February – April 2018: Save $100 Off Dental Cleanings with Wellness Exam at Encina Veterinary Hospital

Dear Clients of Encina Veterinary Hospital.

It is very important that our pets get proper dental care. It is estimated that 85% of our pets will have periodontal disease by the time they are 3 years of age. Periodontal disease is a progressive disease of the supporting tissues surrounding teeth and the main cause of early tooth loss. In the early stages of periodontal disease, food particles combine with bacteria to form plaque on the teeth. Within days, minerals from saliva bond with the plaque to form tartar, a hard substance that adheres to the teeth. The bacteria will travel under the gums and cause gingivitis, which is inflammation of the gums. As the bacterial infection progresses the supporting tissue around the teeth become weakened, which leads to tooth loss.

The proper way to address your pet’s dental disease is to have a veterinarian perform a dental cleaning under general anesthesia. While a patient is anesthetized we have a breathing tube in place to provide gas anesthesia and oxygen, have intravenous fluids going into the patient during the entire procedure, have extensive monitoring equipment (EKG, pulse oximetry, blood pressure, capnograph) attached to the patient, and one anesthetist monitoring the patient under the supervision of the veterinarian. This allows the veterinarian to do a full examination of the teeth and supporting structures, and to take x rays of all the teeth to assess the roots and supporting bone. Following the evaluation, the veterinarian will remove the plaque and tartar from the teeth and clean below the gum line. It would not be possible to do this properly without the use of general anesthesia. Unless your pet needs extractions the final step is to polish the teeth.

The benefits of a proper dental cleaning are that the plaque and tartar can be removed from the teeth and below the gum line along with the bacteria that can lead to periodontal disease. It is important to know that gingivitis is reversible, but periodontal disease is not reversible. If you notice your pet has bad breath or their teeth have gingivitis or plaque/tartar it is not too soon to have your pet scheduled for a dental cleaning.

As a way of promoting dental health for our patients we are offering our clients a $100 discount on dental cleanings for each pet that is scheduled during February, March, and April 2018, with Dr. Aengus, Dr. Milauskas, or Dr. Rifat. All you have to do is give us a call at 925-937-5000, schedule your pet’s dental cleaning during the above months, and provide us with the dental cleaning coupon at the time you bring your pet in for the scheduled cleaning. You can find the coupon at the bottom of this email for convenience.

We look forward to seeing you in the coming months as we continue our partnership to provide your pets with the veterinary care they need to remain healthy.

Dr. Peter Nurre
Medical Director

Anesthesia Free Dental Cleanings

    Dental care is extremely important for our pets. As one of the ICU technicians at Encina Veterinary Hospital, I have personally seen the painful aftereffects of non-anesthetic dental cleanings performed by individuals (feed or pet stores, groomers) and I felt compelled to write about it (as well as some pushing and shoving [read: strong encouragement] from our blogger, Christina!) Although I am not one of the dental technicians, my heart breaks when someone brings in their pet with a tooth root abscess, or some other damage inflicted by an individual who “cleaned” their beloved pet’s teeth.

    Here at Encina Veterinary Hospital we recommend dental cleanings to our patients which require full anesthesia so that our Doctors and Technicians can do a safe and thorough job of fully examining, evaluating, cleaning and polishing your pet’s teeth. There are many places out there now that advertise non-anesthetic dental cleanings for very little money, who also convince/put the fear in pet owners that this is a safer technique than general anesthesia cleanings performed by licensed professionals like registered veterinary assistants and veterinarians. The problem lies in the fact that they may not be cleaning and polishing all the teeth properly. If teeth aren’t polished after scaling, bacteria can work its way deeper into the tooth cavity and create abscesses and many more (expensive) problems. It may seem like an easy and inexpensive alternative, but if not done correctly can be both expensive to your wallet, painful to your pet and even deadly.

    I know I have enough trouble trying to brush my dog’s teeth on the outside, never mind getting in all those nooks and crannies on the inside! And she certainly wouldn’t allow me to spend time scraping tartar off any of her back teeth and then polishing out the microscratches that the scraping leaves behind. The California Veterinary Medical Association (CVMA) opposed a bill (AB 2304) recently which would allow unlicensed individuals to scale pet’s teeth as long as it is with an unmotorized instrument without veterinary supervision. There are companies and websites out there touting the benefits of non-anesthetic cleaning, which are ill informed and send the wrong message to owners. They leave owners scared of veterinarians and general anesthesia, while subjecting your pets to harmful and scary improper dental cleanings. While cleanings here Encina Vet Hospital may be more expensive than the “cleanings” at your groomers, we have your pet’s best health and care in mind; we always treat your pets as if they are our own and we don’t lie to our clients to make a buck. Aren’t your pets worth doing what is right for them?

– Meg Davies, RVT

Here is an excerpt from Dr. Jill Christofferson’s advice article in the Contra Costa Times regarding anesthesia free dental cleanings:

When an animal is anesthetized, the area under the gum line can be properly cleaned using ultrasonic or sonic instruments and any pockets can be assessed and treated properly. The teeth are then polished. Dental X-rays and oral surgery can also be performed when needed. Many pet owners are frightened by anesthesia and think that having the teeth cleaned without it will be safer for their pet.

Anesthetic deaths do occur, and almost every veterinarian can tell of a death that occurred under their care. These deaths are rare, however, and the anesthetic agents currently used in veterinary medicine are considered very safe.

Animals who have had their teeth scaled without anesthesia can suffer from cuts to the gums, bruising of the skin due to excessive restraint, neck injuries, and even jaw fractures. I have known a few dogs who have had expensive and even life-threatening illnesses as a result of having their teeth cleaned in this manner.

The law in California states that performing dentistry on an animal constitutes the practice of veterinary medicine and needs to be done under the supervision of a veterinarian. The people performing anesthesia-free dental cleanings are not state-licensed or regulated and rarely work under a veterinarian’s supervision.

– Dr. Jill Christofferson

Procedure Day Play-By-Play

I recently had the unique experience of bringing one of my furry babies in for a COHAT (Comprehensive Oral Health Assessment and Treatment…a.k.a. dental cleaning), and I gained perspective on what you encounter as clients on the day your pet undergoes a procedure. Please read on for what happens before, during, and after a procedure.

Meet Seal, my gregarious black lab. I rescued him from the pound two years ago, and let me tell you, he has come a long way since our first night together. We don’t know his age for certain, but we are guessing he is somewhere in the neighborhood of five to six years old. Prior to my adopting him, it would appear that he had no dental care. Though I brushed his teeth every night, fighting against the amount of tartar and plaque that had built up was impossible, he needed a thorough cleaning to get his mouth in order.

The night before the procedure: Seal was fed a normal-sized dinner and was given access to water until we left home in the morning. My parents wanted to feed him an extra-large feast since he was going to miss breakfast the next morning, but I reassured them that this was not necessary, as he would be anesthetized and given fluids early on in the day (large meals also = large bowel movements during the surgery).

Dropping off for the procedure: I brought Seal into Encina at 7:15a sharp on procedure day. When you drop your pet off, you can expect to sign an estimate, and leave the low end of the estimate as a deposit. The COHAT estimate has a very important portion for you to initial, regarding whether or not you authorize the veterinarian to extract teeth in the event that you cannot be reached, among other particulars. A client services representative will then take your pet to be weighed, and back into our surgical pre-op area.

Pre-procedure: Technicians will get vital signs, and place an intravenous catheter. If your pet has not had blood work processed within the last month or so, they will also draw blood and run an in-house blood panel to ensure your pet’s safety during anesthesia. The veterinarian performing the procedure will then perform a physical exam on your pet, again to make certain that your pet is healthy enough for the procedure to be performed. The patient is then administered intravenous fluids until anesthesia is given. Seal was very brave during the poking and prodding, and thankfully his lab results were all within normal range.

Going under: Pets are given a cocktail of what we refer to as “pre-medication,” which basically means that a technician administers a sedative prior to inducing anesthesia to reduce the stress level of our patients, and also to decrease the amount of anesthetic needed as well. Once the pre-medication has taken effect, an induction agent is administered, and technicians place an endotracheal tube when the jaw has relaxed completely. The tube allows doctors to use gas anesthesia, and gives them more control over the pet’s breathing during the procedure. After the endotracheal tube is placed, sevoflourane is used to keep the patient in a peaceful state of slumber.

Part one of the COHAT: One technician is posted at the side of the anesthetized patient at all times. Her sole purpose is to monitor and log vital signs (blood pressure, blood oxygen concentration, temperature, etc.) every five minutes, while keeping watch over the animal. A warming blanket is placed over your pet to combat the lowering of body temperature that can occur under anesthesia. A second technician then cleans and scales the teeth using the same type of sterile tools that your dental hygienist uses when you get your teeth cleaned. Gum pockets are measured and the teeth are deep-cleaned and polished in a process that can take up to an hour. As you can see below, Seal had a very dirty mouth!

Part two of the COHAT: After the teeth are shined up, the technicians then take radiographs of the entire mouth. These x-rays are used to measure the health of the roots and teeth, and help the veterinarian to determine whether or not extractions are necessary. This part of the procedure takes thirty to sixty minutes. The veterinarian reviews the radiographs and if needed, may ask the advice of one of our specialists. At this point, a doctor’s assistant will contact you if extractions are recommended, and provide you with an updated estimate of any additional cost. Seal only needed one extraction, the tooth pointed out in the picture below (the picture was taken post-cleaning/radiographs).

Extractions: If extractions are required, a technician will administer a “nerve block,” which is a local anesthetic that reduces the amount of pain your pet endures resultant of the procedure. The veterinarian will then surgically remove the teeth, and repair the area with dis-solvable suture material (stitches). Once this is complete, the mouth is rinsed, inspected, and fluoride foam is applied to the teeth. After the teeth are taken care of, the technicians trim the nails and express the anal glands, and administer both an antibiotic and anti-inflammatory injection, both of which last until the next day.

Post-Procedure: The sevofluorane is turned off, which enables the patient to wake. Technicians continue to monitor the pet, and once it is clear that the pet is awake enough to breath reliably on his own (indicated by an attempt to cough around the tube), the endotracheal tube is removed. Intravenous fluids are continued as the pet is placed in a cage to recover, and technicians carefully monitor the temperature and appearance of the patient until he is fully awake. We wait until this point to call you to set up a pick-up time. Your pet is administered fluids until the IV bag is empty. Technicians take your pet outside to use the bathroom as needed.

Pick-up: Several hours after the procedure (typically between 3-6 p.m.), we have you come in to meet with a doctor’s assistant and pick up your little friend. The assistant will have typed discharge instructions prepared for you, in addition to any medications that will be sent home. If no extractions were required, no medications are necessary unless the gums became overly inflamed during the cleaning. With extractions, patients are usually sent home with an antibiotic, an anti-inflammatory, and depending on the severity of the extraction(s), a pain medication. Seal was sent home with clindamycin (an antibiotic commonly used to fend off infections in the mouth), and Rimadyl (the veterinary version of Ibuprofen). The assistant will go over what to expect when you go home, as well as any questions you may have.

The night after the procedure: Seal went home a bit more tired than usual, but not overly drunk. At around 7pm I offered him water, and when he kept that down, I fed him half of his normal amount of kibble, which was soaked in warm water for ten minutes. He ate eagerly (he is a lab, after all), and then retired to his bed for the evening.

The next day: I fed Seal his normal amount of food, again soaked in warm water. I began his medications, which he took with a bit of cheese. He was as good as new, though I caught my parents feeding him scrambled eggs because they felt he looked extra hungry. Encina called to check on him in the afternoon, as they do with all patients. I nearly forgot to clear the house of any hard toys. The rule of thumb (pun intended) with post-extraction patients is that if your fingernail can leave an indent on a toy, it is soft enough for them to chew.

The following two weeks: Seal’s food had to be soaked in warm water for the two weeks following his procedure. He was given antibiotics for the first week, and the anti-inflammatory for the first five days. You would never know anything had happened to him, as he was back to doing his kibble ballet during meal times. No tug-of-war was played, and we were instructed not to brush his teeth.

The dental recheck: Two weeks after the procedure, if extractions were needed, we ask that you bring your pet in for a complimentary dental recheck with the veterinarian. The appointment takes roughly fifteen minutes, and during that time the doctor looks to see that everything is healing properly. After the recheck, you may commence brushing, feeding un-soaked kibble, and games of tug-of-war.

For a video of how to properly brush your pet’s teeth, please visit our YouTube channel at www.youtube.com/encinavet.