Today I’m a tetchy dentist

I’ve been getting feedback on a recent post (The Ten Commandments of Dentalism). Veterinarians saw the humor in it, and the clients who have read the explanation gave generally positive feedback.

There is, however, a small subset of readers who think that veterinary dentistry is just a way for vets to make money as they sit back and twirl their Snidely Whiplash mustaches. Why would owners spend $500, $600 or more to have the vet “clean the teeth” when it’s obviously something that can just be done by a groomer for $75? What a scam vets are running. 

The root of this particular problem (ha ha) lies in the verbal laziness of the veterinary profession for the last 40 years. We’ve always referred to this as a “dental cleaning” or, worse, a “dental”, which minimizes the actual procedure and reduces it to “tartar scraping” in the minds of clients.

It’s a professional assessment of the mouth, examining every square inch of real estate in there, probing pockets, taking x-rays, removing tartar in the least damaging manner possible, assessing periodontal disease, extracting diseased teeth or doing periodontal surgery, taking biopsies, repairing trauma, and more. But we call it a “dental”, which is a nonsensical term in itself.

(Frankly, I have trouble with the new acronyms that vets are using, too. Clients have no idea what a “COHAT” (comprehensive oral health assessment and treatment) or an oral APT (assessment, planning and treatment) means, either. Why can’t we just explain the procedure without resorting to verbal shortcuts? COHAT is just as meaningless as “dental” insofar as client comprehension of the value of what we do. )

Veterinarians have done little to distinguish their services from those of the groomers. We’ve allowed non-professionals to advertise that they are performing “just the same as the vet, without the anesthetic” without challenge. It isn’t the same. There can be no proper evaluation, and the groomer is in no position, even if they had the skills to recognize a problem, to actually do anything about it, so there is no proper treatment.

I’m also disturbed by the methods used by the anesthetic-free proponents. Most will not allow clients to observe the procedure, which bothers me. Some are sedating pets, sometimes without the owner’s knowledge or consent.

I’ve been dealing with dogs and cats for most of my life. I know exactly what it takes to get a pet to sit still while you stick something in the mouth and do things that are physically uncomfortable, not to mention painful. In the majority of pets this will require considerable forcible restraint. The clients are told it’s all “gentle” and “soothing”. I guarantee you it isn’t. It’s force to one degree or another, whether mild or strong, mental or physical, every time.

There are many reasons that veterinarians won’t consider doing this. Can you even imagine your vet saying, “He needs his teeth cleaned; we’ll just tie him up and hold him down while we do that, OK?”  Ain’t gonna happen. It’s just mean. The second reason is the potential for physical harm to the pet. Money doesn’t even make the list.

There are videos posted online by some cleaners showing what they obviously think are acceptable practices (or they wouldn’t post the videos themselves; it’s not like these are undercover investigations). I see small dogs tightly restrained in towels, fighting the cleaning. Larger dogs are physically held down. Every single one of these dogs is flipped onto its back, a position that most hate. Some groomers muzzle all dogs, even the most cooperative, with cords or leashes to allow access to the teeth without them licking or biting at hands or instruments.

In one video the text says that a loose tooth was found and it was “extracted” after the cleaning, by the person doing the cleaning. No analgesia. And apparently zero recognition that if one tooth is loose there is probably a great deal of underlying periodontal disease that, if it was addressed promptly, might allow the dog to retain more of its teeth for a longer time. Nope, nothing but a reminder that it’s really expensive to have this done at the vet, lip service to the concept that lack of tartar does not equal dental health, and that yearly veterinary checkups are a good idea (but not for routine dental care apparently).

The online videos are probably the “best of the best” as far as cooperative pets go, and even so there are a lot of animals who are trying really hard to be good but are obviously distressed to anyone who understand dog behavior and body language. It’s a tribute to their good natures and training that more people aren’t bitten doing this.

It reminds me of one of those investigative pieces on TV that I saw a while back, looking at the practices of some dentists in the USA who were physically restraining children to do dental procedures.You can see the public response in the comments section of that link. It looks like it’s definitely not OK to do this to kids, but apparently it’s OK to do the same thing to a dog or cat.

I know that pets are not kids, no matter what some owners feel. But we are talking about similar situations where you have a physically smaller subject who cannot comprehend the reason or necessity for the procedure, who is being physically forced to capitulate to a prolonged period of manipulation and discomfort, and who cannot remove himself from the situation.

Panic is often the result, and panic in a dog or cat is a heartbreaking thing to see. They revert to flight or fight, during which they can hurt themselves, and if they can do neither they shut down, which is interpreted as “finally cooperating” but which it so fundamentally is not.

In the last year I have treated two small dogs with acutely herniated discs in the neck after seeing a groomer for a “tooth cleaning”. These pets had no clinical signs of neck problems before, and started to show signs within hours of the procedure (one was already partly paralyzed when the owner picked him up from the groomer). That dog went on to require surgery on the neck to relieve the herniated disc, and the other recovered after a few weeks of medical care. Both can be directly attributed to restraint and struggling.

Another patient will no longer let me look in his mouth. He’s a very nice, well behaved Golden Retriever that became mouth shy immediately after having his teeth de-tartared (poorly) and receiving multiple lacerations to his gums from the instruments. He snaps if the owner tries to brush his teeth or pull his lips back. Obviously this doesn’t bode well for future preventive maintenance of his teeth.

Groomers seldom ask owners about health risks, because they often don’t know that physical restraint can kill pets with certain conditions. Two years ago a patient of mine, who was being treated for heart disease, went into congestive heart failure during tartar scraping and died that night. The person doing the cleaning was a dental hygienist who decided to branch out into the animal world and impressed everyone with her credentials. Unfortunately she didn’t understand basic medicine and didn’t refuse to perform this procedure in a risky dog.

And then there are the innumerable patients whose owners deny them proper and timely dental care because “he just has his teeth cleaned at the groomer”. This leaves them with ongoing disease and discomfort and worsening oral infection because the owners have the mistaken impression that the mouth has been “fixed”.

In short, I find anesthetic-free dental cleaning to be somewhere between highly uncomfortable for the pet and downright inhumane, fraught with the potential for direct physical and emotional harm, fraudulent as far as the benefits touted from removing tartar, and harmful in that it delays definitive treatment of disease. It is performed by people who probably mean well but want your money. “If they really cared about animals” they’d decline to perform these purely cosmetic procedures and refer you to a veterinarian for proper evaluation.