COHAT (Dental Cleaning)
Before Surgery
✓ DO NOT feed your pet a meal/treats after 10pm the night before unless otherwise directed
✓ DO allow your pet water overnight
✓ DO give any medications prescribed for the procedure as directed
✓ DO check if your pet’s other medication(s) may be given that morning
✓ DO bring your pet for your scheduled time between 7:45 am and 8:15 am
✓ DO ensure you have CONTACT and EMERGENCY CONTACT phone numbers
✓ DO allow yourself a few minutes to go over admitting information with the technician
Preface
Pets are very good at hiding that they are feeling sick or painful. Sometimes, they show us subtle signs that their mouth is painful, such as becoming shy about being touched around the head and mouth, dropping more food while they are eating, preferentially chewing on one side of their mouth, and not playing with their usual toys. Sometimes it is more obvious, where they are lethargic (lacking energy), whining or whimpering especially when they chew or have their face touched, refusing to eat dry kibble or other crunchy things, or pawing at their face or teeth. Cats may hiss at their food while eating and run away if their pain is severe enough. If you have any concerns about whether your pet is in pain, it always a good idea to have your pet examined. The most common signs include bad breath (halitosis), swelling and redness of the gum tissue or other soft tissues in the mouth, drooling or excessive salivation. Other signs include difficulty chewing, discolored or broken teeth, loose or missing teeth, discharge from the nose or sneezing, and swelling of the face, jaw or neck.
Pre-Operative Exam
In order for your pet to have a safe surgical experience the veterinarian performing the procedure should be familiar with your pet's history and physical condition. With modern drugs and sophisticated equipment, the risk associated with general anesthesia and surgery is minimal for the healthy pet. However, the potential for complications still exists, and the best way to minimize the risk for your pet is to have a complete pre-surgical evaluation performed before the procedure. This allows us to determine if your pet has developed any underlying problems that might lead to complications during or after surgery, and to make any adjustments necessary to safeguard your pet’s health and comfort. The amount of preparation will be dictated by the age and health concerns of your pet, and by the nature of the procedure. Once all the information has been gathered and analyzed, our veterinarians will make recommendations about the advisability to proceed with anesthesia and surgery. In some situations, the risk will be too great, and the procedure will be delayed allowing time to treat the underlying problem. In other cases, the decision will be that it is safe to proceed as planned. Sometimes adjustments will be made to minimize risk even further, such as using a different type of anesthetic, administering pre-surgical antibiotics, giving intravenous fluids prior to the surgery or additional fluids after surgery, or whatever else the veterinarian deems necessary for your pet.
A systematic visual inspection of the pet’s head, neck, limbs, and body including palpation (feeling with the hands) of the body’s outer surface (skin, fur, muscles etc.), assessment of internal abdominal organs through the body wall, auscultation (listening with a stethoscope) to the heart, lungs, and abdomen and measuring of your pet’s temperature, respiration rate and heart rate will all be assessed.
Pre-Anesthetic Blood Work
The 10 Chemistry and CBC (complete blood cell count); blood collection & interpretation charge is for blood work to be run prior to the procedure. This blood work is like an internal exam for your pet. It will check a complete blood cell count; white bloods cells that fight infection, red blood cells that carry oxygen and platelets which help with clotting. It will also look at electrolytes, liver and kidney function. Obviously, we want everything to be normal but if we find something abnormal, we can either change our anesthetic plan or defer the procedure until a later time, depending on what is found. For this reason, we like to run the blood work a few days prior to the anesthesia so any findings can be dealt with. It can also be run the morning of the procedure if needed. This treatment is optional but strongly recommended.
General Anesthesia
General Anesthesia is worrisome for many clients, particularly older pets. Fortunately, age is not a disease, and some older cats and dogs may be in better health than some young patients that have systemic disease (like diabetes or heart disease). Your pet will be evaluated individually to determine health status and whether he or she can be safely anesthetized. Anesthesia is tailored to each patient, and even patients with health constraints can have safe anesthesia and receive the dental care that they need. The risks of anesthesia are most often far outweighed by the benefits of what can be diagnosed and treated when anesthesia is performed safely by trained individuals.
IV Fluids
Your pet will have an IV placed and will receive IV fluids during their surgery to maintain hydration and proper blood pressure to the body and kidneys. They may also receive pain medications through their IV as well.
Dental x-ray - Comprehensive
This entails a complete set of full mouth radiographs of all your pet’s teeth while under anesthesia. The plaque, tartar or calculus (white and sticky, brown or yellow) you see on the teeth is often odorous and unappealing but the health of the teeth under the gum line is most concerning. Often, a tooth can appear healthy once most of the heavy tartar is removed, but dental x-rays may reveal significant bone loss or a periapical abscess at the tooth root. These teeth are painful and generally need to be extracted.
Dental Charting
Probing gingiva assesses the periodontal pocket depth. For dogs, normal pocket depth is 1-3 mm and in cats it is 0.5-1 mm. Depths that exceed these values indicate loss of bone (as gingiva only attaches to alveolar bone that covers the tooth roots). This means that there is a periodontal pocket which allows plaque and bacteria to form leading to periodontal disease.
Professional Oral Care Package
Although cleaning the teeth is certainly part of the dental care we provide, we prefer to use the more descriptive term COHAT.
C= Comprehensive
O=Oral
H=Health
A=Assessment and
T=Treatment
Why COHAT?
To safely and fully evaluate all tooth surfaces, and below the gum line, our patients need to be anesthetized. It is important to perform a complete oral examination to fully diagnose dental conditions and perform proper treatment. There may be several different stages of periodontal disease or other oral conditions present in one patient. Once your pet is induced under general anesthesia, we are ready to examine and treat your pet’s oral condition:
• Each tooth is examined, and a periodontal probe is used to check for pockets.
• The gum tissue is examined for inflammation. The crowns of the teeth are cleaned with hand and ultrasonic instruments to remove plaque and tartar.
• An ultrasonic scaler or hand instruments are then used under the gums which are the most critical part of treating periodontal disease.
• Dental radiographs are taken to evaluate the bone and roots beneath the gum line.
• Any teeth with periodontal disease will have recommendations made to resolve the pathology.
• If no further treatment is needed, then the teeth are polished.
Why don’t we know exactly what will be done to my pet’s mouth prior to anesthesia?
Seventy percent of the tooth is located under the gum line – this means that we can’t detect what is going on with 70% of the tooth until we can take dental x-rays and probe under the gum line. In addition, there are areas around the teeth, behind the tongue and in the back of the mouth that can only be visualized under anesthesia. For these reasons, we cannot completely diagnose what is going on in the mouth on an awake patient. This means that we can give you our best estimate of what disease is present and the best therapy to make them healthy again after your pet’s consultation, but we cannot know for sure until they are asleep, and we can use our dental x-rays and oral examination to confirm the best treatment plan for your pet. Many different stages and types of dental disease can be present in the same patient at the same time!
Why do teeth need to be extracted?
There are multiple reasons why a tooth may need to be extracted. The two most common reasons are periodontal disease and because of endodontal disease.
With periodontal disease, there are several criteria we use to determine if a tooth must be extracted. These criteria are if the tooth has more than 1mm of mobility (when you push on the tooth, it moves), if there is more than 50% of the supporting bone around the tooth missing due to periodontal inflammation, or if there is no bone between the two roots of a tooth. If any of these criteria are present, there is no possibility of returning the tooth to a healthy status where your pet’s mouth will be free of inflammation and pain. There may be cases where we can attempt to return a tooth to health, but this often requires referral and intensive at-home care (including daily brushing) to maintain tooth health while it heals.
In endodontal disease, the tooth has died either from a fracture or from other trauma to the tooth that has caused irreversible pulpitis (inflammation of the pulp leading to pulp and tooth death). For non-strategic teeth, teeth where the fracture extends under the gum line, and in teeth with severe inflammation affecting the root, extraction is the best option.
My pet needs to have teeth extracted—how will they eat?
Dogs and cats only use their back premolar and molar teeth (the carnassial teeth) to chew. The incisor teeth (the little ones up front) can be helpful in scratching itches. The canine teeth (the big fang-like teeth) are great for biting prey. The smaller premolar teeth are used to some extent to gnaw and chew, but most chewing is done by the upper 4th premolar teeth and lower 1st molar teeth. What this means is that if the incisors, canine teeth, or other premolar or molar teeth need to be extracted, you will probably not notice any difference in how your pet chews after these teeth are extracted.
What if one of the carnassial teeth needs to be extracted? You still do not have to worry because dogs and cats are very adaptable. It may take them a little longer to chew kibble than it did before. It may mean that we need to give them smaller kibble, kibble soaked until it is soft, or a wet diet for them to get enough nutrition. Teeth are often so painful and diseased before they are extracted that your pet will be relieved enough to eat the same night after it is removed. Even pets that have full-mouth extractions can eat well after their extractions. All pets will receive local nerve blocks prior to extractions to ensure their immediate comfort post-operatively while we wait for conventional pain medications to take effect thereby avoiding wind-up pain.
Dental Extractions
If our veterinarians have determined there are teeth that require extraction, you will then receive a call from either the doctor or a technician to go over the details of the x-rays and the quote (if different from what you have been given previously) and get your verbal permission to proceed with the extractions. It is very important that you are available at the contact number(s) you have provided so that we can treat your pet in a timely manner and reduce anesthesia.
Hospital Care
During your pet’s stay, we will keep him comfortable on a memory foam bed with lots of blankets, treat hypothermia with warmers, and continue IV fluids if required. He will have close supervision to assess and treat pain post-operatively; observe for signs of nausea associated with anesthesia and treat if needed. Our goal will be to have him up walking to go to the washroom and eating by later in the day.
If your pet required extractions, we will be sending home pain medications to help your pet’s recovery at home. If there are any concerns about infection, antibiotics may be deemed necessary by our veterinarians. These pain medications treat inflammation (Metacam), and nerve pain (Tramadol or Gabapentin). Pain control is necessary for a successful recovery and comfort at home. These medications should not be stopped until they are finished as prescribed or until otherwise directed.
Finally....
We will call you at your contact number after surgery to relay an update on your pet and schedule a discharge time for later in the day. The discharge time is with a technician to go over post-operative instructions, medications and answer any questions you might have.
A Note on "Cosmetic Anesthesia Free Dental Cleaning".
Thank You For Entrusting Us With Your Pet’s Care
The Glendale Team
✓ DO NOT feed your pet a meal/treats after 10pm the night before unless otherwise directed
✓ DO allow your pet water overnight
✓ DO give any medications prescribed for the procedure as directed
✓ DO check if your pet’s other medication(s) may be given that morning
✓ DO bring your pet for your scheduled time between 7:45 am and 8:15 am
✓ DO ensure you have CONTACT and EMERGENCY CONTACT phone numbers
✓ DO allow yourself a few minutes to go over admitting information with the technician
Preface
Pets are very good at hiding that they are feeling sick or painful. Sometimes, they show us subtle signs that their mouth is painful, such as becoming shy about being touched around the head and mouth, dropping more food while they are eating, preferentially chewing on one side of their mouth, and not playing with their usual toys. Sometimes it is more obvious, where they are lethargic (lacking energy), whining or whimpering especially when they chew or have their face touched, refusing to eat dry kibble or other crunchy things, or pawing at their face or teeth. Cats may hiss at their food while eating and run away if their pain is severe enough. If you have any concerns about whether your pet is in pain, it always a good idea to have your pet examined. The most common signs include bad breath (halitosis), swelling and redness of the gum tissue or other soft tissues in the mouth, drooling or excessive salivation. Other signs include difficulty chewing, discolored or broken teeth, loose or missing teeth, discharge from the nose or sneezing, and swelling of the face, jaw or neck.
Pre-Operative Exam
In order for your pet to have a safe surgical experience the veterinarian performing the procedure should be familiar with your pet's history and physical condition. With modern drugs and sophisticated equipment, the risk associated with general anesthesia and surgery is minimal for the healthy pet. However, the potential for complications still exists, and the best way to minimize the risk for your pet is to have a complete pre-surgical evaluation performed before the procedure. This allows us to determine if your pet has developed any underlying problems that might lead to complications during or after surgery, and to make any adjustments necessary to safeguard your pet’s health and comfort. The amount of preparation will be dictated by the age and health concerns of your pet, and by the nature of the procedure. Once all the information has been gathered and analyzed, our veterinarians will make recommendations about the advisability to proceed with anesthesia and surgery. In some situations, the risk will be too great, and the procedure will be delayed allowing time to treat the underlying problem. In other cases, the decision will be that it is safe to proceed as planned. Sometimes adjustments will be made to minimize risk even further, such as using a different type of anesthetic, administering pre-surgical antibiotics, giving intravenous fluids prior to the surgery or additional fluids after surgery, or whatever else the veterinarian deems necessary for your pet.
A systematic visual inspection of the pet’s head, neck, limbs, and body including palpation (feeling with the hands) of the body’s outer surface (skin, fur, muscles etc.), assessment of internal abdominal organs through the body wall, auscultation (listening with a stethoscope) to the heart, lungs, and abdomen and measuring of your pet’s temperature, respiration rate and heart rate will all be assessed.
Pre-Anesthetic Blood Work
The 10 Chemistry and CBC (complete blood cell count); blood collection & interpretation charge is for blood work to be run prior to the procedure. This blood work is like an internal exam for your pet. It will check a complete blood cell count; white bloods cells that fight infection, red blood cells that carry oxygen and platelets which help with clotting. It will also look at electrolytes, liver and kidney function. Obviously, we want everything to be normal but if we find something abnormal, we can either change our anesthetic plan or defer the procedure until a later time, depending on what is found. For this reason, we like to run the blood work a few days prior to the anesthesia so any findings can be dealt with. It can also be run the morning of the procedure if needed. This treatment is optional but strongly recommended.
General Anesthesia
General Anesthesia is worrisome for many clients, particularly older pets. Fortunately, age is not a disease, and some older cats and dogs may be in better health than some young patients that have systemic disease (like diabetes or heart disease). Your pet will be evaluated individually to determine health status and whether he or she can be safely anesthetized. Anesthesia is tailored to each patient, and even patients with health constraints can have safe anesthesia and receive the dental care that they need. The risks of anesthesia are most often far outweighed by the benefits of what can be diagnosed and treated when anesthesia is performed safely by trained individuals.
IV Fluids
Your pet will have an IV placed and will receive IV fluids during their surgery to maintain hydration and proper blood pressure to the body and kidneys. They may also receive pain medications through their IV as well.
Dental x-ray - Comprehensive
This entails a complete set of full mouth radiographs of all your pet’s teeth while under anesthesia. The plaque, tartar or calculus (white and sticky, brown or yellow) you see on the teeth is often odorous and unappealing but the health of the teeth under the gum line is most concerning. Often, a tooth can appear healthy once most of the heavy tartar is removed, but dental x-rays may reveal significant bone loss or a periapical abscess at the tooth root. These teeth are painful and generally need to be extracted.
Dental Charting
Probing gingiva assesses the periodontal pocket depth. For dogs, normal pocket depth is 1-3 mm and in cats it is 0.5-1 mm. Depths that exceed these values indicate loss of bone (as gingiva only attaches to alveolar bone that covers the tooth roots). This means that there is a periodontal pocket which allows plaque and bacteria to form leading to periodontal disease.
Professional Oral Care Package
Although cleaning the teeth is certainly part of the dental care we provide, we prefer to use the more descriptive term COHAT.
C= Comprehensive
O=Oral
H=Health
A=Assessment and
T=Treatment
Why COHAT?
To safely and fully evaluate all tooth surfaces, and below the gum line, our patients need to be anesthetized. It is important to perform a complete oral examination to fully diagnose dental conditions and perform proper treatment. There may be several different stages of periodontal disease or other oral conditions present in one patient. Once your pet is induced under general anesthesia, we are ready to examine and treat your pet’s oral condition:
• Each tooth is examined, and a periodontal probe is used to check for pockets.
• The gum tissue is examined for inflammation. The crowns of the teeth are cleaned with hand and ultrasonic instruments to remove plaque and tartar.
• An ultrasonic scaler or hand instruments are then used under the gums which are the most critical part of treating periodontal disease.
• Dental radiographs are taken to evaluate the bone and roots beneath the gum line.
• Any teeth with periodontal disease will have recommendations made to resolve the pathology.
• If no further treatment is needed, then the teeth are polished.
Why don’t we know exactly what will be done to my pet’s mouth prior to anesthesia?
Seventy percent of the tooth is located under the gum line – this means that we can’t detect what is going on with 70% of the tooth until we can take dental x-rays and probe under the gum line. In addition, there are areas around the teeth, behind the tongue and in the back of the mouth that can only be visualized under anesthesia. For these reasons, we cannot completely diagnose what is going on in the mouth on an awake patient. This means that we can give you our best estimate of what disease is present and the best therapy to make them healthy again after your pet’s consultation, but we cannot know for sure until they are asleep, and we can use our dental x-rays and oral examination to confirm the best treatment plan for your pet. Many different stages and types of dental disease can be present in the same patient at the same time!
Why do teeth need to be extracted?
There are multiple reasons why a tooth may need to be extracted. The two most common reasons are periodontal disease and because of endodontal disease.
With periodontal disease, there are several criteria we use to determine if a tooth must be extracted. These criteria are if the tooth has more than 1mm of mobility (when you push on the tooth, it moves), if there is more than 50% of the supporting bone around the tooth missing due to periodontal inflammation, or if there is no bone between the two roots of a tooth. If any of these criteria are present, there is no possibility of returning the tooth to a healthy status where your pet’s mouth will be free of inflammation and pain. There may be cases where we can attempt to return a tooth to health, but this often requires referral and intensive at-home care (including daily brushing) to maintain tooth health while it heals.
In endodontal disease, the tooth has died either from a fracture or from other trauma to the tooth that has caused irreversible pulpitis (inflammation of the pulp leading to pulp and tooth death). For non-strategic teeth, teeth where the fracture extends under the gum line, and in teeth with severe inflammation affecting the root, extraction is the best option.
My pet needs to have teeth extracted—how will they eat?
Dogs and cats only use their back premolar and molar teeth (the carnassial teeth) to chew. The incisor teeth (the little ones up front) can be helpful in scratching itches. The canine teeth (the big fang-like teeth) are great for biting prey. The smaller premolar teeth are used to some extent to gnaw and chew, but most chewing is done by the upper 4th premolar teeth and lower 1st molar teeth. What this means is that if the incisors, canine teeth, or other premolar or molar teeth need to be extracted, you will probably not notice any difference in how your pet chews after these teeth are extracted.
What if one of the carnassial teeth needs to be extracted? You still do not have to worry because dogs and cats are very adaptable. It may take them a little longer to chew kibble than it did before. It may mean that we need to give them smaller kibble, kibble soaked until it is soft, or a wet diet for them to get enough nutrition. Teeth are often so painful and diseased before they are extracted that your pet will be relieved enough to eat the same night after it is removed. Even pets that have full-mouth extractions can eat well after their extractions. All pets will receive local nerve blocks prior to extractions to ensure their immediate comfort post-operatively while we wait for conventional pain medications to take effect thereby avoiding wind-up pain.
Dental Extractions
If our veterinarians have determined there are teeth that require extraction, you will then receive a call from either the doctor or a technician to go over the details of the x-rays and the quote (if different from what you have been given previously) and get your verbal permission to proceed with the extractions. It is very important that you are available at the contact number(s) you have provided so that we can treat your pet in a timely manner and reduce anesthesia.
Hospital Care
During your pet’s stay, we will keep him comfortable on a memory foam bed with lots of blankets, treat hypothermia with warmers, and continue IV fluids if required. He will have close supervision to assess and treat pain post-operatively; observe for signs of nausea associated with anesthesia and treat if needed. Our goal will be to have him up walking to go to the washroom and eating by later in the day.
If your pet required extractions, we will be sending home pain medications to help your pet’s recovery at home. If there are any concerns about infection, antibiotics may be deemed necessary by our veterinarians. These pain medications treat inflammation (Metacam), and nerve pain (Tramadol or Gabapentin). Pain control is necessary for a successful recovery and comfort at home. These medications should not be stopped until they are finished as prescribed or until otherwise directed.
Finally....
We will call you at your contact number after surgery to relay an update on your pet and schedule a discharge time for later in the day. The discharge time is with a technician to go over post-operative instructions, medications and answer any questions you might have.
A Note on "Cosmetic Anesthesia Free Dental Cleaning".
Thank You For Entrusting Us With Your Pet’s Care
The Glendale Team
