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Avatar universal

Pomeranian 6 years 6 months old dental cleaning. I'm worried about anesthesia.

My 6 year 6 month Pomeranian went in for his yearly shots. We finally got a good look in his mouth and found that he has 3 loose teeth. One tooth fell out 2 weeks after his yearly visit so back to the vet on Thursday was told no sign of abscess or infection. I gave him bones used enzymatic toothpaste when HE would allow me yet it didn't work out and I feel terribly about this. He was supposed to go in for a dental last year but I put it off b/c my friends said I was insane to put a dog under anesthesia for a cleaning and I was scared to put him under and didn't know what I know now. Moderate build up on some teeth and he needs a dental. I'm having a consultation w/the vet on Monday and hopefully will have him done next week. He banged his snout a few weeks ago while chasing a cat would that cause the teeth to become loose? Now that's the background here's the issue. I'M DEATHLY AFRAID of him going under the anesthesia. I know tooth loss and decay causes worse problems but I've been crying myself sick and have been ultra nervous about this. I thought I was doing the right thing by giving him bones and brushing with the enzymatic toothpaste but I just couldn't reach all the areas.
I'm afraid he will die at the vets. It's terrible I've lost sleep and can barely eat. I just feel my best friend is going to be lost. Can you please tell me any precautions I can ask the vet to do? I heard certain small breeds don't do well under injection anesthesia and should be given as gas, but on the website it says they pre-medicate with an injection, then IV medication to lose consciousness then gas to keep them under. I heard bad stories about the injections and I'm fearful. This is an animal hospital that is AAHA certified. This isn't a vet dentistry office. Do I need the specialist or am I OK at this vet(this vet also performed my dogs neutering using Isoflurane anesthesia. Does isoflurane involve the injections too or is it just gas? Could his heart and kidneys be damaged?
37 Responses
931217 tn?1283484935
MEDICAL PROFESSIONAL
Dear Wtps,

I understand your anxiety and dilemma only too well. This is an example of justified anxiety about anesthesia being weighed against allowing ongoing disease to progress.

Unchecked dental disease, especially when infection is present, often "seed" bacteria to the blood stream with disturbance such as chewing or other normal activities. That can in turn cause colonization in such places as the heart valve leaflets, kidneys and pancreas. Indeed, a paper published last year in the human literature, tied untreated periodontal disease to human pancreatic cancer. So that is the benefit of addressing dental disease regularly and thoroughly, avoiding progression and new problems, some serious.

The down side, is the risk of death with poorly administered general anesthesia, and much less common, but still plausible unseen and unknowable idiosyncratic adverse reactions.

In a young, otherwise healthy animal such as yours, the risk of anesthesia may be less.

In a brachycephalic (short-faced) breed, there are added challenges and risks with anesthesia. No question, careful management of this and every pet is of course warranted.

In the end, only you can weigh the risks and benefits of going ahead with the procedure. If in doubt, get a second opinion from a dental specialist in your area.
One can be found at:

http://www.avdc-dms.org/dms/diplomates.cfm

Finally, please read my blog and associated links on the risks of anesthesia here:

http://www.medhelp.org/user_journals/show/162049?personal_page_id=864097

Please let us know what you decide and how it turns out. Thank you.

Sincerely,

Arnold L. Goldman DVM, MS
MedHelp & PDOC
931614 tn?1283486270
MEDICAL PROFESSIONAL
I agree with Dr. Goldman.  I am a member of the American Veterinary Dental Society and am working on my specialty degree.  You are encouraged and welcome to see a veterinary dentist as Dr. Goldman said, "http://www.avdc-dms.org/dms/diplomates.cfm"

Many non specialists do a good job with veterinary dentistry, but seeking another opinion should help you understand that the minimal risks of anesthesia significantly out weight the large risks of dental disease that is present and progressing now.

Please read these files.  It explains the need for dental care as well as anesthesia risks.  Please be aware that this first one mentions prices from 1997, which are about 1/2 of what they may be today, given advancing technology and increased costs of drugs.
http://www.toothvet.ca/PDFfiles/mythology.pdf

http://www.toothvet.ca/PDFfiles/Dental_Truths.pdf

I would not hesitate to do the dental with anesthesia.  Please be sure that pre-operative bloodwork is done as well as IV fluids during the procedure (to support blood pressure, speed recovery, help flush bacteria (from mouth) through the body, and provide an emergency port should a problem arise.)

Please let us know should you have further questions or concerns.  It is a plus that your veterinary hospital is an AAHA hospital, but it does not require them to do every thing, it suggests that they can and will and likely do require the best medicine for your pet.
Avatar universal
Dear Arnold L Goldman, D.V.M., Jennifer Mathis, D.V.M.,

I want to sincerely thank you for the wealth of information that you both provided me with. I greatly appreciate the time you spent helping me. You have educated me and put my mind at ease (I'm not going to lie I'll be a wreck the day he goes under though). I decided that I will have the dental done at the same place that he was neutered because I really trust our veterinarian there especially since we had not one issue with the neutering. I knew waiting this long would not be the best thing to do however I thought his teeth would be OK and thought that the risk of anesthesia was worse than the need(boy was I wrong and I feel terrible about that). I strongly feel that he needs this and it is necessary and just know that it's for his better health and a longer life with me!

We go next week for the consultation and I made a list of everything to ask our Dr. (Most of my questions are addressed on the Dr.'s website but I just want to be sure)

Since he had Isoflurane in the past I'm assuming he was only given gas for his neutering and will ask (if possible) that he receives the same since there were no issues in the past. I'll also ask what our Dr. recommends if that can't be done.

I thank you both tremendously for your responses. I was able to calm down and think rationally about the situation and you both provided me with information to make an informed decision. There was no doubt in my mind he needed this, I just worry so much about him because he is so special to me and the thought of losing him is the most painful thought. I realize now more than before that worse things can happen if you let this go too long.

I pray that his pre-blood-work panels come back healthy. I'm going to be vigilant about dental care after this whether he likes it or not :)

I will update you both once I know more. I just know I'm not going to be able to leave the facility until I know he's done and he's back in my arms with tail wagging. I'm so attached to my boy and the bond we have is amazing.

Thank you both again so very much! Your kindness and helpfulness helped me tremendously.



Avatar universal
We had our consultation appointment and exam today. We had blood taken for pre-anesthetic blood work and I asked for urine to be taken as well. The results will be back tomorrow 2/23. I'm praying there are no abnormalities.

It turns out his periodontal disease isn't moderate as we were first told by another veterinarian but it is severe. We also discussed the Porphyromonas vaccine, but I don't feel that I will go with that at this time. I'm going to do a prescription diet after the cleaning and use oravet as well as brush and give good chews.

I will update tomorrow with results. I really hope he is OK. I'm so scared.

Our vet said that they use propofol as part of the procedure. As well as the isoflurane gas. He also mentioned valium pain meds for take home. Does this sound right? The thought of propofol scares me.

I found that he will be monitored as if he was a human during the procedure.

However when I asked if they had a fibrillator the Dr. said they don't have one and told me how in his scope of practice they've never needed one and using one probably wouldn't unless the heart is in a certain way(sorry I can't remember the technical terms)

Is it ok that there's no fibrillator? This is the same vet that did my boys neutering without a problem and he's a wonderful vet.

Your thoughts and suggestions/feedback would be appreciated. Anything I missed etc. Thank you so much.
931614 tn?1283486270
MEDICAL PROFESSIONAL
Using an iv or im drug prior to isoflorane is the best medicine.  I would not worry about the propofol - that's good medicine to make it less stressful your little boy's procedure.

It's okay that there's no fibrillator.  At the university emergency clinic, they once commented that it was almost an unnecessary piece of equipment it rarely changes the outcome even when used promptly properly.

I hope valium is not the only pain med they're using.  I would recommend a combination pain protocol starting with an NSAID prior to the procedure (assuming he'll stay hydrated and warmed with IV fluids during the dentistry), a nerve block (think novacaine from your dentist, but slightly different) during the procedure, and ideally morphine during/just post op assuming teeth need extraction.  If bloodwork is good and fluids were given during the procedure, an NSAID should go home with you.

The porphormonas vaccine can be good, but needs a clean slate to be administered and may have a local swelling at injection site that is less so on the booster 1 month later.  If many teeth are removed, it may not be worth doing until the mouth has healed, but it is a beneficial vaccine.  A dental diet and oravet are good choices.  I use CET veggie dents in addition to those two home care options for my little dog.  A combination approach is best, but nothing will prevent the need for a cleaning in the next 6-12 months.  You will delay the buildup with your home care making the problems not as bad for future - ie less systemic damage over time.

Good job for taking care of your little guy!
Dr. Jen
931614 tn?1283486270
MEDICAL PROFESSIONAL
Oh, you mentioned brushing teeth.  I wanted to share a surprising fact from new research:  If you brush your pet's teeth 5, 6, or 7 times a week, brushing is beneficial for your pet.  If you brush your pet's teeth 4 times a week, it's equal to not brushing!
ie unless you can commit to brushing your pet's teeth AT LEAST 5 times a week - ie every weekday or practically every day, you may as well not brush.

Honestly, I cannot commit to that with my pet, so I just use oravet weekly and don't brush my dog's teeth.

Also, never pay a groomer/veterinary personnel to brush your pet's teeth.  Unless that person is doing a professional cleaning under anesthesia or you are also brushing your pet's teeth daily as well (which if you are, you likely wouldn't pay someone else to do it).
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