DentalsA step by step guide to your pet’s dental procedure

Are you ready to take a journey into Dental World?! Meet our patient for the day - Ellie! She is a 10 year old spayed female Labrador-mix. A few years ago, Ellie was diagnosed with Systemic Lupus Erythematosus (SLE), which is an autoimmune disease that attacks multiple body systems. Her signs are pretty well controlled with medication, but because of her immune suppression, it is very important to maintain good oral hygiene and control any possible dental disease or infections. She has been coming in for regular dental exams and cleanings every 6-12 months for the past 2 years. Prior to her dental procedure today, she received a full physical examination to make sure she is still healthy enough for anesthesia. Other than previously noted dental disease, she also has some arthritis in her hind legs and muscle wasting over her head (due to the SLE).

Meet Ellie!

Pre-anesthetic ScreeningAll dental patients have pre-anesthetic bloodwork the day of their dental procedure to ensure all body systems are normal. Ellie was a super star to have her blood drawn! With our in-house laboratory equipment, we can run a CBC/Chemistry panel within 15 minutes for any in-patient animals. It is very important to make sure there are no signs of infection, anemia (low red blood cell numbers), liver or kidney disease prior to any anesthesia.

Intravenous Catheter and FluidsAll dental patients receive an IV catheter for venous access and nearly all receive IV fluids during their procedure. The yellow, blue, and pink top items seen below are the various size catheters we can use, depending on the size of the patient. Just like human patients, we use a new, sterile IV fluid line and bag of sterile IV fluids for every pet. We have found that patients receiving IV fluid therapy during a dental recover smoother and quicker. IV catheters are also essential to ensure quick venous access in case of any anesthetic complications or emergencies. You may notice your pet go home following a dental with a shaved area on their front leg - this is where the IV catheter was placed!

Dental and Anesthetic EquipmentNow that Ellie has had her complete physical examination and pre-anesthetic bloodwork, she is ready for her dental. But first, we need to make sure all our equipment is in order and ready for use. Our certified dental technician checks all our equipment and ensures it is all in good, working order. The first image below with the large "tank" underneath is our Dental Machine. It powers all of our dental equipment including our drill, ultrasonic scaler and polisher, and air water syringe. The second image is our Anesthesia Machine. It provides both oxygen and isoflurane (an inhaled anesthetic) to maintain our patients under the correct level of anesthetic depth.

Surgical Warming UnitWhat do you think this is? An air mattress? No, it's our surgical warming unit! Patients under anesthesia can get quite chilled. Our warming unit circulates warm air through the soft fabric, which can be placed under or on top of the patient to help maintain normal body temperature. Cold patients wake up slower and have a harder time metabolizing the anesthetic drugs. Maintaining a normal body temperature is another way to ensure each patient has quicker and smoother recovery. It’s quite warm and toasty under this hot air blanket!

Anesthetic MonitoringAfter all the pre-dental preparation is complete, Ellie is finally sedated and intubated for anesthesia. We use a combination of both injectable and inhaled anesthesia to ensure as smooth of a induction and recovery as possible. Depending on the age or health status of our dental patients, we have several different anesthetic drug protocols that can be used to individualize the care of each and every patient. Once Ellie is under general anesthesia, she is hooked up to several different monitors. We use a continuous EKG to monitor heart rate and rhythm and a pulse oximeter to measure oxygen saturation. We also use a blood pressure cuff with automatic readings every few minutes to make sure our patients maintain a steady blood pressure. Not shown on this screen are the readings for our esophageal thermometer and exhaled CO2 monitor. (For those medically minded out there - yes, her O2 saturation is low in the picture because it was having trouble reading on Ellie's fuzzy toes!)

Initial EvaluationIn this picture, Ellie is intubated (the plastic tube in her mouth) so she can breath both oxygen and the gas anesthetic (isoflurane) to maintain both a good anesthetic depth and oxygen saturation. The tube also has an inflatable cuff at the end to prevent any fluid from getting into the trachea and lungs. Once we have ensured she is doing well under anesthesia via our monitors and visual checks, we can now being to evaluate her mouth. Just like with your dentist, we also use probes and mirrors to evaluate all surfaces of the mouth. We can probe for any periodontal pockets, caries (dog "cavities"), or loose teeth. The third picture shows two tools we use to remove heavy tartar from teeth. Because most dogs do not brush their teeth daily, heavy plague and calculus can build up to form almost rock-hard layers of tartar over the teeth. To evaluate teeth properly, all plaque and tartar must be removed first.

Dental DiseaseThe arrows below show several areas of concern with Ellie's mouth. The yellow arrow points to her upper left canine. She has a large flap of gum tissue covering the base of the canine and trapping some hair! The orange arrow shows more excessive gum tissue covering the large molar as well as some tartar buildup. The green arrow points to the lower canine where we can see some more tartar and debris surrounding the base of the canine. We need to evaluate these areas further!

Probing Dental DiseaseCheck out our probing of Ellie's upper left canine and large molar. We have circled the problem areas. In the first picture, there is a deep pocket under the gums as well as some hair lodged there. Just probing the area gently leads to some bleeding from the gums. This is a sign of gingivitis. There should not be any deep pockets around any teeth. Ellie has some excessive gum growth around several teeth which has lead to trapping of food particles, hair, and other debris. This creates localized inflammation and infection, which can cause more serious periodontal disease. The second picture shows a similar issue with excessive gum growth, pocketing, and bleeding of the gums.

Dental RadiographsBesides a visual examination of Ellie's mouth, we also take full mouth radiographs (x-rays) to evaluate any disease under the surface. While a tooth may look okay visually, there can often be significant dental disease below the gum line. The first image is our handheld Nomad x-ray machine - this is what generates the x-ray beam. The second image shows the various size x-ray films we use in our patients - similar to the ones used at your dentist. The third image is our x-ray processor - this develops the digital x-rays to be displayed on our computer.

Periodontal DiseaseHere is an example of periodontal disease under the surface. Ellie has significant bone loss (red line) surrounding this upper left premolar. The bone should be up at the blue line to the level of the crown. You can "see" between the roots on this x-ray film, which is not a normal finding. Tooth roots should be firmly seated within surrounding bone. After some further probing, we elected to remove this premolar due to bone loss. If left intact, it would lead to further tooth mobility, localized pain, and risk of infection.

Dental ExtractionsSo how do we remove a tooth? Depending on the size, location, and number of roots, we can extract teeth in several ways. For larger teeth or those with multiple roots, we must do some type of surgical extraction which can involve drilling to section roots or creating a gingival and alveolar bone flap. The first picture shows our dental drill and the second picture shows our hand elevators. These tools are used to manually extract teeth. For Ellie's premolar, we used the drill to separate the two roots and then manually extracted the root sections with the elevators. The extraction site was then closed with dissoluble sutures.

Ultrasonic Scaling and PolishingRegardless of what other dental disease is found, all patient receive ultrasonic scaling to remove tartar and stains as well as polishing -just like at your dentist! Ellie wasn't able to choose bubblegum flavored toothpaste, but she did wake up from anesthesia with beautiful clean teeth. Because Ellie had several teeth extracted, she was given an injectable pain medication to keep her comfortable. Some patients will also receive antibiotics if there is any sign of infection. Ellie had a very smooth recovery post-anesthesia and recovered in our ICU ward under supervision by our technicians.

The EndWe hope you enjoyed this journey through Dental World with us today! Ellie is very happy at home again with her family with clean teeth and fresh breath. We wanted to show you what happens to your pet if they come in for any dental work so you can better understand the process and need for a full professional dental evaluation and cleaning under anesthesia. Oral health is a huge part of keeping our pets happy, healthy, and pain-free, especially in their senior years. If you have any questions about your pet's dental health, please contact us or schedule an appointment for an evaluation. Thank you!