The American Animal Hospital Association is an independent trade organization for veterinarians. One of its key roles is to “accredit” hospitals. Accreditation is optional (and expensive), and it is separate from the licensure that animal hospitals are required to obtain from local and state authorities.
AAHA’s accreditation requirements are generally much stricter than those of state and local authorities. The process is rigorous, and the standards are high. The accreditation is a mark of honor, and AAHA-accredited hospitals take pride in the accomplishment.
Beginning Nov. 1, 2013, AAHA is adding a new requirement for hospitals that wish to be accredited. The hospitals must anesthetize and intubate (provide a breathing tube for) all animals undergoing dental work — work that includes routine dental cleanings. The move was applauded by the American Veterinary Dental College.
Vets are familiar with AAHA but the general public probably isn’t. Therefore, the new regulations probably won’t cause much of a to-do in the world at large. But they got me thinking about the perennial questions I receive about pets and dental care. Namely, why do cats need to be anesthetized for dental work?
In fact, the matter does not merely elicit questions. It also elicits controversy (although not among vets). Some groomers, pet stores, and other individuals offer “anesthesia-free” dental work. Some of these people claim that the anesthesia administered by veterinarians is nothing but a money-grubbing tactic with no significant benefit to the pet.
In my home state of California, one such individual ran a franchising operation. She trained people to perform anesthesia-free dental cleanings, and then issued them franchise licenses for the procedure. The state Legislature, with coaxing from the state veterinary medical association, ultimately reaffirmed that only veterinarians (or staff members under the direct supervision veterinarians) could perform dental work on pets. The person running the franchising business responded apoplectically that veterinarians were nothing but greedy scoundrels. I thought her accusations were highly hypocritical (and no small bit ironic), because her behavior over the years has left me with the strong opinion that she cares about nothing but money herself.
But was there any element of truth in what the woman said about vets? Is dental work just a money-making racket?
I won’t lie. Dental work is a significant revenue generator for most veterinary practices. (My practice is an exception; I work at an emergency hospital, and dental work comprises very little of our business.) But it’s not a racket. In fact, dental work reliably improves patients’ quality of life in many ways. Dental disease causes pain, bad breath (and subsequently malodorous hair in cats, since they groom with their mouths), and chronic inflammation that can predispose cats to a variety of medical problems. When I was in general practice I had hundreds — maybe thousands — of clients report that their cats were more active and generally seemed happier and healthier after dental work was performed.
What about the anesthesia? In California, anesthesia-free dental work is still legal, as long as it’s performed by or under the supervision of a licensed veterinarian. However, the new AAHA rules most are likely to be a step on the path toward anesthesia being legally required for dental work in cats and dogs. Experts such as the members of the American Veterinary Dental College no doubt would support this.
But why? Why are so many experts so adamant that cats (and dogs) should be anesthetized for dental work?
The answer, in short, is that it’s simply not possible to do the job correctly without anesthesia. Yes, some tartar can be scraped off the teeth of an awake animal. But that’s about all.
Consider this: I went to the dentist a few days ago. I was not anesthetized (although I wish I had been). The scraping, probing, and prodding were just barely tolerable for me. I knew why I was there, and I knew that, even though it didn’t seem like it, my dentist was trying to help me. Because of this, I held still. I hated every minute of it, and it was unpleasant despite the fact that I brush my teeth after every meal and floss before bed every night.
Cats undergoing dental work do not understand what’s happening. They will not voluntarily hold still for root planing and probing of pockets. Dental radiographs are not possible in an awake animal. And cats don’t brush their teeth. The average cat undergoing dental work suffers from a degree of periodontal disease that would make my dentist’s eyes pop out of her sockets. If you went several years without brushing your teeth, your dentist would probably need to anesthetize you, too.
How about the breathing tube? It serves two purposes. First, it allows control of the airway and prevents complications from anesthesia. Second, it protects against aspiration. Dental work involves the physical removal of bacteria and their byproducts from the teeth and gums. Those bacteria could cause a nasty pneumonia if inhaled into the lungs. Intubation prevents that.
And speaking of complications, should owners be afraid of anesthesia? Although anesthesia will never be completely risk-free, modern anesthetic protocols are much safer than those of the past. I have anesthetized cats, young and old, healthy and ill, on a daily basis for 13 years. In that time, exactly one of my patients suffered from a significant complication (he recovered fully). So yes, there is a slight risk to anesthesia. But the key word is “slight.” For most animals with dental disease the benefits of anesthesia and dental work far outweigh the risks.
And don’t forget that foregoing dental work also is risky. I have seen many patients for dental emergencies since I became an emergency vet. The story in each case is usually the same: the client had decided not to perform dental work because the animal was old or ill and the client was afraid of anesthesia. A year or two later, the cat developed an abscessed tooth at three in the morning. Now the cat had to undergo anesthesia, it was a year or two older, and it had a nasty infection (abscess) that could potentially complicate the matter. The good news: among those older, frail, ill cats with abscessed teeth that I have treated at 3:00 in the morning, exactly none of them has suffered from a significant anesthetic complication.
None of this should mean that you should take anesthesia and dental work lightly. In fact, you should try to avoid it by keeping your cat’s mouth healthy. Although cats don’t brush their teeth, you can brush your cat’s teeth. This is the simplest home step that prevents dental disease.
Also, don’t be shy about asking questions if your vet recommends dental work. Ask about anesthetic protocols (a good vet will take pride in using advanced, balanced, safe protocols), pain management, dental radiographs, recovery time, and home care to prevent further dental disease. Confirm with your vet that the benefits outweigh the risks.
In most cases, it is likely that the benefits will strongly outweigh the risks. When I recommend dental work for a patient, I do so with confidence that I am recommending something that is in the patient’s best interest.
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