Introducing a new pet to a home can be a difficult task. When you have both cats and dogs, these animals both do not trust each other and represent real threats towards their ability to get what they want in the household. Though in cartoons it is often the dog that chases the cat, in real life, friendly dogs are often at the mercy of the cruel cat’s nails, as many cats swipe and scratch and new dogs in order to let them know who is boss.

A household that has both animals needs to make sure that they train their cats to treat their dogs well, or else they may find their dog becoming injured and unhealthily submissive, unable to roam freely around the house. Below are two ways to try to help train your cat to accept your dog as a family member.

For New Dogs in Homes with Cats

When you are introducing a new dog to a home, it is a good idea to do as follows:

·         Make sure both know that you are in charge, not the cat or the dog.

·         Create the dog and give the cat an opportunity to sniff it, as well as show any dominance in a harm free manner. If your cat is aggressive, do not worry about it – that is why your dog is in the crate.

·         Try to mix scents between the two animals by sharing a brush or petting both using the same hand so that the two smell of each other.

·         Allow this to continue for several days.

·         Let the pets interact by letting the cat roam free and keeping your dog on a leash. If they are friendly, that’s a good sign, but do not let the friendliness overstay its welcome.

·         Repeat their interaction time for a few more days, then try it without the leash.

·         If a fight breaks out, start the process over. Eventually they will gain an acceptance for the presence of one another.

For Dogs and Cats That Already Live Together and Do Not Get Along

Sometimes you already have a dog or cat in your home that is not interacting well with the other. When that is the case, you will need to try to do the following:

·         Get a tall baby gate that neither the cat nor dog can jump over.

·         Allow them to sniff each other through the gate and show their signs of dominance if need be.

·         Whenever the cat is showing friendliness, give the cat a treat. Cats may not respond as well as dogs do to positive reinforcement, but that does not mean they do not understand it.

·         Make sure your dog learns proper commands for staying, sitting, etc., so that you can make sure your dog does not do anything to instigate the cat.

·         Continue the gate/reward process until the cat is less aggressive towards the dog, then try it with the dog on a leash and the gate removed (you may need someone else to hold onto your dog while you give your cat treats).

Over time your cat will learn to accept your dog as a member of the family, and though there is a high likelihood your cat will never treat your dog like a companion (cuddling and sleeping together as some dogs and cats do), at the very least you can teach your cat to ignore your dog’s presence, so that there is no violence and both of your pets are happy.

When human beings gain weight, that weight gain is obvious. Our skin starts to sag and grow, our pants get too tight while our bodies start to jiggle as we run. There is almost no one in the world that does not notice that they have gained several pounds, and even fewer that do not notice that they have gone from fit to “obese.”

But when it comes to your dog, obesity becomes far less obvious. In fact, what defines obesity is not well known in the general pet owner population, despite obesity being one of the main health concerns of dogs and puppies across the nation.

What is an Obese Dog?

Obesity amongst dogs is a serious problem. But unlike with human beings, where you are not “obese” until you are more than 20 or 30 pounds overweight, with dogs a few extra pounds can be the difference between healthy and dangerously overweight.

Dog obesity is defined as any time that you cannot feel your dog’s ribs, your dog is overweight, and if the ribs are especially hard to touch, the difference in weight is considerable.

What amounts to a few extra pounds is actually quite a bit of weight gain. A dog that should weigh 30 pounds but weights 35 pounds is 16% larger than it should be. It is the same as a human that should weight 150 that weighs 175.

What Health Concerns Stem From Obesity?

When your dog is overweight, a number of health problems may occur. Some of these issues include:

·         Diabetes

·         Heart Disease

·         Increased Cancer Risk

·         Hip Dysplasia

·         Joint Problems

Among many others – and all of these are linked to simply a few added pounds over your dog’s ideal weight. It is important to remember that a dog’s body was not designed to handle weight gain. Many breed, especially, have increased levels of weakness on their body (the dachshund and its spine, for example) which are simply not able to handle any increased pressure, as they are barely able to handle their “ideal” weight. A few extra pounds can be dangerous.

What to Do to Limit Obesity

Part of the reason that pet owners do not often realize that their dogs are gaining weight is because that weight gain is hard to see. When you see your dog every day and the difference in weight gain is just one or two pounds, it can be hard to notice that your dog has changed inside at all. If your dog has a great deal of air, too, this can also make it very hard to notice.

There are several things you can do to reduce this weight gain. The first, of course, is to exercise your dog daily – giving it at minimum its daily recommended requirement, and more if possible. Dogs need to exercise for their own health.

The next thing you can do is give your dog only its recommended diet and adhere to effective feeding practices, including limiting its food and feeding it at very specific intervals every day. Dogs that can overeat will overeat, and the dogs that do not know when they are going to be fed may try hard to find unhealthy food elsewhere.

Finally, start rewarding with affection instead of treats. Treats are usually fattening foods and not ideal for your dog’s diet. Affection, on the other hand, causes no weight gain and for most dogs is just as much of a reward as a treat. If you are worried that your dog may be gaining too much weight, exercising and monitoring your dog’s diet should be all you need to do to make sure that your dog stays healthy for longer.

Signs Your Dog Has Fleas

The best way to find out if your dog has fleas is to pay attention to the obvious and unobvious signs. Some of the signs that your dog has fleas include:

·         Excessive Scratching or Chewing

Perhaps the most obvious sign that a dog has fleas is a constant biting of their own skin or scratching with their nails. Depending on the severity of the itch, the scratching and biting can be fairly aggressive, and it is not uncommon to see clumps of hair ripped out from some of the medium to longer hair breeds. Assuming your dog has had a full bath and the irritations are not caused by allergy, chances are there is a flea there somewhere.

·         Flea Dirt

Fleas, like all animals, need to poop. Flea waste is very unique. Filled with blood, fleas like to leave their waste in a single location on your dog so that it can be out of the way of their eating area. If you see a small patch of what appears to be a pepper looking substance on your dog’s skin, chances are it is flea waste (often referred to as “flea dirt”). If you dab it with a wet cloth, the dirt will often be dark red due to the presence of blood.

·         Checking for Fleas

One of the reasons these alternative signs are important is because fleas do a tremendous job of hiding. But your dog only has a limited amount of skin. If you check inside of hidden areas, such as on the inside of the leg, or beneath a large clump of hair, it is not uncommon to find a flea presence. They will run away quickly and are fast jumpers, so you cannot pick them out one by one, but at least you can know your dog has fleas and do something about it.

·         Red Bumps on Your Legs

Fleas are biters, and if your dog has fleas, chances are they will bite you too. If you have mosquito bites despite seeing no mosquitoes, there is a good chance they are flea bites from a stray insect that jumped from your dog to your leg. This is especially true when combined with any of the other observations noted above.

Treat Quickly/Easily – Use Known Brands

When you find your dog has fleas, you should quickly treat it with an effective flea killer. However, make sure you use one of the main brands recommended by your vet. Flea killer is a toxin, and the cheaper brands can injure your dog’s organs when used for a long period of time. By killing the fleas on your dog early, you will be able to drastically reduce the amount of irritation your dog feels, as well as ensure that you, yourself, do not wake up in the morning with a great deal of itchy red bumps from these annoying flightless insects.

When you are ready to get a puppy, it is not uncommon to purchase the puppy from the breeder before the dog is even born (or as soon as breeder makes the litter available). Most websites that set potential owners up with breeders will have a listing of puppy availability within days of the puppy being born, allowing each puppy to be claimed before it has even opened its eyes.

There is a strong temptation to want to pick up the puppy right then and there – to drive down to the breeder and have the tiny little animal in your hands. Puppies, however, need time with their mother before they can be safely taken away and brought to your home.

When is the Best Time?

Experts have differing opinions on when the best time to pick up a puppy is. However, it is widely believed that the best range for picking your puppy up from the breeder is within a 6-8 week window after the puppy is born.

The first weeks of your puppy’s life are about survival. You want the pet to be feeding from its mother, getting the nutrients that it needs as well as the love and care of its parent. After it has gained some of its health, the next few weeks are dedicated to continued wellness as well as interacting with its parents, brothers and sisters. This time is valuable for creating a well behaved dog (and one that understand other dog behaviors/communication).

Around 7 to 8 weeks the puppy has started to learn proper dog behaviors, and while it is still young and in need of a great deal of care and affection, it has also picked up enough good habits to be a happy and healthy dog.

What Happens if You Pick up the Dog too Early?

Dogs that are taken too early from their parents may not be in the best of health, may have behavioral issues, and may not understand how to interact and communicate with other dogs. You can still have a loving member of the family, especially if you maintain good feeding habits, but a dog that doesn’t understand how to interact with other dogs can be trouble when it gets older.

Also, it is important to note that many states have laws that forbid a puppy from being picked up before EIGHT weeks, so check your local laws before you pick up your pet.

What Happens if You Pick up the Dog too Late?

Though the 6 to 8 week window has been considered the norm for many years, there is a consensus among the dog behavior community that any time between 9 to 11 weeks is still perfectly adequate, and may even be preferable for ensuring your pet understands dog behaviors. However, after 12 or so weeks, it is best to try to get your puppy to its new and permanent home, as around that time the dog will start to form permanent attachments, and you want your puppy to feel more of an attachment to you than to its parents.

Overall Thoughts on Picking Up a Puppy

Though 6 to 8 weeks has been the norm and acceptable time period for many years, the best time to pick up your new family member is around the 8 week mark, and possible weeks 9 or 10. Some breeders like to keep the pets until as long as 6 months to help teach it good behaviors, but it is better if your dog is in its permanent home before than to help create attachments to your family members. If the breeder allows you to pick up your dog before 6 weeks, you may not be working with a reputable breeder.

Veterinary medicine and surgical procedures have come a long way in the last twenty years, and many of the technological advances and options rival some of the human procedures.  New technology for human medicine has allowed advances in veterinary medicine.  For example, pets with cancer now have the option of chemotherapy.  Cats with diseased kidneys may have the choice of a kidney transplant, and blood transfusions are common place. 

There are two venues that surgical procedures take place in: the general veterinary practice and the specialty/emergency clinic.  Under most conditions, you will begin at the general practice level.  If your veterinarian feels your pet’s condition will be better served at a specialty clinic, he will refer you to one in the area.  Most general practice veterinarians handle more routine or common situations like bladder stone removal, spaying/neutering, etc.  Hip replacements, ACL (anterior cruciate ligament) knee repair surgeries, and fine detail/interior surgery work like correcting liver shunts is normally conducted in a specialty clinic. 

Specialty clinics do not perform routine general practice veterinarian care like vaccinations or checkups.  Instead, they are full of veterinarians that have advanced schooling and specialized residencies in things like internal care, heart, orthopedic surgeries, etc.  You know that your pet will receive the optimal care at a specialty facility.

These clinics often have a physical therapist on staff or are located near one.  Pet physical therapists are trained human physical therapists that have had additional schooling in pet therapy.  There, pets coming out of surgery can schedule physical therapy sessions tailored to their individual needs and may include things like an underwater treadmill, balance balls, rocker boards, stairs, and dog treadmill. 

Depending on what type of surgery your pet should have, there are a few considerations.  First, it is important to run at least a basic blood panel or CBC prior to any surgical procedure to insure your pet’s organs are functioning well.  It is especially imperative for an older pet.  Second, make sure you do your homework on the procedure, especially more complicated ones, to have a firm grasp on what it is.  You want to be comfortable with what it entails and know what questions to ask.  If you don’t like the bedside manner of one surgeon or would like a second opinion, feel free to seek one out.

In addition to knowing the surgery and getting necessary blood work prior to the procedure, it is important to know there are financial considerations.  All surgeries cost a considerable amount, and specialty or emergency work can range into the thousands.  Especially at the specialty level, there are usually options for payments through credit.  You may also ask your personal veterinarian if there are payment options, but often upfront payment through either credit or some other means is required. 

Most surgical procedures will require at least a one night stay at the clinic to insure your pet is recovering well.  More extensive procedures may require a longer stay of a few days.  All veterinarian clinics welcome you visiting your pet, so know that you may easily visit while your pet is staying there. 

In our time and day, there are many veterinary options for our pets.  While we can’t fix everything, we certainly have the choice to surgically correct many things that once were untreatable.  Just make sure to follow your veterinarian’s advice, have preliminary blood work run, and do your homework to make sure you know the ins and outs of any procedure going in.      

Dr. Jan Bellows’ veterinary dentistry interests include: Author of two dental texts- The Practice of Veterinary Dentistry …. A team effort (1999), and Small Animal Dental Equipment, Materials, and Techniques (2005) published by Blackwell Press and the four Smile Books ( Dental Overview (1998), Dental Radiology (2001), Periodontal Disease (2003), Oral Pathology and Charting 2005) He also is a frequent contributor to DVM Newsmagazine- (six times yearly), Veterinary Forum, and Veterinary Medicine, additionally Dr. Bellows is a charter editor of Veterinary Information Network’s (VIN) dental board and has retained that role for the past twelve years. Lastly, in order to speak to veterinarians about communicating best to dental clients, Dr.Jan Bellows became an avid toastmaster and rose to toastmaster’s highest level of Distinguished Toastmaster. Dr. Bellows was also chosen as one of the dental experts to formulate AAHA’s Small Animal Dental Guidelines published in 2005.

Doctor Jan Bellows practices at All Pets Dental, 17100 Royal Palm Blvd, Weston, Florida 954-349-5800

Romeo, a 4 year old, 3.5 kg, neutered Italian greyhound, presented for chronic oral pain so severe that the dog’s owners could not approach the dog’s face without being bitten. The dog’s teeth were cleaned and polished at 2 years of age, and semi-monthly to monthly repositol steroid injections were administered by the referring veterinarian for 1 year prior to presentation. The injections resulted in dramatic behavioral improvement that lasted 2 to 3 weeks. Daily oral hygiene with toothbrush and dentrifrice and weekly application of a plaque preventative wax polymer were recommended by the referring veterinarian. Unfortunately, the owner was unable to provide consistent oral hygiene.

Bilateral caudal vestibular mucositis, cheilitis, glossitis, and ulceration adjacent to the maxillary canines and incisors were present. Other physical examination findings were unremarkable. The maxillary and mandibular incisors were mobile secondary to stages 3 and 4 periodontal disease. The client was advised that a closer examination of the oral cavity was needed under general anesthesia.

Further communication with the owner included an explanation of the oral assessment, treatment, and prevention (Oral ATP) process. Recommendation for the initial preoperative laboratory testing (CBC, serum profile, and thyroid panel), anesthesia, intraoral radiography, and a tooth by tooth examination was accepted with the understanding that a treatment plan would be formulated and discussed after the intial assessment. The client was advised that treatment of chronic oro-phayngeal inflamation typically included multiple extractions.

Laboratory test results were within normal limits. The dog was premedicated with hydromorphone at .1 mg/kg IM, combined with acepromazine at .02 mg/kg IM; induced with propofol at 3 mg/kg IV; and intubated and maintained on 2% isoflurane mixed with oxygen. The body temperature was controlled with the Hotdog patient warming system.

Individual clinical and radiograph tooth examination revealed stage 2 and 3 mobility of the maxillary and mandibular incisors.

A recommendation for extraction of the right and left maxillary first and second incisors, canines, the third and fourth premolars and first and second molars, as well as extraction of the mandibular incisors, first, second, and third molars was made to the owner. This would be needed to relieve gingival inflammation, even in areas where the underlying radiographs appeared normal. The treatment plan was approved.

The oral cavity was irrigated with .12% chlorhexidine solution. Envelope gingival flaps were created using a #15 scalpel blade to incise vertically into the gingival sulcus circumferentially around the teeth to be extracted. A Freer periosteal elevator was used to expose the alveoli of the teeth to be extracted. A #2 round carbide bur loaded on a sterile saline-irrigated high speed drill was used to remove the coronal aspect of the alveoli for ease of visualization and extraction. The multirooted teeth were sectioned using a #701 surgical bur to create single-rooted segments. A sharpened wing-tipped elevator was gently rotated perpendicular to the alveolar margins to help create sufficient mobility to deliver the tooth segments from the oral cavity using extraction forceps.

Alveoloplasty using a #2 carbide round bur loaded on a sterile saline-irrigated high-speed drill was performed in all exposed areas to smooth the coronal extent of the alveolus before closure. Intraoral radiographs were exposed and examined to confirm the extraction sites were free from root fragments. The incised gingiva was closed with 4-0 monocryl (Ethicon) suture using a continuous pattern. The dog made an uneventful recovery from anesthesia. The owner was instructed to medicate with clindamycin at 15mg/kg q 12h, firocoxib at 5 mg/kg q24h, and tramadol HCL at 2 mg/kg PO q12h.

Follow up examinations at 1 month and 6 months after surgery revealed total clinical resolution of the oropharyngeal inflammation, as well as the aggressive behavior. A recommendation of home oral care included twice daily application of a dental wipe infused with sodium hexametaphosphate (DentAcetic Wipes, Dermapet), and application of a wax polymer (OraVet, Merial) every other day.

By Doctor Jan Bellows

In a study conducted at the University of California, Davis ( Am J Vet Res 1998, 59, pgs. 686-691 and 692-695), where all dogs and cats presented for dental cleanings were radiographed, significant lesions requiring therapy were uncovered in a majority of the cases. Currently, less than 10 percent of practices use dental radiology to help their patients. This low percentage is due to many factors including set up expense, inexperience with radiographic technique and processing as well as inexperience with film interpretation.

What are the advantages, equipment needed and techniques used to expose and process dental films?

Advantages of taking dental radiographs are many:

The radiographic unit A conventional radiograph unit can expose quality films using 100 ma 10 mas technique at 40(cat)-60 (large dog) Kv, with a film focal distance of 16-in. While the veterinarian does not need to own a dedicated dental unit, it makes the process more efficient.

There are great advantages in owning a dental radiograph unit: most dental units cost between $3,000-$5,000; shorter film focal length and automatic collimation result in less scattered radiation and exposure to the patient; extension arms of various lengths allow vertical, horizontal, and rotational movement resulting in less patient repositioning; and radiographs can be obtained on the dental operatory table rather than moving the patient to a radiography area (Figure 1).

The film The efficiency which a film (Figure 2) responds to X-ray exposure is known as film sensitivity or speed. The three film speeds are:

Exposure example for a typical 20-pound dog using a dental radiograph unit is 55kVp, 10 mA: Ultraspeed 0.40 sec, Ektaspeed 0.30 sec, InSight 0.16 sec.

Four sizes of dental film are used (Figure 3, p. 12S):

Digital dental radiology uses a sensor rather than film. The image captured on the sensor is displayed on a computer screen. (Figure 4, p. 12S).

A radiographic dental survey consists of a minimum of eight views:

• Rostral maxilla
• Lateral left canine
• Lateral right canine
• Rostral mandible
• Right maxillary cheek (premolars and molars) teeth.
• Left maxillary cheek teeth
• Right mandibular cheek teeth
• Left mandibular cheek teeth

Tube/film/patient positioning For the maxillary views, the patient is positioned in sternal recumbency with support placed under the chin at a height where the muzzle is parallel to the tabletop:

Determine the angle between the plane of the canine root and the plane of the film. Position the cone perpendicular to the bisected angle (Figure 6).

The maxillary fourth premolar has three roots (mesial buccal, mesial palatal and distal). To avoid overlap of the mesial buccal and palatal roots, position the PID 20-degrees in the horizontal plane (rostral oblique) in the medium- to long-muzzled dog, and caudal oblique in brachycephalic breeds. In cats, the zygomatic arch is superimposed over the maxillary fourth premolar root. To avoid the arch, use a rostral oblique bisecting angle projection, aimed at the premolar roots with the PID positioned just ventral to the arch. Alternatively, extraoral near-parallel technique may be used to visualize the maxillary cheek teeth (Figure 7).

When radiographing the mandible, place the patient in ventral or lateral recumbency with support under the neck to place the muzzle parallel to the tabletop.

Film may be developed in the following ways:

Manually, using developer, water and fixer solutions in the practice darkroom.

With the chairside darkroom, a portable light-safe box containing rapid developer, distilled water and fixer in small containers is placed in the dental operatory. The chair- side darkroom is covered with a plexiglas safety filter, which enables operators to see their hands while handling the film(s). The filter is either amber (when D speed film is exposed), or red (for E or F speed films). Processing time from opening the film packet to initial examination of a rinsed film takes approximately two minutes (Figure 13).

Using an automatic dental processor (preferred by author) delivers dry films in six minutes.

Manual processing Manual processing includes the following steps:

1. After exposure, carry the film into the practice darkroom or chairside darkroom for processing. Slide the film packet tab down to present film, cardboard and lead blocker. The film will feel firm to the touch, compared to the other film pack contents.

2. A film hanger is attached to the film edge. Touch only the sides of the film with fingers. Apply a gentle tug to make certain the film is firmly attached to the clip.

3. Place the film in prestirred developer solution for the specified time recommended by the manufacturer (Kodak Rapid Access Chemistry: 15 seconds at 68-degrees). Note: an alternative method starts manual film processing with water immersion to soften the emulsion before placement in the developer.

4. After placement in the developer, rinse the film in fresh distilled water (wash) for 10-15 seconds. Rinsing removes the alkaline developer from the film surface, preventing mixture with the acid fixer.

5. Place the film in the prestirred fixing solution for at least two minutes. Fixer removes the unexposed or underdeveloped silver halide crystals and rehardens the emulsion.

6. Rinse the film for 30 seconds in distilled water.

7. After viewing, place the film back in the fixer for five minutes, followed by distilled water rinse for 10 minutes.

8. When rinsing is complete, attach the radiograph to a clip on the drying rack. Dental radiology is as important to patient dental care as radiology in any other organ system. The information gained is crucial to perform quality dentistry. The next article will concern evaluating dental films to help formulate a dental treatment plan.

By Dr. Jan Bellows

• Incisors: Position the film packet toward the tube head against the incisors and the lingual frenulum. Position the PID perpendicular to the bisecting angle (Figure 9).
• Canine: Place the patient in ventral recumbency. Position the film between the tongue and mandible, pushing the lingual frenulum distally. To obtain a lateral view, position the PID approximately 45° toward the canine (Figure 10).
• Anterior premolars: Place the patient in lateral recumbency, with the film against the anterior premolars to include the periapical area. Aim the PID at the apex of the first premolar 20 degrees to the ventral border of the mandible (Figure 11).
• Posterior premolars and molars: Place the patient in lateral recumbency. Position the film at the floor of the mouth lingual to the premolars. Place gauze or a hemostat to help depress the film into the floor of the mouth. Aim the PID perpendicular to the tooth roots and film (parallel technique) larger teeth, survey studies, and maxillary occlusal views in dogs and cats (Figure 12).

• Molars: Place the film packet against the maxilla beneath the molar teeth. Aim the PID at the eye and film in a caudoventral direction (Figure 8).

• Premolars: Place the film packet as close as possible to the inner surface of the cheek teeth. Aim the PID at the roots of the premolars at approximately 45-degrees.

• Incisors: Place the film packet toward the tube head against the incisors and palate. Position the PID perpendicular to an angle bisecting the film and teeth planes (Figure 5).
• Canine: Place the film packet facing the tube, between the tongue and maxilla beneath the canine tooth root. Center the PID over the mesial root of the second maxillary premolar, dorsally or laterally depending on the view needed.

• Child periapical (size 0) measures 7¼8 x 15¼8 inches. Size 0 is used mostly in cats, exotics and small dogs.
• Adult bitewing (size 2) measures 11¼4 x 15¼8 inches and is the most commonly used size in veterinary dentistry. Size 2 fits into 35 mm slide mounts for use in presentations.
• Bitewing (size 3) film measures 11¼16 by 21¼8 inches. Size 3 films adapt well to the mandibular cheek teeth.
• Occlusal (size 4) film measures 21¼4 by 3 inches. Occlusal film is used to radiograph large breeds.

• D speed (Ultraspeed, Kodak) provides high contrast and fine detail. Ultraspeed is the most popular film used in veterinary dentistry.
• E speed (Ektaspeed, Kodak) requires 25 percent less exposure time, compared to D speed film, with minimal loss of contrast.
• F speed (InSight, Kodak) requires 60 percent less exposure time than D speed film, and 20 percent less than E speed film.

• Viewing pathology below the gingiva and inside the tooth documenting the presence of lesions to support treatment decisions.
• Evaluating an area where the teeth are not clinically apparent for root fragments.
• Determining the cause of chronic nasal discharge.
• Evaluating tooth vitality
• Evaluating the number of permanent teeth present in a puppy or kitten as part of a detailed soundness examination before the secondary teeth erupt. Some breeds must have a minimum number of teeth to be accepted in the show ring.
• Anatomical orientation and documentation of root structure before extraction.
• Evaluation after extraction to confirm all root fragments were removed.
• Pre-operative evaluation of gross tumor margins to help plan surgery.
• Treatment planning evaluation when periodontal disease is present (gingival bleeding on probing, tooth mobility, gingival recession, furcation exposure, increased probing depths).
• Evaluating feline odontoclastic resorptive lesions (FORLs).
• Evaluating jaw fractures.
• Evaluating oral and facial swellings.
• Evaluating pre-operative, intra-operative and post-operative endodontic treatment.

A disturbing e-mail arrived the other day: Hello, Dr. Bellows: I have a 5-year-old yellow Labrador Retriever that I have routinely cleaned her teeth (with enzyme toothpaste and a brush, recently using Sonicare). Despite all best efforts, she is building up tartar and I think may have a dark spot (cavity on a rear molar).

I appreciate your time and hope you can provide some insight. Our Labrador has had general anesthesia several times, but I’m a bit skeptical to put her under anesthesia unless it is absolutely necessary.

I have seen some advertisements for non-general dental cleaning and was wondering if you are familiar with other anesthesia options? Can cleanings be done with IV sedation or simple acepromazine? Or do you intubate to protect the airway from debris?

Photo 1: Technician cleaning a dog’s teeth under general anesthesia

Client anxiety about anesthesia for dental procedures is a concern that practitioners face every day. Choosing the correct patient, anesthetic protocol, as well as intra- and post-operative monitoring allows the most favorable anesthesia outcome. How can you convey that anesthesia is necessary to perform dental procedures, and that it is well worth the smallest risk as long as precautions are taken?

Client anxiety about anesthesia is similar to dread of flying — fear of the unknown. To allay this trepidation, we take time to explain what happens and what we do to make the experience as safe as possible.

Case for anesthesia

To evaluate and clean teeth properly, general anesthesia is mandatory. Some veterinarians and non-veterinarians advertise anesthesia-free dentistry. This is a disservice to the patient, client and our profession.

The American Veterinary Dental College (AVDC) developed a position statement for veterinarians and the public. The AVDC prefers to use the more accurate term non-professional dental scaling (NPDS) to describe anesthesia-free dentistry.

Naturally, owners of pets are concerned when anesthesia is required. However, performing NPDS on an unanesthetized pet is inappropriate for the following reasons:  

Professional dental scaling includes scaling the surfaces of the teeth above and below the gingival margin (gum line), followed by dental polishing. The most critical part of a dental scaling procedure is scaling the tooth surfaces that are within the gingival pocket (the subgingival space between the gum and the root), where periodontal disease is active. Because the patient cooperates, dental scaling of human teeth performed by a professional trained in the procedures can be completed successfully without anesthesia. However, access to the subgingival area of every tooth is impossible in an unanesthetized canine or feline patient. Removal of dental tartar on the visible surfaces of the teeth has little effect on a pet’s health, and it provides a false sense of accomplishment. The result is purely cosmetic.  

What can you do?

Choose the correct patient

When a client asks whether his or her dog or cat is too old for anesthesia, remember age is not a disease. However, older patients often are discriminated against that need urgent dental care to decrease pain and improve quality of life. No amount of antibiotics is going to help a companion animal suffering with mobile teeth secondary to Stage 4 periodontal disease. My point: Letting the periodontal syndrome rage on is far more dangerous than professional oral hygiene care performed under general anesthesia.

Every patient must be evaluated before anesthesia. The patient history is a vital part of the preoperative process and in some cases will clue the practitioner of potential problems better than lab results and radiographs.

When the physical exam is normal in our office, age-appropriate and condition blood tests and electrocardiograph evaluations are performed. Thanks to the advent of easy-to-operate, economical blood analyzers, which deliver almost instantaneous valuable results, and handheld electro-cardiographic devices, all anesthetic procedures are preceded with patient blood analysis and ECG (Photo 2). Much like a pilot performing a pre-flight checklist, run through a list of critical systems beforehand. I also want to know as much as possible about the patient. Argument can be made that preanesthetic testing lacks evidence-based medical rational (preanesthesia lab testing and ECG equals or does not equal a successful anesthetic event), if you compare preoperative testing to a pilot’s preflight checklist, both the veterinarian and pilot want to know as much as practically possible before an event. It just adds to our comfort knowing as much about our patient as practical before performing a procedure that will drastically alter its current status. Additionally, the testing makes the client feel more secure. Before dental anesthesia, my own clinically normal 4-year-old Lowland Sheepdog’s blood work revealed a 3.9 creatinine, albumin 1.9, urine specific gravity 1.014 with 3+ protein and a urine-protein-creatinine ratio of 6.2!

For procedures expected to last less than two hours, our protocol is:  

If all the preoperative tests are normal before the patient is anesthetized in our office, the doctor signs off on the case. Much like our pilot example, the procedure helps confirm that the tests were performed and evaluated.

The correct anesthesia protocol

Anesthesia protocols vary by patient age, condition, co-morbidity factors, length of and type of procedure. Local anesthetics are used on all operative dental procedures where tissue is incised. There are many anesthesia protocols; the best one is the one that you are most comfortable with. Here is the one that has met with success in our office:  

For healthy dogs, our first choice is hydro-morphone 0.1 to 0.2 mg/kg or morphine 0.5 to 1.0 mg/kg combined with acepromazine 0.010 to 0.040 mg/kg. No anticholinergic unless patient demonstrates need, are pediatric or brachycephalic.

As they become more debilitated or aged, we shift toward hydromorphone 0.1 to 0.2 mg/kg alone or with midazolam 0.2 to 0.4 mg/kg. Still no anticholinergic unless specific need.

For healthy cats, our first choice is hydro-morphone 0.2 mg/kg or butorphanol 0.2 mg/kg combined with medetomidine 0.010 to 0.015 mg/kg, plus atropine.

Anesthesia is generally maintained with isoflurane or sevoflurane and oxygen. Little isoflurane or sevoflurane is metabolized, the insolubility of the inhalants allows for a speedier induction and recovery. Patient temperature is controlled in many ways including blankets, warm intravenous bottles placed next to the patient under the blankets, and a warm air Bair Hugger.

Intraoperative local anesthesia blocks are used to decrease pain, and the need for excessive anesthesia when painful procedures and contemplated.

Patient monitoring

The third leg of the anesthetic safety trilogy is evaluating the patient while anesthetized and after. Anesthesia monitoring varies from observing respiration and noting mucous membrane color refill, to arterial blood gas evaluation. American Animal Hospital Association (AAHA) anesthesia guidelines require that one or more of the following monitors must be used on the anesthetized patient:  

As with any complicated endeavor, it is far better to know more. Some manufacturers incorporate multiple monitors into a master unit.

Electrocardiogram

ECG evaluations before and during anesthesia give the veterinarian information regarding heart rate, rhythm and abnormal complexes. Lead 2 is primarily used to monitor rate and rhythm in patients under anesthesia. Handheld units used as part of the pre-operative patient evaluation can also perform single-lead continuous readings during the dental procedure.

Electrocardiograms can also be generated using esophageal probes. While anesthetized, the probe is inserted into the esophagus until the distal electrode reaches the area dorsal to the heart base. If the ECG tracing appears small, the probe may not be inserted far enough. If inserted too deep, the tracing can appear inverted.

The electrocardiogram gives minimal information on cardiac contractility and tissue perfusion. Presence of normal-appearing complexes does not indicate the patient’s tissues are adequately perfused. The ECG should be used with another form of monitoring (end tidal CO₂ and/or blood pressure) for patient evaluation during anesthesia.

Respiratory monitor

Respiratory depression from anesthetic premedication, induction agents and inhalant anesthetics occur. The effects of these medications are dose-dependent and, when multiple agents are used, may become synergistic.

Apnea monitors alert the clinician when the patient’s respiratory rate is depressed or stops. Most respiratory monitors detect exhaled airflow. The sensor is attached between the endotracheal tube and anesthesia machine’s delivery tubes. Every time the animal exhales, the monitor emits an audible sound. When choosing an apnea monitor, it is important that the signal is loud enough to easily hear over the ambient noise and that an alarm sounds when breathing stops.

Pulse oximeter

Hemoglobin travels through the blood in two forms: oxyhemoglobin and reduced hemoglobin. Most oxygen transported to the tissues is carried on the hemoglobin molecule. The pulse oximeter estimates the patient’s oxygenation via light absorption measurement of arterial hemoglobin oxygen saturation. One of the most effective placements of the oximeter probe is on the tongue. Dental procedures by their nature involve movement and instruments in the mouth, which often dislodge the tongue oximeter probe. Other areas for probe placement include the pinna, toe, prepuce, vulva, metacarpus (tarsus), digits, tail and rectum.

Oxygen saturation should be maintained between 95 percent and 100 percent, particularly if the animal is breathing 100-percent oxygen. Saturation readings of 90 percent or less indicate marked desaturation, hypovolemia, shock or anemia.

• Electronic respiratory monitor
• Pulse oximeter
• Blood-pressure monitor
• Continuous electrocardiograph (ECG) monitor
• Esophageal stethoscope
• End-tidal CO₂ monitor

In human medicine, blood pressure measurement is part of most examinations and constantly evaluated under general anesthesia. In small animal practice, blood pressure measurement is equally important. The mean arterial pressure (MAP) should be greater than 60 mm Hg under anesthesia. If blood pressure drops below this level, the anesthetic concentration should be lowered.

Noninvasive blood pressure measurement uses a cuff placed around the patient’s limb or tail at the level of the heart. In cats, the tail base may have to be clipped. The cuff diameter should be 40 percent of the circumference of the limb or tail base (3 cm in cats, 4 cm for small dogs, and 5 cm and up for larger dogs). Normal readings for anesthetized dogs and cats are systolic 90-105 mm Hg, diastolic 40-60 mm Hg, mean 60-70 mm Hg.

Commonly used types of noninvasive blood pressure monitors include:  

Pressure-plethysmography provides systolic, diastolic and mean pressure using an inflatable cuff to occlude blood flow, and a sensor is placed distal to the cuff to detect arterial pulsation. The cuff is wrapped above the carpus, tail or below the hock, and the sensor placed on the same limb just below the cuff. Accurate placement over an artery is not essential. The cuff automatically inflates to a pressure, which occludes the underlying arteries and then deflates gradually. When the cuff pressure is equal to systolic arterial pressure, flow proceeds and arterial pulsation returns. After systolic and diastolic arterial pressures have been determined, the computer calculates the mean pressure.

Carbon dioxide measurement

Carbon dioxide is produced by all cells, transported by the circulatory system and eliminated through the lungs. Alveoli are sites of gas exchange. The highest concentration of carbon dioxide should occur at the end of expiration when the diluted gases from the trachea and primary bronchi are no longer being sampled. Changes in carbon dioxide levels reflect changes in metabolism, circulation and respiration. Measuring expired carbon dioxide allows an estimation of arterial CO₂, which lets the veterinarian know whether the anesthetized patient is ventilating adequately.  

Blood-gas acid/base monitoring

Blood-gas acid/base measurement can provide useful information in the anesthetized patient. While capnography and pulse oximetry give an indirect indication of respiratory function, direct measurement of pO₂ and pCO₂ can be made using arterial blood-gas measurements (obtained from the femoral or lingual artery). Typically, these measurements are done serially as rapid changes can occur with changes in the patient’s respiratory function. As such, these parameters are sensitive indicators of what is at times a challenge in the compromised patient under anesthesia.

• Increased CO₂ readings can be seen due to the following:
• Mild to moderate airway obstruction
• Hypoventilation
• Faulty check valves
• Exhausted soda lime
• Decreased CO₂ readings can be seen due to the following:
• Hyperventilation
• Extubation
• Disconnection from the breathing circuit
• Esophageal intubation
• Cardiac arrest.

• Doppler that measures systolic arterial pressure. The pitch of the sound reflected from the moving blood cells is proportional to its velocity. A piezoelectric crystal microphone, amplifier, inflatable cuff, manometer and earphones are used. An ultrasonic flow detector is placed over an artery and taped in place. A cuff is placed proximal to the crystal and inflated until blood flow is occluded. The cuff is slowly deflated. The pressure at which blood flow becomes audible again is the systolic pressure.

Temperature monitoring

Temperature control and monitoring is important for dental patients. Dental procedures often last hours, during which the animal may be exposed to air conditioning and water irrigation. As the patient temperature decreases, so does the blood pressure and heart rate. Temperature monitors can be as straightforward as a technician inserting a rectal thermometer every 15 minutes and recording results, to a real-time constant digital evaluation.

Putting it all together….

Molly, a 16-year-old Poodle was presented to our office for dental care. Her owners, two general surgeons, could not tolerate her breath; even guests in their homes complained. As soon as I entered the exam room, I knew this dog was in dental trouble; the odor was intolerable.

Why did these highly educated, loving pet owners let poor Molly suffer so long? For the first 10 years of her life, they were afraid of anesthesia, and for the last six, three veterinarians said she was too old to safely perform dental care.

This story has a good ending. After age- and condition-appropriate blood and urine tests, radiographs and electrocardiogram, she was placed under three hours of general anesthesia for extraction of 26 teeth. Two weeks post procedure, her owners were ecstatic to have a “new dog”.

How can we as veterinarians allay our client’s fear of anesthesia for dental procedures? The answer is threefold: choose the correct patient, the correct anesthesia protocol, and proper monitoring during and after the procedure, so everyone wins.

Dr. Jan Bellows owns Hometown Animal Hospital and Dental Clinic in Weston, Florida. He is a diplomate of the American Veterinary Dental College and the American Board of Veterinary Practitioners. He can be reached at (954) 349-5800; e-mail, dentalvet@aol.com