Explanation of Anesthesia and Dental Procedures

There has been an explosion of knowledge in veterinary medicine in the last 10 years. The techniques used in veterinary dentistry have become much more sophisticated during this time, leading to more complicated and thorough procedures. The veterinarians at Aztec Animal Clinic attend advanced training sessions with Dr. Tony Woodward in Colorado Springs. These sessions allow them to gain knowledge and expertise in dental techniques, all of which aim to preserve the health of your pet’s mouth as well as reduce the trauma involved when extractions need to be done. This training ensures that the level of care provided by the veterinarians at Aztec is consistent and up to date. We have also made the commitment to have two technicians present during the cleaning, charting and monitoring stages in order to allow for constant attention and anesthetic monitoring. While the doctor is performing extractions, the dental technician will assume full monitoring duties (see below for monitoring information).

Below is an explanation of Anesthesia and Dental Procedures. We feel that it is important that you understand why the cost of a dental procedure here may be more expensive than at many clinics in Albuquerque. When comparing the cost between veterinary clinics, we would suggest that you ask questions about the details of the care that will be provided. The level of dental and anesthetic care may not be comparable.

1. Preanesthetic bloodwork is recommended for all patients that are scheduled to undergo a general anesthesia. For younger patients, we recommend an abbreviated chemistry panel (Chem 11) and for senior or geriatric patients we prefer more comprehensive blood work (Senior Screen or Health Check Plus). The Chem 11 panel has the most important values including kidney values, liver values, blood sugar and serum protein levels while the Senior Screen has electrolytes, minerals, thyroid hormone level and a urinalysis. For each of these patient groups, we are able to evaluate for any unexpected risks as well as plan appropriately for the types of medications that are used for pre-anesthetic sedation and induction of anesthesia.

This lab work can be done the day of the dental procedure but we prefer to have this lab work done at the initial visit. This allows for better planning as well as gives us more information at less expense than lab work run in hospital.

2. Intravenous catheter placement and fluid administration: Placement of an intravenous catheter allows us comfortable access to a peripheral vein in our patients. This decreases the stress on our patients during induction (less restraint needed) as well as allows us to give intravenous fluids during anesthesia. Fluid therapy is helpful in maintaining blood pressure, ensuring circulation to the kidneys and brain. Having access to a peripheral vein also allows us to give any further medications or support if needed during the general anesthesia. Having a catheter in place can be crucial in addressing any concerning changes in patient status noted during the dental. We like to continue our patients on intravenous fluids for a few hours after recovery allowing more rapid clearance of medications and ensuring good hydration when they are discharged from the hospital.

3. Preanesthetic injection(s): opiate (sedation and pain injection), dexdomitor (sedation and enhancement of pain injection), diazepam/midazolam (sedation and anti-anxiety): The use of opiates and other sedative/pain blockers prior to anesthesia has several benefits for our patients. The first is the ability for us to address and block pain prior to stimulating pain pathways during the dental cleaning and possible extraction of teeth. As with the local block (see below) the perception of pain is greatly decreased if the pain fibers are inactivated prior to the surgical “insult”. The second benefit of using these medications is the dramatic reduction in the amount of medication that is required to induce and maintain anesthesia. By having our patients already quiet and calm when we start induction (sedation), we are often able to use only a fraction of the induction medication (Propofol) that would be needed without sedation. During the procedure we are also able to maintain our patients on a lower level of inhalant anesthetic (Isoflurane) and have the same level of anesthesia and pain control. This greatly improves our ability to maintain good blood pressure as well as helps to reduce the overall depth of anesthesia needed for even significant surgical extractions.

4. Propofol for induction: Propofol is a short acting anesthetic that is given intravenously as a slow injection to allow for placement of the intratracheal tube. It is considered a very safe medication when used appropriately. By giving this drug slowly over 1-2 minutes, we are able to use the smallest amount possible to allow for intubation. Although considered very safe, we want to use it judiciously in order to minimize side effects.

5. Etomidate for induction of fragile patients: We use etomidate for the induction of our cardiac or debilitated patients. This medication is more expensive than propofol but it is extremely safe in this fragile group of patients.

6. Isoflurane inhalant anesthesia: This is the anesthetic that helps maintain our patients during the procedure. It is felt to be one of the safest inhalant drugs available as it allows for smooth but relatively rapid adjustments in the level of anesthesia. As with propofol, this medication is always used at the lowest effective level to allow for proper depth of anesthesia.

7. Fentanyl drips to improve patient comfort and enhance anesthetic safety: for more extensive or painful procedures we place patients on a fentanyl IV drip. This is a powerful short acting opiate (effects can be increased or stopped very rapidly). Although it adds to the cost of a dental procedure it allows us to increase comfort and safety by decreasing the anesthetic gas requirement.

8. Monitoring and support under anesthesia: While our patients are under anesthesia the following parameters are monitored continually and recorded every few minutes; pulse oxygen level, heart rate, systolic blood pressure, body temperature and pulse quality. By constantly recording the values, we are able to quickly recognize changes in the status of the patient and make appropriate adjustments in our medications as well as give additional medications when needed to maintain good vital signs, blood pressure and oxygen levels. This level of monitoring greatly increases our comfort in recommending dental procedures for our patients. During the dental cleaning your pet will be covered by a circulating air blanket. This blanket allows a constant flow of warm air to pass over the patient during anesthesia. This helps maintain core body temperature which is critical for stability during and while recovering from anesthesia.

9. Full oral exam, deep cleaning and polishing: Once the patient is under anesthesia a full oral examination is done. This involves visual inspection, full probing of the circumference of each tooth looking for pockets or cavities and noting any defects or fractures present in the crown. Every tooth is charted carefully in the dental record to reflect the changes found during the examination. Appropriate teeth are noted for possible radiographs. Ultrasonic scaling of the teeth is then performed followed by polishing.

10. Dental radiographs: If indicated by the oral examination, teeth that are fractured, abnormal in color or have significant gingival pockets are evaluated with digital radiographs. The doctors will be looking for evidence of loss of bone around the base of the root or along the length of the root and checking for defects in the layers of the tooth below the gum line.

11. Surgical extractions with local anesthesia: When there are teeth that require removal, the extractions are done using the most gentle and least traumatic techniques. This may involve gingival surgery to allow access to the root as well as gentle drilling to help loosen the tooth from the surrounding bone. The skills learned at the dental training have allowed our veterinarians to reduce the trauma of having teeth extracted. All patients requiring extractions are treated with a local anesthetic to block most of the pain of the procedure before it happens. We have seen significant improvement in recovery time in patients since starting to use these techniques.

12. Dental sealants: Teeth that have superficial defects are often painful and are at high risk of becoming infected due to bacterial invasion of the root canal. These teeth are radiographed to determine if the tooth is viable. Teeth that do not appear infected are treated with a bonded sealant to remove the source of discomfort and to try to prevent bacterial invasion of the root canal.

13. Doxirobe™ periodontal treatment: As periodontal disease progresses, bone is lost and tooth attachment diminishes. Teeth that have significant periodontal pockets are radiographed to ensure that they are salvageable. When the tooth is deemed viable, the pocket is cleaned thoroughly with a scaler and the pocket can be filled with a long acting (approximately 2 weeks) antibiotic product (Doxirobe™) which will slowly dissolve out of the periodontal pocket. This treats residual infection and in some cases allows some degree of reattachment.

We strive to provide the best possible dental and anesthetic care for your pet. The vast majority of procedures can be performed in a single anesthetic event. In the event of encountering an important tooth that is salvageable, but in need of a root canal procedure (endodontics) referral to a Veterinarian specializing in dentistry can be arranged.