformed anesthesia-free dental done in the veterinary clinic. Most of the objections raised and problems seen are from poor training. Polishing, cleaning lingual surfaces, and calm patients with lack of damage are possible in the right hands with the right training. Maintaining dental health is critical for the health of all animals. In an integrative practice, there are many approaches to this. Client education is always primary, so explain how dental health affects metabolic and mental health (and vice versa) and offer multiple approaches to dental health. Have your clients continue to evaluate dental health along with other health criteria, and encourage them to call with even the slightest concern. Re-visit your decisions for dental care recommendations at least annually.