Dentistry

Stage I – Comprehensive oral assessment and full mouth x-rays

• Admission with a clinical team member prior to comprehensive oral assessment procedure.
• Pre-anaesthetic bloods (recommended for all patients older than 8 years, or if there is a clinical indication in those younger). These could be booked prior to the day of your pets' dental procedure. 
• Intravenous fluid therapy is included in all comprehensive oral assessment procedures.

A comprehensive oral assessment includes:

• Premedication and pre-emptive analgesia followed by induction of general anaesthesia

• Full oral assessment of the mouth including radiographs and charting

• Descale (cleaning) of teeth

• Recovery of patient

• Discharge with a clinical team member

• Home with additional pain relief or other medications (if indicated)

• A clinical team member will discuss findings of x-rays and examination with you.
• If excessively mobile teeth or other urgent extractions are needed, we will contact you during the procedure to discuss this and cost associated.
• Discharge with veterinary nurse 
• Scheduling of Stage II (if required) within 4-6weeks following procedure, including production of estimate by vet. 
• 10% off for PHC members. 
• Nurse post-op check 5 - 7 days post procedure if required.

Stage II – Oral Surgery 

• Second procedure performed 4-6 weeks after the first, to complete surgery requirements identified during Stage I. 
• Admission with clinical team member. 
• Intravenous fluid therapy are included in all oral surgery.

Oral surgery includes:

• Premedication and pre-emptive analgesia followed by induction of general anaesthesia

• Surgical tooth extraction(s) or crown amputation(s) as indicated (common in Feline Resorptive Lesions Type 2)

• Suturing of gums after tooth extractions 

• Repeat x-rays post extractions (if indicated)

• Recovery of patient

• Discharge with a clinical team member

• Home with additional pain relief or other medications (if indicated)

10% off for PHC members

Why is the procedure split into two stages?

• The main reason for this is to prevent your pet from being under anaesthesia for an excessively long period of time. The oral assessment and full mouth x-rays (i.e. Stage I) can take up to one hour alone. 
• Extended anaesthetics can lead to low blood pressure issues (hypotension), as well as the development of a reduced body temperature (hypothermia), both of which can be harmful to your pet’s anaesthetic safety and may cause a prolonged recovery. 
• It also allows for proper planning of the required oral surgery, rather than unexpected diseases being identified during dental x-ray, and these having to be addressed immediately. 
• Performing Stage II on a separate day allows the oral surgery to be performed in a cleaner environment, rather than immediately after the descaling (cleaning) process.
• Two planned, shorter procedures increase the likelihood of smoother and timelier recoveries at both stages. 

Is this going to cost me more?

• Having a staged dental does not increase the cost of dentistry. We can give a more accurate estimate for extractions following stage 1. This is due to most dental disease not being obviously apparent in most conscious patients.
• However, the staging process allows us to properly estimate for what is involved.

Are multiple anaesthetics safe for my pet?

• If your pet is able to receive one anaesthetic, then there is no reason why they shouldn’t be able to cope with a second (or third).
• The premedication and anaesthetic combinations that we use are selected specifically for your pet, based on their individual health needs.
• Furthermore, every pet’s anaesthetic is closely monitored by trained professionals, as well as electronic multiparameter anaesthetic monitoring equipment.
• In all cases, consideration has to be given to the risks and benefits. However, in the case of dental disease, then the benefits often outweigh the risks.
• Two shorter planned anaesthetics are certainly much safer than one excessively long one, especially when dealing with a chronic problem, which is elective as opposed to being an emergency.

My groomer offers conscious teeth cleaning…

So why do you require them to have an anaesthetic?

• Although some groomers offer this practice, it presents a major animal welfare concern.
• The World Small Animal Veterinary Association (WSAVA) have published the following statement regarding non-anaesthesia dentistry (NAD) in their Global Dental Guidelines;

1. Veterinary organisations worldwide agree that dentistry without anaesthesia is not medically beneficial.
2. The person conducting the dental procedure cannot possibly evaluate the pathology, nor conduct any meaningful sub gingival treatment without proper anaesthesia.
3. This may lead to a cosmetically improved oral cavity with persistent infection, inflammation, and pain.
4. Therefore, not only is the procedure ineffective, it often results in masking the pathology present, which delays appropriate care.
5. This directly opposes the welfare benefits, and improvements to quality of life, that are at the centre of these guidelines.
6. Additionally, the stress or discomfort incurred during this time consuming cosmetic procedure is wholly avoidable and indefensible from a medical and ethical standpoint.
7. As such, the World Small Animal Veterinary Association strongly objects to the practice of veterinary dentistry without appropriate anaesthesia is inadequate, and provides a substandard level of care, which may be misleading to the pet owner.

What happens after Stage II?

• Once the Stage II procedure is complete and all the oral disease is under control, then the process doesn’t stop there.
• On-going home dental care and routine check-ups are essential to maintain your pet’s mouth, gums, and remaining teeth in as healthy a state as possible.
• Daily tooth brushing with pet toothpaste is the Gold Standard, as plaque begins to accumulate within 24 hours of being removed.
• Regular nurse appointments are recommended after a dental procedure, to ensure that success is being achieved, and to help and offer advice if problems are starting to return.
• The first appointment should initially be 3-4 weeks after completion of the final Stage II post op check.
• Thereafter, we will recommend seeing your pet every 3-6 months so that future oral health is monitored and maintained.

Will the cost be claimable on my pet insurance?

Many insurance companies specifically exclude dental procedures. A small number of policies may potentially cover your pet but there are often certain details in the small print that may affect the claim. If you would like to be sure your insurance policy will cover the cost beforehand, we are happy to help with a pre-authorisation form from your insurance company – ask our team for more details.

What if my pet is left with no remaining teeth?

While this is actually quite an uncommon situation dogs and cats eat very well with no teeth, often even managing to eat dry food.

My pet’s teeth don’t look that bad to me and he/she is still eating ok so why is a dental procedure being recommended by the vet/nurse?

• Dental disease can lead to unrelenting pain and unchecked infection, create stress to the immune system and physiological stress that is linked with local and systemic diseases.
• Behavioural changes due to oral pain can be vague and non-specific, and rarely result in loss of appetite.
• Periodontal infections have been linked to numerous systemic illnesses including diabetes and heart disease.
• Periodontal disease has been associated with numerous severe local effects including; oronasal fistula, oral cancer, mandibular fractures and bone infection.