Disagrees with policy on veterinary dentistry

Although I appreciate the hard work done by the AVMA Council on Veterinary Service in proposing revisions to the AVMA policy “Veterinary Dentistry,”^1,2 I disagree with the statement in the policy that “[w]hen procedures such as periodontal probing, intraoral radiography, dental scaling, and dental extraction are justified by the oral examination, they should be performed under anesthesia.” I do not recommend anesthesia for nonendodontic services such as hand scaling, ultrasonic scaling, or machine polishing and have performed hundreds of dental procedures in pets without anesthesia every month for well over a year now. Owing to the risks involved, I believe anesthesia should not be used in pets that can be handled without anesthesia or with only mild sedation. In addition, advocating a procedure whereby pets can be seen monthly not only increases client loyalty but also helps prevent periodontal disease, something that I believe is impossible with only once-yearly cleanings in certain breeds. I hear over and over from my clients that they do not want to put their pets under anesthesia because of health issues, and I believe that pet owners as well as veterinarians should have the choice of either having or not having anesthesia performed.

As veterinarians, we are not always going to share the same opinion on matters, but we should always maintain the highest level of professionalism while respecting each other and our clients’ needs and desires.

Danielle L Spade, dvm

To The Point Equine Acupuncture San Diego, Calif

Another opinion on the AVMA policy on veterinary dentistry

During its meeting this past July, the AVMA House of Delegates approved several changes to the AVMA policy on veterinary dentistry, including adding the statement that “[w]hen procedures such as periodontal probing, intraoral radiography, dental scaling, and dental extraction are justified by the oral examination, they should be performed under anesthesia.”¹ I wonder, however, how many members of the House of Delegates have actually observed dental procedures being performed on awake dogs by individuals skilled in these techniques, versus relying on secondhand input.

I am not a veterinary dentist and do not clean teeth. However, I consult in a practice that performs a variety of dental procedures, both with and without anesthesia. Because I was uneducated on the subject of dental procedures in nonanesthetized dogs, I thought this would be great opportunity to learn. I entered the room expecting to see an unhappy dog on a table being held by an assistant, as in the old days, before we started anesthetizing dogs for dentistry. This is not what I found. What I saw was the hygienist sitting on the floor cross-legged with the dog curled up in his lap, wagging its tail and enjoying the attention. I watched while the hygienist worked his way around the dog's mouth, cleaning teeth with no resistance from the patient, opening the dog's mouth with ease, and getting access to the medial surfaces of the teeth. I pestered the hygienist with questions, and he demonstrated checking for pockets and showed how he was able to access all surfaces of all teeth. When I asked about uncooperative dogs, his reply was that in those dogs, all procedures are done with anesthesia. When I asked about various abnormalities involving the teeth and oral cavity, his response was that animals with those abnormalities are anesthetized. He was happy doing appropriate cases without anesthesia and having those for which this was not the best approach done with anesthesia.

It seems to me that the most important issue in performing dental procedures in nonanesthetized dogs is appropriate case selection. I contend that properly selected cases will benefit from this approach because of the lower cost for owners and the lower risk for patients. Although I have heard about some disasters that have occurred as a result of performing veterinary dentistry without anesthesia, I suspect that most of these are due to improper case selection.

Another issue is the skill, training, and attitude of the hygienist. Does the hygienist understand the limitations of what he or she can do? Is he or she aware of what procedures cannot be performed and able to admit that the technique is not appropriate for certain cases?

I have my teeth cleaned twice a year. I am not anesthetized for this procedure. I also do not have radiographs taken of my teeth every time they are cleaned, but only once every 2 to 3 years. There is no argument that dental radiography in dogs and cats requires anesthesia. The question is, how often do we need to take dental radiographs in animals without grossly visible dental abnormalities?

As a profession, we have to face the issue of the high cost of veterinary care. Clearly, good medicine is expensive. But, we also need to examine whether the policies we adopt make a true difference in the quality of the medicine we provide to our patients.

Timothy C. McCarthy, dvm, phd

Beaverton, Ore