Pokey and I are on the floor, man and beast in a playful tussle. I poke, scratch, pull, and tug on the genial Lab-mix, using my fingers and arms. I fake a left jab and poke him with my right hand. His only recourse is to duck and jump, first in retreat, then, with lips drawn in a mock snarl, pouncing on me and mouthing my hands and shirt. Fortunately, Pokey came from a family of nine puppies, cared for by seven home-schooled kids, so he was well socialized as a puppy and knows how to mouth-play without biting too hard.

A dog’s mouth is his most intimate connection to the outside world, his gateway for primary contact. He uses his mouth for sustenance, investigation, and communication. He uses his jaws as a tool; they can carry, crush, slice, gnaw, grind, or, as in Pokey’s case, gently grab and render my “superior” hands helpless.

The mouth is also the beginning point for the dog’s harvest of life-sustaining nutrients. The initial identification of immune-stimulating substances contained in whatever the dog ingests starts in the mouth. The tonsils, lying deep in the mouth, are a prominent site of lymph tissue, and the mouth is lined with other lymphoid elements – all of which transport immune-sensing information to the rest of the body.

It is important to keep this “gateway” function of the mouth in mind as we consider how to best deliver remedies to enhance the innate immune system’s ability to respond. Herbs that contact the mouth’s lymphoid tissues (that is, herbal remedies not encased within capsules) have the advantage of stimulating this early alert, immune-enhancing lymphoid tissue.

But from the perspective of a veterinarian, a dog’s mouth is mostly a primary site of disease. Periodontitis (inflammation of the tissues surrounding a tooth) and dental calculus (an accumulation of mineral salts on teeth) are respectively the number one and number two problems seen in dogs over seven years of age. Periodontal disease is present in an estimated 50 to 80 percent of all dogs.

Furthermore, there is evidence that periodontitis also predisposes animals to a number of diseases such as heart disease, diabetes, and even respiratory disease. At least one (human) study has indicated that poor oral health is a stronger predictor of heart disease than markers such as fibrino-gen (a clotting factor and indicator of inflammation), low HDL (good) cholesterol, or high triglycerides.

In addition, endotoxins have been isolated from calculus residues on the teeth of dogs, and there is anecdotal evidence (perhaps related to the endotoxins) that dental disease may also be responsible for (or at least increase the likelihood of) other chronic diseases such as arthritis.

Unfortunately, when it comes to pointing the finger at who or what is to be blamed for much of our pets’ dental problems, “We have met the enemy, and they are us.” We have created at least a two-fold problem.

First, we have bred dogs for cuteness; many of the toy breeds have jaws too small to accommodate all their teeth. This forces teeth to grow abnormally and the resulting misalignments and malocclusions create foci for future calculus buildup. Second, our commercial foods don’t provide the tooth-cleansing effects of pulling meat and other soft tissues off raw bones, as well as time-consuming gnawing on raw hide and bones.

The canine mouth
The dog’s teeth and gums are the most important considerations in the mouth, both because the incidence of disease of the teeth and gums is so high, and because their influence on overall health and disease is so profound. However, I’ll briefly mention other structures of the oral cavity and oropharynx (an ill-defined area that includes the posterior part of the oral cavity and the pharynx) and give a brief list of potential problems that may occur in them.

The oral cavity is an open-ended tube that functions in prehension (the act of seizing or grasping), mastication (chewing), fluid intake, taste, and swallowing.

The relative size of the dewlap and amount of flesh associated with a dog’s lips are characteristic of the individual breed. Facial expressions are controlled by the lip muscles,which are innervated by the facial nerve. Several cranial nerves innervate the dog’s fleshy and highly active tongue, providing muscular control and sensory innervation from the taste buds – round, prominent structures on the posterior portion of the upper surface of the tongue.

Salivary glands open into the oral cavity; saliva provides an acid medium along with bacterial-fighting substances that help to keep any disease process from proliferating in the mouth.

The palate forms the dorsal roof of the oral cavity, separating it from the nasal cavity. The caudal (rear-most) part of the palate is the soft palate, a mobile structure that functions during swallowing to restrict access of the food bolus into the nasal area. The epiglottis is a cartilaginous structure that moves to open the trachea (wind pipe) during inspiration; during swallowing, the epiglottis moves to restrict the opening to the trachea.

The palatine tonsils are elliptically-shaped lymph nodes lying on the lateral walls of the oropharynx within crypts formed by folds of the pharyngeal wall. In the dog they are normally visible, and in puppies they may stand out of their crypts.

The right and left condyles (rounded projections on a bone) of the mandible (lower jaw) articulates with the temporal bone of the skull at the temporomandibular joint (TMJ). Omnivorous animals classically have a large condyle that permits up and down and lateral movement. In the carnivorous dog, which has smaller condyles with only limited lateral movement, the TMJ is limited largely to hinge-like movements.

Canine dental structures
A dog’s deciduous (baby) teeth erupt between two weeks and eight weeks after birth. From two to six months of age, the baby teeth shed as the permanent or adult teeth erupt. Eruption time varies according to breed; the larger the breed, the earlier the eruption sequence. Dogs seldom show signs related to teething; the most frequent problem encountered is retained deciduous teeth. Retained baby teeth need to be removed to prevent buildup of calculus on them, and anesthesia may be required for the process.

Eruption and full growth of the crown of all the permanent teeth is complete in most dogs by 10 to 12 months; however, the tooth roots (especially of the canine tooth) may not be fully developed until as late as 30 months of age. (This is a consideration if a young dog fractures a tooth.)

Most dogs exhibit a so-called “scissor bite” wherein the maxillary (upper) canine tooth (“fang”) fits behind the mandibular (lower) canine tooth, and this lower canine fits between the upper canine and the upper lateral incisor (front teeth). Breed selection, however, has resulted in major variations in normal occlusion in the dog. Maloccluded teeth (teeth that don’t align properly into the scissor bite) are relatively common in toy breeds and in dogs with pronounced over- or under-bites. Dogs with malocclusion are more prone to calculus buildup.

The dental unit consists of the teeth and their supporting tissues, the periodontium. The latter consists of the gingiva (gums), the supporting bony portion of the tooth’s root structures, and the periodontal ligament.

The teeth vary in size, shape, and number of roots, depending upon location and function. A tooth consists of a mass of dentin surrounding the innermost pulpal tissues. The root portion of the dentin is covered with cementum; the crown portion with enamel. Enamel provides resistance to wear and protects underlying dentinal tissue from damage or caries (cavities). Penetration or removal of the enamel exposes the nerve endings located in the dentin.

Around the circumference of each tooth is a one- to two-millimeter deep gingival sulcus (groove or furrow) between the gingiva and enamel surface of the tooth. The sulcus is the site where food particles and other debris most frequently accumulate, leading to inflammation of the gums and eventual calculus buildup.

Diseases of the mouth
Dental calculus buildup and the resultant peridontitis is the most significant disease condition of the mouth, both in terms of numbers and potential for severe long-term disease; this process is dealt with below. Other diseases of the oral cavity include:

• Stomatitis – Infections anywhere within the oral cavity. These can be caused by any number of microorganisms and are often induced by trauma or injuries.

• Glossitis – Infection of the tongue. Also commonly due to injuries, ingestion of caustics, licking sharp objects, or biting into electrical cords.

• Ulcers – These can occur anywhere in the mouth, but they are more common on the gums opposite heavy accumulations of calculus. They are often related to an immune deficiency, so treatment should include herbs or other alternative medicines to restore balance to the immune system.

• Hyperplasia of the gingiva – Most commonly due to periodontal disease. (See also epulis.)

• Epulis – A nonspecific term applied to benign, tumor-like masses of the gingiva. These may occur in any animal, but some breeds (Boxers, for example) seem to have a high incidence, indicating the possibility of genetic involvement.

• Lip-fold dermatitis – Inflammation at the fold of lips, between the upper and lower lips. This condition is oftentimes secondary to periodontal inflammation, but may also be due to toxic materials leaching out of plastic food and water dishes. Switch to glass, porcelain, or stainless steel dishes.

• Neoplasia – Cancers of the mouth can be aggressive, but initially they are difficult to differentiate from the benign epulis. If you see a growth in the mouth, get an accurate diagnosis via a biopsy, fast.

• Temporomandibular Joint (TMJ) problems – The joint may be subluxated, a condition that may be exacerbated by calculus buildup. The pain of subluxation can lead to symptoms similar to those of oral disease – refusal to eat, slobbering, painful to the touch, etc. If your dog exhibits these signs, consider having a veterinary chiropractor check him out; deep massage often returns the TMJ to normal function (providing the calculus has been removed).

• Secondary conditions – Oral lesions may occur as a secondary problem, related to diseases such as uremia and diabetes.

Treating oral diseases
Conventional treatment for most of these diseases consists of antibiotics, possibly along with glucocorticoids and/or antihist-amines. My experience would indicate that alternate therapies almost always work as well as, or better than, any conventional treatment I once used.

I think the most important component for oral health (after teeth cleaning) is the immune system. Consider herbs (such as echinacea) and other herbal medicines, which can be used internally to enhance the whole body immune system, or they can be used as a tea or tincture as a mouthwash. (See herbal section below).

Nutritional support is almost as important. Add therapeutic levels (check with your holistic vet for correct dosages) of vitamins A, C, and E, and herbal and other antioxidants such as coenzyme Q10, thyme, goldenseal, or myrrh. Acupuncture and/or homeopathy can be added if necessary; I have both to be helpful when treating oral cancers.

Periodontal disease
Periodontal disease is the general term used to denote diseases of the periodontium, and it includes gingivitis, periodontitis, and periodontal abscess. Periodontal disease is by far the most common oral disease found in all species and is arguably the most common disease condition seen in small animal practice. As previously mentioned, it is found in 50-80 percent of all dogs and its incidence approaches 95 percent in animals over two years of age. The severity of periodontal disease correlates with the quantity of plaque and calculus present on the teeth as well as with the age of the animal.

Plaque is a soft colorless coating found on tooth surfaces, from the crown extending deep down into the sulcus. Plaque is not readily seen by the naked eye unless it is either naturally stained by dietary constituents or is extremely thick. It can, however, be demonstrated by plaque-disclosing dyes.

Contrary to popular belief, plaque is not a food residue. Its formation begins with adhesion of bacteria onto a thin film of an acidic glycoprotein that precipitates from the saliva onto the enamel surfaces of the teeth. Unless it is removed, plaque formation is extensive after a day or two – further reason for daily brushings.

The accumulation of plaque is enhanced by the presence of surface irregularities, the most common of which is calculus. Brushing with a stiff-bristled toothbrush can scratch the tooth’s surfaces, and scratches may occur when metal scrapers are used to remove calculus – thus the importance of dental polishing after every dental cleaning procedure.

Calculus is a mass of calcium salts precipitated from saliva. Calculus is easily seen and appears as varying amounts of off-white, yellow, or brown crusty material on the teeth – often concentrated at the tooth-gingival interface. Calculus acts as a focal point that attracts and retains plaque, a characteristic that is even more important in the creation of disease than is its function as a mechanical irritant. It has also been shown that endotoxins from the bacteria found in plaque may be found in calculus.

Calculus is not seen to any great degree in animals younger than nine months of age.

Gingivitis is inflammation of the gingiva or gum. The first noticeable sign of gingivitis is a noticeably darker red color where the tooth meets the gum line. This early inflammation may lead to excessive growth of the gingiva, and as the gingiva grows, it tends to move away from its once-firm contact with the tooth. A blunt-tipped probe into the sulcus is diagnostic; the probe will normally penetrate one to three millimeters. Any deeper penetration indicates gingivitis. For most dogs, a complete oral examination, including probing the sulcus of all teeth, requires anesthesia or at least sedation.

The treatment for gingivitis is the removal of bacterial plaque from the surfaces of the teeth (tooth brushing) on a consistent basis. Conventional treatments might include chlorhexidine gluconate which, when applied to teeth, effectively treats established gingivitis; other antibiotics such as clindamycin, tetracycline, and metronidazole have also been used for treatment. However, plaque and gingivitis rapidly return when treatment is discontinued, and all these products carry with them the usual concerns about antibiotic use. We cannot expect any long-term results without consistent tooth brushing.

Clinical signs
There are several symptoms that may lead to the diagnosis of a problem in the dog’s mouth, including a change in eating habits, pawing at the mouth, abnormal salivation, oral hypersensitivity, facial swelling, draining tracts, obvious blood or bloody (or brown-colored) saliva, sneezing and nasal discharge, abnormal behavior (some dogs, especially old and cranky ones, can become even crankier when their teeth hurt), and eye changes (infections around the upper teeth or upper jaw area often cause swellings around the eyes).

Facial swelling is a common symptom of almost any disease of the oral cavity, and a thorough exam of the entire mouth and its structures is indicated whenever a facial swelling is noticed.

While all the above symptoms can be significant, the first and most important tip-off to dental or other oral problems is halitosis (bad breath.) A healthy dog’s breath does not smell bad; anytime your dog’s breath has an off odor, be suspicious of dental or oral problems. (Some digestive or metabolic upsets can cause off odors, but these are less common.)

Plaque is difficult to see without staining aids, but calculus is easy to spot; it’s the chalky or crusty-looking, off-white or brown stuff on the surface of the teeth, and it is often associated with a reddened gum line.

One of the problems with diagnosing tooth conditions is that, oftentimes after an initial painful period, the pain and any other associated symptoms go away but the condition remains. This is a further reason for a complete inspection of all the far reaches of the oral and oropharyngeal cavities.

Holistic dental care
For humans, ideal dental care consists of twice daily tooth brushing, rinsing with a mouthwash, tongue cleaning, irrigation, and the addition of supplements that support oral health. For our dogs, most of these are impossible, so we rely on daily brushing, food supplements that support oral health, at least several times a week chewing on hard food (foods designed to clean teeth and/or bones), and periodic professional cleanings.

• Nutrition – Two aspects of a dog’s diet are very important for maintaining dental and oral health: The dentrifice (cleaning) activity of the diet, and supplements that can help maintain healthy teeth and gums.

Many people promote diets that include raw bone – both in the form of recreational chew bones and in raw bone that is consumed – crediting both the mechanical action of chewing the bones and the nutritional benefit of a fresh, natural calcium supplement. (For more on this topic, see “Bones of Contention,” September 2000 and “Dem Bones,” August 2003.) Others prefer to give their dogs rawhide or other chews for their dentifrice action. (For selection tips, see “What Choosy Chewers Choose,” May 2003.)

There are a number of nutritional supplements that can contribute to oral health. In all cases, check with your holistic veterinarian for proper dosages and for the length of time to continue the doses. All doses depend on the severity of the disease and on the size of the dog. Larger, therapeutic doses may used for the short term; maintenance doses may be given over longer periods.

Vitamins A, C, and E can be given for their antioxidant activity; vitamin C also helps aid healing. Vitamin A can be given at doses from 5,000 to 10,000 IU per day. Vitamin C (crystalline ascorbic acid) can be given from 250 milligrams to several grams daily. Vitamin E can be given from 200 up to 2,000 IU daily. I repeat: Discuss this supplementation with your vet.

Coenzyme Q10 is a potent antioxidant that reduces damage to cells, and has been shown to be especially beneficial for reducing gingival inflammation and periodontal pocket depth in humans. The typical recommended dosage is 0.25 to 1.0 mg per pound of body weight per day.

Bioflavinoids, especially rutin and hesperidin, are required for the formation of collagen, the protein building block for gum tissue, cartilage, and bone. They also play an important role in maintaining a competent immune system. These are available within the formula of some toothpastes, or they may be added to your dog’s diet as a supplement, from 50 to 500 mg daily.

• Herbs – Almost any herb or herbal combination that has antibiotic, vulnerary (wound healing), or astringent activity can be useful in helping to fend off oral disease; the key is to find herbs with a taste your dog doesn’t hate. I look at herbal teas as a mouthwash substitute for dogs. It’s true you can’t get a dog to swoosh the fluid around in the mouth and then spit it out. But if we use teas that can be swallowed, just the contact of the tea with the oral cavity and teeth can be beneficial.

Green tea is known to be especially beneficial for preventing oral and dental problems. (In humans green tea has been shown to help prevent cavities, and there is some evidence that it may reverse the progress of oral cancers.) First, try the brewed green tea, straight, in your dog’s water dish. If he rejects that, try adding a little meat broth as flavoring.

For drinking teas, also consider calendula (Calendula officinalis), chamomile (Anthemus nobile or Matricaria chamomilla), thyme (Thymus vulgaris), and yarrow (Achillea millefolium). Any of these will help prevent oral disease, and chances are good that your dog will eventually begin to like their taste.

For treatment of oral lesions, a strong herbal tea or tincture can be simply squirted into the mouth. Or you can make a slurry (some herbal product, boiled with a small amount of water, just enough to make into a slurry) and apply it directly to the lesions.

Herbs to consider for treatment include barberry (Berberis vulgaris), red root (Ceanothus americanus), agrimony (Agrimonia eupatoria), myrrh (Commiphora myrha), and goldenseal (Hydrastis can-adensis). Unfortunately, many of these herbs are not especially tasty.

• Acupuncture – Acupuncture can be an effective means of treating some oral disease. Most of the treatment protocols call for treating through the Large Intestine, Stomach, and Small Intestine meridians, with points along the Conception Vessel and Governing Vessel also commonly included.

• Homeopathy – Many homeopathic remedies are used for tooth problems, but most of these are related to specific types of tooth pain that only someone who can speak can describe. Fragaria (wood-strawberry) is a special case remedy that has been used by some homeopaths to help enhance the removal of and to prevent the buildup of calculus – always with the caveat that the only true way to prevent calculus is to keep plaque off the teeth.

Some homeopathic vets report that they have seen calculus disappear in animals when they use a constitutional remedy for other conditions. I have not personally witnessed this, but I have treated animals that were able to go much longer between professional cleanings while we were using the dog’s constitutional remedy – after we had initially cleaned the teeth.

However, I have had reasonably good success using homeopathy for treating oral cancers. By that I mean that the rare successes I have had almost all came from homeopathic treatments – always relying on finding the animal’s constitutional remedy. (For more on homeopathy, see “Tiny Doses, Huge Effects,” June 2000.)

Also With This Article
Click here to view “Dog Teeth Cleaning: Don’t Deny Dental Health”
Click here to view “Oral Diseases in Dog”
Click here to view “Clean Teeth, Healthy Dog”

-Dr. Randy Kidd earned his DVM degree from Ohio State University and his Ph.D. in Pathology/Clinical Pathology from Kansas State University. A past president of the American Holistic Veterinary Medical Association, he’s author of Dr. Kidd’s Guide to Herbal Dog Care and Dr. Kidd’s Guide to Herbal Cat Care.

[Updated December 18, 2018]

ANESTHESIA-FREE TEETH CLEANING OVERVIEW

1. If your dog’s teeth are tartar-encrusted, or if his gumline looks inflamed, schedule an exam with your vet. Make sure she is aware of all of your dog’s health issues, and ask for her treatment recommendations.

2. If your dog’s teeth need cleaning, but he has health problems that put him at risk for complications during anesthesia, ask your vet whether she will perform an anesthesia-free teeth cleaning. If she declines, make it clear that you will seek the services of a veterinarian who will provide the service.

3. This is not the time for bargainhunting. Whether or not anesthesia is used, be prepared to pay for appropriate supportive measures as needed: blood tests, IV fluids, antibiotics, and/or pain-relieving drugs. Any or all of these may be needed to maximize the safety and effectiveness of the procedure.

Most of us have seen signs or advertisements for “anesthesia-free teeth cleaning” for dogs and cats. To most people, this sounds like a good idea, especially if you have a really old dog, a dog with a heart condition, or any other dog you’d hesitate to put through general anesthesia.

The procedure can be a terrific service for some dogs, but only if rendered under the direct supervision of a veterinarian, if not by a veterinarian. Unfortunately, some vets don’t offer the service – often, because they don’t believe it’s necessary. This pretty much guarantees that some pet owners will seek out non-veterinary technicians who perform the procedure – illegally – in grooming shops or pet supply stores.

We suggest that dog owners who are concerned about the risks of anesthesia ask their own trusted veterinarians to provide dental cleanings without anesthesia – and to seek out another veterinarian who does provide the service if their own veterinarian does not or will not. Here’s why:

Teeth Cleanliness Means Dog Healthiness

Tartar-encrusted teeth are not just unattractive; they are absolutely dangerous to a dog’s health.

Just as with humans, tartar or calculus forms on a dog’s teeth when plaque – a combination of salivary proteins and bacteria – accumulates on the teeth and is not brushed or mechanically scraped away by vigorous chewing. And just as with humans, some dogs seem more prone to tartar accumulation than others. Some of this may be due to an inherited trait; it’s also thought that the chemistry in some dogs’ saliva seems to promote tartar formation.

However it happens to accumulate, the mineralized concretion acts as a trap for even more plaque deposits. Soon, the gums become inflamed by the plaque, and bacterial infections may develop. Yes, the dog will have bad breath and unsightly red gums. He may experience pain when he’s eating his food, playing with toys, or during recreational chewing. Chronic mouth pain can cause behavioral changes, including crankiness and sudden onset of “bad moods.” But even more serious dangers are lurking unseen.

When plaque deposits begin to form in proximity to and then, gradually, under the dog’s gums, the immuno-inflammatory response begins to cause destruction of the structures that hold the dog’s teeth in place: the cementum (the calcified tissue that covers the root surfaces), periodontal ligament (connective tissue that helps anchor the teeth), and alveolar bone (the bone that surrounds the roots of the teeth). As these structures are damaged in the inflammatory response “crossfire,” the teeth can become loose and even fall out.

A more serious danger is the bacterial infection and resultant inflammation in the gums, which can send bacteria through the dog’s bloodstream, where it can wreak havoc with the heart, lungs, kidney, and liver. Dogs with chronic health problems that affect these organs and dogs with immune-mediated disease are at special risk of experiencing complications due to periodontal disease. For this reason alone, owners of these dogs should be the most proactive in keeping their dogs’ teeth clean.

Fears Around Teeth Cleaning with Anesthesia

People whose dogs are in poor health, however, are often the most reluctant to schedule a teeth-cleaning. Most frequently, they cite the effects of anesthesia on their dogs’ already compromised health as their biggest concern. In many cases, though, there are more serious things they should be concerned about, because the fact is that the vast majority of dogs, even old ones, come through the anesthetic experience without peril, as long as the veterinarian provides appropriate supportive care. (See “What You Should Know Before Your Dog Receives Anesthesia,” WDJ November 2002, for a detailed article about the safest anesthesia protocols and how to insist on them for your dog.)

Far more perilous than properly administered anesthesia are the risks posed by dental “technicians” who are not well trained or are inexperienced, and who are working without the benefit of veterinary support or supervision.

Undoubtedly, some of the people who provide “anesthesia-free teeth cleaning” services outside of veterinarians’ offices are well-educated and experienced. Some may be former (human) dental hygienists or licensed veterinary healthcare technicians. Some do a terrific job.

But the fact is, no matter how talented or experienced or well-educated they are, if they are not working with a vet who will perform a complete physical examination of the dog before the procedure and provide care afterward (if needed), they are performing veterinary medicine without a license. And because their services are illegal, it’s not possible for a consumer to confirm their credentials or even have legal recourse if they injure or harm a client’s dog.

The Best Candidates for Anesthesia-Free Teeth Cleaning

Fortunately, some veterinarians now offer anesthesia-free dental cleanings in their clinics, in recognition of the fact that some dogs may be adversely affected by anesthesia, and yet would benefit from dental care. The best candidates include dogs with tartar-encrusted teeth who exhibit any of the following:

• Poor kidney and/or liver function (detected with a blood test)

• Congenital heart defects (including murmurs), impaired heart function (such as congestive heart failure) or arrhythmia

• A recent injury or infection of any kind (even skin infections, including “hot spots,” are good cause to delay scheduling any procedure that requires anesthesia)

• A history of seizures (some preanesthetic sedatives can lower the seizure threshold)

If your dog has one of the conditions listed here, or another health problem that concerns your veterinarian, he may be a good candidate for anesthesia-free teeth cleaning. But you should understand that the procedure is not a walk in the park; it can be hard on the dog, and the cleaning is necessarily less thorough than one conducted with the dog asleep.

“It’s so much easier to do a good job on a dog who is asleep,” says Jenny Taylor, DVM, founder and co-owner of Creature Comfort Holistic Veterinary Center in Oakland, California. “You get a vastly more thorough examination and a much better cleaning when the dog is unconscious.”

To do a good cleaning, the veterinarian or technician will need to spend long moments on each tooth – the cute ones in the front and the difficult-to-reach ones in the back. The outer surfaces (closest to the lips) are the easiest to reach and are always the most tartar-encrusted, but even the surfaces on the inside of the dogs’ teeth (closest to the tongue) should be examined and cleaned. This is tough to accomplish with even the most compliant dog.

Also, working without anesthesia may require the vet or technician to work without the benefit of the fastest and most effective tool in the teeth-cleaning arsenal: the ultrasonic scaler. Few dogs will sit still in the face of its noise and vibration, so the vet frequently can use only hand-held scalers. It can be difficult to manipulate the sharp tools with the required force to remove stubborn calculus without causing inadvertent injury to the dog’s gums, tongue, or lips, especially if he’s wiggling.

Finally, there is the dog’s experience to consider. A few happy-go-lucky dogs will comply with any procedure dreamed up by humans, as long as they get kisses and treats. But for some dogs, it’s torture. “People need to understand that working in the mouth can be a traumatic experience for some dogs,” warns Dr. Taylor. “We do a lot of things to keep the dog as comfortable as possible, but the procedure can cause some discomfort. Some dogs can tolerate a little pain and not hold it against anyone. But others can get upset no matter how tactful we are.”

For all of these reasons, even veterinarians who perform anesthesia-free teeth cleaning for certain dogs may promote an anesthetized procedure to the owners of dogs who are not at any special risk of complications from anesthesia. “Sometimes an anesthetized procedure is the kindest, safest thing for the dog,” says Dr. Taylor. “You have to consider each dog’s case individually and weigh all the factors: health, age, condition of the teeth, and temperament.”

Don’t Neglect Your Dog’s Teeth

In the best of all possible worlds, dog owners would provide appropriate home care to prevent their dogs from developing tartar buildup and gingivitis. (Some dogs go through their entire lives with sparkling white teeth, with absolutely no effort on their lucky owners’ part; we’re not talking about them!) For dogs who develop tartar buildup very quickly, daily brushing can go a long way to reduce (although, probably not eliminate) the need for professional cleanings.

For people who have concerns about professional teeth cleaning with anesthesia, then, prevention should be key. Maintaining your young, healthy dog’s mouth is largely a matter of daily discipline.

If your dog has already developed tartar accumulations, though, don’t despair. But don’t delay taking action, either, because tartar leads to gum disease which leads to systemic disease. Recent human health studies, in fact, have suggested that there may be a link between periodontal disease, heart disease, and other health conditions, and that gum disease may be a more serious risk factor for heart disease than hypertension, smoking, cholesterol, gender, and age. So get that dog to your vet’s office and map out a management strategy. It might take just one cleaning to get your dog back on a healthy track, enabling you to maintain his pearly whites thereafter.

Don’t Clean Without a Vet!

But in case we haven’t already said it clearly enough, don’t just have a groomer or technician clean your dog’s teeth in the back room of a pet supply store. A veterinarian should examine your dog before his teeth-cleaning appointment, and may want to give you antibiotics to give the dog a few days before the cleaning takes place and for a few days afterward. Even if a dog owner sought out a technician who was not working under a veterinarian’s supervision, this one thing could make the difference between life and death for some dogs.

Another reason why a vet exam is critical: She may judge your dog to be a poor candidate for any sort of teeth-cleaning, with or without anesthesia. If your dog has advanced periodontal and/or active infection in his gums, any sort of cleaning may be temporarily out of the question. He’ll need antibiotics to get the infection under control before dental work should proceed.

And if your vet judges your at-risk dog to be very near the end of his life, if he is very ill, or if the amount of gingivitis (inflammation of the gums) is relatively minor considering the amount of tartar present, she may suggest not cleaning the dog’s teeth after all. In these cases, often the vet will opt to treat the dog with an occasional dose of antibiotics to reduce the bacterial burden, and monitor the response. If the dog improves sufficiently, she may proceed with an abbreviated, gentle cleaning.

Dr. Taylor began offering anesthesia-free dental cleaning in her practice specifically to ensure that her clients who were worried about anesthesia wouldn’t just sneak off to a back-room technician for their dog’s dental care. “I want my clients to discuss their fears with me, so I can help them understand all of the ramifications of their decisions, and help them plan the most effective and safest course of treatment for their dogs,” she says. “If they really want the anesthesia-free service, I’m happy to provide it – along with any other needed support. This may include antibiotics, but it also includes flower essences, aromatherapy, and maybe even acupuncture to help reduce the stress of the cleaning.”

It’s a model we wish all veterinarians would emulate.

Unless They Work With a Vet, They Work Without a Net

In the United States, only licensed veterinarians, or certain healthcare workers who are under the direct supervision of a veterinarian, may legally clean your dog’s teeth. (“Healthcare workers” include licensed, certified, or registered veterinary technicians, veterinary assistants with advanced dental training, dentists, or registered dental hygienists; “under the direct supervision of a veterinarian” means with a vet in the same building, who will examine the dog and check the tech’s work.)

Some technicians allege that this is a matter of veterinarians protecting their revenue. They claim that teeth cleaning isn’t rocket science, and that an experienced technician can do as good a job or better than most vets. The vastly lower price they charge for the service, they say, encourages more pet owners to have their pets’ teeth cleaned more frequently. This is all true.

But because of the risks of harm that can be done by an unskilled or poorly educated technician – or even a skilled one without veterinary backup or supervision – we suggest making sure your dog’s teeth are cleaned in a veterinary clinic.

Inexperienced technicians, especially working on a wideawake dog, might not notice dental problems that need professional veterinary dental care, such as a fractured or loose tooth, extra or retained teeth that are causing orthodontic problems, or advanced periodontal disease. Dogs with the latter condition (especially small and tiny dogs) risk jaw fractures caused by weakened, diseased bone.

There are also plenty of non-dental health problems that a non-veterinarian may fail to notice, such as early signs of oral tumors, enlarged lymph nodes, or certain odors in the dog’s breath that can indicate other disease processes (sweet, fruity breath can indicate diabetes, and the odor of urea can indicate kidney failure). A vet can take a tissue biopsy or pull a sample for a blood or urine test if she notices one of these signs, thus diagnosing serious health problems in their earliest stages; of course, a technician working without a vet cannot.

The most likely problem that can be caused by a technician who has no veterinary supervision, however, is infection. Teethcleaning unleashes a storm of bacteria into the mouth and into the bloodstream. For dogs with cardiac problems and many other illnesses, this can be fatal – if not countered with preemptive as well as postoperative antibiotics, which are legally available only with a veterinarian’s prescription.

Recently, Oakland, California, veterinarian Jenny Taylor had a client bring her dog in for an emergency visit, admitting she had recently had her dog’s teeth cleaned by a technician, who suggested she get the dog to a vet for antibiotics immediately.

“I would have preferred that the tech had declined to clean the dog’s teeth until the owner got the dog on antibiotics,” Dr. Taylor says ruefully. “But at least the tech was competent enough to recognize a case where the dog really needed to get prompt follow-up care from a vet. By insisting the client follow up with a vet, he took the risk that the vet would report him; some might have just risked the dog’s health and kept their mouths shut.”

Nancy Kerns is Editor of WDJ.