There is a recent fad that is re-emerging in the realm of small animal veterinary dentistry. Unlicensed and unregulated individuals who have marketed the term “Anesthesia-free” or “non-anesthetic” dentistry (NAD) are exploiting client’s fears of anesthesia and economic hardships to perform dental procedures on awake patients. On the surface, this sounds like a fabulous idea to save owners money and to avoid anesthesia. Some veterinarians across the country are even providing this “service” in their offices. However, just like with dental disease, what we see on the surface is only the tip of the iceberg, and the dangerous stuff is hidden from view.
In reality, these procedures are not only ineffective and potentially more expensive, they are also harmful to the patient. Clients may come into your practice requesting a less expensive, anesthesia-free alternative to dental cleanings. They may have heard about this from a friend or perhaps a groomer or lay person who is doing this. While you will not be able to convince everyone that NAD is not in their pet’s best interest, there are many reasons that the American Veterinary Dental College™ has spoken out against anesthesia-free dental procedures. Below are a few to help you understand the problems with NAD and be able to comfortably explain those to your clients.
First of all, a dental cleaning is a multi-step process. At a minimum, a thorough dental procedure requires supragingival and subgingival scaling, dental polishing, oral examination and dental charting, and ideally intraoral radiographs. Only the first step of this process, the supragingival scaling, can be performed in an awake patient. Even then, it is simply not possible to clean every tooth surface of every tooth, especially the lingual and palatal surfaces, and the most distal teeth (i.e.the molars).Besides, it’s not enough. The cleaning of the visible crowns of the teeth is a cosmetic procedure, making the teeth look clean, but providing no medical benefit whatsoever. In fact, when the teeth are scraped without polishing them smooth, the plaque and calculus build up more quickly. This is often touted as a reason to need more frequent treatment, but in fact it is actually an adverse complication from the procedure.
The actual medical benefit of a dental cleaning is the subgingival plaque and calculus removal. This is where the periodontal disease happens. There are many reports of patients who have had their teeth “cleaned” by a NAD practitioner regularly for years, only to find out that the periodontal disease has been progressing unbeknownst to the owner. When the animal finally receives an anesthetized evaluation, it often has to have extensive extractions due to end stage periodontal disease. Clients are usually upset when they realize the extent of disease that has developed despite their investment in regular NAD procedures and they feel that they have failed their pet.
Lower left molar before treatment
Radiograph of the left molar showing extensive bone loss
Proponents of non-anesthetic dentistry often tout it as being safer than using general anesthesia. Unfortunately, NAD carries a high risk for iatrogenic damage. The use of sharp metal instruments in the mouth near the gumline and the tongue frequently leads to gingival lacerations, pain for the patient, and can lead to the patient becoming head shy. Jaw fractures and neck injuries have been reported following restraint for NAD procedures, and the high risk of aspiration pneumonia due to lack of intubation with aerosolized calculus, blood, plaque and oral bacteria is a major concern.
In contrast, well performed general anesthesia is low risk. Using current standards of multi-modal anesthesia with a thorough pre-anesthetic workup, individualized patient protocols, intubation and proper monitoring, the risk of complications with general anesthesia is minimal. This is a great client education point to explain your clinic’s wonderful and extensive monitoring equipment, safe warming devices, and make your clinic stand out.
Finally, a thorough oral examination is an important part of the dental cleaning procedure. This is simply not possible in the awake patient. Oral tumors, foreign bodies, fractured teeth, and many other problems may be missed by the use of NAD. And when identified, the NAD practitioner is technically diagnosing without a veterinary license.
Radiograph of the lower right molar in a dog showing extensive infection and chronic thickening of the cortex
Lower right molar in a dog before treatment
NAD is illegal in many states unless performed under the supervision of a veterinarian. Many companies have worked around this by performing their service in a veterinary hospital. While this is technically legal, it is considered well below the standard of practice. It should also be noted that in these cases, it is the practice owner’s veterinary license that is at risk, not the contracted service provider. Therefore, please think carefully before allowing this procedure to be performed in your practice.
The best way to challenge this dangerous and non-beneficial practice is client education. In the minds of most clients (and some veterinarians), this seems like an excellent alternative to general anesthesia, reinforced by the apparently clean teeth in the visible areas of the mouth. However, disease lurks under the gumline regardless of how clean the crowns appear to be. When the clients realize that the cost “savings” of doing monthly NAD procedures typically turns out to be more expensive than one anesthetized cleaning per year, it does not appear as economical. And then when they find out that all that money spent still allowed perfectly treatable and preventable periodontal disease to progress, you will be glad that you did not offer this “service” in your hospital.
Based on the numerous limitations and dangers of NAD, the American Veterinary Dental College™ has drafted a position statement against this procedure. As the only board-certified veterinary dentist in the state, I am happy to talk to you about this in greater depth and answer any questions you may have. You can visit me at VDOSNM’s facility located in Algodones, NM, or go to the American Veterinary Dental College™ website for more information.
Kris Bannon, DVM
Diplomate, American Veterinary Dental College™
Fellow, Academy of Veterinary Dentistry
President, American Veterinary Dental Society 2013-2015