What are the animal welfare issues with anaesthesia-free dentistry?

Anaesthesia-free dentistry involves physically restraining a conscious animal, to remove calculus and tartar from the surface of their teeth and is generally performed by non-veterinarians who are not trained in dentistry. It may be offered as a cheaper or easier alternative to professional dentistry under anaesthesia but it does not prevent or treat dental diseases, and can cause significant pain and distress to the animal.

There are a number of animal welfare issues associated with anaesthesia-free dentistry, including the following [1]:

• It does not allow a complete examination of the teeth, gums and mouth, leading to delayed diagnosis and treatment of potentially serious dental problems;
• It causes unnecessary pain, anxiety, and distress to the animal; and
• It does not address gum or tooth disease and just makes the teeth look externally clean while potentially masking underlying disease.

Dental disease can occur above and below the gum line, as well as anywhere in the mouth. Therefore, complete dental examination involves probing above and below the gum line, scaling and removing tartar, polishing, and taking X-rays to fully assess the condition of the teeth and mouth [1]. The back of the mouth must also be accessed to check each individual tooth, and to evaluate the tissues surrounding it. It is not possible to perform a full examination of the mouth in a conscious animal, anaesthesia is needed. In particular, areas below the gum line cannot be thoroughly examined and X-rays cannot be performed in a conscious patient, thus the presence of disease is missed [2]. Studies have shown that 28% of normal looking teeth in dogs, and 42% of normal looking teeth in cats had important findings on X-rays [3, 4]. Dental X-rays are an important part of dental assessment and can only be obtained while the patient is under anaesthesia and immobile.

If a full dental assessment is not performed, this can lead to ongoing pain and discomfort, and delayed effective treatment for the animal [5]. Anaesthesia-free dentistry only examines and cleans teeth superficially, without addressing the underlying disease.

Above: Tooth of a cat with gingivitis (shown by reddening of the gum, highlighted by the orange arrow), showing what looks like a relatively normal looking tooth (image reproduced with kind permission from Dr Tara Cashman, President of the Australian Veterinary Dental Society).

Below: The same tooth showing extensive destruction of both the tooth root and crown (the part above the gum line). This shows on the X-ray as grey fluffy looking areas (highlighted by the orange arrow and circle), compared this to the adjacent healthy tooth root and crown showing on the X-ray as a solid white tooth (highlighted by the green arrow and circle). This is a feline resorptive lesion and is a very painful condition. (Image reproduced with kind permission from Dr Tara Cashman, President of the Australian Veterinary Dental Society), demonstrating the importance of dental X-rays to uncover serious dental disease which could otherwise be missed.

Above: A dog’s tooth before probing – highlighted by the orange arrow and circle (Image reproduced with kind permission from Dr Tara Cashman, President of the Australian Veterinary Dental Society).

Below: The same tooth as above after probing. There was minimal tartar present on the tooth before cleaning but there was this very painful fracture present – highlighted by the orange arrow and circle (Image reproduced with kind permission from Dr Tara Cashman, President of the Australian Veterinary Dental Society). This shows the importance of a full dental examination to discover serious dental disease which could otherwise be missed. It also demonstrates the importance of the patient being under anaesthesia so that they are unable to feel pain.

If an animal is not anaesthetised for dental examination and cleaning of their teeth, they will experience mild to moderate pain, and more extensive procedures such as tooth extractions would cause severe pain. Providing good animal welfare involves the prevention and management of pain [5] and this cannot be achieved with anaesthesia-free dentistry.

It is stressful and uncomfortable to examine the teeth and mouth fully if the animal is conscious. For anaesthesia-free dentistry, the pet is often physically restrained for a prolonged period of time, causing unnecessary stress and fear. This creates a traumatic experience for your pet. In addition, it is not possible to adequately protect an animal who is not anaesthetised from inhaling bacteria and fluids (such as blood, water, and saliva) which are all usually present in the oral cavity during dentistry.

It is also unsafe for the operators and handlers to perform dental work when the pet is not aneasthetised [1]. Sharp dental tools can injure a moving patient, dental operator or handler and a distressed pet may bite or scratch.

Modern anaesthetic agents used by veterinarians are safe and anaesthetic complications are rare. Animals are closely monitored by veterinary staff throughout the procedure and until they fully recover. Prior to anaesthesia, screening is performed to identify and manage any risks involved. This includes a full physical exam and reviewing your pet’s medical history. Your veterinarian may also advise some laboratory tests to obtain further information where indicated.

Taking your pet for regular general health and dental examinations with your vet can help to prevent, identify and manage dental disease. When indicated, dental work under general anaesthetic ensures that your pet gets the professional dental treatment that they need safely, while ensuring that they are not in pain and minimising their stress.