Veterinary vs Anesthesia-Free Teeth Cleaning

In honor of Pet Dental Health Month, here’s an article I wrote for Your Dog, the newsletter of the Cummings School of Veterinary Medicine at Tufts University  (published September 2009)

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Maybe you’ve seen a sign for “Teeth cleaning without anesthesia” in your groomer’s shop or on a pet store bulletin board, and you’ve wondered: Would my dog benefit from some quick tartar removal, free from the perceived dangers — and costs — of a professional cleaning under anesthesia at a veterinarian’s office?

“Definitely not,” says Jean Joo, DVM, a veterinary dentist at Tufts Veterinary Emergency Treatment & Specialties in Walpole, Mass. She stresses that the hazards of such services far outweigh any superficial cosmetic benefits. “Not only do these types of cleanings fail to prevent periodontal disease, which takes place below the gum line,” Dr. Joo says, “but they create a false sense of security in the owner because the teeth look clean.”

The results can be devastating. “I had a toy poodle come in with clean, white teeth,” Dr. Joo says. “The groomer scaled her teeth every month, and they had almost no calculus at all. However, when I examined the dog under anesthesia, I saw that her teeth were in terrible shape, many of them loose and diseased. I ended up extracting 16 of them.”

Calculus, commonly called tartar, is the hardened form of plaque, the bacteria-laden material that naturally forms on and between teeth. It’s easy to chip tartar off the upper part, or crown, of the tooth — which is why it can be done without anesthesia — but that’s not where problems occur.

Painful below-gum scaling is not the only essential cleaning that must be done under anesthesia to be safe and effective. Without the smoothing action of polishing and a final antiseptic rinse — only achievable with suction since dogs can’t be trained to spit — the teeth and gums are even more susceptible to bacterial infection than they are before being scaled. And it’s difficult to perform an in-depth examination or get accurate dental X-rays when the patient is squirming or making sudden moves.

Steven Holmstrom, DVM, who is board certified in veterinary dentistry and practices at the Animal Dental Clinic in San Carlos Calif., has seen many patients after an anesthesia-free cleaning. “They were better off before the procedure,” he says. “We tried teeth cleaning without anesthesia 35 years ago. If it had been appropriate, we in the AVDC [American Veterinary Dental College] would all be doing it. It would dramatically increase our business.”

Fair Warning

Dr. Holmstrom, former president of the AVDC, suggests that anyone contemplating a nonprofessional cleaning read  “Companion Animal Dental Scaling Without Anesthesia,” a position statement posted on the AVDC’s web site. It details the medical issues involved and points out the legal ones, noting that, “In the United States and Canada, only licensed veterinarians can practice veterinary medicine …. Anyone providing dental services other than a licensed veterinarian, or a supervised and trained veterinary technician, is practicing veterinary medicine without a license and shall be subject to criminal charges.”

The statement also addresses the fears that many people have about anesthesia — fears that Dr. Joo encounters regularly in her practice. “I never tell clients that there are no risks,” she says. “But they’re greatly reduced by tailoring the anesthetic protocol to each patient. As long as we have current blood work and urinalysis, know the dog’s medical history and are proactive in monitoring and treating the patients while under anesthesia, we can minimize the risks.” Besides, she says, “Anesthesia has become a lot safer now with the use of balanced techniques and inhalant anesthesia.”

Dr. Holstrom concurs, noting that most problems associated with anesthesia date back decades, when barbiturates, which are a lot less predictable, were used. “The effects of today’s anesthetic agents like sevofluorane and propofol are reversed more quickly and the drugs metabolized far more easily than the ones used in the past.”

Dangers Exaggerated

Concerns over anesthesia and the proliferation of nonprofessional teeth cleaning services — which sometimes exaggerate anesthesia’s dangers to drum up business, according to Dr. Holmstrom — reflect widespread public confusion about veterinary dentistry and especially preventive care. The confusion is understandable. The American College of Veterinary Dentistry was established little more than 20 years ago, in 1988, and full recognition of dentistry as an approved specialty in veterinary schools was granted only in 1995. Dr. Joo says, “Today, less than half of the veterinary schools in this country have veterinary dentists on staff.”

The awareness of the impact of dental disease on other body systems, in humans as well as in dogs, is also relatively new. “We are just beginning to find the links between overall health and dental health,” says Dr. Holmstrom, one of fewer than 100 diplomates in veterinary dentistry in the United States. “Studies on humans show that advanced periodontal diseases lowers mortality.”

There’s no question that, if left unhindered, bacteria from the teeth and gums can spread through the bloodstream and infiltrate other parts of the body, including the heart, liver and kidneys. At minimum, periodontal disease causes mouth pain in dogs, and, as a result, difficulty eating.

Professional cleaning is the only way to prevent and treat it.

“Subgingival [below the gums] calculus harbors the bacteria that cause periodontal disease,” Dr. Joo says. “We brush our teeth daily and still need to go to the dentist for professional cleanings because we can’t reach below the gum line. Most owners don’t brush their dogs’ teeth at all, so you can imagine how much more plaque and calculus build up.”

Indeed, according to the [gross picture alert if you click on this link] Veterinary Oral Health Council, periodontal disease is the most common clinical condition in companion animals. Most studies indicate that at least 75 percent of dogs show signs of it by the time they’re 2 or 3 years old. And because these statistics rely on a sample of pets who receive regular veterinary care, the percentage is likely higher.

Toy breeds affected

The disease is particularly rife among small and toy breeds. “They have disproportionately large teeth for their small mouths and jaws, which results in crowding,” Dr. Joo says. “This means that food and debris, which turn into plaque and tartar, get caught on and between teeth. It doesn’t take much before the teeth become loose and for infection to set in. In extreme cases, small dogs have such severe dental disease that they can break their jaws.”

This happens when the alveolar bone, which surrounds the tooth sockets, erodes. This weakens the lower jaw so much that a slight trauma — everything from bumping into furniture to chewing on a toy — can cause it to fracture.

In contrast, larger dogs have a more balanced tooth-to-jaw ratio. “When they lose a few milliliters of attachment, it’s not as significant,” Dr. Joo says. Larger dogs also tend to chew on toys and other things that help keep their teeth healthier — as well as some that don’t. These breeds need regular dental checkups because, Dr. Joo cautions, “They have a tendency to break their teeth chewing on hard objects like bones or rocks.”

Also affecting the onset and progression of periodontal disease is a dog’s tendency to pant. The more a dog pants, the drier the mouth and the less saliva available to perform natural dental cleansing, Dr. Joo says.

Although size definitely counts when it comes to the recommended frequency of professional cleanings, each case has to be judged individually. Larger dogs can sometimes go for more than a year without professional care if the owner keeps up with brushing while some smaller dogs may benefit from cleanings twice a year, no matter how assiduous the home care.

But it’s not only the lack of knowledge about the prevalence and repercussions of dental disease and the fear of anesthesia that keep people from having their dogs’ teeth cleaned professionally. For many, it’s the cost. No question: Professional cleaning can be expensive. Prices vary across the country, from little more a hundred dollars to more than a thousand.

Fees will vary

In part, teeth cleaning rates are based on the cost of living. For example, you can expect to pay more in cities where office space is at a premium. Other factors that impact fees include the experience of those performing the procedure and the quality of the equipment used.  “Many practitioners go to continuing education courses to fill the gaps in their knowledge,” Dr. Joo says. “And while some practices have only simple hand scalers, others offer state-of-the-art dental units.”

How do you rationalize spending the money to clean your dog’s teeth? Dr. Joo quotes the proverb “an ounce of prevention is worth a pound of cure,” adding that by providing routine dental care, owners can avoid multiple extractions. Moreover, dental care may pay for itself by mitigating other costly conditions. As an example, Dr. Joo has seen dogs with hard-to-manage diabetes become significantly better once their dental disease had been treated.

The most immediate, direct benefit of a professional cleaning is usually the elimination of canine bad breath. Getting kissed by your dog without wanting to recoil? Priceless.

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32 Comments

  1. Posted February 17, 2011 at 4:17 am | Permalink

    The first time I realized how important dental care was for animals was when my friend took her cranky, 16 year old cat in for a dental cleaning under anesthesia. Evidently the cat’s teeth had gotten quite bad over the years and she needed a few extractions.

    The cat came back from the vet and was an entirely different girl. She was more playful and relaxed. She seemed to have lost 10 years off her age. Evidently the bad teeth were causing her crankiness.

    A short time under anesthesia also gives your vet time to do a very thorough exam and find other health concerns. It was during a dental cleaning that our vet discovered Shadow’s osteosarcoma in her jaw. For some diseases, early discovery can make a huge difference in outcome.

    Thanks for a great article. I’ll certainly pass it along.
    Pamela recently posted..Too awful Or awful cuteMy Profile

    • Edie Jarolim
      Posted February 17, 2011 at 5:33 am | Permalink

      Thanks, Pamela. I too was dubious until I did the research. It’s time for Frankie to go in, in fact… I just made the appointment.

  2. Posted February 17, 2011 at 7:21 am | Permalink

    Thanks for this post!! I am just now coming to realize how important brushing Riley’s teeth (and having professional cleanings) are! I’ve tried (unsuccessfully) to brush Riley’s teeth a few times and finally gave up on it because she would put up such a fuss about it. Then I read an article on someone else’s blog the other day about how important brushing their teeth is and have decided to try again. I realized that the doggy toothpaste I had for her was a flavor she didn’t like…I put it on my finger for her to taste it to get used to it and she licked some, made a nasty face, and spit it out. So I picked up some poultry flavored doggy toothpaste at Petsmart last night and she loves it. So I’m slowly getting her used to having my finger in her mouth, the taste of the toothpaste, and eventually a toothbrush in her mouth.

    I will take her for a professional cleaning probably in May (she’ll be two in March and hasn’t had one yet) when she goes for her check-up. She already has a little bit of discoloration on her teeth, so I want to get it taken care of before it develops into something worse!

    Anyway, sorry for the long winded comment…thanks again for this informative post!

    Elyse

    • Edie Jarolim
      Posted February 17, 2011 at 9:19 am | Permalink

      You’re welcome! Yes, home teeth cleaning is hard to get a dog accustomed to but like anything else, once you get into a routine, it’s well worth it. In fact, maybe that’ll be another February post…

    • Shary
      Posted September 28, 2012 at 9:47 am | Permalink

      Many dogs fight against having a toothbrush in their mouth. Try wearing a cheap washable cotton glove to clean your dog’s teeth. Much easier to clean all the surfaces, both inner and outer because you have a better sense of touch. You can buy them online, something like 24 for $11. My dog loves having me clean her teeth! She comes running every time I put that white glove on. Genuine sheepskin toys are also good for keeping the teeth clean. They are washable and very durable.

  3. Posted February 17, 2011 at 10:07 am | Permalink

    I’m glad I read this! I honestly didn’t think full out dentals were required in younger dogs…my dog is a regular bone chewer, as well as gets a Dingo brand Denta Treat every day (or every other day). She’ll be 2 in October, but we’re due for vaccines, etc in July. I’ll definitely be inquiring when we’re there!

    • Edie Jarolim
      Posted February 17, 2011 at 10:19 am | Permalink

      Your dog might not need a vet cleaning yet, depending on whether her teeth are in good shape or not — but it’s always good to ask.

  4. Posted February 17, 2011 at 5:10 pm | Permalink

    Yep, every fall we make a pilgrimage to Colorado Springs to see Sadie’s dentist for a teeth cleaning. Good thing we do. On different occasions he found worn enamel, a chipped tooth, and a cracked tooth. He repaired them all on the spot. I hate to imagine the problems we’d be contending with now if that damage hadn’t been dealt with in a timely manner.
    Deborah Flick recently posted..My Bed Is Your BedMy Profile

  5. Posted February 17, 2011 at 9:14 pm | Permalink

    Yeah, read and heard about the ineffectiveness of anesthesia-free teeth cleaning and even how this can make things worse than no cleaning at all. It does make sense to me.
    Jana Rade recently posted..Indy’s Struggle with DysplasiaMy Profile

  6. Posted February 17, 2011 at 10:10 pm | Permalink

    Thanks for this article. It was very timely for me. I have a dog that needs his teeth cleaned. I saw and add for the anesthesia-free teeth cleaning the other day and was intrigued. I hadn’t looked further into it yet but now I won’t bother.
    Adventureweiner recently posted..Weiner Dogs Named Sadie Love to HikeMy Profile

    • Edie Jarolim
      Posted February 18, 2011 at 6:45 am | Permalink

      Thanks for coming by. I love the name of your blog and checked it out — terrific concept and execution! It’s great that you’re promoting the notion that small dogs can be athletic too.

  7. Posted February 17, 2011 at 11:25 pm | Permalink

    My head is still reeling from the Poodle with the 16 extractions!! Jersey gets regular check-ups from the vet and so far, a dental cleaning has not been recommended. But I’m sure that her time will come to visit the dentists chair. Healthy mouth = healthy dog :)
    Karen Friesecke recently posted..The 7 Heavenly Virtues As Illustrated By DogsMy Profile

    • Edie Jarolim
      Posted February 18, 2011 at 6:41 am | Permalink

      As I told Georgia, some dogs don’t need professional teeth cleaning. Ever. Jersey is a larger breed too so you might be able to elude to the dread dentist’s chair. That should be your next photo series: Dogs in dentists chairs. I challenge you in fact, to find enough pictures!

  8. Posted February 17, 2011 at 11:54 pm | Permalink

    Interesting. I always thought regular home cleaning with a toothbrush and doggie toothpaste or baking soda, and plenty of raw bones were all that was needed. Conventional wisdom. Maybe not after all. Will have to check with our vet the next time we’re there. Thanks Ms Jarolim :)
    georgia little pea recently posted..Things fall apart- not by Chinua AchebeMy Profile

    • Edie Jarolim
      Posted February 18, 2011 at 6:38 am | Permalink

      It’s entirely possible that all those things you’re doing are enough — especially since you have larger dogs. But some people — guilty! — are not that vigilant about the brushing/bone chewing routines and have smaller dogs with more crowded teeth. If you have a good vet, I’m sure he or she would let you know if teeth cleaning is needed. Hope it isn’t — it’s pricey!

  9. Posted February 21, 2011 at 8:03 am | Permalink

    I wish I’d read this post before I had Bella’s teeth cleaned recently… might have helped allay some of my fears about the anesthesia! (The first time we did it, the anesthesia hit her pretty hard, but this time the vet used something different and it was much better.)
    Pup Fan recently posted..And now- for something completely differentMy Profile

    • Edie Jarolim
      Posted February 21, 2011 at 9:48 am | Permalink

      Glad to hear it went well! Frankie was not a happy camper after his first teeth cleaning but I think it’s because he had 7 (!) extractions. I’m taking him next week and although I’m not going to lie and say I’m completely relaxed, I know the alternative — not having his teeth cleaned — is far worse.

  10. Posted February 23, 2011 at 2:26 pm | Permalink

    We took Bella in this morning for her first ‘professional’ dental clean at our vet. We dropped her off, arrived at work, then got a phone call that she didn’t need the cleaning done (she’s only 2 and a half years old)! I hadn’t really seen anywhere what age to start getting their teeth cleaned, but glad that my vet didn’t just take my money when there was no need! Thanks for the post!

    • Edie Jarolim
      Posted February 23, 2011 at 2:42 pm | Permalink

      Thanks for the report! Not every dog needs professional cleanings at an early age — or ever, in some cases — and I’m glad your vet sent Bella home with a clean bill of dental health.

      Frankie is going in next week, but he really, really needs a cleaning… I’ll report back too.

  11. Jessie
    Posted March 15, 2011 at 4:17 pm | Permalink

    Great post! I have an almost 4 year old German Shepherd whose accumulated some nasty tartar on his teeth after a bout of health issues that prompted a wet food diet for a few weeks. I’ve spoken with my vet about doing a cleaning, but was hesitant about the anesthesia for him (he’s been under before to get neutered and have a banged up shoulder stitched up and never had any problems, though. Just being overprotective I guess!). After reading your post, I’m going to call tomorrow and get an appointment set up for a cleaning.

  12. Keira
    Posted August 11, 2011 at 9:57 am | Permalink

    Please tell me there is a way to have my Pom’s teeth cleaned without intubation. He’s had his teeth cleaned three times, once a year for the last three years. He’s five. This last time was terrible. I’ve found out that small dogs can have collapsing trachea and I just feel horrible putting my guy through that again; he had several rounds of antibiotics, steroids, and cough pills.

    • Edie Jarolim
      Posted August 11, 2011 at 11:15 am | Permalink

      I’m usually all for professional cleanings under anesthesia but this sounds like the trade-off is NOT worth it if your dog had such a bad reaction. I’ve got to admit that I didn’t realize that the anesthesia was administered through intubation; I assumed it was just through an area on the leg.

      Did you ask your vet if there was another option for anesthesia? Better management through regular dental care? Actually, I’m going to ask around and see if I can get you a good answer because your concern is certainly very valid.

  13. William Green
    Posted November 14, 2011 at 12:38 pm | Permalink

    What if you have a dog with horrible, horrible, breath and simply cannot find a vet that you can afford the cleaning? My dad is 72, had a stroke, and lives on only his SSI. I have been unemployed for 6 months and have to go live with him as my wife and I must divorce due to finances. We cannot afford $350 + for her cleaning and we know she needs it. She has had two front teeth come out, breath is repulsive, and will not chew on bones under any circumstance. This dog is his life since my mother passed away. We have taken her everywhere trying to get someone to clean them and put it on payment system. None will. If this dog dies due to something from her dental care it will kill him too.

    • Edie Jarolim
      Posted November 14, 2011 at 12:49 pm | Permalink

      Where are you based? Have you tried asking any of the local shelters? Many of them have vets come around and do dentals so the dogs will be more adoptable. It’s possible if you explain your situation you might find someone to help out.

      Alternatively, there is the Care Credit Card, with no interest for six months (I believe) or longer. It includes health care for pets. You do need not to miss any payments; otherwise there is a high interest rate. But it’s a good option: http://www.carecredit.com/

      Good luck!

    • Mandy
      Posted September 23, 2012 at 12:54 pm | Permalink

      Hi William, that is so terrible. As Edie said you may find a charity that will help. Here in the U.K they have charity pet vets and if you are on a low income you can take your pet to them for free for any illness and they will treat it. All they ask is that you make a small donation when you leave in the box on the reception desk. You can put in anything you feel happy with how ever small. I wish you all the best in locating some one somewhere who will help you and also all the best for you and your father.

  14. Mandy
    Posted September 23, 2012 at 7:23 am | Permalink

    My Dog is 13 years old and his teeth are almost perfect on the bottom set and white and clean. His upper teeth are a different story. He had an encounter with a German Shepherd and bit him really hard. It surprised the German Shepherd (and probably hurt him too!) just long enough for my dog to make his escape. The result was a trip to the dentist and loosing 7 teeth from the top of his mouth. That was 5 years ago. Now his teeth are very bad on the top and his gums inflamed. The vet says that she would rather not put him under to clean his teeth and so we tried antibiotics. They worked a treat. Over night the bad breath disappeard and my dog seemed much happier. However it was short lived and now it is back again the inflamation and the bad breath. I am sure he is in pain. I have tried all sorts of mouth sprays and water additives but he really needs to go to the vets. I am so scared that he may not make it through the anisthetic though. What can I do? I am certain he has another year or two of life in him. I cant just ignore his teeth. What do you suggest? By the way he hates going to the vets and gets really upset about it.

    • Edie Jarolim
      Posted September 23, 2012 at 8:07 am | Permalink

      Aw, I’m sorry to hear about your dog, Mandy. That’s tough. Maybe you can take him to a veterinary dentist to discuss your options? I don’t know where you live, but almost all cities have specialty centers with a dentist/mouth specialist on staff. Another type of antibiotic might be an option — or it’s possible your dog will do fine under anesthesia (my 13 year old Frankie just had a dental under anesthesia). I would definitely get a second opinion though to see what the possibilities are.

      • Mandy
        Posted September 23, 2012 at 12:48 pm | Permalink

        Hi Edie, I didn’t realize Frankie was 13 too. I’m going to go back and see them the vet again. I’m going to ask about sevofluorane and propofol Anesthetic too. I am in the U.K. I will let you all know the outcome.

        • Edie Jarolim
          Posted September 23, 2012 at 1:10 pm | Permalink

          Good luck!

  15. Posted January 9, 2013 at 6:11 pm | Permalink

    I would like to know is there a product for groomers to use to help with cleaning teeth and bad breath. I started as a vet tech I know the importance of cleaning but I didn’t realize that I might be offering something against the law. I do not currently offer cleaning service but I have thought about it and would like to offer at least brushing and products to help owners, I just don’t know what is a good product to carry and use. Any help???

    • Edie Jarolim
      Posted January 11, 2013 at 7:55 am | Permalink

      Thanks for writing. Really, just a tooth brush and paste that is designed for dogs is the best thing you can do for your clients. Watch a film that teaches people how to brush their dogs’ and cats’ teeth — and explain which chipping off tartar is bad. You’ll be doing your clients a great service.

One Trackback

  1. By Another reason to brush your dog’s teeth on February 26, 2011 at 8:32 am

    [...] honor of National Pet Dental Health Month, I recently blogged about how essential it was to get your dog’s teeth checked professionally, especially small dogs who are prone to periodontal disease. I didn’t mention that, although [...]

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