What is an anesthesia-free dental procedure?
Anesthesia-free dentistry is a service commonly offered at pet stores and grooming facilities. It involves scaling (scraping) the tartar from the teeth of a dog or cat that is awake, without the use of anesthesia. This procedure stands in contrast to veterinary dental procedures, in which the pet is fully anesthetized to permit thorough examination and treatment of the oral cavity.
In order to perform anesthesia-free dentistry, a pet is first restrained on an exam table. Next, a sharp instrument, known as a dental scaler, is used to chip away tartar from the visible surfaces of the teeth. After this scaling, the pet’s teeth may also be brushed using a toothbrush and toothpaste.
How does a veterinary dental procedure differ from an anesthesia-free dental procedure?
Veterinarians use general anesthesia during dental procedures so they can perform a thorough oral examination and treat any diagnosed dental disease. Before a pet receives anesthesia, they receive a thorough pre-surgical exam, pre-anesthetic blood testing, and pre-anesthetic sedation. Next, an injectable anesthetic agent is given via an intravenous catheter. This injection anesthetizes the pet, allowing your veterinary team to place a breathing tube that can be used to deliver inhalant anesthetic for the duration of the dental procedure.
"Veterinarians use general anesthesia during dental procedures so they can perform a thorough oral examination and treat any diagnosed dental disease."
While the pet is anesthetized, a veterinarian and veterinary technician work together to evaluate the pet’s oral health. They examine the entire oral cavity, looking for evidence of masses or other lesions on the lips, gums, palate, or tongue. Each tooth is examined visually, then further evaluated with a periodontal probe, which allows them to find periodontal pockets (deep pockets in the gums) that indicate the presence of periodontal disease. Full-mouth dental X-rays (radiographs) are also typically performed, allowing your veterinarian to evaluate the jaw bones and the roots of the teeth.
After the mouth is fully examined and all findings are documented in the pet’s medical record, the veterinary technician will scale the pet’s teeth with an ultrasonic scaler. This scaler is used not only to remove visible surface tartar, but also to remove tartar from just below the gumline and the areas between the teeth. Additional treatments may also be performed if needed, such as extractions, advanced dental procedures, or local antibiotic administration. Finally, your pet’s teeth will be polished, and your pet will be recovered from anesthesia.
Fig. 1: Stages of periodontal disease. Veterinary dentistry under anesthesia allows for removal of visible tartar as well as tartar below the gumline, which can lead to periodontal disease.
Is anesthesia-free dentistry less stressful than going under anesthesia?
At face value, anesthesia-free dentistry might sound appealing because it avoids putting a pet under general anesthesia, but unfortunately, anesthesia-free dentistry is often the higher-stress option.
Scaling the teeth involves placing sharp instruments inside the mouth. In anesthesia-free dentistry, the pet must be physically restrained for a lengthy period, to allow scaling of the teeth. Depending on the pet, high levels of restraint may be required, and this can be very stressful. Additionally, if a pet wiggles or moves during anesthesia-free dentistry, they may be injured by the sharp dental instruments, which can cause further stress and pain.
Veterinarians anesthetize pets before a dental procedure, so they can safely use these instruments without a need for prolonged restraint and with minimal risk of injury.
Does anesthesia-free dentistry offer the same benefits as veterinary dentistry?
No. A veterinary dental procedure has two primary goals: diagnosis of oral/dental disease and treatment of disease. A thorough oral examination is arguably the most important component of a veterinary dental procedure, because it allows your veterinarian to look for evidence of oral disease and determine the most appropriate course of treatment. Anesthesia permits a thorough oral evaluation and aids in treatment by giving your veterinarian access to your pet’s entire mouth, including all surfaces of the teeth and areas below the gumline.
"There is no way to remove tartar below the gumline or between the teeth without anesthesia."
Anesthesia-free dentistry is far more limited than veterinary dentistry. Few pets will permit a thorough oral evaluation without anesthesia, which means that only the outside surfaces of the teeth can be examined. Significant disease can be missed, including periodontal disease, oral tumors, and dental abscesses. Additionally, while anesthesia-free dentistry may help to remove some visible tartar from easily accessible surfaces of the teeth, there is no way to remove tartar below the gumline or between the teeth without anesthesia.
Given these drawbacks, the majority of major veterinary organizations, including the American Veterinary Dental College, the American Veterinary Medical Association, and the American Animal Hospital Association, agree that dental cleanings should be performed only under anesthesia. While anesthesia-free dentistry may offer a slight cosmetic benefit, it offers little true medical benefit for patients.
What if I am concerned about my pet going under anesthesia?
If you are hesitant to have your pet anesthetized, talk to your veterinarian. Your veterinarian knows your pet’s complete medical history and can help you balance the benefits of a dental cleaning against any risks associated with anesthesia.
Your veterinarian will perform a thorough physical exam and blood testing, including a complete blood cell count and serum biochemistry, prior to anesthesia. This pre-anesthetic evaluation helps detect any underlying internal conditions that might affect your pet’s risk, allowing your veterinarian to customize the anesthetic plan for your pet's overall health.
While your pet is under anesthesia, they will be closely monitored, allowing for detection of any anesthetic complications. Most veterinary practices use a combination of a pulse oximeter (which detects blood oxygenation), blood pressure monitoring, electrocardiogram (ECG monitoring), temperature monitoring, and other monitors to provide information about your pet’s body function while under anesthesia. Any abnormalities detected on monitoring can be addressed by anesthetic changes or other medications, further reducing the risk of any significant anesthetic complications.
