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Behind the Scenes at a Dental Cleaning

Julia Thomson, a client of Clappison Animal Hospital, shares her experience as her 8-year-old Boxer Lab receives a dental cleaning. 

Baxter joined our family six years ago when he was three. Since that time, we’ve tried various ways to take care of his teeth: brushing, scraping, additives for his water, chews, raw bones. We haven’t been very consistent with any of them (view my tips on how to make teeth cleaning a habit), and over the years he developed a lot of tartar build-up on his teeth.

I know how important teeth are to his overall health (read the Q&A about dental health with Dr. Longridge and Laurie Stevenson), so I arranged to have a professional cleaning.

How to prepare for a dental cleaning
The first step towards a dental cleaning is a check-up with one of the clinic’s veterinarians or registered veterinary technicians — in our case, Laurie Stevenson. It was a quick appointment where Laurie looked at Baxter’s mouth and tried to identify any issues and assess how involved the cleaning would be. I say “try” because sometimes it’s difficult to see all of the details in your pet’s mouth. Laurie didn’t have any immediate concerns and thought Baxter’s cleaning would be pretty straightforward.

Baxter had bloodwork done recently. If he hadn’t, Laurie would have drawn some blood to check that he would be okay under anesthetic.

Based on Laurie’s assessment, the clinic provided a written estimate and, once I decided to proceed, an appointment date.

Because a dental cleaning is a surgical procedure where Baxter would be under anesthetic, it was important that he didn’t have anything to eat 12 hours before the procedure. Some animals may vomit when they’re under anesthesia, and an empty stomach lessens the chance that he would inhale anything into his lungs. Bax was allowed to drink water.

On cleaning day, we arrived at the clinic and staff weighed Baxter (to calculate the exact amount of medicine he would receive), and provided me with more paperwork. The paperwork included a consent form where I gave my permission for the staff to carry out the cleaning procedure and a detailed outline of all of the expected costs (the clinic strives to have no surprises, although issues may arise during cleaning that results in additional costs).

Another form covered the possible dangers of anesthesia and included a section for my contact information. Clinic staff must be able to reach owners during the cleaning procedure in case they run into unforeseen events, such as teeth which may need to be removed or issues while under anesthetic.

After that, we moved to the procedure room (usually the owner would leave at this point).

Beginning the dental procedure
A lot went into getting Baxter ready for his cleaning, and all of it was focused on his well-being.

First, Dr. Longridge listened to Baxter’s heart, took his temperature, checked his colour and took a look at his teeth.

Second, Baxter received an injection that contained a pain control medication and a sedative. This medication made him vomit, an extremely common side effect, which lessened the chance of him vomiting during the procedure and confirmed he had fasted for the appropriate time. Within 15 minutes, he was drowsy and was laying quietly on the floor under the table.

Laurie, along with another of the clinic’s assistants, Aislin Reese, lifted him onto the table and inserted an IV in his front left leg. Through the IV, Bax received a dose of propofol, a short acting anesthetic. Then a tube was put down his throat, and he was connected to the anesthetic machine which delivers isoflurane gas and oxygen. The tube has a cuff on the end, and once the tube is in place, the cuff is inflated as another measure to prevent vomit (if it happens) from going into the trachea.

Through the IV, Bax continued to receive fluids, which helped to maintain his blood pressure, keep him hydrated and, for post-procedure, help flush the anesthetic from his system. He got eye lubricant to help lubricate his eyes, as he wasn’t going to be blinking while he was under anesthetic. He had an SPO2 monitor clipped to his tongue to monitor the oxygen in his bloodstream and his heart rate, and he had a blood pressure cuff on his front right leg. He had a rolled up towel under his neck to ensure any water used during the cleaning ran out of his mouth and not down his throat.

Laurie and Aislin were monitoring all of his vital signs and charting their observations throughout.

Finally, it was time to start the cleaning.

How to clean a dog’s teeth
Tartar, which everyone—human and dog—has, starts from plaque. Dental plaque is a film of bacteria that grows in your mouth. If it’s not removed, plaque hardens and forms tartar, or calculus, and builds up on your teeth. Calculus can’t be removed by brushing.

Laurie started by cracking off the worst of the calculus. She used an extractor (a plier-like tool, which is also used for pulling teeth) to scrape the calculus off the teeth. I was amazed at the size of the chunks that came off. There was no way I would have been able to remove it myself at home.

She then moved on to the ultrasonic scaler. This tool vibrates at a very high rate and knocks the calculus off the teeth. This tool is very powerful, and Laurie had to be careful not to damage the teeth as she was working. She never touched the point to the tooth and kept the scaler moving, spending only 10-15 seconds on a tooth.

Between the extractor and the scaler, we were finally able to see some of the details on Baxter’s teeth. One of his back molars was so badly crusted with calculus, that I thought the tooth might have been broken or damaged. Laurie uncovered a small chip, but otherwise, once it was clean, the tooth was absolutely fine. I was amazed at the transformation.

The cleaning did cause a bit of blood as his gums got irritated. I had been warned to expect it, and given my own experiences flossing or going to the dentist, I knew it wasn’t anything to worry about.

The third tool that she used was a tiny probe that she traced along Baxter’s gumline. The tip of the probe was marked with millimetre measurements, so Laurie was able to see any pockets or recession in Baxter’s gums. He had some recession, but no areas that indicated serious disease. She used a curette—a small hooked dental tool—to clean under his gumline.

Throughout each of the steps, Laurie and Aislin kept a close eye on Baxter’s vital signs, both through the machines and by their own observations. Dr. Longridge came in as well to look at Baxter’s mouth and double check any areas of concern that Laurie identified.

Laurie cleaned the outside of his right teeth and the inside of his left teeth. Then they flipped Bax over to clean the opposite sides. When rolling him, they made sure to turn him with his feet under to prevent twisting his stomach and possibly inducing bloat.

They repeated the cleaning on the other side of Baxter’s mouth. Here they identified the most serious issue. One of his big upper molars (carnassials) was broken. The tip had snapped off. Dr. Longridge returned to assess the damage. He said that the injury was in a common trouble spot. The back molars bear the brunt of the force when Baxter is chewing and can be damaged if he bites on something too hard. In Baxter’s case, the soft, interior “pulp” of the tooth was exposed.

They asked if I’d noticed any sensitivity from Bax. Was he not chewing on that side of his mouth? I didn’t know what side Bax chewed on and hadn’t noticed it bothering him.

The usual fix when a tooth is damaged is to remove it. However, Dr. Longridge explained that in the case of this particular tooth, he preferred to leave it in place as long as possible. The upper tooth was an important mate to the lower tooth, and removing one could lead to damage to the other.

Usually, at this point of the procedure, Dr. Longridge would call the client and explain the situation, share his recommendation and ask how the client wanted to proceed—hence the importance of leaving accurate contact information prior to the procedure. Since I was in the room, I was able to make the decision then and there, and I agreed with Dr. Longridge’s recommendation to leave the tooth in place.

He expects that it may have to come out at some point if Bax does develop sensitivity or an infection (which Baxter is now vulnerable to at this spot). However, Baxter may be able to live with the tooth as it is for the rest of his life. We’ll keep an eye on it and treat it if we need to in the future.

The final step of the cleaning was polishing (exactly like my dentist appointments). Removing the tartar leaves scrapes and grooves on the teeth, which can be ideal spots for bacteria and plaque. A polisher along with a gritty toothpaste buffed the scratches out and left Baxter’s teeth smooth and clean.

Extractions
Extractions are the complication—and a potentially significant expense—in a dental cleaning. While there are caps and other repairs available for dogs, they are rare. The usual approach if a tooth is damaged or infected, is to remove it.

For some pets, their teeth may be so severely rotted that they fall out as the technicians are cleaning. However, some teeth are very firmly rooted, and extraction can be an involved undertaking. Laurie recounted one surgery where they spent an hour working to remove a single tooth. Detaching the roots, without breaking them, and if necessary stitching the gums can be very complicated so patience is key.

Extractions may be unknown at the beginning of a cleaning. It is hard to tell the integrity of the teeth while an animal is awake due to the calculus build-up on the teeth and the challenge of examining the animal’s mouth. It’s often only once the animal is anesthetized that the mouth can be adequately examined and staff can determine if any teeth need to be removed.

If an extraction is necessary, this will be performed by the veterinarian, as technicians are not licensed to perform invasive procedures like removing teeth.

Cost
Cleaning is expensive which can be a barrier for many pet owners.

Going behind the scenes opened my eyes to how much is involved in a cleaning — a registered veterinary technician, an experienced veterinary assistant, a veterinarian, a multitude of equipment, documentation and multiple medications; the pre-appointment, the time for the actual cleaning, and then Baxter’s recovery following the procedure. A dental cleaning was a big undertaking. And the cost is related.

Clappison has put a number of dental packages in place to help make dental cleaning more of a possibility for pets.

The starting point for a cleaning are guidelines set out by the OVMA (Ontario Veterinary Medical Association). Every clinic must follow these guidelines. But there will be differences in how much clinics charge and how they structure their fees.

At Clappison, they have opted to group dental prophies (the cleaning only) into three packages based on the size of the animal: less than 10kg, 10.1-25kg and over 25.1 kg. They have also instituted a cap on how much they charge for extractions, which is helpful if an animal needs to have many teeth removed.

I appreciated learning how Clappison has packaged their fees and the cap for extractions. I feel like they are trying to be fair in their costs to ensure that animals get much-needed dental care. It is a very complex procedure involving multiple staff members and a significant amount of time, and the costs reflect that.

Some insurance programs do offer coverage for dental cleanings.

What to expect after a cleaning
Once the cleaning was complete, Laurie kept Baxter on oxygen for a short time before lifting him onto the floor, disconnecting him from the anesthesia machine and waking him up. They massaged him and gave him firm pats. They tugged on his tongue, making sure he was able to swallow before they removed the tube from his throat.

Then, awake, but still very groggy, he was moved to the back where he was placed in a kennel to recover. Laurie stayed with him until he was able to stand, and they monitored him closely all afternoon. I picked him up four hours after the cleaning had concluded, and he was still a little tipsy. He couldn’t walk straight, and once home, he went to bed and slept for another four hours.

I had been told to expect that his mouth might be a bit tender, but he shouldn’t be in pain. Pain medication is given following extractions but isn’t usually needed for a cleaning. He could eat a light dinner of canned food or kibble softened in water.

When he finally woke up, he went straight to his food and happily ate his soggy kibble and drank his whole bowl of water. The next day he was back to normal—and hungry!

Healthy teeth
Now that Bax’s teeth are clean, I’m hoping that we can be more diligent with our brushing. I feel like this will be the best way to keep his mouth clean—and maintenance is much easier now that we have a clean slate, so to speak.

Dr. Longridge said that another helpful cleaning technique is to encourage Bax to have an hour-long chew twice a month. For this, Dr. Longridge recommended a large pressed rawhide bone (note that pressed rawhide is very dense and hard and different from rawhides with knots at the ends). A long bone that Bax can hold in his paws and push to the back of his mouth will ensure his rear molars get cleaned.

The chewing helps to chip tartar and calculus off the teeth. Small dental treats that dogs devour in a few bites are less effective. The sustained chewing is important.

Conclusion
After considering a dental cleaning for a while, I am so glad that we decided to do this procedure. No major issues were uncovered, which is a relief. I know now about Baxter’s one damaged tooth and can monitor it closely. I have a new appreciation for the importance of oral health and a renewed commitment to keeping his teeth in good condition. I feel like this cleaning is an important part of Baxter’s overall health and will help us to keep him in the best shape possible.

I appreciate the opportunity to see the cleaning first-hand and to share it with other clients. The amount of work involved is significant, as is the amount of care all of the staff showed to Bax. I hope that this blog helps to remove some of the mystery around dental cleanings and helps other people to realize how important they are for our pets.

If you have any questions or want to book your pet’s dental exam, the knowledgeable team at Clappison Animal Hospital are ready to help.

Julia Thomson lives in Puslinch with her rescue dog Baxter, barn cat Ralph, daughter and husband. She writes about her adventures in home renovation and country living at Home on 129 Acres. She also runs a communications consulting business, 129 Communications, where she provides writing, editing and strategic planning.

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Behind the Scenes at a Dental Cleaning

Julia Thomson, a client of Clappison Animal Hospital, shares her experience as her 8-year-old Boxer Lab receives a dental cleaning. 

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