Getting to the root of anesthesia-free veterinary dental care

Despite the fact that the American Animal Hospital Association (AAHA) calls pet dentistry without anesthesia "unacceptable and below the standard of care" and the American Veterinary Dental College (AVDC) has issued a position statement warning against its use, the practice is gaining acceptance in the veterinary community. The result? A wide range of opinions and some strenuous objections.

For one thing, as of Nov. 1, AAHA-accredited practices that don't comply with this standard won't pass their evaluation. For another, the AVDC objects altogether to the term "anesthesia-free dentistry," preferring to call it "nonprofessional dental scaling"—the word "dentistry" is a misnomer, they say. But other doctors say some level of care without anesthesia is better than nothing, and it's at least a step in the right direction. Before making your final call, read on to see what your colleagues have to say about this issue.

It's better than nothing—isn't it?

"I have clients who are completely unwilling to put their pet under anesthesia either from fear or due to a severe cardiovascular disease that makes it higher-risk," says Stephanie Sur, DVM, associate at The Whole Pet Vet Hospital and Wellness Center in Los Gatos, Calif. "For those patients, it provides a way to give some oral care, which in my opinion is better than no oral healthcare at all."

Sur has worked with Pet Dental Services, a fast-growing company that provides pet owners with an anesthesia-free option. The company works with a network of about 300 veterinary practices (it started in 2006 in California with about 10), offering its services within veterinary clinics. Sur has personally worked with anesthesia-free dentistry since 2003 and for two years at her current practice. She also has recently co-authored a study on the effectiveness of non-anesthetic dentistry (see "Study on professional outpatient preventative dentistry," ivcjournal.com/research-studies).

"My clients have responded very well to this option," she says. "Some sigh with relief that they don't have to spend hundreds of dollars for an anesthetic procedure. Others are relieved because we have removed the fear of anesthesia."

Sur has had patients come from other area clinics just for this service, and her waiting list is long. She says clients trust that she won't recommend a more expensive anesthetic procedure when she deems an anesthesia-free option appropriate for that pet.

And that's another reason some doctors support this growing trend: It costs less, which means more clients are willing to spring for it. That increases compliance and ancillary services, proponents say—plus, many clients do opt for anesthesia-required procedures if their pets' needs are beyond the scope of what an anesthesia-free cleaning can address.

For George Zafir, DVM, an independent general practitioner in Lake Worth, Fla., non-anesthetic dental cleanings have provided a whole new revenue stream. "Here we have an independent third party that charts the pet's mouth and discusses issues they find with the client, in detail," he says. "This alerts pet owners to potential problems and gives us a chance to promote oral care products."

This so-called halo effect has been good for Zafir's business. For the last seven years, he has seen 12 to 14 patients a month for non-anesthetic dental cleanings at $200 each. He says many of those clients wouldn't otherwise pay for a dental with anesthesia. "We can do a non-anesthetic at less risk or cost until we are to a point where that is not the appropriate way to deal with that mouth," he says. "I offer it as an adjunct service, an alternative that gives us a competitive edge over other veterinarians. It's not my first option, but it's a good option."

Weighing the risks

On the flip side, Brett Beckman, DVM, DAVDC, DAAPM, says non-anesthetic cleanings do get clients to comply when otherwise they might not, but that's not good enough. "Without radiographs, the cleaning is cosmetic only," says Beckman, past president of the American Veterinary Dental Society. "If disease is present, which in almost all cases it is, then it does little to no good for the patient and wastes valuable client resources that could be used to actually help the pet with a thorough evaluation, radiographs and treatment. We see a tremendous amount of disease that is severe that we never detect on oral exam."

AAHA and the AVDC, along with many others in the veterinary community, agree that the procedure isn't thorough enough, could cause more damage and does a disservice to patients—and to their owners, who think their pets' teeth are getting cleaned at an appropriate level.

"A thorough dental procedure includes a tooth-by-tooth exam, tooth mobility tests, probing and radiographs," says Jan Bellows, DVM, DAVDC, DABVP. "This just cannot be done without anesthesia. Sixty percent of the tooth is located under the gum line, you can't see pathology without radiographs, and dogs and cats can't tell their dentist where the pain comes from. Dogs and cats have to suffer silently, and we can't thoroughly assess their dental health without anesthesia."

Dental experts also worry about a pet aspirating dental tartar or calculi and other debris produced during cleanings without the use of an endotracheal tube during anesthesia. "I think the non-anesthetic dental companies prey on clients' fear of anesthesia," Bellows says. "Fortunately, due to advances in anesthetic protocols, the risk is minimal."

Proponents of non-anesthetic cleaning, however, say the risk of aspiration during cleaning is a nonissue because a pet's gag reflex will provide protection. And as for the cleaning being less than thorough, Sur says, "My 12-year-old dog has had her teeth cleaned without anesthesia twice a year since she was 2 years old. She has never developed subgingival pockets or major calculus buildup and has never required an extraction. I never saw a lingual side that was missed or a tooth that was unpolished. They are able to get under the gum line comfortably, but just like humans, if deep root planing is needed, this should be done with anesthesia."

As the saying goes, it appears some members of the profession will have to agree to disagree on whether non-anesthetic cleanings are a good idea. AAHA and the AVDC have posted their views on the issue, and AAHA practices that don't comply can lose their accreditation. This has also been a political issue in California and other states in recent years, with veterinarians working to make or keep it illegal for nonveterinarians to perform dentistry on pets. However, many veterinarians are bringing the service under their hospital roof where they can supervise to comply with the law.

"I know these companies say they promote anesthetic dentals as well, but I have seen the opposite," says Bellows. "I've seen animals that had their teeth cleaned this way for years ultimately present with a mouth full of hurt."

Sarah A. Moser is a freelance writer and editor in Lenexa, Kan.