Twelve Steps of the Teeth-Cleaning/Diagnostic Visit

1. A general exam before anesthesia (including oral exam).
The general examination is completed by a veterinarian. It allows them to take a look over your pet to rule out any readily determined reasons as to why your pet should not under-go a dental procedure.

2. Pre-operative bloodwork to assess internal health.
Pre-anesthetic bloodwork is mandatory for all patients over 7 years and highly recommended for patients under 7 years.  The blood tests run give the veterinarian an inside view of your pet’s liver and kidney function, it can also give them a heads up if there is an underlying issue that’s not detectable during the general examination.

3. An oral exam under anesthesia.
Unfortunately, we can’t explain to our pets that we need to look in their mouth to see any issues and even in the most cooperative animal, there are places in their mouth difficult to visualize. When under general anesthesia the veterinarian can get a full view of both the teeth and the tissue inside the mouth without upsetting your pet, or risking injury.

4. X-rays of all teeth to identify disease of roots and bone.
The majority of dental disease is below the gumline and cannot be viewed without taking dental x-rays. Often teeth look healthy once cleaned, but dental x-rays show extensive bone loss around the roots of the teeth. There are many conditions which can only been found by dental x-rays, so it is essential that they are done properly and interpreted by a veterinarian with dental experience.

5. Tartar removal from the visible part of the teeth by dental scaling.
Supragingival scaling (above the gumline) is the process of removing the plaque and tartar deposits from the crowns of the teeth. Typically we use an ultrasonic scaler which removes plaque by rapidly vibrating and flushing the surface of the tooth with water. In the event this is insufficient to remove calculus build up on the crown of a tooth, we have hand scalers nearby.

6. Subgingival (below the gum line) scaling, root planing, and curetting where indicated.
Removing tartar from the tooth crowns may improve the appearance of teeth, but dental disease is more proliferative below the gum line as this is where the infection is most destructive.

Subgingival scaling removes the layer of tartar and plaque on the root of the tooth. To do this we use a special ultrasonic tip and hand curettes with curved edges to prevent damage to your pet’s gums.

Sometimes the veterinarian feels it would be beneficial to do something called “root planing”. Root planing is a bit more aggressive than typical subgingival scaling of the teeth as instead of removing just plaque and tartar, the goal is to remove a thin layer infected tooth cementum (surface layer of the tooth root).

In addition to subgingival scaling and root planing, we occasionally do a thorough curetting of the gingival pocket. Curetting is done with hand curettes and is the process of removing some of the inflamed gum that rests against the root of the tooth.

7. Tooth polishing.
When cleaning the teeth there are often small abrasions left from the use of scalers/curettes. These abrasions and grooves left behind are ideal places for bacteria to live and proliferate. Using a polisher and dental polish smooths the marks left behind to prevent this from happening.

8. Rinsing of periodontal pockets with chlorhexidine solution (anti-bacterial).
After cleaning both the teeth and the periodontal pockets, they are rinsed with a chlorehexadine/anti-bacterial solution to remove and temporarily prevent bacteria from colonizing the area.

9. Dental Charting for the medical record.
Once the cleaning portion of the dental procedure is completed, the veterinarian completes something called a dental chart. A dental chart is used to keep track of various dental conditions and therapies, it allows veterinarians to easily communicate any issues your pet and to other vets viewing their medical records.

10. Therapy if necessary (ie. dental surgery).
Before starting any dental therapies, specifically dental extractions, the veterinarian will call you at the contact number you have left for them. During this time they will go over the cost of extractions on top of the dental cleaning with you before proceeding and address any pressing questions you may have. During this time your pet is still under general anesthesia so these phone calls need to be relatively short to minimize anesthetic time.

Once having obtained permission the veterinarian will start with performing a dental block of the teeth to be removed. Just like when you have your mouth frozen for fillings, we freeze your pet’s mouth.

This allows us to further decrease the amount of anesthetics used, which is significantly safer for your pet as well as giving them excellent pain management. To extract a tooth the veterinarian needs to open the gum to expose the bone and use a dental drill to remove bone around the root. Once the tooth is exposed they are able to remove the tooth. The more roots a tooth has the longer this procedure takes. Sometimes with advanced dental disease the teeth are very fragile and can fracture when they are being removed, leaving pieces of roots behind. Over time this can cause discomfort for your pet and potentially get infected, so it is very important that the tooth and all its pieces are removed. Without dental x-rays there is no way to know 100% that there are no pieces left behind.

11. Home care instructions on oral hygiene.
When it is time for your pet to go home following a dental procedure, you will have a one on one meeting with a veterinarian regarding the dental procedure. This is an opportunity for them to go over any problems found in your pet’s teeth and your pet’s custom-designed oral hygiene program. Also, this is a perfect time for you to ask any questions you may have.

12. A follow-up appointment and periodic rechecks.
It is important for the veterinarian to see your pet a few weeks after a dental procedure to asses healing of extraction sites and determine if additional therapies may be required. This is also an opportune time for you to ask any questions you may have about the effectiveness of the dental home care you have been providing since the dental procedure.