Non Anesthesia Dentistry (NAD)

I’ve noticed many people are looking for dentistry information for their pets.  There is one board certified dental society, the American Veterinary Dental College in the United States, and a second Academy of Veterinary Dentistry, which has less stringent membership requirements.  Both are sources of official information about dentistry.

There is a practice which concerns Doc Truli greatly, so-called Non-Anesthesia Dentistry.  This is an evil wrong perpetrated on pets, sometimes under the roof of an animal hospital.  The American Veterinary Dental College has issued a position statement speaking out against this practice. I have included the text at the end of this post, in its entirety, or you can go to the Academy site and read it there.

Here’s how Doc Truli first learned of this “practice:”

“Doc, you have a call!”

“Hi, this is Ralph, I’m here with Jamie, the Yorkie.  You need to prescribe antibiotics for her.”

“Pardon Me?”  Who is this? “Who are you?”

“Oh!  I’m Jamie’s groomer.  I just scaled her teeth and it’s bleeding a little and a couple teeth fell out.  She’s gonna need antibiotics.”

“Tell Jamie’s mom to bring her right over.”

Well, Jamie had massive periodontal disease with many, many loose teeth.  Her mom always nodded her head and ignored me when I brought up the need for tooth surgery.  She always said she didn’t have the money.  It took 4 hours in surgery and over $1,000 to fix the mouth, otherwise the bleeding from the groomer extracting loose teeth would not stop.

Yikes!

I found out that there was a company out of California certifying veterinary technicians, groomers, or whomever paid for the class, to scale dogs teeth without sedation or anesthesia.  This is the practice of veterinary medicine without a license!  It is very, very dangerous, and the disease spread or overlooked can kill a dog.  As this company morphs across the US from West to East, they are sued and shut down state by state.  But not until countless animals are injured.  All because people are afraid of anesthesia.

Now, in 2009, there is a new version of this travesty.  Now, the technicians “certified” by this, and other bogus programs, come into veterinary hospitals.  Instead of a real cleaning, exam, and full x-rays of the teeth, the vet actually prescribes the NAD, or non-anesthesia dentistry, often without examining the pet, or even meeting the pet parent.

One of my medical clients likes the (excellent) groomer who happens to work at a nearby animal hospital.  She had been dithering about dentistry, saying it cost too much.  What did she do?  She got talked into an $180 NAD!  $180!!!! for cosmetic cleaning!!!!  It doesn’t do anything to help her dog feel better, live longer, or be healthier.  They talked her into it.  Did not examine her pet, and a vet who has not been in active practice for at least 7 years was the name on the antibiotic prescription bottle.  This nasty, money ripping little trick has not been found to be malpractice in a court of law, but it should be.  It’s just a matter of time.

Talk with your veterinarian about anesthesia for your pet. Be sure your vet has full dental x-ray capability and uses it on every dentistry patient.  Preferably, digital x-rays decrease the amount of time your pet is under anesthesia, but if your vet’s team is good with the regular old-fashioned x-rays, that’ll be fine, too, (regular old-fashioned x-rays can be better visual quality than digital, anyway).  Be sure your vet team monitors anesthesia rigorously, especially if your pet is under 10 pounds.

Ask your vet about this anesthesia/dentistry check list:

• -pulse oximeter
• -carbon dioxide
• -external heat, like bair hugger, circulating hot water blanket, heating pad, hot water bottles, or heated surgery table
• -continuous core body temperature monitoring
• -blood pressure monitoring
• -protected airway with intubation
• -intravenous fluids on every dentistry patient
• -anesthetist assigned to monitor pet
• -high speed drill
• -dental x-ray capability and familiarity
• -hospital with many tiny patients.  The more experienced your vet is with condo pets and lap dogs, the better.
• -if more than 2 hours under anesthesia, venous blood gas analysis capability

Pet Anesthesia Checklist (pdf)

Pet Anesthesia Checklist (.odt)

If they are missing some of these basics, ask if you may have a referral to a board-certified specialist in dentistry, or search for one on the AVDC website.  I have not listed nearly all the “university” bells and whistles you could have used to monitor your pet, just the basics I use every day.  I believe every veterinarian practicing dentistry should have no trouble checking off every item on the basic list.

The carbon dioxide monitor, the venous blood gases, and the dental x-rays may trip up about 80-90% of regular small animal hospitals.  Very few have invested in this equipment.  Some dentists for people do not have high-speed hand pieces for their drills, so be sure your veterinarian does.

It all comes down to the people working with your pet.  Can you see the treatment area?  Will they show you where your pet will be staying?  Do they look you in the eye when they say they’ve never lost a patient under anesthesia?  Do you feel cared for, and your pet is cared for?  The people can mess up any fancy machine, and many miracles can be performed without fancy machines, although the hidden risks are higher.

The American Dental College Position Statement Against Non-Anesthesia Dentistry

In the United States and Canada, only licensed veterinarians can practice veterinary medicine. Veterinary medicine includes veterinary surgery, medicine and dentistry. Anyone providing dental services other than a licensed veterinarian, or a supervised and trained veterinary technician, is practicing veterinary medicine without a license and shall be subject to criminal charges.

This position statement addresses dental scaling procedures performed on pets without anesthesia, often by individuals untrained in veterinary dental techniques. Although the term Anesthesia-Free Dentistry has been used in this context, AVDC prefers to use the more accurate term Non-Professional Dental Scaling (NPDS) to describe this combination.

Owners of pets naturally are concerned when anesthesia is required for their pet. However, performing NPDS on an unanesthetized pet is inappropriate for the following reasons:

• 1. Dental tartar is firmly adhered to the surface of the teeth. Scaling to remove tartar is accomplished using ultrasonic and sonic power scalers, plus hand instruments that must have a sharp working edge to be used effectively. Even slight head movement by the patient could result in injury to the oral tissues of the patient, and the operator may be bitten when the patient reacts.
• 2. Professional dental scaling includes scaling the surfaces of the teeth both above and below the gingival margin (gum line), followed by dental polishing. The most critical part of a dental scaling procedure is scaling the tooth surfaces that are within the gingival pocket (the subgingival space between the gum and the root), where periodontal disease is active. Because the patient cooperates, dental scaling of human teeth performed by a professional trained in the procedures can be completed successfully without anesthesia. However, access to the subgingival area of every tooth is impossible in an unanesthetized canine or feline patient. Removal of dental tartar on the visible surfaces of the teeth has little effect on a pet’s health, and provides a false sense of accomplishment. The effect is purely cosmetic. (Doc Truli’s emphasis.)
• 3. Inhalation anesthesia using a cuffed endotracheal tube provides three important advantages… the cooperation of the patient with a procedure it does not understand, elimination of pain resulting from examination and treatment of affected dental tissues during the procedure, and protection of the airway and lungs from accidental aspiration.
• 4. A complete oral examination, which is an important part of a professional dental scaling procedure, is not possible in an unanesthetized patient. The surfaces of the teeth facing the tongue cannot be examined, and areas of disease and discomfort are likely to be missed.

"Thank you for my proper dental care, can I sleep on your pillow tonight?" (Who am I kidding, cats don't ask first...)

Safe use of an anesthetic or sedative in a dog or cat requires evaluation of the general health and size of the patient to determine the appropriate drug and dose, and continual monitoring of the patient. Veterinarians are trained in all of these procedures. Prescribing or administering anesthetic or sedative drugs by a non-veterinarian can be very dangerous, and is illegal. Although anesthesia will never be 100% risk-free, modern anesthetic and patient evaluation techniques used in veterinary hospitals minimize the risks, and millions of dental scaling procedures are safely performed each year in veterinary hospitals.

To minimize the need for professional dental scaling procedures and to maintain optimal oral health, the AVDC recommends daily dental home care from an early age. This should include brushing or use of other effective techniques to retard accumulation of dental plaque, such as dental diets and chew materials. This, combined with periodic examination of the patient by a veterinarian and with dental scaling under anesthesia when indicated, will optimize life-long oral health for dogs and cats.

For general information on performance of dental procedures on veterinary patients, please read the AVDC Position Statement on Veterinary Dental Healthcare Providers, which is available on the AVDC web site (www.AVDC.org). For information on effective oral hygiene products for dogs and cats, visit the Veterinary Oral Health Council web site (www.VOHC.org).