Anesthesia-Free Dental Cleaning

It’s natural to have concerns about general anesthesia, whether for ourselves or for our beloved pets. After all, no matter how young and healthy the patient, there is always some associated risk. For this reason, anesthesia-free dental cleaning for pets has become more and more popular. And with no anesthesia, the cost of cleaning Fido’s or Fluffy’s teeth is significantly reduced- clearly another attractive feature. Anesthesia-free dental cleaning for your pet sounds rather tempting, doesn’t it? Before you jump on this bandwagon I encourage you to consider whether or not this option truly serves your dog’s or your cat’s best health interest.

I’m a big believer in regularly brushing your pet’s teeth at home. Thoroughly removing dental tartar on an awake animal, however, is a whole nother ball game! Even with highly skilled hands and a super-cooperative animal, it is impossible to successfully and painlessly remove tartar from underneath the gum lines and along the inner surfaces of the teeth (the surfaces in closest proximity to the tongue). And, if the end result of cleaning is anything other than polished, super smooth, dental surfaces, tartar will quickly reaccumulate. Anesthesia-free dental cleaning definitely gives the outer surfaces of the teeth a cleaner look. While this may be pleasing to your eye, there is no significant benefit to your pet’s health. For all of these reasons, if and when dental cleaning is warranted for your dog or cat, I strongly encourage that it be performed with the aid of general anesthesia.

Now, there are some caveats that accompany my recommendation. 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. A list of important questions to ask your veterinarian about general anesthesia can be found in Speaking for Spot within the chapter called “Important Questions to Ask Your Vet…and How to Ask Them.”

The American Veterinary Dental College also advises against anesthesia-free dental cleaning. Here is an excerpt from their recently drafted position statement:

“Owners of pets naturally are concerned when anesthesia is required for their pet. However, performing nonprofessional dental scaling on an unanesthetized pet is inappropriate for the following reasons:

  1. Dental tartar is firmly adhered to the surface of the teeth. Scaling to remove tartar is accomplished using ultrasonic and sonic power scalers, plus hand instruments that must have a sharp working edge to be used effectively. Even slight head movement by the patient could result in injury to the oral tissues of the patient, and the operator may be bitten when the patient reacts.
  2. Professional dental scaling includes scaling the surfaces of the teeth both above and below the gingival margin (gum line), followed by dental polishing. The most critical part of a dental scaling procedure is scaling the tooth surfaces that are within the gingival pocket (the subgingival space between the gum and the root), where periodontal disease is active. Because the patient cooperates, dental scaling of human teeth performed by a professional trained in the procedures can be completed successfully without anesthesia. However, access to the subgingival area of every tooth is impossible in an unanesthetized canine or feline patient. 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.
  3. Inhalation anesthesia using a cuffed endotracheal tube provides three important advantages- the cooperation of the patient with a procedure it does not understand, elimination of pain resulting from examination and treatment of affected dental tissues during the procedure, and protection of the airway and lungs from accidental aspiration.
  4. A complete oral examination, which is an important part of a professional dental scaling procedure, is not possible in an unanesthetized patient. The surfaces of the teeth facing the tongue cannot be examined, and areas of disease and discomfort are likely to be missed.”

How do you feel about anesthesia-free versus anesthetized dental cleaning? Keep in mind, for some folks this is a rather heated topic. Let’s keep the conversation civilized!

Happy holidays to you and your loved ones,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

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19 Responses to “Anesthesia-Free Dental Cleaning”

  1. Jana Rade Says:

    Enough people I respect expressed that anesthesia-free dental cleaning is not good. What they say makes sense to me.

    Trust me, I’d like nothing better than not having to put my dog under to get their teeth cleaned. But I do believe that’s how it needs to be done.

    On the upside, since her last dental cleaning, with twice-daily brushing, Jasmine’s teeth don’t need any additional maintenance at this time. So that was a good news to us.

    How do you feel about the products that are supposed to modify saliva in order to prevent tartar?

  2. Amy Says:

    One of my dogs has a heart that skips beats, and my vet was able to do an EKG in his office and have a cardiologist elsewhere evaluate his anesthesia plans for her in light of those results, so even with heart disease it might be possible.

    I just wish I’d known what a reasonable price was for it, because a few years ago my vet at the time quoted a price I couldn’t afford, mostly due to his inflated price for surgery he should have referred to a specialist anyway. My dog developed meningitis and I’ve always wondered if it was due to her dental issues. If I ever have to move again, I’ll call around to ask for prices for spay & dental, and that should give me an idea of the range for that area. My new vet charges half as much as that first one, even considering the heart condition, and his reputation is better too.

  3. Carolyn in Belize Says:

    My little dog was adopted as adult with terrible teeth. Even though we brush daily, over the years, they’ve been cleaned three times after other procedures (e.g. 2 cherry eye surgeries, small growth removal). She also had tooth resorption so has had several teeth removed. Our vet uses sedation — not inhalation anesthesia. Sounds like that is riskier?

    Wish that you could just ask your dog to smile for the dentist and have at it. But since the reality is that it will be uncomfortable, then I think it is a kindness to use anesthesia.

    A further note on tooth resorption — CoQ10 was suggested (10 mg daily based on her size) and it appears to have helped. She has not lost any more teeth in the past 3 years.

  4. Tracy B Ann Says:

    It seems like a lose-lose situation to me. I don’t want my dog to be put under anesthesia for a simple teeth cleaning (though I wouldn’t mind it for myself!), and I know what bacteria from teeth can do when it enters the blood stream. (Kill my dog.)

    So I think what is needed is a better procedure. I wish the AVMA would stat to work exploring that.

    Until then I feed my dog raw bones twice a week. At 5 and a half years old the vet is amazed at how clean his teeth are.

    The best I can do for now, while I wait for a better procedure, is just request that Ketamine not be used.

  5. tom woolner Says:

    My dog, a rescue shepherd mix, has had so many procedures done – lungs scoped x2, multiple x-rays, biopsies, etc – the it woud be no way he would allow anyone to clean his teeth, Havingsaid that, I would like to minimize the times he is knocked out – he is only 4.5 yo, and he has had genral at least 6 times, including teeth cleaning.
    When he had the dental work done, there was no sign of serious gum disease, etc. How frequently do you recommend the procedure?

  6. China Lanier Says:

    Excellent article, as always … very informative and of particular interest to me as it answered a nagging question in the back of my mind.
    I have mentioned before a bad experience I had with a very large chain type Vet clinic generally associated with a Petfood store …
    My baby girl is an 11 year old Lab/Chow … when asking questions about what is best toothbrush/toothpaste I was talked into having her teeth cleaned being told that brushing is not effective. I was very concerned about her being put under but considering she is in excellent health, decided to go ahead. I must say that I was amazed at how beautiful, shiny and white her teeth were afterwards, jokingly saying I no longer needed a flashlight as her smile would lite a room. Well in short order, I’d say a couple of months, her teeth were back to the same state of discoloring and ? as they were before the cleaning. I’ll add here that her diet is primarily dry food, Iams Naturals. This brand has been the only thing she has eaten for the last 10 years (lamb and rice before Naturals were introduced) She does get canned food on occasion, usually when I give her heartworm med once a month. Treats are Pup-peroni or other natural treats. I only mention all this as I’ve heard and read that dry foods help to keep teeth clean. I found the state of her teeth to be a nag in the back of my mind but didn’t follow up. Well, Dr., You have answered that ‘nag’. After the trouble I had with this clinic giving my baby a mis-labeled Rx and then trying to deny it. Thank God my baby was smart enough to spit it out immediately and her reaction being so unusual, I took notice. After all this, it came back to me the discussion of the cleaning, the who, what and how. I had been told it would be by a tech under the ever watchful eye of the Vet of the day. Now after reading your article I have to question just exactly ‘how they cleaned’ her teeth and ‘to what extent’ not to mention, when I broke the yearly contract of care, for dangerous and bad care, to my way of thinking as they very well could have killed her, they want to charge me $600 for this “cleaning”! Needless to say, it will be a cold day in … ! After your article, I can only conclude that her teeth were merely polished (?) as opposed to actual cleaning.
    Now, a question … would it not be possible to give a local, much as a dentist does, with a light dose of some calming medication as apposed to putting a pet under? Now I realize that wouldn’t work on all pets as some are just to leery of strangers but how about on those who don’t know a stranger?
    Also, is it possible for you to recommend a particular brush and toothpaste?

  7. Susan K. Says:

    My collies have had anesthesia-free dental cleaning for several years. It is not about cosmetics but removing plaque, and it is done at my vet’s office through a provider that has been doing this for over 20 years. They have regularly scheduled visits throughout many states. I have always been impressed by the technician and her ability to work with my dogs. It is important to have my collies teeth cleaned but they are very sensitive to anesthesia. I do not agree that this is all about cosmetics, but providing a safe alternative to dental cleaning using anesthesia.

  8. Rachael Says:

    If you have multiple pets, I don’t think it’s economically feasible to have each animals teeth cleaned under anesthesia annually. With my vet, cost is between $500 to $1000 each, depending on whether there are any extractions. Also, while dealing with medical issues on one of my animals (successfully fighting mast cell cancer for the last four years)…annual exams and dental cleaning sort of end up on a back burner. Maybe there could be a lower cost specialty practice, like spay and shot clinics that would make annual dental cleaning a more practical option for the masses. We do scrape tarter and also use the saliva modification products to keep tarter from attaching to the teeth, but still, professional cleaning would accomplish a better end result.

  9. Deborah Crippen Says:

    Thanks so much for bringing this issue up. I often see patients with horrendous teeth that have been having them cleaned anesthesia free. A decent physical exam often lets us know there is dental disease but doesn’t always let us know to what extent. There have been cases where things don’t look too bad until we are able to probe and find the huge pockets or broken teeth that aren’t visible.

    Cheap doesn’t seem so cheap when one realizes that the true cleaning and evaluation wasn’t actually done. Doing pre-anesthetic blood work also is helpful in the long term care of our aging pets.

    Lets think about value rather than low price.

    Deborah Crippen DVM

  10. speakingforspot Says:

    Hi Rachael,

    Thanks for posting your comment. Please know that not every dog or cat needs dental work yearly. Some animals (particularly larger dog breeds) may never need professional dental cleaning throughout their entire lives. When it comes to “herd health” I would encourage you to be selective about who truly needs dental work rather than assuming that each animal needs professional cleaning once yearly.

    Hope this helps.
    Dr. Nancy

  11. speakingforspot Says:

    Hi China,
    Local anesthetics have not been used (to my knowledge) with success in dogs and cats. They really do have to be fully under anesthesia in order to keep their mouths open and their tongues out of the way. I use a children’s toothbrush on my medium sized dogs. There are a number of dental paste products on the market that claim to prevent tartar. The best prevention is, in fact, the brushing action of the toothbrush.

    Dr. Nancy

  12. speakingforspot Says:

    Hi Tom,

    Every animal is different. Some dogs need dental cleaning as often as twice a year. Others never need a single dental cleaning throughout their lives. Without opening your dog’s mouth, pull his lips back to expose his back teeth. Are the teeth covered with brown plaque material? Do the adjacent gums appear swollen or inflamed. Next time you and your dog pay a visit to the vet hospital, ask the vet to give you a tour of your dog’s mouth and show you what is clean and what isn’t.

    Dr. Nancy

  13. Miriam Yarden, B.Sc.,MS,APDT Says:

    I don’t allow my dentist to touch me without a local, even for scaling. Why would I allow my pet to sit there, nervous, uncomfortable, accepting possible painful jabs when he moves his head, AND incomplete treatment under the gumline? Why would I allow my pet to develop infections an inflammations BECAUSE areas that are painful were not addressed, let alone treated? Why would I permit my pet to be treated by anyone WITHOUT a license to practice medicine and/or medical procedures?
    Exxpensive? Sometimes yes, indeeed. But that planned vacation can wait, that extra is something I CAN live without……my Companion comes first (after mortgage, utilities and other similar essentials).
    OF COURSE I brush his teeth regularly. I brush mine, don’t I?
    Miriam

  14. Donna Says:

    I have experience in the dental field and many humans have great difficulty sitting through a dental cleaning (anxiety). If the dog is not under anesthesia a thorough and complete exam of the gums and teeth is not possible because it would be too painful for even the best of dog to sit still for a deep cleaning. With several of my dogs the vet has discovered damaged teeth that needed to be extracted. If teeth need to be extracted that can be done while the dog is on the table for the cleaning and not have to return for another visit and anesthesia.

  15. Susan Says:

    This is very timely. I have just scheduled a cleaning for my dog to coincide with another procedure (removal of benign cysts that are inconveniently located). This is the second cleaning for my dog (he is a giant breed, had his first cleaning at 4 years and now again at 8 years).

    Before the first cleaning, I was required to schedule an appointment and cursory examination with the canine dentist. It was an added expense, but I learned a lot from that visit, including the necessity of using anesthesia.

    I certainly understand the misgivings that people have about anesthesia, but it does seem necessary for the procedure. (Additionally, I do recall reading – or hearing – Dr. Dodman comment that he began as an anesthesiologist, and that it was his opinion that a dog was safer under anesthesia under the care of a qualified anesthesiologist than breathing on his own.)

    And that’s not to say that I’m not in knots the whole day my dog is there for the procedure.

    I do, however, think it is important to know about the veterinary practice itself. I would not feel comfortable if the dentist were also acting as anesthesiologist, and if there were not emergency staff on hand. Fortunately, we go to a very good (Angell Memorial), very expensive practice here in Boston.

    Finally, it is important (and unfortunately expensive) to get presurgery bloodwork done before going under anesthesia for any purpose.

  16. laura christiansen Says:

    I have had great success with anesthesia free cleaning for my 2 Belgian Tervurens. My vet suggested we do this every 6mths.
    My male has addisons disease and gets very stressed at the vets.
    We pay an extra fee to have the technician come to our home to perform the cleanings. Both my dogs teeth have stayed sparkly clean since the last anesthesia free cleaning in June.
    We see our regular vet at least once a year. He said he would let us know when a thorough cleaning was needed.
    I am thoroughly impressed by the handling skills of the dental technician we use.
    My dogs are very cooperative and not stressed with the at home cleanings.
    With teeth brushing and yearly vet exams this has been a great option for us.
    Please give a highly skilled technician credit where credit is due

  17. Carolyn in Belize Says:

    As I read through some of the comments, I thought it might be worth re-posting part what I wrote in response to Dr. Nancy’s previous post on teeth, for those that are just getting started:

    “I found that commercial canine toothpastes cause an allergic reaction (she’s white but turns reddish-brown at all of her body openings and her skin even turns this color), so I use a Vitamin C tablet dissolved in water to brush with (see Dr. Pitcairn’s site for details) and that has worked fine; the tear stains and discoloration cleared right up. ”

    As a further note, since I posted this, Maggie has had a senior wellness exam and her vet complimented her dental hygiene so I have no doubt that the Vitamin C solution has been effective.

  18. K. L. Seifert Says:

    My husband and I retired 8 years ago and have 4 dogs. (all older now of course) All of them have had their teeth cleaned regularly until this fall. The cost used to be $200.00 per dog. It is now, in my area, $700.00 per dog. My dogs have their teeth brushed every night, have their mouths cleaned with oral spray every morning (and sometimes night), and are given enzymatic oral hygiene chews. This fall they all had anesthesia free cleaning, which was gentle and easy for each of them, even for my girl that becomes extremely anxious at the vet’s office. I understand that using anesthesia may be better, but what retired person has an extra $2,800.00 available on a yearly basis, especially when pet insurance companies cover only a fraction of that cost. It is very frustrating, so I, and all my dog owning friends, do what we can. It has worked well for my girls so far.

  19. Fauna Says:

    Let’s first discuss a human experience since we have a voice. I personally was born with a lack of good gums or strong teeth. Many gum surgeries; 17 root canals; bone replacement & implants. Since early childhood I brushed 4-6 times a day & ongoing specialized cleaning. Specialists said I just wasn’t born with what I needed & most likely inherited. Also, I have a huge tolerance of pain. I share all of this to support being an “expert patient”.

    Scraping the teeth so the are white has nothing to do with gum disease or creating strong teeth. If anything the enamel can become damage. As mentioned in a couple of comments, the problem that causes gum and tooth problems is at the gum line & is a very delicate and precise procedure. As many of us know, poor teeth, gums and bone are usually inherited & continue to worsen with all the interbreeding. Small animals with tight teeth add problems & then throw in a dog that won’t chew or fights his/her daily brushing and you do have a problem. If you can’t insure that your pet doesn’t need to suffer to insure a healthy mouth than perhaps you need to find a guardian who can rather then put them through a painful procedure if done correctly.

    As a dog owner (4 right now) I have been a guardian to the good, the bad and the ugly. Just yesterday I had to take my Mom’s Schnauzer to have 12 rotted teeth removed. This girl had her teeth cleaned every 3 months with at least four while under anesthetic. She just had her teeth cleaned anesthetic free just 3 months ago and I was told all was well and now this! Why? Because it is TOO painful and TOO difficult to properly clean where the true problems sit…at the gum lines. This area is difficult and painful, I know. I suggest you try it first on yourselves. Have your dental hygienist locate an area requiring scraping and a deep cleaning without taking X-rays; don’t sit still so you have to be held down all for the sake of pretty white teeth!

    Our babies go through all of this so we can have a false sense of security. I know and so does our little schnauzer with 12 missing teeth.

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