Dental Consumer Guide
Veterinary dentistry is a very important part of routine health care for our pets, as leading veterinarians, teaching hospitals and accrediting bodies such as AAHA nationwide now agree. However, veterinary dentistry is a relatively new field and so few veterinarians were taught a lot about dentistry in veterinary school. Veterinarians keep up with modern medical advances including advances in dentistry through journals, classes, conferences and other continuing education.
The emerging field of veterinary dentistry is benefiting from rapid advances in our knowledge, tools and techniques. The individual veterinarian's commitment to self-education as well an on-going investment in modern equipment and staff training is essential to providing appropriate care. Practices that are not equipped or staffed to provide appropriate dental care can and should refer dental procedures to better equipped primary care veterinarians or to a board-certified veterinary dentist.
As with any major medical procedure, educating yourself will help you make the best decisions for your pet. Standards of care for veterinary dentistry vary dramatically from practice to practice. A "dental cleaning" at one clinic may be completely different from a "dental cleaning" at a second hospital. Every dental procedure requires anesthesia and many dental procedures (those requiring extractions or other surgery) are actually significant surgical events.
A properly done dental procedure should be relatively pain-free and result in a healthier, happier, and more comfortable pet. Goo dental care is very important to the health and wellbeing of your pet, so don't delay needed dental care. But DO choose to trust a veterinary team that shows a commitment to excellence in dentistry and is prepared to discuss your concerns and answer your questions.
Never choose a team to provide your pet's dental care or other medical care based on price unless you are aware of and accepting of the compromises in care your choice likely entails. In most cases, price differences reflect differences in the quality of care your pet will receive.
Some questions to ask when planning a dental procedure:Will you take intraoral dental x-rays? Will you take survey films as well as after-films on extractions? They should. Veterinary dentists state that performing dental extractions without intraoral x-ray is unacceptable and poses significant risks to patients. X-ray finds many problems including bone loss, fractures and other problems that could otherwise be missed and also helps ensure safe complete tooth extractions when needed.
At AMC, intra-oral x-ray films of the entire mouth are a part of our routine dental AH&T procedure, as are before & after films for extractions. These x-rays allow us to identify serious dental problems hidden below the gumline and to make better decisions about extractions or other procedures.
Do you use a high-speed, water-cooled dental drill for extractions? They should. Veterinary dentist state that a high-speed, water-cooled dental drill (like those used by your own dentist) is the only acceptable tool for drilling, sectioning and removing teeth. Large, multi-rooted teeth are cut with the drill into sections before removal, allowing each root to be removed intact. Other, "old-school" methods some veterinarians may use for sectioning teeth include: chisel & hammer; hack-saw blade; or low-speed non-water cooled drills. Removal with these methods often results in incomplete removal and/or damage to other teeth, jaw bone or other oral tissues from the trauma and/or heat caused by these extraction techniques. Not having the appropriate dental drill can also lead the veterinarian to leave a diseased tooth in place rather than face the risks of a difficult or incomplete extraction.
At AMC, our dental station (pictured above right) includes a fiber-optically lit, high-speed, water-cooled dental drill, along with an air & water syringe, pizeoelectronic scaler, low-speed polisher and other essential tools. This dental station is comparable to the equipment used by human dentists and allow our veterinarians to properly and safely section teeth for extraction with minimal risk of trauma to surrounding tissues.
Do you section multi-rooted teeth before extractions? Using what tool(s)? They should section all multi-rooted teeth using a high-speed water cooled drill.
At AMC, our veterinarian performs all extractions and sections multi-rooted teeth with our high speed drill.
Do you ensure removal of all root tips (via x-ray when appropriate)? They should.
At AMC, we use intra-oral x-rays to confirm the outcome of extractions when there is any doubt that the tooth and it's entire root was removed intact.
What will happen before, during and after anaesthesia? What procedures will take place to maximize safety and comfort? All dental procedures require complete anaesthesia. (Run, don't walk, away should anyone suggest an "awake" dental procedure!) Your pet should have an individualized anaesthesia plan to maximize safety and comfort. Your pet should have appropriate blood and/or urine tests evaluated before anesthesia. Your pet's vital signs should be monitored throughout anaesthesia by a trained assistant and with appropriate electronic monitors. Your pet should be intubated during anesthesia, have an IV catheter placed and receive IV fluids during anaesthesia. Hypothermia (becoming too cold) should be prevented through using appropriate patient warming techniques.
At AMC, all our dental (and other anaesthetic) procedures are performed under stringent safety guidelines. A full veterinary exam as well as age and health-appropriate pre-anaesthetic blood and/or urine testing are evaluated prior to anaesthesia. A well-trained assistant monitors your pet throughout anaesthesia using a variety of electronic vital sign monitors as appropriate. We ensure patient warmth with excellent patient warming equipment including circulating warm water blankets and warm air blanket as well as fleece blankets. Our recovering patients are bundled in a cozy warm nest of blankets; never left alone and cold. As an AAHA hospital, we use AAHA's high standards for surgical safety, hygiene and sterility. Our surgery page describes some of our rigorous standards in more detail.
Will antibiotics be prescribed? Which antibiotic? Why or why not? Antibiotics before, during and/or after a dental procedure are sometimes advised for serious dental disease. An individual decision about antibiotics for your pet should be made based on the severity of dental disease.
At AMC, Dr. Zucker minimizes the risks of over-use of antibiotics and maximize patient benefit by making an individual assessment about appropriate antibiotic use for each patient and by using particular antibiotics shown to be particularly effective for oral disease.
What is the pain management plan for my pet? Each pet should have an individual pain management plan, especially if extractions or other surgical procedures are performed.
At AMC, we take pain seriously and we work to ensure that all patients are free of pain and discomfort. We use good surgical techniques and good quality, well maintained equipment to minimize trauma, and we use appropriate pain medications whenever appropriate. An uncomplicated dental exam and cleaning may not require any pain medication, but procedures that include significant extractions, gingivectomies, or other surgery require a pain management plan. Injectable medications given at the hospital, injections of local anesthetic, and take-home oral medications are all good options, depending on the nature of the surgery and the health status of the patient.
What training and experience do the veterinarian and nurse/technician who will be performing the procedure have in dentistry? The team working on your pet should show a commitment to good dentistry. Being able to discuss these topics intelligently is a good sign that you have found a hospital committed to good dentistry. As a consumer, it is very hard to measure a team's education level, but if you hear talk about dental continuing education or various new dental procedures or equipment, it is a very good sign.
The AMC staff receives ongoing and extensive education on all medical topics, with a special emphasis in dentistry. Our staff education program emphasizes dental health since dental disease is one of the most common but most preventable diseases affecting our patients. Dr. Zucker and other staff members have received many hours of formal continuing education classes on dental topics from some of the best veteirnary dentists in the United States. All staff members receive many hours per year in dentistry training and advanced education.
Will a tooth-by-tooth exam and detailed oral chart be completed on my pet's mouth? A thorough oral exam is the most vital first step during a dental procedure. Once your pet is under anesthesia, the veterinarian is able to thoroughly examine the entire mouth. The health of every tooth should be recorded, as should the nature and location of all treatments performed. This careful record will help the veterinarian measure progress during future dental visits.
At AMC, the veterinarian performs a careful exam of the entire mouth. The veterinarian and nurse probe each tooth and chart the condition of every tooth as well as all treatments performed.
Do you scale below the gumline (as well as the crowns)? This is essential! Not cleaning below the gumline is one of the cardinal sins of poor dentistry! Cleaning only the "crowns" of the teeth result in a mouth that looks nice but is still a hotbed of festering dental disease.
AMC's highly trained nursing team scales the entire tooth surface thoroughly using effective and safe scaling tools including our pizeoelectric scaler and exacting hand tools.
Do you polish with a professional tooth polisher (with "fine" or "flour of pumice" polish) after scaling the teeth? This is another must. Proper polishing with a fine polish remove the microscopic roughness left behind by scaling. The smooth tooth surface is less prone to accumulation of new plaque and tartar. Some practices skip polishing or use an electric tooth brush to polish! This doesn't do the job and leaves the teeth prone to future dental problems.
At AMC, we use a professional low speed hand-piece with (bubble gum flavored!) fine grit dental polish to polish all the teeth after scaling. The equipment and polish is just like what your own dentist uses.
Do you use fluoride and/or OraVet Sealant after polishing? Fluoride and OraVet should be available tools for dental care. Most veterinary dentists recommend fluoride treatments and sealant application after a dental cleaning. Fluoride can help reduce tooth sensitivity and help strengthen the teeth. Sealant can help protect the teeth against plaque and tartar formation.
At AMC, we routinely provide fluoride and OraVet sealant after each dental procedure. Oravet application is pictured at right.
What homecare and future professional care will be recommended? Will you teach me how to brush my pet's teeth and help prevent future problems? Proper care at home, including brushing, is very important to maintaining your pet's oral health. Brushing isn't difficult but it can take a little practice for both you and your pet to become comfortable. Your veterinary team should be able to teach you how to care for your pet's teeth at home and support you and your pet as you get into new, good, home care habits. Follow up visits and practice sessions are very important.
AMC's entire team is committed to helping you learn to take care of your pet's teeth at home. As a sign of our commitment to home care, we even provide AMC toothbrushes at no charge to all of our patients. Every wellness visit includes education on dental home care. We will teach you how to brush your pet's teeth and to perform any other needed home care. We include a re-check appointment two weeks after a dental procedure as part of the cost of the initial procedure. At this dental recheck appointment, the nurse will review homecare, tooth brushing, and any other appropriate home care, such as weekly application of OraVet Plaque Prevention Gel (re-coatings of the Sealant applied during the professional cleaning.)
If your veterinarian can't or won't discuss these issues with you, you should ask around until you find a local veterinarian who can and will or seek a referral to a board certified veterinary dentist.
These are just a few questions to start you thinking about what standards of care you want for your pet. In the end, the best thing you can do for your pet's health is to find a veterinarian who is a true, trusted partner in caring for your pet and then follow their advice.