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Simply "cleaning the teeth" is not enough to prevent and control infection in the gums (gingivitis) and bones of the upper and lower jaw surrounding the tooth socket (periodontal disease). This infection is initiated by the formation of plaque. Plaque is a "biofilm" composed of bacteria, saliva and food particles that stick to the surface of the teeth. This process of plaque formation begins within hours, hence the reason for advocating brushing pets' teeth (and ours!) every day. In time, the plaque calcifies and hardens on the tooth surface to become tartar or calculus. In contrast to plaque, once tartar/calculus forms, it is virtually impossible to eliminate it by simply brushing the teeth.

The most important point to understand is that the gingivitis and periodontal disease is caused by the bacteria when it invades the gum tissues, and not directly by the tartar. The bacteria on the tooth crown (within the calculus) is much less important than plaque bacteria within the gum tissues and on the tooth roots. Suffice it to say that simply "cleaning the teeth" to remove calculus or tartar is largely cosmetic and does NOTHING for the overall oral health of your pet. It is also quite important to note that infection within the gum tissues (gingivitis) is REVERSIBLE, while infection that has spread from the gums into the surrounding bone and tooth socket is NOT REVERSIBLE. It is a huge understatement to say: Prevention is the key!!! Therefore, if we catch dental disease before the gingivitis spreads to true periodontal disease, we can save your pet a lot of oral pain and discomfort as well as many systemic problems that are associated with dental infections (e.g. kidney, liver, heart problems). Needless to say, your pocketbook will be spared as well!

At Veterinary Medical Center we do much more than clean teeth during a "dentistry." We perform a complete oral health assessment and treatment. This approach to dentistry is what sets us apart.

THE COMPLETE ORAL HEALTH ASSESSMENT AND TREATMENT: What is this and what does this mean?

  1.         This begins in the exam room with a general physical exam with special focus on the mouth and teeth. The oral exam is continued in detail during the dental "cleaning" while the pet is under anesthesia. Typical abnormalities are fractured teeth, chipped teeth/enamel, swelling, redness, cavities, resorptive lesions, retained baby teeth, missing teeth and cavities.
  2.        In addition to careful visual examination, a periodontal probe (similar to a toothpick) is used to look for "pockets" of infection along the tooth root surface (below the gum line) as well as exposed root surfaces or loose teeth.
  3.         Next, full mouth dental xrays are taken to find any unseen problems. Keep in mind that 67% of a dog or cat's tooth is under the gums and are not visible!! Dental xrays are the most vital tool in veterinary dentistry. It is virtually impossible to practice quality dentistry without xrays! In most cases, xrays are essential to make an accurate diagnosis and treatment plan. Studies show that without dental xrays, abnormalities (in the form of anatomical changes, anomalies and, obviously, periodontal infection) are missed in 75% of pets. Dental xrays can only be taken while under anesthesia. By the way, the dental x-ray unit we have is probably very similar to the one that your own dentist uses on you!
  4.         Next is the actually scaling of the tooth. This is what most consider to be the "teeth cleaning", but as you can see, this is only a portion of what a dental at Veterinary Medical Center entails! The first part of the scaling is to use an ultrasonic scaler to remove the largest portion of tartar and plaque.
  5.         One of the most important steps is to remove plaque from the gum surface and especially from the normal two millimeter pocket at the gum line (so called subgingival sulcus). This pocket is where gingivitis and periodontal disease starts. This must be scaled by hand and can only be achieved while the pet is under anesthesia. This specialized hand scaling is called subgingival scaling.
  6.         After scaling to remove the plaque and tartar from the tooth and subgingival sulcus, it is polished. Scaling leaves the tooth surface rough with "micro-etches" in the enamel. This rough tooth surface actually accelerates the plaque attachment so that calculus forms faster if it is not smoothed out by polishing.
  7.        The last step in a dental "cleaning" is gentle flushing of the mouth and application of fluoride. Although true cavities are a very uncommon finding, the fluoride is used in veterinary dentistry primarily because it has been shown to decrease sensitivity of the teeth.
  8.         In This last, most important step all the above information is collectively evaluated and interpreted to make a treatment plan. The doctor evaluates the teeth and gums visually along with the results of the periodontal probing and the dental xrays to determine if any other procedures, such as extractions, periodontal pocket treatment, surgery, enamel restoration for chipped or fractured teeth are necessary. If anything unexpected is found, the owner is informed and consulted. This is what individualizes the dentistry and makes it unique for every pet!


Lastly, lets discuss DENTAL PROCEDURES WITHOUT ANESTHESIA: While no one wants anesthesia on themselves, nor their pets, dental procedures without anesthesia are impossible and considered malpractice. Why?

The most important parts of dental evaluation and treatment cannot be performed without anesthesia. This includes: close visual inspection of the teeth and mouth, periodontal probing, subgingival scaling (the most important part of the dental "cleaning"), xrays (the most important diagnostic step) and polishing to smooth the tooth surface. None of these parameters can be performed or evaluated without anesthesia in veterinary patients!!!!! Without periodontal probing and xrays, we're going to miss tooth problems 75% of the time. Without subgingival scaling, we're missing where ALL the gingivitis and periodontal disease begins. Without polishing, the plaque and tartar builds up faster and accelerates dental disease. Simply removing the calculus is purely cosmetic and not only does it do nothing for the oral health of your pet, but it makes any gingivitis or periodontal disease that is most likely present worse. If these vital portions of the complete oral health assessment are left out, then we are simply not treating dental problems properly. That's why these non-anesthetic procedures are not only malpractice, but simply an injustice to our patients who deserve proper dental care.

Now you can see why Veterinary Medical Center is vehemently opposed to non-anesthesia dentals. We are advocates for your pet and we only promote proper dental diagnostics, treatment and care so that your pet will not have to suffer in silence with dental disease and pain.


If a dental procedure is deemed necessary after initial physical exam and oral assessment, the following will, hopefully, give you a better understanding of the thorough and rigorous comprehensive dental health evaluation and treatment at Veterinary Medical Center.

During the anesthesia we take every precaution and monitor the patient closely. We place every patient on intravenous fluids and monitor the blood pressure, breathing, temperature, oxygen levels and depth of anesthesia. Critical to proper anesthesia is to ensure that proper blood pressure is maintained. These parameters are measured a minimum of every 10 minutes.

Patient Monitoring

You can see this patient is being kept warm with a warm air "blanket", maintained on intravenous fluids (for blood pressure support) and the technician is monitoring the blood pressure (pictured) as well as temperature, anesthetic depth, respiration and blood oxygen levels.

Posted below are before and after pictures of dental scaling. It shows how nice and clean the teeth look. BUT this is only the tip of the iceberg. Since about two-thirds of the tooth is invisible under the gum and within the jaw, the next steps of periodontal probing and most especially dental xrays complete the vitally important diagnostic portion of the comprehensive dental health assessment.


                           Before Dental Scaling                   After Dental Scaling


                               Periodontal probing                    Taking Dental X-rays


Example of Dental X-ray

The last part of the teeth "cleaning" process is polishing the tooth surface to smooth out the rough "etches" left after ultrasonic and hand scaling. Polishing does not mean making the teeth shiny and pearly-white, but serves to decrease plaque adhesion to the tooth surface and retard subsequent dental disease.


Polishing the Teeth

The final evaluation, performed by the veterinarian, is where all the pieces of the oral exam and evaluation come together (visual exam, periodontal probe assessment, xrays) so a treatment plan and consultation is constructed. I consider this the evaluation of information from the visible and invisible portions of the teeth. In other words, the visible information is that which we can see: are there any fractured or chipped teeth, red gums, swelling, exposed roots (indicating severe tooth bone loss) or loose teeth, to name just a few examples. The invisible evaluation examines the 67% of the tooth that is below the gum line and in the tooth socket. This is where periodontal probing and x-ray evaluation is imperative. Without ALL these pieces of knowledge, a proper dental assessment cannot be achieved.


The following is an example where, without periodontal probing and dental xrays, a severely infected, and undoubtedly painful tooth, would have been missed. This illustrates the necessity for a complete and comprehensive oral health assessment ………………….. so much more than merely a "dental cleaning."

The picture below shows a totally normal looking tooth with equally normal gum tissue overlying it. There were absolutely no visible signs of pathology (disease) in this tooth (second one to the right of the large "canine" (fang) tooth).

P1011483.JPGbone loss_1.JPG

                            Visually Normal Teeth        X-ray showing marked bone loss

However, we could see on the x-ray that, due to infection, there was so much bone loss that the bone around the tooth socket had receded more than half way down the length of the root. This is indication of severe periodontal infection at this tooth. Remember, infection that is limited to the gums (gingivitis) is reversible, but infection in the tooth socket and bone (periodontal infection) is NOT reversible. Therefore, the only treatment option for this severely infected, but visibly normal, tooth was extraction.

 Again, the tooth looked totally normal on visual exam, didn't it? It was only after examining the x-ray that the bone loss (infection) was seen. After periodontal probing, the bone loss was found to be so severe that the probe advanced down into the tooth socket so far that it passed between the two roots!


Periodontal probe passing between where the roots split (furcation)

The only option in this advanced case was extraction of the infected tooth. We perform surgical extractions and these are only done by the veterinarian.

The first step is to use a novocaine-like local anesthetic, similar to what your dentist will use on you! If the pet is already anesthetized, why do we numb the area with novocaine? Dental procedures can be painful and blocking the dental pain during and after the procedure greatly minimizes the amount of anesthetic needed for the patient. This not only minimizes post-operative pain, but the lower anesthesia minimizes anesthetic related problems such as lowered blood pressure and makes the recovery from anesthesia much faster and safer! I am a huge advocate of the use of these local anesthetics.


Injecting a novocaine-like nerve block

Teeth with more than one root are surgically transected (cut) with a drill so the roots can be taken out seperately as if they were individual teeth. This greatly speeds up the surgery and minimizes complications such as fractured tooth roots left behind.


"Splitting" the tooth with a dental drill


Using dental elevators to extract the individual tooth sections

After the tooth is removed, the gum tissue is surgically closed. Using sterile surgical techniques and performed ONLY by the veterinarian, virtually all our extractions are closed.


The results is a nice, neat closed tooth socket that heals quickly with very few complications.


We recheck the surgical procedures two weeks later to not only evaluate healing, but to also consult the owners regarding future dental care. Although brushing your pet's teeth is the absolute best dental care, other options exist and we will teach you all that you want to know about dental care for your pet. We want to minimize the amount of veterinary dental care your pet will need in the future. Your pet will thank us and your wallet will thank us.