"Dentals" at North County Cat Hospital
When we talk about "performing a dental" in a cat, we always mean cleaning and polishing all of the healthy teeth; but we also mean looking for and treating any diseased and painful teeth. If teeth are painful or diseased, it is of no benefit to the patient to just make them clean.
Cats don't tell us when their mouth hurts so a thorough examination of the teeth, including dental radiographs (x-rays) to look at the teeth below the gum line, is important to identify and treat problems. These are necessary to make the "dental" beneficial to the cat.
We should note that while we still call dental procedures "dentals", some veterinarians prefer to use the less idiomatic acronym "COHAT" to describe the procedure.
All of these images are of cats with severe, painful dental disease. Cleaning these teeth without treating the diseases won't help any of these cats.
Every Dental Includes:
There is a list of things that we feel are important for any dental to be as safe and as beneficial as possible. If we "perform a dental" on your cat, it will include the following.
(If you are looking at an estimate that we have given you for your cat's dental procedure, it will include all of these with the possible exception of a blood panel, which may have been done already.)
It is illegal, unethical, and risky to anesthetize an animal without a proper examination on the day of the procedure. Even if we examined your cat the day before, we will do it again. The condition of a cat can change that fast. (To be fair to you, we will discount the cost of this back to you if we have done an examination recently.)
Examination of a Cat
A Blood Panel
Before any anesthesia, we want to see the results of a blood panel. It helps us assess risk and may change decisions regarding the anesthesia. If a panel hasn't been done recently, we perform it on the day of the procedure.
Preparing a Blood Panel
Even for the best behaved cats, it's impossible to do more than a superficial, cosmetic cleaning of the teeth without a general anesthetic. At best, an anesthetic free cleaning will make the teeth look better (while not improving the health of the mouth and not addressing any disease in the mouth). At worst it will cause damage to previously healthy teeth and gums.
We always give preanesthetic medications to reduce anxiety, prevent pain, and decrease the amount of general anesthetic needed. We induce the patient with a short acting intravenous anesthetic (usually propofol) and then use a general gas anesthetic (usually sevoflurane) to maintain the anesthesia.
Because they severely reduce the ability of the heart to pump blood, we never use medetomidine or xylazine. We also never use intramuscular anesthetics and we never "mask" or "box" a cat "down."
Our Video on Anesthesia Safety
Intravenous (I.V.) Catheter and Fluids
Anesthetics cause blood vessels to dilate. Without fluids, this can lead to an unsafe drop in blood pressure. The intravenous catheter allows us to give those intravenous fluids before, during, and after the anesthesia. It also gives us instant access to a vein if any drugs are needed to support the patient.
Giving Drugs Through an Intravenous Catheter
By their very nature, anesthetics change the metabolism of the cat and the functioning of internal organs. We always monitor reflexes, mucous membranes, heart rate, respiratory rate, blood pressure, oxygen saturation, carbon dioxide elimination, and temperature. If any of these point to a problem with the patient, we act to correct it.
We always have one person whose only responsibilty is to monitor the patient under anesthesia.
Cats under anesthesia lose their ability to self regulate their temperature. If the temperature drops even a few degrees it has a severe effect on the metabolism of the cat and potentially causes long term health problems. It also causes them to feel very cold when they wake up. A temperature that goes too high can also cause severe problems. We make sure to monitor and control our patients' temperatures.
A Bair Hugger Warming Unit that we use to keep cats warm.
Dental Radiographs (X-rays)
With people, if there is a painful problem under the gum line, they will usually report it. With cats, it is usually impossible to know what is going on below the gum line without radiographs, so a full set are always included when we perform a dental on a cat. It really makes no sense to clean diseased teeth without treating the disease.
Radiographing a Cat's Incisors
Properly cleaning the teeth helps maintain the health of the gums and teeth. This includes getting under the gum line. Cleaning also allows us to examine the teeth more thoroughly.
Cleaning a Cat's Teeth
We don't charge extra for polishing the teeth but it is such an important aspect of the procedure, that we include it separately. Cleaning the teeth without polishing them well (as with anesthetic free dentals) will make the teeth look good, but is damaging to the teeth in the long run. Unpolished teeth will accumulate more tartar.
Polishing a Cat's Teeth
A Dental May Include:
If you are looking at an estimate that we made for your cat's dental procedure, you may find additional items not mentioned above.
Preanesthetic Radiographs (X-rays):
These are separate from and different than dental radiographs.
Preanesthetic radiographs are traditional radiographs that give us information about the cat's chest and abdomen. Like the preanesthetic blood panel, they help us assess risk and they may change the anesthetic protocol.
Depending on the condition of the teeth and the condition of the patient, and depending on what procedures are performed, we may treat with antibiotics.
Radiograph of a Cat
Often we will know ahead of time about diseased teeth (e.g., infection, fracture, tooth resorption) and will have already discussed possible treatments - usually extraction. If we suspect or know that tooth extraction will benefit the patient ahead of time, we will let you know and it will be on the estimate. If we don't know before the procedure that extractions will be indicated and if we then find problematic teeth during the procedure, we will want permission to treat them. There is a section on our estimates that gives us permission to proceed with additional treatments.
We almost always suture extraction sites (the only exception being when there is a very small open area). We don't charge extra for this so you won't see it on the estimates.
Tooth resorption is one of the reasons
that we might extract a cat's tooth.
Before extracting teeth, we block the nerves to those teeth. This is to help prevent wind-up pain and to make the mouth more comfortable after the cat wakes from anesthesia.
If we perform an extraction or other painful procedure, we treat for pain, usually with a combination of an NSAID and a narcotic.
We will often recommend performing other beneficial treatments on your cat while they are here for a dental. Sometimes this is because the treatment is painful or uncomfortable and is best done under anesthesia and sometimes it's just to save you and your cat an extra trip here.
Performing a Dental Nerve Block