An increasing number of lay practitioners are offering anaesthesia-free dentistry services across Australia. Now the AVA is taking a stand against it, reports Katie McCaffery
After having highlighted this topic on World Veterinary Congress Day, Dr Tara Cashman, president of the Australian Veterinary Dental Society, says, “it is evident we need to steer clear of anaesthesia-free dentistry (AFD) and start referring to it as ‘cosmetic teeth cleaning’ in order to help eradicate the problem.”
Dr Cashman says there is simply a lack of education on the topic and that “some clients tend to self-diagnose through Google and don’t fully comprehend the mental and physical risks involved with AFD. We need to be advocates of promoting excellent physical and mental health in our patients as well as assuring our clients that anaesthesia is safe. The risks involved are minimal and statistically, you’re more likely to get hit by a bus than have a problem during anaesthesia.
“The comparisons could include why a client may not be fully aware about why their pets need pre-anaesthetic screening prior to surgery,” continues Dr Cashman, while the Australian Veterinary Association’s (AVA) policy says that “at best, AFD is a purely cosmetic activity, which delivers no health care benefits and at worst, it has the potential to mask underlying dental pathology, resulting in delayed treatment of dental disease.”
A growing industry
An increasing number of non-veterinary companies are offering AFD in Australia, focusing especially on teeth cleaning. Many of these promise in their marketing materials to clean dogs’ teeth without pain or anaesthetic, even though the consensus among veterinary professionals is that animals ought to be anaesthetised before undergoing a thorough, whole-mouth clean.
That is not to say that anaesthesia is risk-free; what it does mean is that the risk that anaesthesia poses to the animal ought to be assessed by a person qualified to do so.
“To conduct a safe and adequate dental examination, you need to carry out a pre-anaesthetic screening to reduce the risks involved with anaesthetic, such as those with diabetes who have an increased risk to their kidneys,” says Dr Cashman.
“Then, and only then, is it safe to perform a full scale and polish, as well as radiographs, with the veterinary nurse monitoring the patient’s vital statistics.”
Dr Cashman continues: “Having the animal anaesthetised ensures the experience is a positive one for the pet because it is unaware of pain during the procedure, and does not need to be physically restrained. It ensures the veterinarian can complete a thorough inspection of every single tooth above and below the gum line and address any problems on the spot. Otherwise, serious disease can be missed, and the animal suffers long-term pain and health impacts as a consequence. This is a real animal welfare concern.
“Think of it this way: When you want to improve your own oral health, you wouldn’t go to your local hairdressers to get your teeth cleaned. So why should we condone this treatment for our pets?”
“When you want to improve your own oral health, you wouldn’t go to your local hairdressers to get your teeth cleaned. So why should we condone this treatment for our pets?”—Dr Tara Cashman, president, Australian Veterinary Dental Society
Simply put, the risks involved without using anaesthetic far outweigh the convenience factors in comparison.
“Dentistry is not just about ‘having a look’ and ‘cleaning the tartar off’”, says Dr Christine Hawke of Sydney Pet Dentistry, a referral veterinary dentistry practice. “That is not serving our pets well at all. As pets are not good at telling us when they have a problem, it is up to us to make sure we uncover any issues, and that means being at least as thorough (if not more so) than a human dentist that has the advantage of being able to ask us where it hurts.
“A proper, professional dental examination means checking every surface of every single tooth, above and below the gum line,” Dr Hawke adds. “This includes around the backs and along the insides of all of the teeth, and even in between the teeth, which are often tightly packed in the mouth especially in dogs with little faces, since dogs have a total of 42 teeth.”
Dr Nicole Hoskin from Prahran Veterinary Hospital in Victoria, asks, “How can a procedure which ordinarily requires at least 30 minutes to adequately complete on an anaesthetised patient, be performed with the same outcome, on an animal who is fully conscious and terrified?
“I recently sustained a serious bite from an aggressive dog that was heavily sedated while trying to examine its mouth. It resulted in hospital treatment and several days off work for me. This is something that I think all vets can relate to: the unreliability of sedation,” says Dr Hoskin, adding that “AFD, at best, is a cosmetic clean and the teeth are at least being looked at, but at worst can inflict pain and suffering on patients by delaying appropriate treatment and lulling unsuspecting owners into a false sense of security because the calculus has been removed, while leaving undiagnosed painful disease lurking deep under the gum. Animals don’t complain about dental pain.”
What can you do?
Given the animal-welfare issues it raises, what can vet practices do to discourage pet owners from submitting their pets to AFD?
“We need to communicate to clients that the risk with AFD is high and that there will be problems missed and overlooked, causing months or years of chronic pain and infection, bacteria in the bloodstream, and eventual tooth loss and weakening of the jaws,” says Dr Hawke.
“While a fear of anaesthesia is understandable, you have to weigh up the risks to benefits,” she says.
In terms of eradicating AFD permanently, Dr Cashman emphasises that it has already been ruled out in the United States, especially in the grooming industry.
Speaking about the prospect of Australia following suit with banning AFD, Dr Paula Parker, AVA president, says “Ultimately, we will be exploring options to have legislation in place that only allows companion animal teeth cleaning to be performed by veterinarians under general anaesthesia, as part of a thorough dental examination. This would be based on the animal welfare risks associated with conscious cosmetic teeth cleaning by lay providers.”