Photo by Oleksandr Pidvalnyi
What’s Wrong with Anesthesia Free Dental Cleanings?
By Greg Bishop, DVM
I think anyone who’s ever been around a dog recognizes that their mouths usually stink pretty bad. “Doggie breath” is an endearing term for halitosis, or foul breath, and it’s extremely common. While technically speaking, there are a few different causes (including dogs guilty of recreational coprophagy), by far the most common cause of “doggie breath” is dental disease. And specifically periodontal disease, which is in fact the most common exam finding when dogs go to the vet. If you go to the dog park on any given day of the week and look in some dogs’ mouths (I’m vaccinated against rabies so I have no compunction about doing this), you’d have a very high chance (upwards of 80%) of finding periodontal disease. It’s about the same for cats, but there aren’t any cat parks that I’m aware of (this might be the closest thing?).
Periodontal disease in dogs and cats is complicated, so without going too far into the weeds, what you need to know is that it’s related to plaque buildup and affects pretty much all of our dogs and cats (sorry, it’s not caused by feeding corn, wild dog species get it too). There is a whole residency training program and professional association of veterinary dentists (https://www.avdc.org/) who tackle the complicated cases. For most dogs and cats though, typical plaque buildup can be treated with a dental cleaning by a veterinarian in general practice. The process is actually almost exactly the same as for people and involves: scaling, polishing, x-rays (radiographs), probing and charting. We do these routinely on otherwise healthy pets, because in addition to making the animal feel better (periodontal disease is inflammatory and painful), there are systemic effects that are likely detrimental to health.
There is a big caveat in doing a dental cleaning in animals though, and it is this: it must done under anesthesia. The obvious reason is, that unless you’re a masochist, nobody likes going to the dentist. And when animals think “I don’t like this” and people have to perform a procedure that requires the dexterity of a model-ship builder (e.g. placing a fine tipped ultrasonic scaler in the tiny gap between the teeth and the gums), it’s pretty much impossible to accomplish anything with the animal wiggling, squirming, or even thrashing and trying to bite. Not to mention that they have no idea that they’re benefitting, so they are usually terrified and feel like they’re in the movie The Running Man. Anesthesia lets the animal sleep through the procedure without remembering anything scary, and lets the veterinarian and technicians assess and clean the teeth thoroughly. Although anesthesia is necessary for success, most pet owners are put off for a couple of reasons, (1) they’re scared of the risk of anesthesia, and (2) it makes things more expensive.
Anesthesia for healthy pets is actually pretty safe though, with a mortality rate of about 0.05 to 0.15%. It is higher than for people, but it’s still very rare for anything to go wrong. And the benefits of a healthy mouth do outweigh the risks for most pets with moderate to severe dental disease. As for the cost, that’s always going to vary, but understanding the benefit of a healthy mouth may make it easier to part with that hard earned paycheck. If you consider the cost of a dental cleaning to be an investment in improving a pet’s overall health and just make them feel better, it’s worth it.
Most pet owners are aware their pet’s teeth are a problem. There is (fortunately) a proven solution: a dental cleaning done under anesthesia. However, (unfortunately) many owners avoid this treatment because they lack important information about the benefits and low risk. I see a gap to fill! As is the case so often, this gap has been filled by people willing to spread misinformation to turn a profit. In this case, the misinformation is that you can clean the teeth just as well without anesthesia, and to do it for way less money! You can find these services all over the place* and there are a number of names and acronyms for them, but for now we’ll call them anesthesia free dentals (AFD for short, I thought about Dental Anesthesia Free Treatment but that seemed mean).
What is AFD?
Here’s what happen during these services: someone removes visible tartar off of teeth, then they take money from pet owner, and pet owner leaves feeling like they just saved a bunch of money and avoided a risky procedure. “My vet is such a jerk for suggesting that we knock Muffy out to clean her teeth! Now her teeth are perfectly clean! Why are they so greedy?”. And to most people, the teeth do look better, because the crowns of the teeth don’t have any gross brown gunk on them anymore, which is what they think the benefit of a tooth cleaning is. What does not happen during this procedure though, is any tangible benefit to the pet. There is an important reason for this, and that is because the vast majority of inflammation (and thus pain and detrimental health effects) is underneath the gumline.
Look at the gums of a dog who’s just had an anesthetic free dental, the crowns look pretty good, but the gums are bright red due to persistent gingivitis. That’s because in an awake animal, it’s usually extraordinary difficult to clean that space (and impossible if using better equipment like ultrasonic scalers and polishers that use water irrigation). The owners have just paid to have a cosmetic procedure performed and are now even less likely to do an actual dental cleaning. Worst of all, the animal just had to sit there while somebody scraped their teeth, and they don’t get any benefit from the procedure. The real value of a dental cleaning is treating disease below the gumline. Again, that is where the majority of the problems are. Good luck getting there when the pet is awake.
That has not stopped people from marketing and selling AFD services. There are licensed veterinarians who provide the service, despite the American Veterinary Medical Association, and the American Veterinary Dental College (among many others) taking official positions against the practice. Whether or not these people are doing it because they truly believe in it’s efficacy, or because the demand leads to profit, who knows? The people selling AFD services run the gamut from mobile dog groomers to well-respected veterinarians. There are even national brands emerging who incorporate their techniques into existing veterinary clinics. Don’t be fooled by official sounding programs; if someone’s telling you they can clean your dogs teeth without anesthesia, they lyin’. There are even so-called “scientific studies” out there supposedly showing that AFD works, but they’re so poorly done that their conclusions are not even a stretch, they are a yoga move only achievable by teleportation. They’re simply not good science and they reek like a festival in Gilroy.
Fortunately the major veterinary organizations are taking a stand against these practices. There is a wide range of AFD providers out there, from the outright illegal practice of AFD without the supervision of a veterinarian, to the medically questionable ones done under a veterinarian’s care. None of them has actually shown that their services benefit animals, and there are really serious problems with their “studies”. If these AFD providers can do a better job to show that what they’re doing works, and in a way that doesn’t mislead the public, it will be important and helpful. But I don’t think they’re going to be able to show that there is any measurable benefit for most animals. The other real bummer here is that pet owners are going to be distracted from the true benefits of dental treatments under anesthesia, and the importance of brushing your pet’s teeth. Don’t fall for these practices if you want what’s best for your pet.
* Not only AFD but also a bazillion pet dental care products, very few of which are scientifically tested. If you’re looking for which have some evidence behind them, the nice people at the Veterinary Oral Health Council have done the work for you.
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