This is what is looks like once all the roots have been extracted, prior to suturing the gums closed.
An x-ray of the lower left jaw in a dog. The canine tooth is the long one on the right.
Allison helps Dr. Scarlett get to the far back teeth to suture an extraction site.
Periodontal disease, with gum & bone loss is common in small breed dogs. Fractured teeth are found in dogs that chew hard bones or antlers.
Four Lakes Vet dental suite, with dental x-ray and ultrasonic cleaner/polisher machine.
When I was in veterinary school (early 1990's), we learned about all the different things that could go wrong in an animal and how to treat those problems. Interestingly, we spent very little time on the top two diseases in cats and dogs -- dental disease and obesity. We had ONE lecture with a special guest speaker on dental disease. Dentistry for animals was just becoming a "thing," and we were starting to realize how much dental infections impacted the total health of the dog and cat. Now I spend a lot more than one hour per week on diagnosing and treating dental disease.
I check your pet's teeth at every wellness visit. There are many signs of dental disease that I'm assessing: amount of tartar, gingivitis (that red line along the gum line that signifies bacterial infection), fractured, loose, and missing teeth, resorptive lesions (like cavities that enter the root canal), and pain from just opening the mouth. After 20+ years, I'm pretty immune to bad breath, but that is often the first thing owners notice. Bad breath = infection and means your pet needs a dental cleaning!
We do a lot of dental cleanings at Four Lakes. We commonly have at least four procedures a week (we limit them to two per surgery day) and often fit in another one or two, if there is a problem (like a fractured tooth) that needs to be taken care of quickly.
So what is all involved in a dental procedure? We try not to call them "cleanings" because it is so much more than that. The preferred phrase is "dental prophylaxis," but that is a mouthful, so we generally just shorten it to "dental," which isn't descriptive at all!
When your pet is scheduled for a dental, he will need to be fasted for about 12 hours, as we use full anesthesia. There are some places that do anesthesia-free dentistry, but this might only be useful for those dogs or cats that are young and have very minimal tartar on their teeth. Most of the pets I see already have more problems and need anesthesia. We often do bloodwork prior to anesthesia to make sure there are no underlying problems (dental infections can lead to liver and/or heart disease and impact other internal organs, too). An IV catheter is placed in a front leg vein so we can keep your pet hydrated through the process. After the pet is anesthetized, an endotracheal tube is placed to keep the airway open, allow us to give gas directly to the lungs, and to protect the lungs from the water we use during the procedure.
We take dental x-rays of all the pets teeth. I don't think this should be optional as it helps me decide if a tooth needs extraction, shows the extent of bone loss around the teeth, and allows me to make sure all the roots were extracted. The technician also probes around each tooth, looking for cavities, fractures, pain, and deep pockets under the gum. Deep pockets signify severe disease and bone loss; if a pocket is over 3-4 mm in depth, almost always that tooth needs to be extracted.
I recently went to a full-day course and lab on dental extractions. While I have extracted many teeth in my last 20 years, this wet lab was invaluable and I feel much more confident in my abilities now. I purchased special glasses that magnify the tooth so I can see exactly what I'm doing. Local blocks are used to numb the area, so your pet shouldn't feel mouth pain for several hours afterwards using a special instrument called a freer. For most extractions, an incision is made into the gums and the gum is elevated off the underlying bone. A high-speed burr is used to remove that bone over the tooth roots, the tooth is often sectioned (one root per section) and then each root is removed after loosening the ligaments with a dental elevator. I smooth down any sharp points to the remaining bone, then suture the gums closed with soft, absorbable suture. It is very important to close the gum after an extraction, especially on the top jaw. If holes are left open, the nasal sinuses can become infected and your pet may always have a draining tract connecting the sinus with the mouth.
Once the teeth have been extracted and the area re-radiographed to make sure all the roots were removed, the technician cleans and polishes the remaining teeth. A long-acting pain medication is given and then the pet is taken off anesthesia and recovers under the watchful eye of a certified veterinary nurse. Often the pet is up and ready to go home within a couple hours. Pain medications are always prescribed for four days after the procedure and, if there were extractions, often antibiotics are sent home.
I'm sorry to say that not all veterinarians follow this standard of care when doing dental procedures. If you aren't having your pet's dental procedure done at Four Lakes Vet, I encourage you to ask about dental x-rays, pain medications, and what types of instruments are used to extract teeth. If you have any questions about our procedures or dental disease, please don't hesitate to send us an email or give us a call!
Dr. Scarlett modelling her new Orascoptic magnifying loupes!