Caption- Nipper’s capnograph and temperature probe were not hooked up yet when this picture was snapped.
Dental Cleaning WalkthroughDigital Empathy2023-05-02T11:18:53+00:00
First, let me introduce you to Nipper. She is a rat terrier whose interests include food, blankets, and cuddling. Nipper’s mom is our practice manager, Stephanie. Being a small breed dog, Nipper is predisposed to having more dental disease in her life. Knowing that, her mom is careful to watch for the signs of dental disease, such as plaque and tartar buildup, red gums, and smelly breath. Nipper’s mom noticed her teeth looking like this, and knew it was time to get her in for another dental cleaning. This is Nipper’s fourth dental cleaning in her life.
Nipper has a cleft palate so her dentition (how her teeth look) may look a little funny
Once Nipper was checked in at our friendly front desk, she was taken into an exam room, where her consent form was signed and questions about the procedure were discussed. She was then taken into our treatment area for a blood draw. Since Nipper is over seven years old, she is required to have pre-operative blood work before undergoing anesthesia- although we recommend it at all ages. The blood is processed in our in-house lab. This blood work checks her liver, kidneys, and other metabolic functions to ensure she’s healthy enough to process the anesthetic medication we are going to give. Nipper’s blood work was largely normal, except for a slight elevation in her ALT, which is a liver enzyme that can indicate liver disease. Nipper, however, has had elevated ALT levels for quite a while and has had further diagnostics to confirm that she does not have liver disease, so it was safe to continue with anesthesia.
Next, Nipper is given a complete physical exam. We always perform an exam before a patient is put under anesthesia so we can be sure we are being as safe as possible.
Next, Nipper is placed into a kennel and the technician and doctor get everything ready that they will need for the dental cleaning. Medications are drawn up, labeled, and set to the side. An emergency drug sheet is calculated so in the event of an emergency, we know the dosing without having to stop in the moment to calculate.
Since all animals are given fluids to help support them while under anesthesia, an IV pump ise calibrated and set up near the dental table. Anesthesia tends to lower body temperature of patients, so we make sure to provide lots of warmth to keep the patient comfortable and to improve their recovery. Dental cleanings can be long procedures, so we actually form a “cocoon” of warmth- a warm water blanket under the pet, a warm air blanket on top of them, and a towel or small blanket to help keep the warmth in. After the procedure, Nipper will also wake up in a heated kennel.
After everything is prepared, Nipper is given what we call a “pre-med”- it is a mix of sedatives, anti-anxiety medication, and pain medication. Sometimes we have to remove teeth when we do a dental procedure, and having pain medication prior to that procedure can help the patient have a smoother and easier recovery.
After the pre-med is given, an intravenous (IV) catheter is placed. This catheter allows us to administer fluids during anesthesia, and if any complications were to arise, it allows us instant access to the pet’s vein so we can administer life saving medications.
Once the catheter is placed, Nipper is given medication intravenously that will induce full anesthesia, and an endotracheal (ET) tube is placed in her trachea (windpipe). This allows us to give inhaled anesthesia and oxygen to maintain her sedation level for a longer period of time. In dental cleanings, ET tubes are especially important to protect the airway because of how much water is used during the dental cleaning. If an ET tube wasn’t placed, water could be aspirated into the lungs which could cause major complications like pneumonia. After the ET tube is in place, Nipper’s nails are quickly trimmed (we trim the nails of all animals that go under anesthesia as a courtesy service). Her eyes are also lubricated to protect them from any possible drying that may occur.
Once she is ready, Nipper is placed in the “warm cocoon” and hooked up to our monitoring equipment. We use an ECG to monitor heart rate and rhythm, and we use an pulse oximeter to evaluate oxygen saturation in the blood. We also use a capnograph to monitor carbon dioxide output, and we place an internal thermometer to have constant body temperature readings throughout anesthesia.
Caption- Nipper’s capnograph and temperature probe were not hooked up yet when this picture was snapped.
The first step in our dental cleaning is full mouth radiography. Radiography allows us to see what is going on below the gum line. Sometimes teeth will look healthy to the naked eye and seem ok even on an in-depth exam, but an issue such as a gas pocket or fracture will be visualized that will indicate the need for further treatment or removal of the tooth. That is why it is our belief that full mouth dental radiography is the standard of care, and not performing a set of full mouth x-rays is substandard care.
After the radiography is complete, Nipper’s teeth are cleaned by ultrasonic scaling. Ultrasonic cleaning allows us to clean the teeth much more quickly and completely than using hand tools alone. The technician wears a face shield for this part of the cleaning to protect her eyes and respiratory organs from spray back.
After the teeth are cleaned, the doctor examines Nipper’s teeth in depth. Using a dental probe, she gently probes below the gumline to assess how deep any pockets are. Just as with radiography above, a dental cleaning is not truly complete without this step. Sometimes, the doctor will find an issue on exam that we didn’t visualize in the radiography. A complete dental cleaning has to include both the radiography and the exam.
This is also why it is very hard to give an accurate estimate of how many (if any) teeth will need to be removed prior to the procedure. Nipper had deep pockets on two of her teeth on exam, but no pockets visualized on radiography. After her exam was complete, Dr. Lindsy spoke to Nipper’s mom about her findings and gave her the recommendation to remove the two teeth that had pockets at the gumline. We decided to remove those two teeth to avoid the possibility of more serious dental disease or pain in the future. It is standard for us to call the owner while their pet is under anesthesia so we can discuss how many extractions are needed and get the owner’s ok before further treatment. After removal, the gumline around this tooth was sutured to avoid a pocket there that would make chewing harder. The other tooth that was extracted did not need to be sutured.
One of Nipper’s removed teeth, pictured here, also serves as a great example of why radiography and a complete exam are so important. Nipper has just had a very thorough cleaning performed, but because of her pocket on this tooth, there was tarter below the gum-line that would have been left there had we not removed the tooth. Her tooth also shows how much longer the root of a tooth is than what you see at the surface and why we worry so much about what is below the gum-line, not just on top of it. This tooth is an incisor, which is not even a particularly “long-rooted” tooth- the roots on her canine teeth, for example, are about twice this length.
After all the extractions are complete, the technician polishes Nipper’s teeth completely. The polishing makes the teeth very smooth, which makes it much harder for bacteria, plaque, and tarter to attach to the teeth. The polishing is a very important step in any dental cleaning to help prevent the reformation of future dental disease.
After her teeth are polished and her dental cleaning procedure is complete, Nipper is disconnected from the anesthesia machine, monitoring equipment, and her IV fluids. She is moved into the warm kennel with her ET tube and IV catheter in place. Once she can swallow on her own, the ET tube is removed. It is left in place until she can swallow so that she doesn’t aspirate (suck into her lungs) on any fluid that may be present in her mouth. Once she is fully recovered from the anesthetic medications, her IV catheter is removed. It is left in place until she is recovered from the anesthetic medications so that we can continue to have instant access to her vein if emergency drugs are needed during recovery.
Nipper was allowed to recover for the rest of the afternoon, and a discharge time was set up to go over instructions at home. Sometimes, when extractions are performed, we will see the patient back in two weeks to recheck the teeth. However, Nipper’s extractions were not very extensive so Dr. Lindsy didn’t need to see her back.
There are many ways to follow up on dental care at home. Nipper’s mom has chosen to give Oravet Chewable treats once a day. These treats work to prevent dental disease in several ways. First, the chewing action that the dog performs on the treat works to loosen and dislodge plaque and help it break away from teeth. Then, it forms a barrier to help protect against the bacteria that leads to plaque and calculus buildup. This results in a cleaner mouth and fresher breath. Oravet chews have Delmopinol in them, which is a molecule that is clinically proven to prevent bacterial build up- it is the only chewable on the market that can make that claim. There is not an Oravet chewable treat for cats yet, so for them we recommend Greenies for Felines. Nipper already eats Royal Canin’s Dental food as her daily diet. Royal Canine Dental diet prevents dental disease by encouraging that same chewing and scraping action.
Some other ways to follow up on care that we recommend are brushing of the teeth and using dental wipes such as Dentacetic on the teeth. However, Nipper’s mom has two young kids at home, works full time, and has a busy extracurricular life- so she knows she isn’t going to be compliant with brushing or wiping Nipper’s teeth every day. This is why she chose the more convenient treat option to follow up on Nipper’s dental care.
Thanks for following Nipper’s dental journey from start to finish! She is now back home, resting comfortably in her favorite comforter…because she’s not spoiled AT ALL.
Caption- Nipper’s capnograph and temperature probe were not hooked up yet when this picture was snapped.
