The first step is to place the patient under general anesthesia. Anesthesia-free dentistry is NOT recommended (see below, Why does a dental cleaning have to be done under anesthesia?), and is even illegal in California. Don’t be fooled by “sedation” dentistry. In our opinion, sedation dentistry is more dangerous than general anesthesia for two main reasons. First, in sedation dentistry (or any other anesthesia-free dentistry), the trachea (windpipe), and therefore the lungs, are not protected from the particles generated during a dental cleaning. These particles are full of bacteria and, if inhaled, can result in pneumonia.
The other difference between anesthesia and sedation is the length of effect. Most practices today employ relatively short-acting agents to put the patient under anesthesia, and then gas to keep the patient under anesthesia. If a problem occurs under anesthesia, the veterinarian can turn off the gas and the patient will recover quickly. But under sedation, the effects generally do not go away until the drug is cleared by the system, which can take too long. General anesthesia is very safe today, thanks to advances in anesthetic drugs, training, and monitoring equipment.
True dental prophylaxis consists of several steps, some more critical than others. The required steps that must be performed include:
Supragingival scaling: This is the removal of the plaque and calculus above the gumline (what you can see).
Subgingival scaling: This is the thorough cleaning of the area under the gumline to remove disease-causing bacteria. It is typically performed by hand and is time-consuming, but it is the most important step of dental prophylaxis.
Polishing: Scaling slightly roughens the teeth. This promotes plaque and calculus attachment and reduces the lasting effect of the cleaning, so the teeth are polished afterward. There has been some controversy about this in human dentistry, due to the loss of enamel with many cleanings over time. However, in veterinary dentistry, with relatively fewer cleanings in an animal’s life, this is not a concern.
Sulcal Lavage: Cleaning and polishing results in debris being caught under the gumline, which must be thoroughly rinsed out.
Oral exam, periodontal probing, and dental charting: This is a critical and often misunderstood part of the dental prophylaxis. There are teeth that cannot be thoroughly examined in a pet who is awake when periodontal probing is not possible. With the patient under anesthesia, the mouth is thoroughly and systematically examined, and all findings are noted on a dental chart. Any diseased teeth or tissues are then properly treated.
Optional steps include fluoride therapy or using a barrier sealant.
Make sure you ask that all of the above five steps are performed, or you are likely getting a poor cleaning. Ask to see the veterinary hospital’s dental chart system if you have any concerns.