Cat Care For Veterinarians

Non-Anesthetic Dentals vs Dentals Under General Anesthesia

November 15, 2018

Dear Readers!

I’m sure everyone can agree that going under anesthesia can be very daunting, particularly when it involves your furry little friend. Any anesthetic procedure carries inherent risk, which is why we perform blood work and take chest x-rays (if there’s an underlying heart murmur) prior to the dental to make sure that your kitty is the best anesthetic candidate. To alleviate owners’ fears of general anesthesia, non-anesthetic dentals have becoming increasingly popular. These companies thrive on telling owners what they want to hear, which is that you don’t need to put your pet under general anesthesia to fully clean their teeth. Having overseen a number of non-anesthetic dental procedures in clinics in the past, I can (with good authority) tell you that these cleanings can actually mask disease and prevent a much needed dental cleaning that your pet needs, not to mention they also carry inherent risk themselves.

PROS of non-anesthetic dentals:

1. Limited effect: It may help if your pet is young and you just needs a simple, straight-forward cleaning. However, you won’t truly know if your pet just needs a simple cleaning without extractions and doing dental x-rays. One could even argue that if it’s such a simple cleaning, did your cat even need one to begin with?

2. Preliminary dental exam:  In the best case scenario, non anesthetic dentals can help identify dental problems through a preliminary dental examination depending on how good the patient is and how good the hygienist is.  It can guide owners to pursue a dental under general anesthesia when indicated because they should check for loose teeth prior to cleaning. Some non-anesthetic dental companies even go as far as probing for pocketing around the teeth.  However, more often than not, the non anesthetic dental hygienist still pursues a cleaning even when it’s contraindicated.  They also either never follow up with the client that the next cleaning should be an anesthetic cleaning or the client does not heed the recommendation that an anesthetic dental is indicated, so they book another non-anesthetic cleaning.  And so begins the vicious cycle.

CONS of non-anesthetic dentals:

1. No dental X-rays are performed: You know how when you go to the dentist, they always take X-rays of your teeth?  That’s when you’re awkwardly biting down on films as they manipulate the X-ray beam around your mouth. They do that because they’re looking to see if there is any disease under the gum-line that they can’t evaluate just by looking at the teeth.  One of the things my dentist told me before he extracted my tooth was that I had a fractured root that needed to be addressed. That was something he couldn’t see just by looking at my tooth, he needed the X-ray. Unfortunately, X-rays can only be performed under general anesthesia because imagine trying to make a cat sit still, hold some film in place until an X-ray machine goes “beep.”  You can’t, because it’s impossible.

2. Risk of injury: It takes special people to handle cats for anything. Period. Now add sharp instruments probing around a conscious cat’s mouth?  Nope, try again! Cats will not tolerate that. I can barely brush my cat’s teeth and now you’re asking someone to effectively scale my cat’s teeth while awake?  They better have insurance on their fingers because I don’t think that’s feasible. You’re just looking for trouble like a tongue or gum laceration because one jerky movement of your cat and it’s off to the ER we go! And yes, I’ve seen it happen!

3. Stress/Fear: I openly admitted that I had a HUGE fear of the dentist. About 2 years ago, I had extensive dental work performed on my teeth due to neglect from PTSD from previous dental work. I was so traumatized from dentists and dental hygienists in the past that did not provide me with proper numbing agents and pain management that I feared seeing any dentist thereafter.  Since then I relied on sleep dentistry, which is a GODSEND because it allowed me to endure fear free dentistry. Since then I’ve found a pain-free hygienist, but I suppose I still project that post trauma fear onto my feline friends when it comes to non-anesthetic dental procedures. I imagine them struggling with things in their mouths, not knowing what’s going on, and it pains me when we have tools and drugs that can make the process so much more peaceful for them.  When you instill fear from one traumatic episode, it can instill fear for future visits and make animals more difficult to handle.

4. Masks dental disease: When you scrape off the teeth, you’re only getting the superficial tartar; you’re not getting the deep dental cleaning that comes with general anesthesia. I’ve heard owners who say that they get non-anesthetic dentals every 3 months for their pet and then guess what—they have a dental assessment under general anesthesia and need ELEVEN teeth pulled because there’s significant bone loss from years of neglect! This owner kept noticing halitosis (malodor) from her dog’s mouth despite very frequent cleanings and it wasn’t until a full dental under anesthesia was performed that it was determined that her dog had severe bone loss from dental disease.That’s because you’re not addressing the real disease which lies UNDER the gum. When you do a non-anesthetic dental, it’s like brushing the dirt off of your clothes at the end of the day. But you still have to eventually put your clothes in the washing machine for a full thorough wash. 

5. Cleanings are not thorough enough:  Many non-anesthetic dental facilities will sell owners on the fact that they can clean the teeth with ultrasonic scaling which goes deeper under the gum line than hand-scaling. First of all, I NEVER EVER recommend ultrasonic cleaning on an awake cat. Ever. Cats are fragile and easily scared so putting a vibrating sharp instrument next to an awake cat’s mouth is never ok. There are two main reasons why we intubate them or place a tube down their throat to connect them to an oxygen machine and an gas inhalant:

1. Ultrasonic scaling uses water to help prevent the scaler from burning the teeth. An endotracheal tube allows us to protect their airways so that as we are adding scaling their teeth with water, the water doesn’t end up going into the lungs.

2. It is always important that we make sure that your pet’s airways are open so we intubate them and aerate them with oxygen.

Some of these places also claim it takes them only 15 minutes to clean your cats’ teeth.  Clearly there’s something wrong because you cannot clean a cat’s mouth in 15 minutes (even under general anesthesia). If my dentist cleaned my teeth in 15 minutes, I’d be appalled. Cats have 30 teeth and humans have 32 adult teeth, so why should it take 15 minutes to clean their teeth while it takes my dental hygienist 45 minutes to an hour to clean my own teeth? And I’m a great patient that sits still for it, too.  

6. You cannot extract teeth: Finally, you cannot extract any teeth without general anesthesia. It’s inhumane. You need to block the nerves in that area to help with the pain. Extractions require careful precision and patience to prevent the root from breaking. And you also need to recheck the dental X-ray to make sure you didn’t leave any roots or fragments behind. You can’t do any of that without proper anesthesia and proper local numbing agents. If you think you can, I implore you to have a tooth pulled without any pain medication on board and you can tell me how it went. Good luck. You’ll need it.

I know that every pet owner has concerns about dentals. I did, too. I just had Kingsley’s teeth cleaned under general anesthesia. Thankfully he didn’t need any teeth extracted, but he had full dental X-rays performed and he recovered without complications. Talk to your vet about your concerns. Sometimes if there is underlying heart failure or severe contraindications that prevent your pet from being a good candidate for anesthesia, then I talk to owners about not pursuing a dental cleaning at all (particularly if the kitty is still eating well). But age is not a disease and just because your cat is “old,” doesn’t mean that general anesthesia is contraindicated.

In general, the more on top of your cat’s teeth you are early on, the less likely you are to need dental cleanings under general anesthesia. But a non-anesthetic dental cleaning is not the answer, it can often do more harm than good and delay real dental intervention.

Thanks for reading and please let me know what you think in the comments below!

Dr. Theresa Loo

  • Reply
    Amanda
    November 17, 2018 at 4:29 pm

    Oh my gosh this is so helpful and well said, thank you Theresa!

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