CLIENT GUIDE |
Setting Up for Dental Day Success
Anesthetized procedures like dentals can feel like a big undertaking for you and your companion. The good news is, there are plenty of ways to help your companion have a smooth and successful experience. This information will let you know what to expect, help you understand how we make your companion’s dental procedure is as safe as possible, and outline how you can support them when they return home.
PREPARING FOR DENTAL DAY
Setting Up For Success
Anesthetized procedures like dentals can feel like a big undertaking for you and your companion. The good news is, there is plenty that can be done ahead of time to help make sure your companion has a smooth and successful experience.
This information is designed to let you know what we’ll be doing at the hospital to make sure your companion is healthy and that their dental procedure is as safe as possible. It also includes information that will help you prepare your home, family, and companion beforehand, so that they’re set up for success right from the start.
One thing to keep in mind when considering the upcoming procedure is what a positive difference the results could make for your companion’s daily experience. When an animal experiences an acute injury, we can easily recognize their signs of pain and distress. It can be much trickier to notice when an animal is experiencing dental pain. Even with fractured teeth or other quite painful conditions, your companion might not show outward signs of distress, or show only gradual shifts in behaviour.
Signs of oral discomfort can include changes in posture, drooling, squinting, staring, hiding, lethargy and even purring. We sometimes miss these changes in behaviour, or in older animals we might attribute decreases in appetite or activity to inevitable results of aging. The great news is that in many cases, once their dental concerns are treated and the pain is managed or removed, these animals show a return to their more engaged, energetic behaviour.
STEP ONE | Bloodwork and Assessment
Once you and your veterinarian have confirmed that dental work involving anesthesia will be taking place, the next step toward a safe and uneventful procedure is completing pre-anesthetic bloodwork. This bloodwork may be done the morning of surgery, but preferably we arrange to have this testing completed ahead of the procedure. These test results are very important – they will alert your vet to any potential health problems that need to be addressed before your companion can safely be anesthetized.
In particular, your vet will focus on how the kidneys and liver are functioning. Bloodwork helps here because it is often difficult to tell just from external symptoms if there are problems. Because these organs play a key role in how your companion processes the medications they will receive, it is important to be sure that they are in good shape. This information also gives your vet the chance to customize their procedure plan (the type and amount of drugs used for sedation and anesthesia, the drugs they will choose to manage pain and anxiety) to make it as safe as possible for your companion.
In this case, ‘bloodwork’ typically means two distinct tests: a Complete Blood Count (CBC) and a Serum Biochemistry. Between the two, these tests provide a wealth of information for your veterinarian.
The CBC is a basic blood test which shows the levels of red blood cells, white blood cells, and platelets. Each of these cells has an important role to play during a dental procedure: red blood cells carry and distribute oxygen, white blood cells combat inflammation and infection, and platelets are responsible for helping blood to clot. Your vet wants to make sure that there are no abnormal levels in any of these three cell types before going ahead with the dental.
The Serum Biochemistry test shows how well the kidneys and liver are working by measuring the levels of a number of different chemicals in the blood. Exactly what your veterinarian is checking for will depend on your companion’s age and condition, but in addition to assessing kidney and liver function they could be checking glucose levels (elevated levels can be an indicator for diabetes), serum proteins (low protein levels can lead to slower post-surgical healing, while high levels can indicate dehydration), and electrolytes like potassium, sodium, and chloride (levels outside the normal range can suggest a number of concerns that your vet might want to explore further).
Your veterinarian will interpret the results of the bloodwork in the context of your companion’s particular condition. Some minor abnormalities might not be concerning. Others might require additional tests or treatment before the procedure can take place, or an adjustment to the sedation and anesthetic protocol your vet had planned. In more significant cases, your vet might decide that it is safer to postpone the dental until the issues are addressed, to ensure that your companion is in the safest position possible before undergoing anesthesia.
Two days before your procedure, you’ll also be sent an admission form specifically for the dental. This includes a pre-procedure questionnaire to confirm some key information about your companion, like current medications and supplements, as well as your preferences and permissions for the procedure. Feel free to ask us if you have any questions about the information in the form.
STEP TWO | Good Grooming
As you are preparing your companion for Dental Day, it is helpful to make sure that they are as clean as possible. At minimum, try to avoid mucky outdoor areas and give them a good brushing ahead of time – arriving for their procedure clean and tangle-free will make for a smoother experience and prevent your technician from spending extra time scrubbing and snipping to gain clean access to the area where they will place a catheter, or to their face and ears. Any excess dirt or debris increases the risk of contamination or infection.
STEP THREE | Prepare Your Space
Take the time before Dental Day to prepare your home to welcome your companion back after their procedure. It’s much easier to make sure your space is prepared ahead of time, rather than struggling to sort things out with a groggy companion on your hands. Because you will need to restrict your companion’s movement after their dental so they can rest and heal for the first 24-48 hours, make sure you have an enclosed area of your home set up for them. You might want to move their crate or bed into the area, getting them used to where they will be spending their time.
Also note that if your companion’s dental procedure involves any tooth extractions, they will need to eat softer foods for 7-14 days after their surgery – picking up a few cans of soft food ahead of time, or preparing some soft bland food like chicken and rice, will mean one less thing to worry about when you arrive home. Looking for some more detailed suggestions for post-dental soft food options? We’ve got them right here for you.
STEP FOUR | Fasting Before Surgery
One of the most important instructions to follow when preparing for Dental Day is to stop offering your companion access to food 12 hours before the procedure (but in most cases they should retain access to water). We generally flag 10 PM the night before as the cut-off time for food, although your vet will let you know if they recommend any changes to this (younger animals are sometimes fasted for a shorter time than older animals because younger animals’ metabolism may be faster, they may digest their food more quickly, and they typically have less robust energy reserves). If your companion has diabetes, they might also be fasted for a shorter period of time, offered a very small morning meal, or require an adjustment to their insulin dose. Your vet will also let you know whether or not your companion should be given their evening or morning dose of any medications they normally take on Dental Day.
If you have a cat in a multi-cat household, or your cat typically goes outdoors, it can be more difficult to make sure that they have fasted. If you have multiple cats, you can either remove all of the cats’ food overnight, or keep your cat headed for surgery in a separate room with water and a litterbox. If you have a free-roaming cat, make sure to keep them indoors the night before surgery – this ensures that they haven’t found a meal elsewhere that you don’t know about, and also makes sure that they are present and accounted for when it’s time to leave for the hospital!
The reason it is so important to fast companions before undergoing anesthesia is to prevent them from accidentally inhaling any regurgitated food into their lungs while they are unconscious. Sometimes the anesthetic drugs can cause vomiting; because your companion’s muscles will be relaxed under sedation, their swallowing reflex is suppressed and it is easy to choke or inhale material into the lungs. For this reason, it is much safer to enter their procedure with an empty stomach.
As difficult as it might be to refrain, remember that fasting also means no snacks or little treats, in addition to skipping breakfast! We understand that your companion is probably pretty crafty at finding food, and might accidentally consume something within the fasting window. Don’t be embarrassed to let us know that your companion might have eaten something – this definitely happens, and we would rather be aware of the risk and adjust plans accordingly.
STEP FIVE | Keep a Regular Routine
As the day of the procedure approaches, maintain your regular routine as much as possible so that your companion feels settled and secure. The day before, make sure to take them for a good walk or have a good play session so that they have a chance to burn off some extra energy. Feed them their dinner at a regular time, and allow them to settle down for the evening as normal.
Depending on your companion’s condition and demeanour, your veterinarian might recommend starting a few medications at home the night before. One option is giving them a dose of an anti-nausea medication, to set them up well to combat the disorienting effects of anesthesia. They may also recommend an anti-anxiety medication, to help your companion remain calm and relaxed for their procedure. We know that our patient’s psychological and emotional health is just as important as their physical health, and we have found that adding these pre-procedure medications helps make the experience smoother and less stressful.
In the morning, plan ahead to make sure you’ve got a bit of extra time. Take your companion for a short walk so they have a chance to go to the bathroom – if this isn’t successful, let the team know when you drop your companion off so we can make sure that they have another chance to go out before their procedure. Also allow plenty of travel time to get to the hospital, helping to minimize stress for everyone involved.
When you arrive, please feel welcome to ask us any final questions. We are happy to clarify anything, and will be looking forward to connecting with you after the dental procedure to let you know exactly how things went.
DENTAL DAY PROCEDURE
DENTAL DAY | Staying Calm and Comfortable
We know it might feel unnerving to say farewell to your furry friend at the door of the hospital, trusting us to make sure that their dental procedure goes well. Rest assured, there are many elements in place on dental day to keep your companion calm and comfortable, and to make sure they return home safe and sound.
One of the most important things we can do to alleviate the fear and anxiety your companion might experience during their procedure is to make the day as smooth and pain-free as possible. Based on your companion’s specific condition and medical history, we create a custom treatment plan designed to reduce anxiety and minimize pain during and after their dental procedure.
Here’s an overview of what the day will hold:
STAGE ONE | Arrival and Sedation
When we welcome your companion into our hospital on dental day, they will be taken to a kennel lined with cozy blankets that will be their own ‘home base’ for the day. They will have a chance to rest and acclimatize to their space while the team gets everything ready for a smooth procedure.
We often have several surgical and dental procedures scheduled each day, so it might be the case that although you drop off your companion in the morning, their dental ‘appointment’ will be in the early afternoon. By welcoming all of our patients in the morning, we have a chance to see exactly how they are all doing and to make a plan for the day that creates a logical order and gives each one the time they will need to go through the preparation, procedure, and recovery process. Please don’t worry, we’ll make sure that everyone is comfortable and well-cared for as they await their big moment.
The team will start with an overall physical examination, including a check of your companion’s temperature, pulse, and respiration rate. One your veterinarian is satisfied that all is well, they will give the go-ahead to start the day’s treatment. The first medication your companion will receive, soon after they arrive, is an injection of an analgesic (pain reliever) and a sedative. The sedative will help them relax and reduce their anxiety – they will become calmer and maybe a little drowsy.
This makes the unfamiliar hospital environment a little less nerve-wracking, and helps keep their stress response from kicking into gear. Just like us, when that ‘fight or flight’ reaction occurs, their heart rate, blood pressure, and breathing rate all increase. By making sure your companion starts the day with effective sedatives and pain relievers, we help them stay calm and comfortable. It also often means that we can use a smaller amount of the other drugs needed to induce and maintain anesthesia during the procedure.
By starting analgesic (pain-relieving) medication before the procedure even begins, we also prevent your companion’s pain receptors from winding up in the first place. Preemptive pain medication acts a bit like friends saving seats at the theatre – just as they might place jackets over empty chairs to prevent strangers from sitting down, the pain medication ‘fills up’ pain receptors, preventing them from receiving the pain signals. It is much easier to prevent pain than to relieve it once it starts (much like asking strangers to give up a comfy seat once they’re settled!). By starting pain management early, and by choosing a combination of medications that have different strategies for blocking pain receptors, we have the best chance of keeping your companion comfortable during and after surgery.
STAGE TWO | Catheter Placement - Fluids and Medication
Before your companion is placed under anesthesia, we place a catheter (usually in their front leg – you’ll see a small shaved patch there when they return home). A catheter acts like a ‘quick access’ route for any drugs that might be required during surgery, and also provides a pathway for us to provide a constant source of both fluids and pain management.
IV fluids help maintain proper blood pressure and replace any fluids lost during the procedure. During a dental procedure, fluids can be lost through evaporation, bleeding, or along with any tissue that is removed in the course of the procedure. During recovery, IV fluids help dilute any remaining anaesthetic drugs circulating in the bloodstream, and help the liver and kidneys clear the drugs more quickly from your companion’s system.
When our patients are undergoing a dental procedure, in addition to this initial injection combination they will be started on CRI (constant-rate infusion) of an additional sedative and pain management medication along with the fluids. The use of CRI means that those drugs can be administered in a steady flow throughout the day, evening out the potential ‘peak and valley’ effect of giving higher volumes of drugs at specific intervals. The best results are seen when we start CRI at least an hour before the dental procedure begins, maintain it throughout the procedure, and continue it for approximately an hour after the dental, depending on the circumstances of each individual patient.
STAGE THREE | Induction
When the doctor is ready to begin the dental procedure, your companion’s technician will start the anaesthetic process by giving them an IV injection of a short-term, quick-acting sedative. In human surgery, this is the point where the doctor might ask you to ‘Count backwards from ten…’ – a peaceful and controlled way to enter anesthesia, for humans and animals.
Once the sedative has taken effect and the patient is unconscious, the technician will slide a breathing tube into your companion’s windpipe. This helps keep their airway clear and open against the muscle-relaxing effect of the sedatives, and prevents your companion from accidentally inhaling any liquid while they are unconscious and unable to swallow. The breathing tube is also how your companion will inhale a combination of oxygen and anesthetic gas during the procedure.
STAGE FOUR | Anesthesia
An inhaled anesthetic gas is used to keep your companion unconscious during the dental. Gas is generally preferred over injectable drugs at this stage because it is relatively easy to control how deeply the animal is under anesthesia, and because the gas clears the system quite quickly once the procedure is complete.
Throughout the entire process, but particularly immediately before, during, and after anesthesia, your companion is closely monitored by a technician who is dedicated to this task. They will monitor key indicators for your animal, such as their blood pressure, blood oxygen levels, heart rate and pulse pattern, respiration rate, and body temperature. They have specialized monitoring equipment to help them track these vital signs, but they also stay by your animal’s side and use their own observation and experience to make sure their patient is safe and stable.
STAGE FIVE | Pain Management During the Dental
In addition to the general anesthetic, dental procedures involve the addition of a local nerve block or ‘numbing’ injections in the gums, targeting specific groups of nerves located in various regions of the mouth. This site-specific pain control is longer-lasting (usually between 4 and 8 hours) and minimizes sensation in the mouth as your companion regains consciousness. You might be familiar with having your own mouth ‘frozen’ for dental procedures, with sensation gradually returning to the area in the hours after we leave the clinic – this is very similar to what your companion will experience. Using local nerve blocks also allows the veterinarian to maintain your companion on a lighter plane of anesthesia (because any sensation they might experience is being managed on multiple levels), further reducing the risks associated with this state.
A general pain control medication (usually a non-steroidal anti-inflammatory drug – NSAID) is usually given by injection before your companion even wakes up from their procedure. This ensures that the protective barrier of pain management that began right when your companion arrived at the hospital continues to be effective. These medications are similar to drugs like Advil for humans – they relieve pain, inflammation, and fever.
STAGE SIX | Dental Procedure
A full dental procedure or COHAT (complete oral health assessment and treatment) involves a number of distinct stages – much as our own visits to the dentist do. The vet will start by assessing the state of your companion’s teeth in much more depth than was possible when the animal was conscious.
They will take radiographs (x-rays) of the whole mouth, which helps them detect issues below the gumline and deep within the teeth. They are looking for problems like potential fractures, decaying teeth, abscesses at the tooth root, and even bone loss in the jaw caused by plaque accumulation. They will also physically probe the teeth and gums, allowing them to determine the extent of any issues they have detected thus far.
They will then chart out what elements are recommended and required for the procedure, including whether any extractions are needed and the safest extraction method. This is the point in the procedure where the vet might call you for a consult if that is something you have requested, or if there are unexpected findings during the examination.
The dental procedure itself will typically start with removing any teeth, then cleaning and securing the extraction sites with sutures as necessary.
Then the remaining teeth will be thoroughly cleaned (above and below the gum line) using an ultrasonic scaler and hand tools. If you’re picturing what your dental team uses to clean your pearly whites, you’re on exactly the right track! Once all the accumulated plaque and debris have been removed, the teeth will be polished – this is an important step, smoothing out any microabrasions on the surface of the teeth, making it more difficult for plaque and tartar to accumulate in the future. Finally, your companion’s mouth will get a good rinse, clearing away any remaining material.
STAGE SEVEN | Recovery
Once the dental work is complete, the team will withdraw the anesthetic gas, allowing your companion to breathe in pure oxygen to help clear their system of any residual gas. As the anesthetic effect wears off and your companion begins to regain consciousness and muscle control, the breathing tube will be removed.
The technician keeps a vigilant eye on your companion during the recovery process, making sure that they are warm and comfortable, breathing well, and eventually sitting up on their own.
Once the team is satisfied that the recovery process has gone smoothly and your companion is fully awake (although still groggy) they will allow their patient to rest quietly back in their kennel. These kennels are adjacent to our main treatment room, allowing everyone to check in frequently on recovering patients, offering comforting words and snuggles as they pass by. As a final step, they will stop the CRI treatment and IV fluids, and remove the catheter from your companion’s leg. Finally, they are ready to return home!
Recovery At Home
When you return home after Dental Day, your companion will likely still be showing mild to moderate signs of sedation. You might notice they seem a little off-balance or unsettled. They might feel nauseated. They will be most comfortable if you give them a quiet, dimly-lit place to lie down and rest until the sedatives have cleared their system.
While your family members will likely be thrilled to have their furry friend home, keeping things calm and quiet is best – your companion will likely be more sensitive to light, loud noises, touch, or other stimuli after anesthesia. Some experience dysphoria, a state of unease and disorientation where they might be restless and unable to settle down, sometimes vocalizing and panting, and seeming a bit discombobulated. As the effects of the day work their way through your companion’s system, you should notice these symptoms ease.
When they’re starting to feel more alert and active, you can offer your companion a small amount of food. If they’re interested and the food stays down, you can continue to offer them small snack-size portions of their normal food through the evening. It’s also possible that they might not be interested in anything to eat today – that’s completely okay. We would expect them to return to more normal eating habits the next day. They might also need to go to the bathroom more often than normal at first, because of the volume of IV fluids they received during their procedure.
What to Watch For:
There are a few things that it is important to be on the lookout for after a dental procedure. Keep a careful eye out for any of the following, particularly once the initial recovery period of 24-48 hours has passed:
- Pawing at the face or rubbing face against the floor
- Excessive drooling
- Able to eat harder food again, but not willing to do so
- Disinterested in favourite chew toys
- Dropping food while trying to eat
- Aggressive or painful behaviours when you touch their face
- Swelling or bleeding around the gums
- Swelling or drainage from the eyes
If there were any teeth extracted, don’t be surprised if you notice a small amount of bleeding from their mouth, or if you spot a small amount of water in the dish after they have a drink. Although a small amount of bleeding can be normal, we would not expect to see significant bleeding. If you have any concerns or notice any of the above symptoms, don’t hesitate to call us at any point.
Depending on what was involved in your companion’s procedure we may schedule a dental re-check 10-14 days afterward. This will allow us to make sure everything looks good and is healing well – this is typically not required for standard cleanings, but may be recommended if there were extensive or challenging extractions, for example.
POST-DENTAL TIP ONE | Keep Up With Medication
You will be sent home with medications that have been specially selected based on your companion’s condition and post-dental needs. They will likely include medication to continue to control pain and inflammation. Post-dental medications may also include antibiotics, depending on the nature of any tooth extractions. It is important to follow your companion’s prescribed medication schedule to make sure that their discomfort is minimized. Although it may be tempting to stop giving the medication once your companion seems to be returning to their old self, completing the full prescription will give them the best chance of a smooth and trouble-free recovery.
To encourage your companion to take the pills, you can try concealing them inside a small piece of cheese or other soft yummy treat – Pill Pockets, for example, are specially designed treats for both cats and dogs that have space to tuck medication inside. If you’re having any difficulty getting them to take their medication, please let us know – we can walk you through some tips and tricks, or sometimes alternative medication forms (like liquids) are available.
POST-DENTAL TIP TWO | Soft Food
Whether or not your companion’s dental procedure involved tooth extractions, their mouth will likely be tender for a few days because of the deep cleaning they will have received below the gumline. It is a good idea to avoid hard kibble and treats until your companion’s mouth has begun to heal, usually between five and seven days. Dry kibble can be softened with water, or you can offer them canned food instead. Many animals will readily bite down on hard pieces of food even when their mouth is still sore – it’s hard to resist a good treat, no matter the cost! – so it is important for you to help them take it easy with a soft diet.
Once their mouth is less tender, they will almost certainly be able to return to their previous diet. Even if they have had a substantial number of teeth extracted, they should manage just fine. Animals often use their tongues as much as their teeth as they are eating their kibble and chew less than you might think, frequently swallowing pieces of kibble whole regardless of their number of teeth!
POST-DENTAL TIP THREE | Discourage Vigorous Chewing
Particularly if your companion’s dental procedure did involve the removal of one or more teeth, it is important to restrict their access to hard bones or chew toys (like Kongs) that encourage energetic recreational gnawing for at least a week after their procedure.
In addition to avoiding extra pressure on their aggravated gumline, this will also prevent them straining any sutures that may be in place, breaking apart the surrounding tissues and creating pockets where food can build up and lead to infection.
POST-DENTAL TIP FOUR | Keep Activity Levels Low
In order to help your companion get the rest they need, and to prevent them from adding extra stress to any extraction sites with increased blood pressure, it is also important to keep them quieter than normal for a few days.
If you have other animals in the home, make sure to keep an eye on their antics to prevent them from playing too vigorously with the recovering patient.
POST-DENTAL TIP FIVE | Maintain a Clean Mouth
The easiest time to establish a solid home dental care routine is after a thorough cleaning, when plaque is at a minimum! It’s absolutely possible for companion animals to have strong oral health, and avoid a great deal of pain and discomfort as a result – there’s a lot you can do at home to keep their teeth clean, healthy, and pain-free. Remember to wait a week or two after their dental procedure before starting or resuming their home care, to make sure you’re not poking around near sensitive gums!
Brushing Teeth –
Just like for humans, brushing your companion’s teeth is the best way to remove the plaque and build-up on the teeth that leads to bad breath and gum disease. There are options for finger brushes or ‘regular’ toothbrushes, and pastes that come in animal-friendly flavours like chicken or fish (unappealing for us perhaps, but a tasty treat for them!). It can take some time to work up to your companion being comfortable with having their teeth brushed. The road to success can involve gradually progressing from touching their mouth, lifting their lip, touching their teeth with the brush, adding some paste, and finally cleaning a tooth or two, along with plenty of treats, pats, and praise at every step of the way. Slow and steady, building trust over time, works better than creating frustration or struggle in a longer session.
Oral Rinses, Wipes and Chews –
If physically brushing teeth isn’t a good option for your companion, there are other alternatives to promoting good oral health. Oral rinses (given as an additive in your companion’s daily drinking water) can help prevent dental disease. Other products can include oral wipes or chews that are designed to remove tartar. We are happy to work with you to recommend a product or regimen that will best suit your situation.
Prescription Dental Diets –
Finally, there are some dry foods that are specially designed to mechanically remove tartar from your companion’s teeth as they bite and chew the food. These diets are most effective at helping to maintain clean teeth (rather than removing substantial established tartar), and can be a beneficial addition to a good oral health plan. Let us know if you have questions, and we can help decide if a dental diet is a good choice for your companion.
Congratulations on taking this important aspect of ensuring a high quality of life for your companion. We wish you and your companion all the best after their dental procedure – feel welcome to reach out to us at any point if you have questions or concerns. We’re here to help.