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Planning the Dental Cleaning and Patient Evaluation

Use well-monitored, inhalation anesthesia with cuffed intubation when performing dental cleanings. Such techniques increase safety, reduce stress, decrease the chances of adverse sequelae (e.g., inhalation pneumonia), and are essential for thorough and efficient evaluation and treatment of the patient. Attempting to perform procedures on an awake patient that is struggling, under sedation, or injectable anesthesia reduces the ability to make an accurate diagnosis, does not allow adequate treatment, and increases stress and risks to the patient.

Prior to Anesthesia

Preoperative evaluation includes a preanesthetic physical examination. It is crucial to follow the most up-to-date recommendations for preoperative laboratory testing based on the patient’s life stage and any existing disease. Preoperative care includes IV catheterization to facilitate administration of IV fluid therapy, preemptive pain management, and antibiotics (when indicated). Review the most up-to-date guidelines on anesthesia, antimicrobial use, fluid therapy, feline life stage, canine life stage, preventive healthcare, pain management, and referral for specific recommendations.17–25

Anesthesia

General anesthesia with intubation is necessary to properly assess and treat the companion animal dental patient. It is essential that aspiration of water and debris by the patient is prevented through endotracheal intubation. Cleaning a companion animal’s teeth without general anesthesia is considered unacceptable and below the standard of care. Techniques such as necessary immobilization without discomfort, periodontal probing, intraoral radiology, and the removal of plaque and tartar above and below the gum line that ensure patient health and safety cannot be achieved without general anesthesia.26

During anesthesia, one trained person is dedicated to continuously monitoring and recording vital parameters, such as body temperature, heart rate and rhythm, respiration, oxygen saturation via pulse oximetry, systemic blood pressure, and end-tidal CO2 levels q 5 min (or more frequently if sudden changes are noted).27,28 IV fluid therapy is essential for circulatory maintenance. Customize the type and rate of fluids administered according to the patient’s needs.29,30

TABLE 2: Materials Needed for the Practice of Veterinary Dentistry*


Necessary materials
  • Antiseptic rinse
  • Prophy paste/pumice
  • Prophy angle and cups
  • Hemostatic agents
  • Sealant
  • Needles and syringes
  • Intraoral digital system or radiographic film
  • Measures to prevent hypothermia (e.g., conductive blanket, hot air blanket, circulating water blanket, towels, blankets)
  • Gauze and sponges
  • Antimicrobial agent for local application
  • Suture material (4-0 and smaller)
  • Bone augmentation material
  • Local anesthetic drugs
Necessary equipment
  • Equipment to expose and process intraoral digital radiograph system or intraoral films
  • Suction
  • A high- and low-speed delivery system for air and water
  • Fiber optic light source
  • Equipment for sterilizing instruments
  • Low- and high-speed hand pieces (minimum two of each)
  • Various sizes of round/diamond and cross cut fissure burrs
  • Powered scaler with tips for gross and subgingival scaling (ultrasonic, subsonic, or piezoelectric)
  • Head or eye loupes for magnification
* Please note that disposable items are for single use only.

Prevention of hypothermia with warming devices is essential because the patient may become wet, and dental procedures can be lengthy.31,32 Additionally, suction and packing the caudal oral cavity with gauze can prevent aspiration and decrease hypothermia. If packing materials are used, steps must be taken to ensure there is no chance of the material being left behind following extubation. Regardless of whether packing is used, the last step prior to extubation is an examination of the caudal oral cavity to make certain no foreign material is left behind. Proper positioning of the patient by placing them in lateral recumbency can also help prevent aspiration. Provide safe immobilization of the head.

If oral surgery is planned, the institution of an intraoral local anesthetic is warranted in conjunction with the general anesthesia. This decreases the amount of general anesthetic needed and reduces the amount of systemic pain medication required postoperatively. 1,27,33 Local anesthetic blocks can last up to 8 hr, and they decrease hypotension and hypoventilation caused with inhalant anesthetics by reducing the amount of gas needed to maintain a safe anesthetic plane.3,6,34,35

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