Cleaning a dog’s teeth is far more complicated than the same procedure is for humans. There is much more involved in the process, from when you drop off your dog at the veterinary hospital to the time you pick him up at the end of the day.

Before the dog’s teeth cleaning begins

After your dog is checked in to the hospital, his dental team will begin preparing him for the dental procedure. A veterinary technician will place an intravenous (IV) catheter, and collect a blood sample for pre-anesthetic blood work, including a complete blood count (CBC) and chemistry panel. The CBC checks for anemia and any problems with his platelets or white blood cells. The chemistry panel gives his team a view of his overall organ function, including kidney values, liver enzymes, proteins, and electrolytes.

Your veterinarian will perform a complete physical examination of your dog. Your veterinarian will contact you if any abnormalities are found on his physical exam or blood work that may increase his risk for an adverse event under anesthesia. Your dog’s dental procedure may be rescheduled for another day after these abnormalities are either addressed or resolved.

A customized sedation and anesthetic plan will be created by his veterinarian. This plan takes into account your dog’s age, pre-existing health conditions, and any medications your dog may be taking. Your dog will receive medications first to sedate him and then to induce anesthesia.

Once your dog is anesthetized, the veterinary technician will place an endotracheal tube in his airway (trachea). The endotracheal tube delivers both oxygen and anesthetic gas directly to his lungs and keeps him asleep during his procedure. It also protects his respiratory system from the bacteria that will be aerosolized during his dental cleaning.

The next step is to connect your dog to the anesthetic monitoring equipment that will be keeping a constant vigil over his vital signs while he is anesthetized. His heart rate, respiratory rate, temperature, oxygen and carbon dioxide levels, blood pressure, and electrocardiogram (ECG) are displayed on an anesthetic monitor. This allows the veterinary team to intervene should changes to his vital parameters occur during his procedure.

Tools and techniques for a dog dental cleaning

The veterinary technician begins the dental cleaning by removing dental calculus from his teeth using an ultrasonic scaler – the same tool that your dental hygienist uses on your teeth. The technician will also use the ultrasonic scaler to remove tartar that has accumulated underneath the gum line.

Then dental radiographs are taken of all your dog’s teeth. Most adult dogs have 42 teeth: 20 on the upper jaw and 22 on the lower jaw. Depending on the size of your dog, as few as three teeth and as many as eight teeth can be imaged on a single x-ray. Smaller dogs will need six radiographs to image all of their teeth while larger dogs may require up to 14 radiographs.

The veterinarian will then begin the process of examining the crown – the visible part – of each tooth. She will look for fractures, excessive wear, discoloration, and mobility of the teeth. Teeth that are fractured, gray or black, or that can be wiggled back and forth will likely need to be extracted.

The vet will use a dental probe to look for deep pockets between the teeth and the gingiva (gums). The presence of a deep pocket is indicative of underlying periodontal disease. She will also examine the radiographs of his teeth and take note of any damaged or diseased tooth roots or bone loss around the teeth. Teeth that have damaged or diseased roots or that have significant bone loss around them will likely need to be extracted.

Dog tooth extractions

Extracting a dog’s tooth is a multi-step process. The first step is to numb the region where the offending tooth is located by injecting a local anesthetic. Dogs can still feel pain even when they are under general anesthesia. Injecting a local anesthetic prior to extracting a tooth ensures that your dog will not feel pain during the procedure.

The next step is to create a gingival flap. A small incision is made in the gingiva on either side of the tooth. A flat, spoon-shaped tool called a periosteal elevator is used to lift the gingiva away from the tooth and the underlying bone. A high-speed dental drill is used to carefully burr away the bone that overlays the roots of the tooth. This process is called “making a window” over each root. Each tooth root is completely surrounded by bone. The only part of the bone that is removed is the part that covers the most superficial section of the root. This allows the veterinarian to visualize the root’s position within the bone and aids in extraction of the root.

Dogs have two types of teeth: single-rooted teeth and multi-rooted teeth. Multi-rooted teeth may have two or three roots. Prior to extraction, the crown of a multi-rooted tooth must be split into single-rooted sections. A high speed dental drill with a long cutting bit is used to carefully divide the crown along the position of each root.

Each tooth root is attached to the surrounding bone by a band of tissue called the periodontal ligament. This ligament needs to be carefully stretched and torn in order to release the root from the bone. A tool called a dental root elevator is used to stretch the periodontal ligament.

A dental root elevator has a long stem with a tapered half-moon shape at the end. The end is inserted into the space between the tooth root and the bone; this space is called the root socket. Then the elevator is gently rotated in one direction within the socket and held for 10 seconds. Pressure is released and then the elevator is rotated in the opposite direction and held for 10 seconds. This process is repeated until the root is mobile and can be elevated from the socket.

Elevating a single tooth root can take as little as 30 seconds for roots that are already loosened by severe periodontal disease. But if scar tissue has developed around the root or the root has become brittle, it can take up to 15 minutes to cleanly extract a single root. Brittle roots can break into multiple pieces, creating a situation where more of the surrounding bone has to be removed in order to retrieve each piece of root from the socket. This can be a long and frustrating process – and many swear jars have been filled to the brim during these types of dental procedures!

Once the tooth has been extracted, a dental radiograph is taken of the region to verify that all of the tooth roots have been completely removed. Any sharp edges of the surrounding bone are softened with a high speed dental drill using a rounding burr. The gingival flap is pulled over the top of the bone and sutured to the gingiva on the other side.

What happens after the dental cleaning

The final steps of the dental procedure include polishing your dog’s teeth and applying a dental barrier sealant. Polishing the teeth buffs out the microscopic scratches that the ultrasonic scaler can leave on the enamel. Plaque loves to grab on to those scratches and hang on, so polishing the teeth reduces the grippiness of future plaque deposits. Applying a barrier sealant prevents plaque-forming bacteria from attaching to the teeth for the first two weeks after a dental procedure.

After the dental procedure is finished, your dog will be woken up from anesthesia. His veterinary technician will remove his endotracheal tube and stay with him while he recovers from anesthesia. He will be ready to go home with you once he is able to stand and walk.

Your veterinarian will give you specific instructions about when to give your dog his first meal after his dental procedure and what to feed him over the next several days. You may observe some blood-tinged drool and facial swelling over the next 24 to 48 hours that will gradually subside. Your dog will go home with pain medications to take over the next several days. If he had a tooth root abscess, your dog may also be sent home with an antibiotic.

You will also be given instructions on how to maintain your dog’s clean and healthy teeth. This at-home dental care plan will likely include daily tooth brushing or dental chews (see “At-Home Dental Care for Dogs”). An annual dental prophylaxis (routine cleaning and examination under general anesthesia) will also be recommended.

Most dog owners are disappointed to hear that brushing their dogs’ teeth is a necessary part of maintaining the dental health of their dogs. Regular oral examinations and professional cleaning by a veterinarian is also needed, but this professional service is an adjunct to, not a replacement for, regular tooth brushing and other regular at-home dental care for dogs.

How Often Should You Brush Your Dog’s Teeth?

We brush our teeth at least twice a day. You may have noticed that the surface of your teeth will start to feel fuzzy when you get close to the next time you are due to brush your teeth. When you eat and drink, bacteria in your mouth begin to accumulate on the surface of your teeth. This creates a biofilm, which feels fuzzy when you run your tongue over it.

As the biofilm accumulates layer upon layer, plaque is formed—both on the surface of your teeth and below the gumline. Over time, plaque that is not removed by brushing and flossing becomes hardened and mineralized, forming dental calculus. This same process occurs in your dog’s mouth.

Brushing your dog’s teeth twice a day promotes good oral health and minimizes the risk of developing . However, even brushing just three times a week has been shown to provide a benefit.

It does not matter if your dog eats canned food, dry kibble, frozen fresh food, or a home-cooked diet. Any food in the mouth promotes the production of biofilm, plaque, and dental calculus. The exception to this are kibble diets that have been specifically formulated to remove plaque and tartar accumulation, such as the Hills t/d prescription diet.

How To Brush Your Dog’s Teeth

The key to introducing a dog to tooth brushing is to take it slow. Start with just rubbing your finger or a soft damp washcloth on the outer surface of your dog’s front teeth. Rub with a back and forth motion and concentrate on where the teeth meet the gums.

Once your dog is accustomed to this routine, start advancing toward the back teeth. The teeth on your dog’s upper jaw overhang the teeth on his lower jaw, so you may need to open his mouth slightly to rub the lower teeth.

If your dog will let you open his mouth to access the middle and inner surfaces of his teeth, add this into the tooth-rubbing routine. Many dogs are resistant to this, so if this is a game-changer for him, then don’t push it. You want the tooth-brushing experience to be a good one, not one that he dislikes.

Now you can move on to the next step. Introduce a soft toothbrush or a finger brush to the routine. Again, start with the front teeth and gradually move to the back teeth. You can use a toothbrush that is made for dogs, a rubber brush that fits over the end of your finger, or a soft toothbrush made for human babies. If your dog objects to the toothbrush but is still comfortable with a damp washcloth, you can use the washcloth as your brush.

The final step is to introduce dog toothpaste. Dog toothpaste comes in many flavors, such as chicken, beef, peanut butter, and mint. Put a little dab of toothpaste on your finger and allow your dog to investigate the smell and flavor. If he reels away from it, try a different flavor!

Do not use human toothpaste; it is not meant to be swallowed. We are not able to instruct our dogs to “rinse and spit,” so we need to use a toothpaste that is safe for his gastrointestinal tract.

For even more toothbrushing tips, click here.

How to Choose a Dog Toothbrush and Toothpaste

When selecting a dental health product, look for the seal of approval from the Veterinary Oral Health Council (VOHC).

Look at the toothpaste you use for yourself and look at the label. You will probably notice a small emblem on the label that states “ADA Seal of Acceptance.” This means that the toothpaste has met the standards set forth by the American Dental Association to benefit your oral health.

Your canine companions have a similar organization looking out for their oral health. The VOHC was formed in 1997 and has the support of the Academy of Veterinary Dentistry and the American Veterinary Dental College.

The VOHC does not test dental products. Instead, they accept applications from manufacturers of dental products to receive the seal of approval. The VOHC completes a rigorous review of the scientific studies backing the manufacturer’s claims. If the product meets the stringent standards set forth by the VOHC, then the product is accepted and is added to the VOHC list of approved products.

This is a voluntary program. A product that does not carry the VOHC seal of approval does not mean that the product does not work. But a product that has the VOHC seal of approval gives you peace of mind that the product has met a set of stringent standards, is safe, and is proven to work as intended.

Look for the “VOHC Accepted” logo when selecting a dental product for your dog. A list of approved products can be found here.

Brushing Your Dog’s Teeth is Not Enough!

It is important to note that starting an at-home dental care plan after periodontal disease has been diagnosed will not reverse that disease or stop its progression. If your veterinarian suspects that your dog has periodontal disease, the first step in addressing that problem is a professional dental cleaning and oral exam. Then you can successfully start an at-home dental care program once your dog’s mouth is a clean and healthy slate.

Anesthesia-free teeth cleaning for dogs is offered by anesthesia-free dental clinics and by many groomers. This may sound like an attractive option, as many people are anxious about having their dogs undergo general anesthesia. But the reality is that cleaning the teeth without the benefit of general anesthesia will do more harm than good.

During this procedure, the operator uses a tool called a hand scaler to remove dental calculus from your dog’s teeth. A hand scaler is a long, thin metal tool with a hook on the end. The hook has a sharp edge on the inside of the curve and ends in a sharp point. If your dog moves his head even slightly during the procedure, the operator can lose control of this sharp instrument and cause serious damage to your dog’s gums.

Hand scalers are not effective at removing dental calculus from underneath your dog’s gums or between the teeth. Dogs may not allow the operator to reach the teeth at the back of his mouth, meaning that only the front teeth can be scaled. Most dogs will not allow an operator to scale the inside surfaces of their teeth.

Anesthesia-free teeth cleaning does not allow for a full oral examination of all tooth surfaces and the gums. And the majority of early to mid-stage periodontal disease is hidden below the gumline. Only dental radiographs can give us the full picture of what we cannot see on the surface.

Anesthesia-free teeth cleaning can be painful and traumatic for your dog. It may even make him averse to any dental care plan (like tooth brushing) you try to implement at home.