The ABCs of veterinary dentistry: ‘N’ is for no

By nature of the alphabet, we must get through all of the noes in veterinary dentistry before we can reach the yeses—but that doesn’t mean you won’t feel positively inspired to better your dental practices after reading.

As veterinarians, we respond to clinical signs in our patients and do something about them. But knowing what not to do is just as important. Here are 14 things to say no to in veterinary dentistry:

1. Say no to treatment estimates related to oral malodor (halitosis) before you’ve examined the entire mouth—including every tooth.

Quoting a fee (or even a fee range) for “bad breath” before you know the cause may lead to a disgruntled client and an untreated patient once you discover that a dozen teeth suffer from advanced periodontal disease and need to be extracted. Instead, let your client know you’ll call while the pet is anesthetized to discuss what care the pet needs after dental scaling, probing and full-mouth intraoral radiographs.

2. Say no to dental procedures without general anesthesia.

Anesthesia allows the practitioner and assistants to carry out dental procedures safely and effectively, minimizing the risk of injury to the team, equipment and patient. The American Veterinary Dental College (AVDC) launched a website to deter pet owners and veterinarians from considering anesthesia-free dental cleanings in any context. It advises pet owners that "Anesthesia-free dental cleanings provide no benefit to your pet and do not prevent periodontal disease at any level. In fact, it gives you a false sense of security as a pet owner that because the teeth look whiter that they are healthier."

A similar position statement was ratified by the American Veterinary Medical Association: “When procedures such as periodontal probing, intraoral radiography, dental scaling, and dental extraction are justified by the oral examination, they should be performed under anesthesia.”

3. Say no to dental procedures without an examination.

In some veterinary clinics, the pet owner calls the office to arrange a drop-off for a teeth cleaning because the pet has oral malodor. But if your dental assistant only removes the pet’s plaque and tartar from the crowns without a tooth-by-tooth examination, you’ve accomplished little besides the cosmetic removal of crown debris. Oral malodor occurs secondary to food putrefying in periodontal pockets. Unless you treat the pockets (through deep scaling and root planing, gingivectomy or placement of local antimicrobials into cleaned pockets) and institute home care, malodor will soon return and periodontal disease will progress.

A healthier way to approach dentistry with long-term positive results is to examine the conscious patient first (including the oral cavity), followed by a tooth-by-tooth examination under general anesthesia (with probing and intraoral radiology). If the tooth and support structures are in good shape, move on to the next tooth. If not, diagnose the pathology and formulate a treatment and prevention plan (Figures 1A-1D).

Figure 1A. 12-mm probing depth along the mesial aspects of the left maxillary fourth premolar; extraction indicated. (All images courtesy of Dr. Jan Bellows.)
Figure 1B. Periodontal probe before insertion into a dog’s partially erupted left mandibular canine.
Figure 1C. 10-mm periodontal pocket; gingivectomy, mucogingival surgery or extraction indicated.
Figure 1D. Bleeding on probing with 3-mm periodontal pockets; root planing and instillation of local antibiotics indicated.Walmart’s offerings will soon include veterinary care
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