Olathe Animal Hospital » Dentistry

Anesthesia for dental procedures

J.C. Burcham, DVM — Tue, 22 Dec 2009 16:20:21 +0000

When I inform a pet owner that I recommend a prophy, or teeth cleaning, I’m often asked, “Do you have to put him under anesthesia to do that?” But the REAL question they’re asking is, “Is it safe to put my pet under anesthesia?”

If there’s one thing I could effectively convey to the general pet-owning public, it would be the difference in quality of anesthesia drugs, monitoring equipment, and trained staff. Not all anesthesia is the same. I’ve heard plenty of stories of friends, relatives, and neighbors who’ve had a pet die under anesthesia when it came in for a simple routine procedure such as a prophy (or spay or neuter).

Since I joined Olathe Animal Hospital in 2004, I cannot think of ONE anesthetic death that occurred in association with a dental procedure. And trust me, we remember major events like that. Out of curiosity, I ran a report to see just how many dental procedures (under anesthesia) we’ve performed in the last 5 years. In that time frame, we have performed 1,611 teeth cleanings under anesthesia, and have had NO anesthetic deaths.

While that should ease your mind a bit, what you really need to know more about are the safety precautions we take. Every patient undergoing an anesthetic dental procedure receives an IV catheter for IV fluid support (helps keep blood pressure up). Blood work is performed prior to the procedure to check internal organ function. A physical exam is performed on the day of the procedure to check heart health and hydration status. Monitoring equipment monitors the patient’s heart rate and oxygen levels. A technician is with the patient the whole time, watching breathing, temperature, and heart rate.

These precautions I described above are more than half the battle in terms of having a safe anesthetic event. Obviously the drugs used also play a significant role. Patients are premedicated (made sleepy) with an injection of hydromorphone (a sedating narcotic) and sometimes acepromazine (a sedative), depending on the patient’s anxiety and activity level. To induce a state of anesthesia, we use propofol IV. To maintain anesthesia, we use isoflurane gas, which is widely used in human medicine as well. The gas anesthesia is delivered through an endotracheal tube, which also allows assistance with ventilation if needed and prevents aspiration. Watch the video above to see the process of a dog undergoing anesthesia at Olathe Animal Hospital.

Broken teeth–what should you do?

J.C. Burcham, DVM — Mon, 14 Dec 2009 17:08:59 +0000

Broken incisors

Earlier today, I examined a dog who had been adopted from a shelter. She was very sweet, albeit a little shy, and we could quickly see she’s a good snuggler. During my exam, I noticed some broken incisors and a broken canine tooth. Given her background, we’ll never know how she broke these teeth. Was she kicked? Hit by a car? Did she chew too hard on something?

What we do know is that 98% of broken teeth will eventually develop an abscess. Tooth abscesses, as any humans who’ve experienced this problem can attest, are extremely painful. Being the stoic creatures that they are, however, dogs may not show any signs of pain. The best treatment for this particular dog is extraction of the broken incisors and either extraction or root canal therapy of the broken canine tooth.

Lower left canine tooth is broken

Root canal therapy is a specialty procedure, and we can offer a referral to a qualified veterinarian if this is something you’re interested in for your pet. Remember, dental pain should not be ignored–the sooner it’s addressed, the sooner a dog can be on her way to healing and feeling better!

Periodontal Therapy (Prophy)

J.C. Burcham, DVM — Wed, 09 Dec 2009 16:03:35 +0000

Before

It is very important for you to know that not all veterinary hospitals approach anesthesia and periodontal procedures in the same way. Advancements in veterinary medicine have allowed these procedures to be much safer than ever before. You can be confident that your pet will be provided the highest quality of care with the most compassionate approach at Olathe Animal Hospital. This includes the latest pain management protocols, the most advanced monitoring equipment, a highly trained technical staff, the safest anesthesia, and even thermal warming blankets to maintain body temperature.

When your pet is admitted to our hospital for periodontal therapy and surgery, several steps are taken before the actual procedure occurs. First, your pet’s attending doctor will conduct an examination to determine if there are any current issues that would prevent us from proceeding. We normally will have run a blood panel prior to the day of the procedure. If not, we will draw blood to run the panel in our lab on the morning of the procedure. This important step tells us if the liver, kidneys, blood count, etc., are within normal limits. If all is well, a nurse will administer pre-medications to reduce pain, calm your pet and reduce the amount of gas anesthesia needed. Later, after an intravenous catheter is inserted, a short acting drug is given to allow your pet to fall asleep. At that point, a breathing (tracheal) tube will be placed and a gas anesthesia/oxygen mix will be administered directly into the lungs. We use the same anesthesia as in human hospitals. Monitors will be attached to your pet showing heart rate, blood pressure, and oxygen saturation. Intravenous fluids will be given during and after the procedure to maintain blood pressure. Based on our monitoring, anesthesia can be adjusted accordingly, and any changes can be detected before serious problems occur. The intravenous catheter allows for quick administration of emergency medications if needed.

Once your pet is under anesthesia, we begin a complete examination of the oral cavity. With the same instruments used in human medicine, we clean, scale, and polish each tooth to remove all the calculus. We also clean under the gum, a technique known as subgingival scaling. Once cleaned, we perform a thorough oral examination. After any necessary treatments are performed, our nurse applies fluoride to the teeth and your pet is recovered.

Your pet is constantly monitored by an attending nurse during the entire procedure and when completed, the anesthesia is turned off and oxygen is administered. Your pet continues to be monitored by our trained staff during the recovery period, and is given additional pain management later in the day if teeth were extracted. Owners are often amazed how great their pet looks when they walk out to greet them, often with little or no indication that they have been under general anesthesia. To maintain comfort levels for our pets that require dental surgery, we will send home pain medication.

: After

At Olathe Animal Hospital, our mission is to provide the highest quality care for our patients with the most compassionate approach. The techniques we use for our periodontal therapy and surgical patients are an important part of our mission.

Prophy? What’s that?

J.C. Burcham, DVM — Tue, 08 Dec 2009 02:34:19 +0000

A prophy is often called a “teeth cleaning,” but I’m afraid that description doesn’t quite do justice to what is included in a routine prophy. A better description is “periodontal therapy”, but even that may still leave you asking, “What?”

During a prophy, the heavy layers of tartar and calculus are removed from the tooth using an ultrasonic scaler (what human oral hygenists use). Most importantly, the sub-gingival (“under” the gums) tooth is also cleaned, which you simply can’t achieve on an awake patient.

We then chart the teeth. This is a very important step. Charting measures any pockets between the tooth and gums and allows us to make note of any chipped enamel, mobile teeth, gingivitis, oral masses, or any other potential areas of concern. Because this step can be time-consuming, many vet clinics opt not to do this (or they don’t do a thorough job), but we feel it’s one of the most valuable parts of the process.

Lastly, we rinse the mouth with fluoride and apply Ora-Vet. The Ora-Vet binds to the tooth and prevents tartar and bacteria from binding to it, so we can keep the teeth pearly white for even longer. We recommend that you continue applying the Ora-Vet weekly to help keep the teeth clean. It’s easy to apply and takes less than a minute.