From Admission to Recovery: A Day in the Life of a Dental Patient – Explained Our Vet, Bob

Sometimes, vets will throw around terms like “dentals” and seemingly just expect that everyone understands what we mean, while in reality it may very well leave you with many questions unanswered. Where will you take my pet? What happens whilst they are awaiting their procedure? What happens when they are under anaesthetic? And what exactly does the term “dental” mean? Well, I am here to hopefully answer those questions with a little guide to what actually happens once that consult room door closes.

The admit

This bit you may or may not be familiar with. The first step in the morning of your pet’s procedure is an admission appointment with our nursing team, which is both for our benefit and for yours. It gives us a chance to perorm a quick check of your pet’s health on the day, including measuring their heart and breathing rate, and gives you a chance to ask any questions you may have about the procedure. There will be a consent form that will likely have been given to you in advance of your booking, which is full of questions which give us lots of helpful information to ensure we provide the best care for your loved one during their time with us.

Your admission appointment usually takes about 10-15 minutes, and then your pet will be taken to the most dreaded of places……….. ”out the back”!

In the prep room

The prep room is the hub of the practice when it comes to procedures. All animals that are admitted go via our prep room, where they are weighed (if not done in the waiting room at admit), any blood samples are taken, intravenous cannulas placed and further checks made by our operating vets.

Once they have finished in prep, your pet will proceed to their own VIP kennel space, complete with bedding and water for all pets, and a litter tray and castle (if needed for hiding) for cats.  Any blood samples are run and the results will be evaluated before we move forward with treatment – your vet will be in contact if anything unexpected is shown on the results.

The anaesthetic induction process

Once we are happy to go ahead with the procedure, we will give your pet a ‘premed’. This is usually a combination of two drugs that provide mild sedation to calm any nerves as well as strong pain relief. This generally takes 10-20 minutes to take effect, and once it has the patient is moved through to the dental room. Once in the dental room cannulas are placed (if not already done so) in one of their front legs, and an induction drug is injected until your pet is fully asleep. Once asleep, an endotracheal tube is placed in the windpipe and connected to an anaesthetic machine in order to control delivery of anaesthesia throughout the surgery.

Providing both the vet and nurse are happy that the patient is fully asleep, the dental itself will start.

First steps

The very first thing I do during a dental is charting. For our pets, this is pretty much the same as when you have been sitting in the dentist chair yourself and they are poking around in your mouth reading out an incomprehensible set of numbers to their assistant. Those numbers are short hand for the tooth we are currently examining (108, 208, etc), as well as the level of plaque or tartar present (0-3), and the level of gingivitis (0-3). We also probe around the gumline looking for any damage to individual teeth, any cavities or gum recession, and lots of other potential signs of disease. This is a great way for us to create a map of your pet’s mouth that we can refer to during the dental itself, and which will be kept as a record for the future.

When the charting is finished the next step is cleaning the teeth. We do this with a specialised scaler (the thing that makes a high-pitched scraping sound in your mouth), and aim to remove all of the plaque and tartar from teeth. This helps us further assess the teeth as tartar can hide a multitude of sins, and it also helps us obtain accurate diagnostic x-rays.

X-rays

Every single cat that ends up on my dental table will have full mouth x-rays. This is very important in cats as they can get a condition called resorption (see another of our blog posts) that can be hiding under the surface, and which can be very painful if ignored or missed. This is not the case in dogs; however, we do x-ray them if they have any problem teeth, or questionable ones. Dog mouths are a lot bigger (and a lot fuller) than cats so taking x-rays of their entire mouth is not usually feasible, especially in larger breeds like Labradors.

Now we have the imaging, we should have an accurate picture of what we are dealing with and can crack on with the surgery itself.

The surgery

I have used the word surgery here for a very specific reason, and that is that what we are doing during a dental is in fact surgical. People may imagine that all we do is yank teeth as hard as we can until they pop out of the sockets. Whilst this can occur in very diseased teeth that are already trying their very best to escape the mouth before we even get to them, it is rarer than you would think. The majority of teeth are still clinging on for dear life and need a lot of encouragement from us to remove them. Every tooth is attached to the bone of the jaw by what is called the periodontal ligament, which is literally designed to bend and not break as it needs to hold the tooth in place whilst withstanding external forces such as biting and chewing.

Before moving to performing any extractions, we will apply local anaesthetic blocks to numb the specific area and provide that extra bit of pain relief.

There are two ways in which we approach removing teeth:

1. Closed extraction
2. This is where we do not cut into the gum. Some teeth are starting to get a bit wobbly already, but are still difficult to remove. With a closed extraction we will use a drill to split the tooth between roots (if it is multi rooted), and then use a combination of two instruments, luxators and elevators, to slowly stretch and cut the ligament until the tooth wiggles out.
3. Surgical extraction
4. This is where we make what is called a gingival flap. A section of the gum is cut in order to fold it back, exposing the bone. The bone is then burred away with a specific tool to expose the root. This creates better visualisation for diseased roots, root fragments and stubborn roots, and allows us to remove them in a faster, more efficient manner. This technique is also used for crown amputations (where the root is not present anymore) and the crown needs to be removed on its own.

As you can imagine the time it takes to remove teeth can vary considerably – removing a tiny cat incisor is a completely different job than a whopping great canine from a mastiff!

After the tooth is out, we stitch any gingiva closed with suture material to help speed up healing. However, gums are fragile at the best of times and when there is inflammation present these stitched areas can be prone to breaking down. Thankfully gums are also expert healers and will repair even without stitches in the majority of cases, it just takes a bit longer.

Finishing up

Now that all the diseased teeth are out, the gums have been sutured in place and those remaining are sparkly clean, we will wake your animal up. This involves turning off the anaesthetic gas provision and switching to just oxygen, injecting any reversal drugs for the initial sedation, and a little bit of time. Once your pet is swallowing and their breathing tube has been removed, they go back to their kennel to recover, where our team of nurses monitor them closely until they are fully awake.

We will always offer a meal to your pet once they are fully awake, but do not be offended if our menu is not to their liking – some pets will refuse to eat with us no matter how nice we try and be, or how tasty the treats are that we offer.

And all that’s left after all that is to wait until their beloved owners (that’s you) come and rescue them from the clutches of the evil vets.

So, that is pretty much a dental in a nutshell. Hopefully this helps to illuminate how complex a dental procedure actually is, and how much work goes into it. Dentals are usually lengthy procedures, with average times being 1.5-2hrs, and I hope that you can all appreciate why they can take as long as they do.

Bye for now

Bob Smith

Veterinary Surgeon
BSc BVetMed MRCVS PGCertDent (WBIS)