Dog Teeth Dental Scaling under General Anaesthesia, is it Safe? – Dog Health Series

We are fastidious about Donna getting a regular health check with the vet at least once a year. The last time we were there, the vet checked her teeth and suggested we send her in for dental scaling in six months.

This post talks about the experience and in detail why GA is necessary. But first, here are quick FAQs if you are looking for quick answers :P

Frequently Asked Questions

1. My dog is a senior dog, is there a large risk for him to go under general anaesthesia?
   No vet will tell you there is no risk. From my layman’s perspective, the industry standard appear to be as long as the healthy senior dog passes the blood pre-work and physical examination shows no problems for him, you and the vet have made sure that there is as low a risk for his age to undergo the procedure. It is normal to worry, but if your vet thinks you should go for it, you can consider.  But you are still unsure, why not seek a second opinion with a well-regarded vet in this area.
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2. My dog is a small dog, is there a large risk for him to go under general anaesthesia?
   The amount of anaesthesia varies by weight of the dog. The smaller the dog, the less anaesthesia is administered. From that perspective, the size of the dog makes no difference to the risk level.
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3. My dog’s teeth is not very bad yet, surely I can wait for a while more?
   The worse condition your dog’s teeth is in, the longer the vet needs to work to clean his teeth thoroughly. And that means a longer time under general anaesthesia, and you do not want that.
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4. Do some dogs need teeth cleaning more than others?
   Yes, smaller breed dogs, older dogs and dogs that eat wet food are most likely to need frequent cleaning. Small breed dogs have little heads, but they do not have correspondingly little teeth.They are much more likely than large breed dogs to have crowding of their teeth as well as malocclusions. When the teeth are crowded the gum doesn’t sit nicely around each individual tooth so periodontal disease ensues. Keep your dog’s teeth clean with daily brushing and don’t delay if your vet recommends a dental scaling. ;)
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Health check at the vet

I have to admit that Donna’s teeth is yellow especially at the back, showing the build up of tartar.  Even before the health check I had started to brush Donna’s teeth daily, but since the tartar had already built up, the brushing didn’t really help there. :P

Question What is the difference between tartar and plaque?
Answer Plaque is a sticky, colourless deposit of bacteria that starts forming on teeth 4 to 12 hours after brushing. If plaque is not removed, it hardens to become tartar. Tartar is a crusty deposit that is bonded to the tooth surface and can only be removed by a dental professional. – perio.org

See the stains on her teeth?

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General Anaesthesia sounds scary

The first reaction people have about dental scaling at the vet is the concern about the General Anaesthesia that is administered.

What if my dog never wakes up?

It certainly didn’t help that the consent form we had to sign included content like – Should the vet attempt to resuscitate the pet if the pet stops breathing during the procedure? Yes or no?

Mr P and I were stunned.

Why wouldn’t we want the pet to be resuscitated? 

To be fair, that’s probably a generic form that they use for all patients, including pets with painful terminal illnesses where that choice may make sense at some point. But we are naive pet newbies just 1.5 years into living with Donna so bear with us! :P

And now, what are the chances of 5-year-old Donna not waking up from general anaesthesia?

While anaesthesia can never be 100% safe, Dr Brian Loon BSc. BVMS (Hons) of Amber Vet (Singapore) wrote on their blog, “…dental scaling (without extractions) only requires light anaesthesia as it is not a surgical procedure. Thousands of anaesthesias are performed on pets in Singapore yearly with safe outcomes.”

But what if Donna were really small, like a chihuahua, or when she grows older and start developing health issues that come with being a senior dog?

Does the risk of anaesthesia increase then?

Aanaesthesia has come a long way in both veterinary and human medicine, and there are many factors which can be controlled to allow for successful general anaesthesia. There are a wide variety of drugs available today so that the ideal combination can be chosen to best suit your pet based on its age, temperament, pre-existing medical conditions and type of procedure to be carried out. – Amber Vet

That is quite the PR answer. :P

Nancy Kay, DVM, is more candid in her opinion in this post, “For some animals, the risks associated with general anesthesia clearly outweigh the benefits, for example a dog or cat with advanced heart disease or kidney failure. Even for the healthiest animals, general anesthesia should be accompanied by careful monitoring of the patient’s status at all times.”

Jan Rasmusen (USA) says in the comments of her own Youtube video that her dog, Chiclet belongs to this category of pets, “For some dogs, though, anaesthesia is a big problem. Chiclet has had big problems with a collapsed trachea after anaesthesia. There is no perfect solution. I wish there were.”

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Anaesthesia-free dental cleaning

Jan Rasmusen’s video is one of Chiclet undergoing teeth cleaning without anaesthesia and provides a different point of view on anaesthesia-free dental cleaning, that is not covered in this post.

In Singapore, there are anaesthesia-free dental services offered at some pet groomers. This recent article informed me that anaesthesia-free dental scaling not by a certified dental professional in Singapore can take around 20 minutes.

Donna doesn’t bite but she sure can try very hard to wriggle and clamp her jaws together with your hand in it when you’re still trying to brush her teeth! But that is with me, and she is comfortable showing her displeasure than being fearful.

Unlike Chiclet, put Donna in the hands of any strange groomer, and she immediately displays resistance, violent trembling and avoidance. If said groomer were to prise her mouth open and start scraping her teeth, I can only imagine panic and other “I’m-going-to-die” fear responses will manifest. 

Shutting down loosely means the dog has gone beyond threshold and is trying to/may no longer be able to cope with the stress.  More information here.

Since Donna doesn’t fall into the category of pets where the risks outweigh the benefits where anaesthesia is concerned, the vet is the logical choice for us.

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The science behind dental scaling

Veterinarian Stacy Stacy, DVM, at The Village Vets (USA) has yet another perspective of General Anaesthesia to offer. Here’s her quote from this video.

If your dog is under anaesthesia every year, every two years, that does not increase her risk of death or of any kind of complication. I think it’s the length of anaesthesia and the underlying diseases that cause the biggest problem. If you wait two years, it could be the difference between a dog being under 30 minutes to a dog being under two hours.They have more dental tartar, more dental decay, more gingivitis and more root decay. The more significant the disease, the longer they are going to be under anaesthesia, the longer the recovery. So doing it when your vet recommends it is a good idea. – Stacy Stacy, DVM

So what exactly is involved in dental scaling for dogs and cats?

Professional dental scaling includes
– scaling the surfaces of the teeth both above and below the gum line,
– followed by dental polishing.

The most critical part of a dental scaling procedure is scaling the tooth surfaces that are within the subgingival space between the gum and the root. Here is where periodontal disease is active. – American Veterinary Dental Collage

And why are vets so insistent that the dog or cat gets his teeth cleaned with professionals and not with anaesthesia-free dental service providers? (Besides the fact that these are business competitors, haha!)

Dr Patty Kuly provided a rundown of reasons on PetMD:

1. The necessary, under the gumline cleaning of teeth is painful and poorly tolerated by pets, requires minimal movement for accuracy, and is generally considered ineffective without anesthesia.
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2. Polishing the teeth after a thorough scaling is essential to the continued health of teeth and gums, and is considered very difficult to achieve without anesthesia. Failing to polish well after scaling means more tartar build-up in the end.
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3. Pets struggle and stress during this procedure. Mine underwent it once as a trial, and consequently, I believe it’s unfair to expect an animal to deal with this level of discomfort while awake.
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4. The stated goal of non-anaesthetic dental cleaning services is to remove visible tartar for cosmetic reasons. These companies don’t (and can’t) promise health benefits for our pets.
   1. Removal of dental tartar on the visible surfaces of the teeth has little effect on a pet’s health, and provides a false sense of accomplishment. The effect is purely cosmetic. – American Veterinary Dental Collage
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5. For pets with potentially serious dental issues: Teeth must be evaluated carefully with dental probes and X-rays. This cannot be achieved in pets without anesthesia.

The statement by the Singapore Veterinary Association has similar points:

– Ultrasonic, sonic-power scalers and sharp hand instruments are used in dental scaling procedures to effectively remove dental tartar. Injury can result to the oral tissues of the animal and/or the operator with any movement or reaction in an un-anaesthetised small animal patient.

– Sedatives, tranquillisers, anaesthetics, and/or analgesics … provide restraint and eliminate or reduce the pain resulting from… the procedure.

– During inhalation anaesthesia, a cuffed endotracheal tube is used. This ensures that the airway is secure and prevents the accidental inhalation of saliva and water as well as debris and tartar which is inevitably produced during the dental scaling procedure. Such inhalation – known as aspiration – can result in severe respiratory disease.

– Full position paper here. (pdf)

Blah.. blah.. blah.. blah… blah… these vets are wordy, aren’t they?

But in some pets, these worries about dental scaling without anaesthesia being cosmetic appear to be true. The vets seem to have a morbid delight in showing us gory examples.

Have a go at it if you can stomach some of these pictures. (I warned you!)

– Consequences of anaesthesia free pet dental care – vetdentists.com
– Peridontal disease: Outta sight! (pdf file)  – toothvet.ca
– Anaesthesia free dentistry – aggievetdentist.com

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Donna’s experience of Dental Cleaning at the Vet

We were scheduled to bring Donna in at 10am on the day of the appointment with the vet. Prior to that we were advised to fast the dog from 12 midnight, but still ensure water remained accessible for her.

During the examination, the vet assessed her general condition for the day to be suitable. She then gave us some options with regards to the procedure as well as the estimated costs involved.

Do we want a blood test for her? That would be an extra charge but it will help detect if Donna has any conditions not suitable for the general anaesthesia to be administered.

Pre-anaesthetic blood work (especially for pets 7 years or older) to assess the function of organs such as the liver and kidneys which will be clearing the anaesthetic drugs given from the body. Other diagnostic tests may also be recommended based on any abnormalities found on the physical examination performed. – Amber Vet, Singapore

…geriatric pets pose a higher risk of anesthetic and there is no two ways about it. However, veterinary care has advanced and we now possess a range of equipment and knowledge to assist in offering excellent monitoring of our patients while they are under general anaesthetic.
At our current clinic, we offer if not insist on conducting a pre-anaesthetic blood test and intraoperative intravenous fluid therapy for any geriatric patient undergoing surgery. This helps us make better choices of anaesthetic regimens tailored to our patients. The intravenous fluid therapy ensures our patient’s blood pressure does not plummet during the anesthetic and this helps them recover better. – rayyathevet.com, Australia

Donna is not yet a geriatric pet, but since this is our first time with her going under general anaesthesia, it just seemed prudent for the blood test to be done so we know for sure that the GA is conducted with minimised risk to her.

If one or more teeth needs to be extracted, do you want to be contacted for permission to extract? Yes, I would so that I don’t experience a heart attack should I pick up a toothless dog at the end of the day! But seriously, I feel that I am ill-equipped to even be able to ask the right questions in order to evaluate to say yes, please extract, or no, because xyz… I don’t have that kind of specialised knowledge so the purpose of the phone conversation is really more to reassure myself. I just have to trust that the vet is the professional in this.

So what happens after Donna is checked in to the hospital?

• The blood test will be conducted.
• She will then be caged/crated until 2p.m. (This is the point where I start being thankful that she is crate-trained.)
• If pre-anaesthesia blood test results are fine, vet will being the procedure at 2p.m. as planned.
• Donna should wake up at around 5pm and be ready to be discharged.
• We will be contacted should there be any complications or if she is ready to go home earlier.

And indeed, by 5p.m. I received a phone call that Donna is ready to be picked up.

When they finally led our dog out, Donna appeared a little dopey, her eyes appeared crusted and she had a pressure bandage over a shaved off patch on one of her legs. If I am not wrong, the shaved off patch was for the IV catheter.

Poor Donna with crusted eyes and a pressure bandage on her leg.

An IV catheter is essential for administering an IV drip during anaesthesia and to ensure that there is easy access to the vein in case of emergency. It consists of a soft plastic tube (without needle) sitting in the vein and does not cause any pain once it is placed. – Amber Vet, Singapore

We asked and were assured that she still had her complete set of teeth, now cleaned and there wasn’t anything that we should be concerned with. Good.

During the session with the vet in the morning, I had taken the opportunity to ask all the random questions I had about Donna’s health not relevant to the dental cleaning. And given that the vet gave her a clean bill of health, we are good not to visit the vet for a year. So the next time we go will be June next year, barring accidents!

After care instructions include:

• offer about 1/3 the usual amount of food for that day. Nothing too rich to upset her tummy. And nothing hard (e.g. dry kibble) as her gums would be tender. Feed normally the next day.
  – Donna’s bowel movements became irregular. She also experienced runs and soft stool for 1-2 days. She also seemed temperamental and pooped on the living room floor, which is out of the norm for her when the weather is good. Seemed fine thereafter though.
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• pet may experience some throat irritation from the breathing tube placed during surgery. If coughing or harsh noises when barking or meowing perists after 3 days, then we should be concerned and bring the dog in for checks.
  – Nope, no issues in the area at all.
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• restrict exercise for approximately 7-14 days
  – Oops! Donna has been doing spurts of running after day 3 but seems ok.
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• the effects of anaesthesia can last for a few hours to a few days depending on pet’s age, fat or metabolism. Keep pet in a more restful environment. Be aware that pet may appear more sleepy or disoriented and should be protected from falling off furniture/stairs.

It has been a week since the dental cleaning, and Donna has returned to eating and pooping regularly.

Donna, 2-3 days after dental cleaning. 

According to the American Veterinary Dental Society, more than 80 percent of dogs and 70 percent of cats develop gum disease by the age of three years. – vetmed.ucdavies.edu

Remember to brush daily and send your pet for regular health checks including checks on their teeth! Stay healthy ;)

Besides daily toothbrushing, the following products are also awarded the VOHC (Verterinary Oral Health Council) Seal of Acceptance in 2013-2014 for effective Plaque and/or Tartar control. You can buy them on Amazon by clicking on them.

For more information on pets and dental disease/care, this is an awesome, gory series by rayyathevet.com to scroll through: 

– General pets: Dental disease in pets, the silent killer: Part 1
– For Dogs: Dental disease in pets, the silent killer: Part 2 – gory pictures
– For Cats: Dental disease in pets, the silent killer: Part 3 – gory pictures
– and also, The perils of gum disease in dogs – pets.webmd.com

Also, these Singapore dental links are also quite interesting:
– Dental work without anaesthesia in a very old pomeranian with heart diseases
– Dental health care of the dog in Singapore
– The teeth chattering chihuahua
– The large cheek tumour and 15 rotten teeth in an old dog
– A schnauzer has two loose front teeth and an ear lump

For a look at what goes on in the vet’s office in Singapore, Amber Vet has more information here on how the pet is monitored during dental scaling.

Note While I have referred to Amber Vet in this article, Donna’s dental cleaning was not done there.