By Alex Juriga, DVM,
PVESC, pvesc.com
In dogs and cats, the American Veterinary Dental College recommends an anesthetized dental cleaning, or “COHAT,” be performed annually. COHAT is short for “Comprehensive Oral Health Assessment and Treatment.” This involves placing the patient safely under general anesthesia in order to assess the entirety of the oral cavity. The process begins with a visual examination, probing each tooth for periodontal pockets, and performing full-mouth digital radiographs to identify abnormalities hidden beneath the surface of the gums. After the assessment is completed, treatment involves correction or removal of any abnormalities found (e.g., dental extractions), followed by scaling and polishing the remaining teeth to remove any remaining plaque and tartar.
Periodontal disease, or dental disease, is a very common condition seen in dogs and cats. It is caused by an overpopulation of harmful bacteria that initially accumulate on the surface of the teeth before progressing below the gumline. From there, the bacteria begin eating away at the bone causing pockets to form around the roots of the teeth, which eventually leads to tooth mobility and, in advanced cases, tooth loss. This process is highly inflammatory and causes discomfort, which pets often hide in their day-to-day behavior.
Recently, a new trend toward “anesthesia-free dental cleanings” has become increasingly popular with pet owners. This service is commonly offered through groomers, retail stores, and some veterinary hospitals. These procedures are often advertised as being “safer” by avoiding the potential complications associated with general anesthesia. While general anesthesia is accompanied by inherent risks, a study published in 2017 showed that the overall anesthetic-related death rate (within seven days of anesthesia) is 0.05% in sick or healthy dogs and 0.11% in cats. These deaths are usually seen in the period immediately following surgery and can be mitigated with increased monitoring and support during this stage of the recovery process.
Anesthesia-free dental cleaning (ADF) typically involves scaling (scraping) tartar from the teeth of an awake dog or cat. The first concern with a procedure such as this is the risk of injury to both the individual performing it and the patient undergoing the procedure. Dental scaling tools are sharp instruments designed to remove hardened tartar from the surface of a tooth. If a dog were to move suddenly during the scaling process, both the person and the patient would be at risk of sustaining a serious injury. Additionally, because ADFs do not require sedation or general anesthesia, the likelihood of a fear-based response (e.g., biting) from a pet is much higher.
Anesthesia-free dental cleanings are also only focused on the removal of supra-gingival (above the gums) plaque and calculus. While this provides a cosmetic benefit to the patient and owner, it does little to nothing toward preventing or treating the underlying periodontal disease that is occurring sub-gingivally. In addition to the ineffectiveness of the procedure, it often masks the pathology present, which further delays appropriate and effective care.
With the recent rise in the number of ADFs being performed, the Journal of the American Veterinary Medical Association published a study conducted by veterinary dentists based in California. The study was designed to test the effectiveness of anesthesia-free dental cleanings compared to traditional COHATs performed under general anesthesia. A total of 46 dogs were enrolled and divided into two groups of 23, with one group undergoing an ADF and the other receiving a standard COHAT. The groups’ oral health was compared using commercially approved periodontal diagnostic test strips (OraStripdx). These strips measure the amount of volatile sulfur compounds (thiols) produced by periodontopathogenic bacteria present in the saliva. The strips use a colorimetric scale (color-changing) based on the concentration of thiols present and are graded on a scale of 0 to 5. Results revealed that the average periodontal disease score following an ADF was 4.5, whereas the score following a COHAT was significantly reduced to 0.87. The authors concluded that ADFs provide no medical benefit and are not a viable alternative to anesthetized dental procedures for periodontal disease mitigation.
In summary, periodontal disease has been shown to be the most common medical condition in small animal patients. The most recent studies report that periodontal disease is present in the oral cavity of 90% of dogs over one year of age. Early detection and treatment are essential to maintaining good oral health in our pets and avoiding the need for dental extractions. For more information and other resources for pet owners go to https://avdc.org/animal-owner-resources/.