Assessment Step 5: Anesthesia
Anesthesia is a concern for everyone. The only way we can achieve the best possible outcome
is to select the proper patient, tailor anesthetic protocol and monitor the patient during
and after the procedure.
Why General Anesthesia Is Necessary for the ORAL ATP® Visit
According to the American Veterinary Dental College:
Additionally, a complete oral examination, which is an important part of a professional dental
scaling procedure, is not possible in an unanesthetized patient.
- Dental tartar is firmly adhered to the surface of the teeth. Scaling to remove
tartar is accomplished using ultrasonic and sonic power scalers, plus hand instruments
that must have a sharp working edge to be used effectively. Even a slight head
movement by the patient could result in injury to the oral tissues of the patient, and
the operator may be bitten when the patient reacts.
- Professional plaque and calculus removal includes scaling the surfaces of the teeth, both above
and below the gingival margin (gum line), and dental polishing. The most critical
part of a dental scaling procedure is scaling the tooth surfaces that are within the
gingival pocket, the subgingival space between the gum and the root, where periodontal
disease is active. However, access to the subgingival area of every tooth is impossible
in an unanesthetized canine or feline patient.
- Removal of dental tartar on the visible surfaces of the teeth has little effect on a pet's
health and provides a false sense of accomplishment. The effect is purely cosmetic.
- Inhalation anesthesia using a cuffed endotracheal tube provides three important advantages:
- The cooperation of the patient with a procedure it does not understand
- Elimination of pain resulting from examination and treatment of affected dental
tissues during the procedure
- Protection of the airway and lungs from accidental aspiration
Endotracheal tube connecting anesthesia to the respiratory system
Oral exam under anesthesia
Choosing the Right Patient
General anesthesia is required to diagnose and treat dental disease in companion animals. Patient safety is
everyone's top concern. An important part of the anesthesia safety trilogy (choosing the correct patient,
anesthesia protocol and patient monitoring) is preoperative patient testing after the
Addressing Pet Owners' Concerns
Pet owners are often concerned about anesthesia. Some clients may have more than one concern, especially
in the case of two pet owners for the same pet. Be sure to always speak to each person about his/her
- Pain – Many clients want to know if the procedure will be painful. Assure them
that you will provide pain control before, during and after the procedure.
- Cost – Some clients would like to invest in their pets' oral health but may not
have the resources. Others with extra savings may have designated the money for another cause
(retirement, children's education, etc). In both scenarios, the idea of value becomes an
extremely important part of the exam. Clients must be educated on the importance of oral health
before they can commit.
Always wait until the completion of the exam to discuss costs so the client is paying full
attention to your findings and recommendations.
Tailoring an Anesthetic Protocol
Different anesthetic protocols are used for dogs and cats. Evaluate the animal's blood and heart tests
before deciding which and how much medication to use.
Use intraoral local anesthesia together with general anesthesia for oral surgery to alleviate pain and
decrease the amount of general anesthetic needed. Customized intravenous fluid therapy is essential for
circulatory maintenance and to prevent dehydration.
Patient Monitoring During Anesthesia
A trained assistant is helpful to monitor the patient while performing dental procedures. Vital
parameters, such as body temperature, heart rate and rhythm, respiration rate, oxygen saturation, blood
pressure and end-tidal carbon dioxide levels give helpful information to adjust the anesthetic protocol.
Technician monitoring anesthetized patient
Preservation of the dog and cat's body temperature is essential because the patient may become wet and
dental procedures can be lengthy. Temperature control can be accomplished through the use of a forced
warm air blanket.
Stop anesthesia delivery when the procedure is finished but continue to monitor the patient. Once
swallowing begins, remove the endotracheal tube, and assign an assistant to monitor the patient until
full recovery occurs. Most dogs or cats wake up within minutes.
Technician waiting for the swallowing reflex to remove the endotracheal tube
Patient recovering from anesthesia
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