Because I am afraid of the effects of anesthesia on my cats (anesthetic deaths, reduced bloodflow to kidneys) the idea of "anesthesia free dentistry" has always been intriguing to me (although I do usually get the dentals with anesthesia when recommended by the vet, I have never skimped, I'm just nervous as all get out). As you know I spend a lot of time reading vet board disciplinary actions. I recently read one where people (I don't think they were licensed, I'll have to check) doing "anesthesia free" dentals killed a pet. I think it was during restraint. Kind of at least partly cured me of my curiosity on that score. I will try to find the document to post more info because I know that others are interested in that topic. I believe our current vet does everything listed in Class A, but I will be printing this out and going over it just to check. And they cost about $500. All the techs are licensed. BTW, re: anesthesia. Which is less potentially damaging to the kidneys in terms of reduced blood flow, isoflourane or sevoflourane, or does it matter? I have always thought sevo was safer but I don't know whether there is a specific difference for kidneys. One complaint I have is that our vet does not carry or use sevo so it is not an option.

Stefani April 20th, 2009 01:37:25 PM

Our clinics definately always try for the "A" grouping of dental cleanings, but we work within reality and occassionally go right for the basic stuff or something in the middle. Recently we did a dental which ended up costing nearly $2000.00 and its not finished yet!!! Why? Because the mouth had never been touched and nearly all the teeth were coming out plus we needed to xray due to bone issues....scary yes, but even the owner who was shocked by the price (we discounted by nearly $1000 to keep it under the $1000 mark) said the dog feels better. I just wanted to mention about your technician being the cheap option etc. In our clinics you want the techs to be doing the dental cleanings/extractions, they're FAR better at it then the doctors. We send them for training with a local specialist and they get better training in school for it. I know some clinics don't operate that way but we do. In our clinics techs are more like dental hygenists in a human office.

Kathy April 20th, 2009 02:11:43 PM

Excellent post, and I wish I had known all of this years ago. It makes a heap of sense on why one clinic would charge $100 in the same time frame as another charging $300+ for the actual procedure (not including the "pre-anesthesia" requirements). Joe Q. public, as I did has no clue of the significance.

And from further in-depth research, death because of "routine" dental cleaning is more prevalent than I ever thought. $160 for class A?, gosh I feel like packing up & driving to FL, 5 in tow, have a short vaca and clean teeth x 5!

I'd love it if you could post a part 11, about the advantages of doxyrubin treatment, Oravet treatment pack, pre-clavamox prophylaxis, deatils of the actual "polishing" (because for some reason, I think it affects tartar reforming)

Another question of curiousity: Do you find typically that certain inscisors are usually loose in older dogs?

Pocket's Story: http://walnut-hill.bravehost.com My blog: http://walnut-hill.bravejournal.com

Barbara A. Albright/NH April 20th, 2009 02:11:48 PM

Kathy: Not that I disagree with you, but I think "extractions" legally falls under the Vet's responsibilty.

Barb A./NH

Pocket's Story from N April 20th, 2009 02:15:16 PM

Dr. Patty Khuly April 20th, 2009 03:24:30 PM

But, yes, I strongly agree with Barbara on the issue of extractions. Though some severely undermined teeth may fall out on their own during cleaning, held in with tartar as they are, extractions are the veterinarian's job. Exclusively. Extractions require gumline incisions, drilling, suturing, etc. You should not expect a technician to perform surgery on any other part of the body--so why the teeth? 

If veterinarians are not good at this it's because they've always delegated a veterinary-only skill to their technical staff--just as if they'd always had their techs do the spays and neuters (which used to happen a lot, back in the day).

Dr. Patty Khuly April 20th, 2009 03:29:07 PM

"non-life-threatening issues"  Gotta take issue with that statement.  Think the science is now pretty clear to the contrary for humans and I'd find it difficult to believe it weren't at least equally so for pets.  I've always been disturbed that my vets don't seem to have much (if any) concern over my pets' teeth until they're approaching the decade mark.  Thanks Dr. K for the info.  I've never even tried to discuss this one because I knew I was totally in the dark.

PJBoosinger April 20th, 2009 03:40:56 PM

We were lucky or blessed I suppose one of our cats lived to 19 and never required one single vet visit since she was 2 years until she turned 18.

Evet April 20th, 2009 04:00:06 PM

Mysterious things!

Evet April 20th, 2009 04:04:14 PM

Isn't it bad to have a yearly dental cleaning with anesthesia? what if the pet already has organ damage such as kidney or liver disease? What do you usually recommend for those conditions, Dr. K?

Amanda April 20th, 2009 04:08:55 PM

Kidney and liver disease are two conditions for which we often choose to forgo routine cleanings. There are, exceptions and emergencies, however. Consider that pets with severe periodontal disease have  a greater chance of sustaining further organ damage or of decompensating systemically due to oral infections. That's why these decisions are made on a case-by-case basis. 

As PJB said, dental disease can be life-threatening, though we don't often think of it in those terms. To wit, studies are clear about the cause and effect relationship between oral health and longevity––in humans and in animals.  

Dr. Patty Khuly April 20th, 2009 04:30:48 PM

Wow - are you saying $500 is the high-end including full labs? That's a steal! Heck, a full senior profile (CBC, blood chemistry, T4, urinalysis, and blood pressure) costs a little over $300 at the clinic I go to. Granted not all of those are needed for dentistry, but why run a partial when you should be running the full thing every 6-12 months regardless. That doesn't include the ABVP vet that charges as a specialist, or the UPC test we are doing to further assess our cat's kidneys. But the cost of labs isn't even included in the dental our vet does and we are well over $500. However, vet also does digital dental x-rays, which based on experience I wlll do as long as I can afford to. For one cat, it identified two additonal teeth that needed to come out, for another avoided pulling a tooth that was suspected to be a FORL, but wasn't. Vet has the full monitoring as mentioned, and sonic scaling. Our quote for our upcoming cat's dental is $1000, including a possible extraction. Now we will subtract the Oravet stuff, as we will never maintain it, but will be switching to a mask-down anesthesia, with IV fluids so expect the price to maintain right about $1000. That is amazing if a vet can offer full digital xrays, plus full monitoring, plus sonic scaling and still be $500 without labs. Did I get that right?? Jenny

Jenny April 20th, 2009 04:31:30 PM

Regarding extractions...just had that conversation too. I already understood the process, but wanted it from the vet's perspective. Our vet has three people in the room during a dental: 1) one to monitor the cat's vitals 2) Tech to do the dental cleaning, scaling 3) Vet to check the teeth. Also, all extractions, any cutting is required by law to be the vet. Jenny

Jenny April 20th, 2009 04:33:10 PM

Never needed a veterinary dental - knock on wood.  At least not for one of my own dogs.  Have had to have a few performed on rescue dogs, however.

We currently have a 13+yr old and 10yr old kitty, a four year old and five month old dogs, plus a handful of rescues - everyone is sparkly white.  My golden passed away at almost ten with the teeth of a two year old.  :O)  We provide lots of natural chews - meaty bones, turkey necks, chicken backs, knuckles, gizzards, whatever is appropriately sized, and use home-cooked rock hard herbal cookies for further insurance every other day or so.

So far, this approach has worked - along with, of course, either a raw diet or a grain free kibble and lots of real food.

We did have a pomeranian rescue once who came to us with teeth so bad they were green - I know what you mean about tartar holding them in, Dr. K - I reached in to give a loose one a wiggle and it popped right out in my hand.

Of course, the most bizarre dental issue we've run into so far is with our newest puppy.  Couldn't figure out why her teething breath was so much worse than normal - and then plucked out a deciduous premolar that had THREE 3/4" roots on it.  An archeologist friend of mine was even freaked out by how 'alien' it looked.  I'm wondering if this may be the first dog we have dental issues with.  After all, just like people there are some dogs who just have nasty teeth - two dogs who live in the same house, receive the same care and the same food, and one will be sparkly white and the other has a mouth full of pond scum.  Try explaining that to a client... <sigh>  Trying to reassure them that YES their dog NEEDS to see a vet and NO there's nothing we can do naturally to help him at this point... while their other dog sits in the corner, smirking with pearly whites.

I'll never understand why people don't believe ME when I tell them they need to see the veterinarian.  Honestly - I'm not a vet, I'm not connected to any vet, I don't get anything out of telling them to go to the vet - and generally I'm giving them advice that helps them stay OUT of the vets office in the future.  So you would think when I tell them they are risking their dogs health and wellbeing by allowing his teeth to rot out of his head they would agree that I have NO reason to be making it up!!  Nobody wants to hear what they don't want to hear, I suppose...

Dr. K - how do YOU convince people who are maybe not-so-sure about dentals that their dog/cat is in need?  Not just for routine dentistry, but even when the issue is truly serious and they are in denial (it's no big deal, right?).

Kim April 20th, 2009 04:38:09 PM

"Dr. K - how do YOU convince people who are maybe not-so-sure about dentals that their dog/cat is in need? Not just for routine dentistry, but even when the issue is truly serious and they are in denial (it's no big deal, right?)."

I, too, wonder if there are better ways to say "Your dog/cat is having dental problems that need to be addressed" so that people know you are serious, that it's not a 'made-up' thing to make money, and that it really does have an impact on the animal's health. So many times, when the vet says anything, such as "There's some tartar on the teeth. Do you brush them at all?" I hear the disbelieving laugh that signifies, "Uh, are you kidding me?" with variations on those words, over and over. Even when they, themselves, say the dog/cat has bad to horrible breath, they so seldom 'grok' the connection between odor and dental issues.

KateH April 20th, 2009 04:56:55 PM

Kathy: btw, I didn't mean to sound snarky about the extraction thing. I think what I was trying to say is that how we perform extractions has evolved a lot over the past 20 years. When I first graduated, a tech showed me how to extract teeth. That's how it was done by the vast majority of vets 13 years ago. Since then, dentistry's become quite a "thing" with us vets. Schools are focusing on these techniques. We attend seminars. We learn how to perform oral surgery. 

Extractions can , theoretically, be done by anyone (remember Tom Hanks pulling his own tooth n 'Castaway'?). Not that great techs can't do dentals well (indeed, they do!!). But when you factor in modern dentistry--with its nerve blocks, X-rays and careful scalpel work--it's no longer in the realm of what we consider technician work. And I don't think most owners would have it any other way. 

Dr. Patty Khuly April 20th, 2009 05:03:19 PM

KateH - exactly.

Several times a week I have someone come in and ask me about something natural to cure doggy breath.  Well, is it just doggy breath (as in, I just dug something up and ate it, or licked my butt and then your face) or is the dog in need of a thorough going over?

I have a pre-practiced speech about all the potential causes of bad breath (medical and dental) and how masking this symptom - which is what it really is - can only lead to further damage and a shorter lifespan.

Of course, the canned response is "it's just doggy breath, for cryin' out loud."  Well, in my opinion, if it were just doggy breath and nothing more you could have simply sprinkled some parsley on his food and didn't need to drive halfway across town to come see ME and whine about how horribly stinky it is.

Hey Dr. K - how about a nice, long post detailing the potential effects of ignoring long standing dental issues?  Not just the effects on the teeth and gums, but on the organs as well?  Something to refer people to as a common sense, no punches pulled, realistic look at what can happen when Fluffy's tartar and oral infections migrate.  Just sayin'.

Kim April 20th, 2009 05:30:27 PM

I'll chime-in along with those who take their pets' dental care seriously. I brush my dog's teeth daily, and at 10-years-old, her teeth are sparkling white and perfectly healthy.

But, dental issues can arise even with a good cleaning regime. My dog tends to collect a few hairs at the gum line of her canines...which I clean away daily, at brushing time. Because of my careful attention to her teeth, I noticed when this had caused a bit of a pocket to develop at the gumline. My friend, a vet., suggested I see a dental specialist she knows and adores. My dog was maybe 8-years-old at the time, and this would be her first, proper, dental exam (no real need for a "cleaning" though), under anesthesia. The dental specialist went on and on about how healthy my dog's teeth are, for a dog of just about any age, as well as being astounded that I'd even noticed this small pocket had developed. I was also thrilled that staying with my dog wasn't even an issue. (I always stay with my dog for procedures, but sometimes that requires a bit of 'negotiation'.) As a true specialist, this vet. sees just one patient at a time, and the surgical area is open to owners, if they choose to remain with their pets. I didn't really even have to ask. I was welcome (skipping out of the room when rad's were snapped, though).

When I took my dog to this clinic, I had no idea how much it would cost. (I'm like that. I don't tend to ask/notice the prices of things.) When all was said and done, this visit, with rad's, exam, and some minor polishing, came to around $850. With all the information provided by the vet., the modern facilities, and the care she received, I'd say it was worth every penny.

Marjorie April 20th, 2009 05:47:14 PM

Excellent post! But wow, only $160 for a routine class A dental in a major metro area? Pretty damn cheap is right! I think if I were running your practice, I might ask you to consider raising your prices a little bit :-) Even after having worked in veterinary clinics for the better part of twelve years, I'm still majorly freaked out when my own cat has to have her teeth cleaned. Unfortunately, she's one of those cats that needs it every 6-8 months, so I get to freak out twice a year. But I've come to respect how utterly necessary this preventive care is in order to assure continued good health for her. I really came to appreciate how good animals, especially cats, are at disgusing dental pain when the little cat I lost a few months ago (not due to anything having to do with dental disease) developed an abscessed tooth. Her symptoms were urinary in nature - frequent trips to the litterbox, only urinating small amounts. I figured we were dealing with a UTI and a round of antibiotics would take care of it. Turns out it was referred stress from the infected tooth - which was infected to the point where it would have sent a human screaming all the way to the ER. She never even stopped eating, but I guess eventually this was the only way she could show me that she needed to be seen by a veterinarian! I recently published an article on the importance of good dental care for pets, here's the link: http://ezinearticles.com/?The-Importance-of-Good-Dental-Health-For-Your-Pets&id=1876295 (And even though I registered, I still can't figure out how to elegantly link to another post)

Ingrid King April 20th, 2009 05:50:41 PM

Kim: It's on my list. Thanks!

And Kim and KateH: Convincing is tricky business. I have many clients who are still very resistant to dental issues. They don't even want to hear about it. They say things like, "Yeah, she takes after her mother." Or "I've never had my pets' teeth cleaned and I've never had a problem." (Meanwhile, the teeth are rotting out of its head. Sure, you've never had the problem.) Or, "The anesthesia is too much for her." (Yet when the dog gets a laceration they're completely OK with the anesthesia.)

One of my techs once asked why I still give my [often impassioned] speal to the especially resistant clients. I used to shy away from the confrontation. But after a few years, I learned how to look at these clients in the eye and tell them exactly what they're doing to their pets. I say, "if she needed emergency surgery, you'd do it, right? Well, THIS is an emergency!" 

Some of the times they relent--so its worth getting shot down. Other times I [later] get the chance to tell them, "I told you so." It doesn't make me happy to see their pets sick and droopy with an abscessed tooth, but it does give me some relief that the rest of the teeth can now get some attention––and that maybe now they'll respect my recommendations for future issues. 

Dr. Patty Khuly April 20th, 2009 06:00:26 PM

One of my cats has chronic gum/teeth problems - they were so bad that I had her retested for the major feline immune disorders just to make sure the rescue didn't mess up the records. The good news - negative on all tests. The bad news - 8 extractions initially followed by one or two each subsequent year.

She ate well and seemed happy when I first had her, but boy was there a difference when we got those 8 rotten teeth out. This rather shy cat has become a lively gal - playing with toys, chewing on leather purses (one of her favorite games) and you can just see how much more comfortable she is.

Our last visit a month ago got a 'hey her teeth & gums look good" - from the vet, but considering she only has 4 regular teeth and 3 fangs left there's not much to get infected!

I too would be interested in the safety of the various anesthesia protocols including all gas (which is what my other cat just had).

2CatMom April 20th, 2009 06:07:29 PM

I'm a big proponent of regular dental care. I have 2 elderly kitties, and one had to undergo anesthesia and dental extractions a few years back (I don't do it every year because she had serious problems with the anesthesia). The cost was around $500, but they didn't charge for the overnight stay and IV fluids. My vet is on the mid-range to high scale when it comes to cost, but it's well worth it. They gave me regular updates on how she was doing, both that night and the next day. Now, she's nearly 15 and no one believes it because she plays like a kitten! If only her arthritis were as easy to address:)

Tamara April 20th, 2009 06:29:41 PM

Thanks for this listing of a class A dental and a not-so-class-A dental.  Can I use your list for a handout for our clients?  Our prices are about the same as yours, and we provide a class A dental, except for one thing - x-rays!  It is on our want list - very high in the list, in fact.  I have talked to my own dentist, and any other I meet, asking them to let us know when they update to digital, so we can get their old machines cheap!

You don't mention having a person who is monitoring anesthesia and vitals on the pet during and after the dental - and I don't mean the person doing the cleaning, either!  This is essential, I believe, for a safe procedure.  We have someone assigned to stay with that animal from the time it is given pre-meds until the animal is sternal after the procedure.  And then checking on them every 5 minutes, as well as having a kennel tech in the kennel checking periodically.

I have to admit, though, that I have put off a dental for my 15 year old cat, not because of age, but because of finances.  I am paying off bills from a hospitalization I had (no insurance), and can't do it until that is taken care of.  I feel guilty every day, but, well, as you said at the beginning of your post, decisions have to be made.

Sassy April 20th, 2009 06:37:12 PM

"Now, I’m not trying to guilt you into attending to your pets’ teeth" - but you should!  It is amazing to me how many pet owners - otherwise responsible people who would not hesitate to have a deep cut or a broken bone attended to immediately - will put off dental care for YEARS even though most likely those rotten teeth cause the pet FAR more pain and misery than that deep cut or even that broken leg!

We all understand - in theory if not from personal experience - how very, very painful even a cavity can be, much less a broken, infected or abscessed tooth.  Excruciating is not too strong a word in many of these cases.

But so many pet owners think it's OK to wait on dental work, or even forgo it altogether.  I think it's mostly because they can't see the horrible condition of the pet's mouth - out of sight, out of mind.  Add to that the incredible survival instinct of most animals, who will continue eating even when the pain is nearly unbearable.  Unless the pet owner is very knowledgeable about animal behavior they will miss all of those subtle pain signals the poor animal is displaying.

I guess this is a sensitive subject for me, since I am one of those people with naturally bad teeth - I know how agonizing a dental abscess is.  I had one about 25 years ago when I was a destitute college student and dental care had been cut from my budget for a few years.  The memory of that horrible, horrible experience is still fresh, and I've never failed to keep up with dental appointments since then.  I would never in a million years let any of the pets I love go through that same torture.

Barb April 20th, 2009 07:43:49 PM

Barb, I hope you don't mind if I 'appropriate' most of your words when I get a chance to talk to clients. I'll try to show them to the vet, but he has his own way of explaining and, well, I'm just the assistant (even if I know a ton of helpful info on different aspects of behavior and care from experience) he often recoils from changing things, whether a better way exists or not. We'll see how it goes, but thanks - those points could persuade some people, which will be a good thing.

KateH April 20th, 2009 08:16:29 PM

Barb - I agree with KateH.  I too am one of those unlucky individuals whose teeth seem to enjoy trying any way to escape from my head.  Sometimes they randomly break in half, sometimes they abscess - I've had a few pulls and some root canals, and a filling in pretty much every tooth - I've also chipped most of them.  If I had the money, I would either just have them all replaced with permanent falsies or simply capped.  But, all my money goes to the dogs... and the cats... and the parrots...

And even though I am constantly comparing our dieticians advice to our veterinarians, and other human medical treatments, etc - aside from mentioning plaque buildup in the heart I have never really compared human dental PAIN and DISCOMFORT to the dogs and cats who come in.  I mean, it seems obvious - but I suppose after a while you just assume that other people see things that are right in front of them.

Thanks for the wakeup call - and the tip.  Having undergone several nasty procedures and endured months of swollen, painful dental issues, I'm sure I can personalize this that one step further to convince another few percentage points of the clients who come to me.  I accept that I'll never get them all (all people simply were not born with common sense, sadly) but I think you may have just increased my compliance rate.

Dr. K - looking forward to it!!!  :O)

Kim April 20th, 2009 08:41:51 PM

Part of the problem with the anesthesia being to much, is that the clinic doesn't provide the Class A dental procedure as was stated.  (IV catheter and fluids specifically)  The risk with anesthesia is more from the reduced blood flow to the kidneys and liver, while having to filter out the anesthetic agents and any other medication you give them.  Couple this with the relationship found between kidney disease and oral health and you have a recipe for disaster.  Keep in mind, normal bloodwork doesn't rule out damage, it just rules out extensive damage.

When a skilled anesthisist, a skilled doctor and a skilled technician perform a dental prophy, little if any damage should occur.  Granted, there is risk in any procedure, but much less when those doing the job, know how to do it efficiently and correctly.  When you take any one of those out of the picture, your quality of care goes down the tubes, very quickly. 

One thing that I would add to your list is specific knowledge in dentristry appropriate pain management.  This is sooo often overlooked.  When I get a tooth pulled, I am on vicodin for four days.  A cat, here's some metacam (in our clinic, sometimes even this isn't given).  It is VERY important to ask about pain management, there SHOULD be an opiate on board for any extraction, local blocks should be used, NSAIDs can be given for routine dental prophy, etc.  I could write a ten page paper on the lack of use of pain management in veterinary practice, and it still wouldn't suffice...but there are veterinarians who are excited to use pain management. 

Word to the wise, if your vet is over 40, you need to ask how aggressively they treat peri and post operative pain, and if they participate in continuing education specifically on the topic.  If they hemhaw, get another vet.  If they use words you don't know, ask for explanation.  Frankly, Some vets are abusing animals under the premise of veterinary care because they are too lazy to even attempt to stay current on pain management.

Jackson April 20th, 2009 09:58:39 PM

I think I have stayed away from having my cats (or dogs) teeth cleaned by the vet strictly because no one has ever been able to explain to me the need for all the bloodwork, test, anesthesia, etc. When I think of going to vet myself, none of this is needed. Quite frankly, my vets have eithered scared me out of the idea ("well, of course there is the chance of death....") or shared so little details with me that I feared that they really had no idea what they were talking about, and even less idea on what they should really be doing with my cherished pet. The cost? Yes, its high and that stinks, but if it was ever a question of death/disease/disfigurement vs. dollars and the vet could outline what, who, why, when, where, etc with confidence, I would do the dental thing properly with all my pets.

scotch817 April 20th, 2009 10:38:22 PM

Lousy teeth here too; silver smile as a kid and that was back when local anesthesia was "optional" for humans for extractions (and cost more so most skipped it, including for kids).  Runs in the family and we didn't have any junk food in the house when I was a kid; still remember the very first piece of candy I was allowed at age 5.  Doesn't matter how good a dentist is.  I'm still terrified.  And I think that blinding terror is part of the reason I've never really wanted to deal with this topic for my pets either.

None of my cats have had significant problems over the years other than a couple of broken canines that had to be extracted.  I hear they can fix that now if it happens.  My dogs are coming up on 8 and teeth in pretty good shape but I'm going to suck it up and make sure they get better than I got since I can see that things don't have to be like what I went through for them.

PJBoosinger April 21st, 2009 02:07:01 AM

Jackson: Right on. Great addition to the list. I can't imagine how we ever practiced without nerve blocks, in particular. 

Scotch817: That's a sad story. You need to either specifically ask for what you need...or find a new vet. Sometimes we find ourselves running very short on time. But that's no excuse not to at least have a technician trained well enough to explain this basic information to you. All certified technicians should be able to do this. Then there's the Internet. Veterinarians short on time will many times direct you to specific sites or provide handouts for issues like this. No excuse for you not to have your questions answered. I think I'll write a post on labwork and how it correlates to anesthesia...just for you.

Dr. Patty Khuly April 21st, 2009 06:59:41 AM

Please be careful about the use of metacam/meloxicam in cats. My now 13 year old was given metacam for pain of undetermined origin, the vet thought it might be arthritis, and it blew out her kidney function. She spent almost two weeks on ivs and ended up with a feeding tube and it was a very preventable, horrible experience. My motto now is better safe than sorry. No metacam for my cats!

dottie April 21st, 2009 08:01:02 AM

My wakeup call for my cats' teeth was reading this statement...."according to some veterinarians, good dental hygiene can add 2-5 years to your pets' life, and neglect of dental hygiene can take them away!" It was such a provocative and graphic way to have the problem presented, and to begin to realize that neglect could lead to kidney, liver and heart disease. I think every pet owner should contemplate that thought. After this, I took out pet insurance and religiously have their teth attended to. I would rather cut out something for the 2-legged folks in our family now than play cheap with the teeth and gums of our animals.

Annie April 21st, 2009 09:05:53 AM

Jackson: wow, your pretty hip on this topic! I can tell you that I have come home with extractions & NEVER have been prescribed more than a NASID , if that! (one had 10 teeth removed at once, years ago---no pain meds)

And believe me, I wasn't about to give the "Metacam" last time, in light of elevated liver enzymes (all of them)! But fortunately it was one of my "diehard" Scotties that didn't appear distressed NOR missed a meal.

A HREF="http://walnut-hill.bravehost.com/MP.html">My photos

Barbara A. Albright/NH April 21st, 2009 04:14:47 PM

Can anyone answer my question?

In terms of bloodflow to the kidneys and kidney damage from being under anesthesia, is there any safety difference between isoflurane and sevoflourane?

(sorry if I'm not spelling that right)

Stefani April 21st, 2009 06:57:09 PM

Wow - what timing...

This afternoon a client came in with a five year old papillon she just purchased for $200 from a breeder who was going out of business due to terminal illness.  She is cute enough, but rail thin and just not quite "right."

I popped her up on a table, and pulled back her lips - the stench was enough, but the sight of those teeth and gums was something I don't think I will ever get out of my mind - EVER.  On both sides, top and bottom, the teeth had ceased to become teeth.  Instead, they were single walls of plaque, tartar and pus buildup.  Green, brown and even white like miniature mountains.  In all my years, I have NEVER seen such a sight.  NEVER.  I was absolutely horrified!!

I really wish I had my camera with me - in fact, the dog is going to be back next week, and if she hasn't had the teeth done by then (shame on her if she hasn't!!) I will take photographs.  This is one for the record books.  In fact, the calculus build up has grown to the point where it's actually penetrating her gums on one side - or at least that's how it appears.  It's hard to get a good look when your first reaction is to run in the other direction.

The owner wanted to know what I thought - I explained there was NO way even guess what was under there until the dog was sedated and the teeth scaled.  I explained that pre-surgical antibiotics would most likely be necessary (oh, the infection!!) and she should be on them immediately regardless.  I gave the poor little thing a dehydrated sweet potato chew (a good rawhide alternative) but suggested leaving any hard chewies until after the cleaning (quite frankly, I'm really concerned about knocking too much of that disgusting mess into her system!).  I also suggested canned food for now - no sense stirring things up...

Seriously though - I've been involved in rescue, in cruelty and neglect cases, in senior rescue, and have of course viewed all those scary case study photos available online and in texts... but this was like something out of Alien.  I swear, this dog has never chewed on a damn thing in her whole short, miserable life!  How she was not a raving lunatic is beyond me...

Sorry - I had to share this somewhere... this little dog was only FIVE years old, and was NOT suffering from the dental deformation one generally associates with oral issues in smaller dogs.  Her dentition was perfect - or at least it seemed to be, under all that scale.  There was actually more buildup than tooth - I'd say the ratio was about 2:1.

She will serve to be a reminder of how quickly things can deteriorate when proper dental care is not observed.  The poor little girl... ugh, I've still got the heebie-jeebies just thinking about it... takes a lot to do that!!

Kim April 21st, 2009 07:34:39 PM

KateH & Kim - thank you for the kind words, and please do take any or all of my ideas if it will help convince even ONE pet owner to get that dental done!  I am kind of surprised more vets and staff don't cover the pain angle of rotten teeth.  Bad breath, even heart and kidney disease and a shortened life span should be bad enough but it's like telling a smoker to quit because they'll have a heart attack or get lung cancer in 20 years.  It just doesn't have the same impact.  But the issue of severe pain just seems so obvious to me.

Barb April 21st, 2009 08:14:36 PM

Stefani,

This where the skilled anesthesist part comes in.  Isoflurane and Sevoflurane are very similar inhalant anesthetics.  Sevoflurane is more toxic to the kidneys, but it's largely going to depend on the technician or doctor running the anesthesia.  If they are using ISO and crank it up too high and send the patient really deep, they can do just as much damage if not more than the same tech using SEVO, which responds quicker to anesthetic dose changes.  A lot of technicians just set the vaporizer and go, if they need to go deeper, they go deeper, but I rarely see the techs I work with going shallower unless blood pressure or heartrate decrease considerably.  There's a very real possibility of going too deep on ISO, because you make more drastic changes because it takes longer to respond to those changes, sevo gives you the ability to make small, more frequent changes to the depth of anesthesia, simply because the response is much faster.

I'm sure Dr Khuly can explain much better than I can...

Jackson April 21st, 2009 11:27:20 PM

Jackson: It definitely sounds like teeth are an interest for you. And I need to put a mental note about the SEVO.Thank you.

Kim: No excuses for that ONE BIT!

Barb: I'm with you, I feel that if there is possibility of "pain", that the risk really needs to be weighed for an elderly pet. My Alice had a broken rear molar removed at 12 1/2 & my Dottie had her last teeth cleaning at 13 (no cracked teeth, died with them all!)

I had teeth cleaned & a bad premolar removed on an 11 yr. old (now 12+), my goodness, she became a NEW dog with gorgeous teeth of a 2 yr. old (still)! This is definitely a quality of life issue, even when elderly! It was obvious to me that the GP vet responsible for her teeth (in part or in full) was a bit of a teeth specialty person (enjoyed the work).

Barbara A. Albright/NH April 22nd, 2009 04:05:08 PM

Pet Dental Care should be a daily routine of brushing and providing proper food and quality all natural dog treats that promote good dental health.  With daily dental hygiene we can lesson the need for this kind of deep cleaning.

Brushing your dogs teeth daily will also alert you of potential problems early.

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