Dental discussion, including Dr. Lisa link

I'm cross-posting my condo from Lantus Land, since so many of us have questions about dental:

viewtopic.php?f=9&t=4087&p=39663#p39663

Jill & Alex answered many of my questions, and Jill provided a link to a very worthwhile discussion by Dr. Lisa:

http://www.felinediabetes.com/phorum5/read.php?8,73506

Here's the Dr. Lisa part. Visit my condo for the rest!

Dentals - General comments
Posted by: Lisa dvm (IP Logged)
Date: March 8, 2005 10:32PM

Some thoughts on minimizing any complications from dentistries.

1) I like to have antibiotics on board before the dental procedure ends up showering the body with bacteria. Any cleaning procedure will unleash a lot of bacteria into the system where it can damage kidneys, heart valves, etc. I recommend that the cat get a dose the night before, if possible, but at least an AM dosage the day of the dental. This usually means picking up the antibiotics the day before the procedure or asking your vet to be sure to give the antibiotics upon the arrival of your pet to establish a blood level pre-dental.

2) I recently attended a seminar on Anesthesia and Critical Care where the speaker strongly emphasized the need/benefit of lots of fluids associated with the procedure. I like to start my cats on an IV drip a few hours prior to the procedure, during the procedure and for a few hours after the procedure. Dr. Paddleford also recommended running the fluids at a rate that is much higher than the standard very low rate that most vets run. He stated that "overloading" with fluid was not a factor even at his higher rate.

Anesthesia, dehydration and hypotension results in lowered kidney perfusion and damages valuable nephrons (kidney tissue). Dr. Paddleford stated his opinion that even the most basic of anesthetic procedures can result in nephrons being damaged and could not stress strongly enough that fluids are critical to any anesthetic procedure.

3) Always ask your vet if a catheter is routinely placed. If the answer is "no", I would worry about the level of care being practiced. No cat should undergo a lengthy anesthetic procedure without IV accesss in the event that the animal goes into cardiac arrest.

4) I want to mention also, that any dental done without anesthesia is not only a waste of time, but cruel to the animal. There is no way that an adequate exam/cleaning can be accomplished in an awake animal. In addition to this issue, all an 'anesthetic-free' dental results in is a false sense of security in the pet owner that their pet's dental needs have been adequately addressed which is very far from the truth. The tartar that is seen on the outside of the tooth - that may be removed during an anesthesia-free dentistry - is not a problem with dental health. It is the area UNDER the gumline that is the issue and no awake animal is going to let a human probe under the gumline on the inside and outside of every tooth. Removing the plaque does serve some purpose in that it removes bacteria from the mouth and this is a good thing with regard to seeding the rest of the body with oral bacteria, but this issue is not pertinent to dental health.

Anesthesia-free dentals offered by lay people are illegal in CA and with very good reason.


Lisa, dvm
http://www.felinediabetes.com/phorum5/read.php?8,73506​

 

Kathy,

Thanks for posting this and the links. This is great additional information.

Especially, since I scheduled a dental for Maui next month!

Now, I've got more specifics to ask about regarding their procedures.

 

Do messy eaters need more dentals? :lol: Just kidding, Maui, just kidding.

 

I notice that I wrote this 5 years ago. How time flies!!

Things have changed since then and the boarded dentists are currently NOT in agreement with what I wrote (and with what some of them were saying) 5 years ago - in an effort to stop the overuse/abuse of antibiotics that I have spoken about so many times on this board with respect to urinary tract issues.

ABs are NOT being routinely used in the manner that I stated in 2005. They are being reserved for cases where oral infections have been documented - on a case-by-case basis - but not in a general manner as I discussed in 2005.

 

DR. LISA - Please clarify

So, Dr. Lisa,

Just so we are all clear on what you are saying today in 2010 - do you still agree with your 2005 statement, about giving AB prior to dental or not?

Thanks,

 

No - I do not.

Taking it one step further, I do not necessarily agree with always giving AB's post extractions - per the boarded dentists on VIN and from everything else I have read on this subject.

If the nidus for infection (the bad tooth) had been removed, the ABs are often not warranted.

All that said, keep in mind that NO 100% blanket statements can be made regading this issue. Guidelines can be discussed but this issue still needs to be considered on a case-by-case basis.

The problem is....*generally* speaking....that there is FAR too much CYA ('covering your butt....) going on in this profession with respect to handing out ABs and we need to pull back on handing them out like candy and start to critically evaluate each case more carefully to decide if their use is warranted.

 

PS......this will also mean that more re-checks could be needed in certain cases.

In other words, if you and your vet are on the fenceline about ABs and decide not to use them, then it just makes sense to present the patient back for a re-check to make sure the decision was appropriate for the case.

A re-check is a hassle for the client and the cat but it beats abusing their body with unnecessary meds and....abusing the antibiotic with regard to overuse.

 

Thank you Dr. Lisa for chiming in with the update. The times have certainly changed! When I found my current cat (Dillon) on the street about 6 years ago, he had a total trash mouth (blood-red gums, a thick green crust encasing his actual teeth) but was otherwise healthy (FeLV/FIV neg, etc) and I would have been shocked at the idea of no antibiotics. A year ago he had a full mouth extraction (but for the canines) due to his FORLs and severe gingivitis, and went home with plenty o'pain meds but nary a dose of antibiotics. And by that time he was a 11-12 year old cat with some whispers of CKD. It just isn't warranted in otherwise healthy cats, even if they have trash-mouth. That said, if you have a cat with a serious concurrent health issue or a cat who is on immunosuppressive drugs, a good talk with your vet is in order. Some drugs and underlying diseases can predispose animals and humans to post-operative infection.

The only other point I'd make about dentals is the "new" trend of nerve blocks for dental extractions. Similar to what human dentists use but in many cases longer-lasting, this form of extended analgesia can be a real blessing. For cats with any other type of health issue it can help keep the general anesthesia light (by blocking the pain signals from the mouth that would force an animal awake) and reduce the need for pain medication during the immediate recovery period. Board-certified dentists and anesthesiologists are using them but more and more general practitioners are learning this very useful skill. I wouldn't expect all GPs to be doing them yet, but it's worth asking for.

 

Jess, could you tell me more about nerve blocks? Considering that Squeak likes to attempt a run for the bridge every time an opiate is even in the room with him and sometimes even with other stuff, anything we can do to reduce the drugs in his system would be very much appreciated.

Jen

 

I strong DITTO to all of this!

Thanks, Jess, for bringing up the issue of nerve blocks. My friend who does my dentals is now using nerve blocks. I just wish that more vets would become better educated about this issue.

Jen - start the ball rolling with your vet and suggest that he/she look into this issue.

 

Lisa, I shall

 

Does anyone have an opinion on the use of antibiotics post-extraction in relatively poorly controlled diabetic cats?

Human diabetics often have impaired wound healing:

"After treatment. Clinicians should keep in mind these postoperative considerations. Patients with poorly controlled DM are at greater risk of developing infections and may demonstrate delayed wound healing. Acute infection can adversely affect insulin resistance and glycemic control, which, in turn, may further affect the body’s capacity for healing. Therefore, antibiotic coverage may be necessary for patients with overt oral infections or for those undergoing extensive surgical procedures."

Source: "Dental management considerations for the patient with diabetes mellitus." Lalla et al, J Am Dent Assoc, Vol 132, No 10, 1425-1432, 2001. http://jada.ada.org/cgi/content/full/132/10/1425

I'm inclined to believe this is also the case in cats; we've had a few cases in the German Forum where a single shot of antibiotic given after the procedure did not provide sufficient antibiotic coverage and an infection developed.

 

Hi Kirsten

I think the majority of vets who don't routinely recommend antibiotics would recommend them in such patients. Animals with glucose-packed urine and blood are decidedly more prone to infection. Some would probably go with ABs even in diabetics with better regulation, as a safeguard. Personally if I had a tightly controlled (always euglycemic) cat who was otherwise healthy, it'd be practically impossible to get me to use antibiotics for a dental prophy. I have a more extensive understanding of infection, immunity, and AB use than people in other fields need bore themselves to acquire, however, so I think a general rule of antibiotics for diabetics with dental infections isn't unreasonable.

I think it's important to remember that a lot of the diabetics on this board get dentals because their humans notice their BGs spinning out of control. The combo of an apparent infection, stress, and uncontrolled BG levels in an older diabetic cat make for a good case for the use of post-dental antibiotics. I comment on these dental threads not to snatch antibiotics away from cats who are systemically ill ;-) but rather to voice disagreement with the "all cats need ABs, every dental, every time" in the dental checklists that pop up here every so often.

 

Here is a link for dental nerve blocks:
http://www.toothvet.ca/PDFfiles/LocalAnesthesia.pdf

 

Thanks Larry!

 

Thank you Dr. Lisa for clarifying your recommendations as they are today. I am looking at dentals on two of my cats, one for what I think is a general cleaning and the other may need an extraction and has other medical issues (early kidney disease).

Years ago when they had dentals, they did the week of AB's prior and week following. With your new thoughts on AB's for dentals, it is helpful to know, so when I go to vets for their pre-dental visits/consults, they can examine, we can discuss if this is needed or not.

I have an appt. for Maui (general cleaning) with the regular vet, a pre-visit for checkup and BW and plan to ask all the questions then and will inquire about pain blockers.

The other dental is for Sydney and the vet told me I need to take her to a specialist (board certified dentist) as she isn't comfortable with their office handling the dental (really the anesthesia part - due to the kidney issues - wanting fluids overnight before).

So, before I make this appoint for a consult, I'd like to get all my questions prepared and understand how the specialty place will do things vs. regular vet.

All these discussions and information are really helpful in ensuring that I am prepared and informed and know what to ask.


Thanks!