Nov 30 2017

Non Anesthetic Dentistry Words Of Caution

Brook A. Niemiec, DVM, DAVDC, FAVD

Proponents of nonanesthetic dentistry (NAD), also called anesthesia-free dentistry, exploit unfounded fears regarding general anesthesia, promoting NAD as an economic alternative to traditional procedures.

In reality, NAD procedures are not only ineffective, but also potentially dangerous and as expensive (if not more so) than properly performed cleanings under anesthesia. With NAD, teeth are scaled by nonprofessionals in a conscious patient. Some practitioners and/or companies may tout a “training course” or “certificate” in their “proprietary” technique, but these types of courses offer just a few hours to days of insufficient training. With unskilled operators working on awake (moving) patients, scaled teeth are often left with roughened surfaces.  Combined with the lack of polishing, these factors lead to much faster disease recurrence.1, 2, 3A complete dental prophylaxis or cleaning is an involved process.4, 5, 6 The detailed steps may vary depending on the practitioner, but achieving a positive medical benefit should minimally include supra- and subgingival scaling (ie, cleaning above and below the gum line), polishing, sulcal lavage, oral examination (including periodontal probing), and charting.7, 8, 9, 10 Of the required steps for an effective cleaning, only the first step (supragingival scaling) can be partially performed without anesthesia. Furthermore, even this step is poorly performed in nonanesthetized patients, especially on the lingual/palatal surfaces and in the back of the mouth Moreover, the single most important step of a prophylaxis (subgingival plaque and calculus removal) cannot be done properly without general anesthesia.16, 17

Patients are often seen following NAD with clean crowns but significant areas of subgingival calculus.  This is likely the biggest problem with NAD service, as it gives a false sense of improved dental health for pets. Numerous clients are upset when dental disease is diagnosed despite repeated investment in NAD and the appearance of “clean” crowns in their pet’s mouth. These clients feel that they have failed their pet, allowing them to progress to significant disease despite well intentioned efforts. Many of these patients present for severe halitosis, but some may present after the NAD practitioner has manually extracted several teeth. This author repeatedly treats regular NAD patients needing multiple extractions to resolve severe dental disease who received NAD as recently as 2 weeks prior, including one patient who required extractions at 38 teeth which were “cleaned” within 21 days of presentation.

A tooth-by-tooth oral examination with periodontal probing is another critical step of a proper dental cleaning.18, 19, 20 Oral disease often has subtle clinical signs, even in cases of significant infection Without anesthesia, a complete oral examination is impossible.21, 22 Finally, even when a limited examination is performed by NAD practitioners, they are essentially diagnosing dental disease. This is, by any standard, practicing medicine without a license.

Proponents of NAD tout it as being safer than general anesthesia, but this is not true. This procedure carries a high risk for iatrogenic damage. The sharp instruments required for a proper cleaning can lacerate delicate gingival tissues if the patient moves, which is repeatedly seen and reported. Jaw fractures and neck injuries have been seen following restraint for NAD, and the risk for aspiration pneumonia from the lack of intubation is of high concern.

In contrast, well-performed general anesthesia is very safe. When current standards of multimodal anesthesia are performed with appropriate monitoring, rarely are there complications. One study suggested that mortality risk in healthy dogs was 0.05%.23 Since these practices had widely varying anesthetic protocols and monitoring, ideal anesthesia protocols and monitoring should improve this number even further.24

Based on the numerous limitations and dangers of NAD, the American Veterinary Dental College has drafted a position statement against this procedure.

ndensmore |