What is involved in a dental procedure?
Most of the time we are hoping for prophylaxis – the prevention against inflammation of the gums (gingivitis) and subsequent loosening of the teeth. However, there are many steps throughout this process to make it as safe as possible for your pet
1. Physical exam The veterinarian does a thorough exam on the pet to evaluate for any possible issues such as heart murmurs, lung crackles, masses, and to visually inspect the teeth.
2. Pre-anesthetic labwork Pre-anesthetic laboratory work is done to ensure that the pet’s liver and kidneys are in good working order prior to anesthesia. The liver and kidneys are vital to clearing anesthetic out of the system, and thus allowing the pet to wake up. Blood is drawn from the pet and either run at the laboratory or through our in-house machines. If the in-house option is chosen, we can have results in about 30 minutes. If samples are sent to the lab, then we usually get results the following day. Prior labwork can be used if it is within the past 30 days and the values were normal.
3. Preparation of an anesthetic plan Depending on the age, size, lab results, physical exam findings, and any expected pain (such as extractions) the veterinarian will develop a comprehensive anesthetic plan which will be as safe as possible for the pet.
4. Intravenous catheter placement The pet has a small area of fur shaved on the foreleg and the skin subsequently scrubbed in preparation for an intravenous (IV) catheter placement. The catheter allows fluid support throughout the anesthesia and helps to prevent low blood pressure. It also allows for instant access to a vein if a crisis occurs which requires medication to be injected directly into the veins.
5. Anesthesia Anesthesia is started with the injection of medications into the IV catheter and maintained by the placement of an endotracheal (ET) tube into the pet’s windpipe. This prevents the pet from breathing in water or debris which will be removed from the teeth, and allows inhalation of anesthetic gases and oxygen. The pet is put on warm-air blanket to prevent chilling. Many monitors are also placed to ensure that blood pressure, blood oxygenation, breathing, and heartbeat are all working normally. One technician is dedicated to keeping track of all of this information to keep the pet safe.
6. Dental X-rays We have digital radiographs (x-rays) which allow us to evaluate the attachment of the tooth roots to the bone. Even though a tooth may look healthy on the surface, radiographs can show damaged roots and infections which can be a source of pain for the pet. All teeth are radiographed and those images are evaluated by the veterinarian.
7. Scaling and polishing Another technician uses an ultrasonic scaler to remove the tartar that is attached to the tooth enamel. The scaling procedure can leave micro-scratches in the enamel which can lead to future tartar buildup, so the teeth are polished with prophylaxis paste to buff them smooth and thus make them more resistant to tartar buildup.
8. Probing gingival pockets The technician then probes around each and every tooth, recording the depth of the “pocket” between the gum and the tooth, as well as looseness of teeth or any defects or fractures in the enamel of the tooth. These findings may indicate whether a tooth is still healthy or needs to be extracted.
9. Extractions (if indicated) If a tooth is loose, fractured so that the pulp is exposed, or has enough bone loss that the space between multiple roots of a tooth can be probed, it needs to be extracted. Pre-emptive pain control is employed to minimize discomfort to the pet in the form of anti-inflammatories and nerve blocks using local anesthetics. The veterinarian then uses a combination of the drill and other instruments to section the tooth into single-rooted pieces if needed and to remove all the roots. Extraction sites are re-radiographed to make sure no remaining pieces are left behind. The hole in the gums is
10. Post-anesthesia The pet is then taken off anesthesia, the monitoring devices are removed, and when the pet is able to swallow voluntarily the endotracheal tube is removed and the pet is placed in a warmed kennel to recover quietly.
11. Going home If indicated, medications may be sent home to help control pain, inflammation or infection. The veterinarian may discuss dental diets or other forms of home care to prevent further tartar buildup.
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