Dental Health

Non-Anesthetic Dentistry (NAD) vs Anesthetic Dentistry

Non-Anesthetic Dentistry (NAD) vs Anesthetic Dentistry

The importance of maintaining a healthy mouth is, appropriately so, becoming more and more a priority. We understand one of the key parts of accomplishing this task is regular dental cleanings and dental radiographs. These require general anesthesia…and anesthesia can be scary! The inner dialogue has changed from thinking dentals aren’t necessary or worth the money, to knowing the benefit but wondering if it’s worth the risk.

Behind the Scenes: Bailey's Day at the Dentist (video)

One of our wonderful Golden Retriever patients, Bailey, stars in this montage to show you exactly what goes on behind the scenes at our hospital during your pet's routine dental cleaning under anesthesia.

From start to finish you get to see it all! This includes intubation, a tooth extraction, and a little blood. Fair warning for those who get squeamish!


Bailey the Dog; Dr. Allison Chappell; Mara Acevedo, LVT; Erin Waldrop, Technician's Assistant; and Bailey's Mom!

How To: Brush Your Dog's Teeth (video)

Dr. Rainwater and her dog, Zulie, demonstrate how to brush your pet's teeth. Just 1 minute, every day for healthy teeth and gums. You CAN do it!


  1. Use a pet-specific, enzymatic toothpaste instead of a human toothpaste.
  2. Start with a fingerbrush and work your way up to a toothbrush.
  3. Create a routine to brush teeth before a meal or treat to reward the behavior.
  4. Start slow! Let your pet lick the toothpaste as a treat and brush a few front teeth.
  5. Brush each tooth and the gum line in a circular motion.
  6. Focus on the outsides of the teeth. (The tongue will clean the insides.)
  7. Make sure to brush all of the molars in the back of the mouth - they're easy to miss.

From Your Pet’s Dentist

An Introduction to the Canine and Feline Dental Treatment Process

February is approaching, which the veterinary profession has designated “Dental Health Month” in primary care practices across the country.  Here at Daniel Island Animal Hospital, we want to put a special emphasis on the importance of dental care for your pets. In the next few blogs through the month of February, we will be addressing oral health and preventative care for dogs and cats.

Like many of my clients, I grew up with many dogs and cats and we never paid much attention to their dental health. I couldn’t tell you whether they had dental tartar or not. If dental care came up, it was a reaction to horrible breath, not eating, or bleeding from the mouth. Since those days, the veterinary profession has come a long way in recognizing the importance of dental health to the well being of our canine and feline companions.

What is dental disease?

Dental disease in pets is no different from that found in people. It all starts with plaque bacteria that colonize the tooth surface just as they do in our mouths. Without regular bacterial removal by brushing or chewing, eventually the bacteria develop into a hard cement called calculus or tartar. This cement grows on itself, and eventually the constant presence of bacteria causes inflammation of the gums, known as gingivitis, also generally called periodontal disease.  If the inflammation and bacterial infection continue to progress, they cause the gums to pull away from the teeth, causing deep gingival pockets around the teeth. Eventually, the gums recede from the teeth and the infection proceeds to destruction of the bone that holds the teeth in place, eventually causing them to fall out. Gingivitis and periodontal disease are a significant source of discomfort for many pets, and there may be other potential health risks associated with a constant bacterial infection in the mouth.

What’s involved in a “Dental”?

Unfortunately, many pets, ESPECIALLY pets that have sensitive or painful mouths due to dental disease, don’t really let us get a good look around in their mouths during a routine visit, much less allow us to do anything about a problem that we may see. This is why veterinary practices have developed the basic protocol for what is called a dental prophylaxis treatment, often referred to as a “Dental” for short.  Although preventative care is implied in the name, the process usually involves both the prevention AND treatment of dental disease.

If you think back to the last visit made to your dentist, hopefully you experienced a comprehensive evaluation of each tooth, measuring the gingival pockets, scraping away tartar, taking dental x-rays, doing treatments as needed, followed by thorough cleaning and polishing.  Your dentist should have also evaluated your mouth as a whole, including the gums and tissue of the insides of the cheeks, lips, hard palate, throat and tongue. The veterinary dental prophylaxis is no different – we have 30 (adult cats) to 42 (adult dogs) individual little tooth patients that need to be thoroughly evaluated and treated appropriately.

Why is it so expensive?

Unfortunately, our pet’s reluctance to voluntarily submit to a tooth-by-tooth evaluation makes anesthesia necessary for effective dental prophylaxis treatment.  Which leads to the biggest obstacle to pet dental prophylaxis treatment for most people - the cost.   Inhalant anesthesia, done properly with pre-anesthetic blood screening, appropriate premedication, temperature, circulatory, and respiratory system monitoring throughout the procedure (including ECG, blood pressure, carbon dioxide and tissue oxygen levels), intravenous fluid support, and post-anesthetic monitoring, adds a significant cost. However, it also adds a significant value to the procedure.

Removing calculus when pets are awake, or even performing“sedation” dentistry, where animals are placed in a mild version of anesthesia and tartar is removed by hand, is unequivocally rejected by the members of the American Veterinary Dental College as being inadequate (see  Removing the tartar you can see only addresses the visible part of the problem for pets with dental disease, but it doesn’t deal with the bacteria under the gum line, which is what leads to painful periodontal disease.  Unfortunately we just cannot safely and effectively remove tartar above and below the gum line, check for and treat periodontal disease, get full dental radiographs and thoroughly examine the mouth for other oral problems with an animal in an unpredictable state of sedation.  It’s unsafe for the patient, personnel and equipment and it is not providing the level of medical care that your pet deserves.

Now I will be the last person to ingnore or underplay the risks of anesthesia. It is ALWAYS a risk, for any person or pet, to undergo. However, when all the necessary precautions are taken and it is carefully monitored, anesthesia carries a fairly low risk for even older pets with other underlying medical conditions. When compared to the increase in welfare that can be achieved by removing a constant source of inflammation and infection that is present in the mouth of pet with dental disease, it is usually a risk well worth taking.

How do you “treat” dental disease?

In general private practice, we rely on removal of plaque bacteria and calculus and topical and/or systemic antibiotic therapy to resolve most of the dental disease we see.  In cases where the disease is severe, especially if there has been significant bone loss or there is an abscess at the tooth root (which we can see with our digital radiographs), then dental extraction may be necessary.  Since our dogs and cats aren’t out chewing up carcasses to survive, the loss of teeth is generally well tolerated and a much better alternative to continued pain and disease.  In some cases however, advanced techniques such as periodontal surgery, root canals, crowns and even orthodontic treatments may be the best option for your pet. At this time, we refer cases such as these to a board certified veterinary dental specialist on an individual basis. 

How can I prevent dental disease? 

Once the teeth and gums have been evaluated, cleaned and treated, we move on to the most important step – taking care of your pet’s teeth at home.  Home dental care, especially brushing to remove plaque accumulation, is the best way to extend the amount of time between necessary dental prophylaxis treatments under anesthesia. It is so very critical to your pet’s well being, that it has become one of my preventative care soapboxes, as my clients will attest to ;-)! In an upcoming blog I will go step by step through the process of brushing my own dog’s teeth, cat dental care and give tips on how to work on getting them to accept it.

Your job between now and then is to email us with ANY questions you have about dental care in your pets. In our final dental blog I will address any questions that come up directly, so that we can help all of you better take care of your pet’s teeth at home.

Do Vets Have Pets?

I have many!! I can fully relate to pet owners who find vet care to be expensive – it is. As a veteran veterinarian (translation = old), I have adopted many needy patients over the years, so I own pets with complicated, chronic medical conditions.

I know how frustrating it can be to have an itchy dog who continues to have outbreaks, no matter how many visits, how many medications and how many products you try. I have lost beloved cats and dogs to kidney failure, cancer, stroke in the middle of the night, and mega-esophagus of unknown origin. Even with all the money and knowledge in the world, we still lose them to “mystery diagnoses” because we just don’t know everything yet. There is more research to do!

As one of my friends frequently says, “it is what it is.” He also points out to young people on a regular basis that life is unfair, and the sooner they realize it, the happier they will be. Sometimes, in spite of all our best recommendations and attempts at preventive care, bad things happen. But the preventive care DOES help keep them happier and healthier for longer, so that money is definitely NOT wasted on our wonderful furry friends.

I often get questions about diet and preventive care in my own household and I am happy to share this information with you. At DIAH, we study literature constantly to keep abreast of the best evidence and most current recommendations, and we do follow them in our own homes.

Revolution: my cats all live strictly indoors and get monthly Revolution – a topical medication that prevents internal and external parasites. Even indoor cats get fleas – I guarantee it! They just hide it well.

Diet: my dogs and cats eat Royal Canin, Science Diet or Purina foods. I am aware that there is a lot of public opinion about pet food ingredients, most of it quite passionate - but these are the companies I trust to purchase quality ingredients and to formulate diets using the scientific information we actually KNOW about nutrition. This is one area that needs a lot of research and these are the companies spending millions of dollars doing it. The more “natural” pet foods are based on theory, not science.

Supplements: my dogs and cats each take an Omega 3 fatty acid supplement (AllerG-3) and a joint supplement (Dasuquin) daily. These supplements are at levels far higher than food companies can put into their diets (they go rancid.) We have great evidence to show they reduce the effects of arthritis, heart disease and some cancers. These brands have been tested in pets, so we know they actually get into their systems and do have positive effects. The Costco or other generic versions are not regulated and we just don’t know even if the ingredients are listed accurately, let alone whether they are bioavailable to our pet species.

Canine heartworm and flea control: my dogs take Sentinel and Comfortis monthly because they do not have a tick risk. When I take them to my parents’ farm, I put Preventic collars on them. If my dogs were exposed to ticks regularly, I would use Sentinel and Frontline Plus.

Dental Care: the absolute best care is daily brushing, but I cannot commit to that because of the number of pets I own (don’t ask!) Dr. Rainwater is a model pet owner – she brushes regularly. Instead, I use Aquadent water additive so that when my cats and dogs get a drink of water, they are also getting an antibacterial rinse. I give them Science Diet Prescription T/D Diet as treats daily – the kibble is large and requires chewing and is formulated to clean the teeth as they eat. We now know that canned and dry diets accumulate tartar equally on the teeth, so only dental treats or diets formulated specifically to clean as pets chew actually make a difference.

My rabbit and guinea pig are fed Oxbow brand food and I even purchase my Timothy hay from Nebraska because the quality is so much better than anything I’ve seen locally. Rabbits and ferrets also need monthly Revolution; Guinea pigs do not need parasite control.

I hope this has been interesting and informative for you. I want you to know that when we make recommendations, these are things we believe and understand to be accurate based on our years of education and literature review. We also are passionate about dog and cat health, and are not in the business of selling. Daniel Island Animal Hospital is just that – an animal hospital providing medical, dental and surgical care to pets. We carry most products we recommend for your convenience, not as an income-provider for us.

We’d love to have your thoughts and feedback and are happy to answer questions!

Dental Health for Pets

Why is dental health important?

Like us, your pets need regular dental care to keep their teeth in the best possible condition. The rate and amount of plaque which forms on a pet’s teeth is determined by genetic predisposition even more than diet.  Some breeds and certain individuals are especially prone to early periodontal disease, but all pets develop dental tartar eventually.

Plaque is made of food debris and bacteria, and if not cleaned off in this soft stage, will harden into dental tartar/calculus. The calculus is like cement, holding bacteria against the teeth, leading to an infection of the gums called gingivitis. As gingivitis worsens, it can result in infection of the periodontal ligament, tooth roots, and surrounding bone. Left unchecked, these lead to tooth loss, bone infection and a very painful and potentially debilitating condition for your pet.

Dental home care can significantly reduce the accumulation of dental calculus and may decrease the frequency and/or severity of necessary dental cleanings.  Small breed dogs and Greyhounds are at particular risk for extensive calculus accumulation and home care is especially important for them.

How do I take care of my pets teeth?

There are multiple approaches to providing dental home care. For pets at high risk for dental disease, we recommend that more than one strategy be used.


Finger brushes, pet specific tooth brushes or even children’s soft bristled brushes can be used along with an enzymatic toothpaste. Human toothpastes are not recommended.  Pet’s teeth need to be brushed 1-2 times daily to derive maximum benefit. If they are not brushed at least 3 times per week the pet derives little benefit from brushing.  Using enzymatic toothpaste as a treat and then gradually increasing your pet’s comfort level with having a tooth-brush or your fingers in their mouth can help train them to accept regular brushing. Providing a treat after brushing (such as a chew or their regular meal) can also help reinforce the behavior.

Dental Chews:

In order for a chew to be effective, your pet needs to work on it for at least 5-10 minutes. Although not as effective as brushing it can help to decrease bacteria in the mouth and help clean the teeth.  Hard plastic chew toys should be avoided as they can cause tooth damage. Caution must be used with rawhides and bones as both can lead to intestinal obstructions and other GI problems if not chewed completely.

 T/D Diet:

This is a special diet made by Hills Science Diet pet food company. It can be given as a main diet or as an after-meal treat. The structure of the kibble forms a mesh that helps to clean teeth as it is chewed.

Water Additives:

The product we recommend and carry is called AquaDent.  It has a dilute antibacterial ingredient called xylitol to help decrease the amount of bacteria in the mouth. Many owners report an improvement in their pet’s breath with its use and it can definitely decrease the rate of calculus accumulation, especially in cats. ***Xylitol is extremely toxic to pets when given in large amounts, such as the concentration found in many sugarless chewing gums. However, at the low levels in these products it is reported to be safe for dogs and cats.

October (2010) is Dental Health Month at Daniel Island Animal Hospital. $30 off dental cleanings and 10% off dental products. Call for an appointment - space is limited!