We chronicled the warning signs and dangers of dental disease in the first part of this series on oral health. Now it’s time to explore a teeth-cleaning procedure done right. It’s very important to ask the right questions and make sure your dog is taken care of during his teeth cleaning, as he will be put under general anesthesia and may need to have teeth removed. More on that to come. First, let’s walk through the teeth-cleaning procedure.

Step one: Anesthesia

Sundown has his IV in place and is ready for his injection of propofol to induce anesthesia. A vet should perform a check on your dog before inducing anesthesia to make sure he’s healthy enough for it. Blood work may need to be done. Sundown checked out fine; he is young and quite healthy so he was green-lighted for this procedure. You should ask what precautions your vet takes against anesthetic complications.

Step Two: Intubation

A breathing tube is inserted to protect Sundown’s airway during the cleaning. The purpose of the cleaning is to remove bacteria from under the gum line and his airway needs to be protected from inhaling any of that bacteria, debris or fluid from the cleaning. Sundown is also hooked up to an EKG machine to monitor his heart rate during the procedure and the cuff on his right-rear leg is monitoring his blood pressure. IV fluids are adminstered through a catheter via the pump positioned above his tail. Someone will be monitoring his vitals throughout the procedure, as well as after. These are all MUSTS when looking for a vet or vet tech to perform a cleaning on your dog.

Step Three: Comfort

A Bair Hugger warming blanket is wrapped around Sundown to keep him comfortable during the procedure. Warm patients feel better during recovery, wake up faster and have fewer complications.

Step Four: Cleaning and Polishing the Teeth

To the left, Sundown’s teeth are being cleaned with a water-cooled ultrasonic scaler and to the right, they are being polished to leave smooth surfaces. Plaque builds up more quickly on rough surfaces so by smoothing the tooth, it will be somewhat resistant to plaque build-up.

Step Five: Check the Underlying Bone Structure

Each tooth is probed to discover pockets, or abnormally deep spaces between the tooth and gum. A normal space is between two and four millimeters, depending on the size of the dog. The tick marks on the probe are one millimeter each. To the right, you see the probe goes to a depth of about five millimeters, which is abnormal and indicates the bone beneath the canine is degenerating. This can be slowed with proper and regular brushing, which will keep bacteria from accumulating beneath the gumline.

But in all likelihood, Sundown will eventually need to have his canines extracted. The good news is canines are predatory teeth and since he’s not in the wild, these teeth aren’t as important as his chewing teeth. You can opt to try to save the teeth via root canals or other dental procedures; your vet should be able to give you a referral to a canine dental specialist, if one is available in your area. But these procedures are costly and very involved, which can take a toll on your pet. Also, there’s no guarantee a root canal would even work to save the tooth, so it’s our opinion the best bet is to save a lot of time, hassle and money and do the extraction when the vet deems it necessary.

Above are Sundown’s lower-rear teeth. This is how the probe should look; a normal sulcus (or space between the tooth and gum) depth of one millimeter. This indicates healthy bone structure on Sundown’s chewing teeth. Again, as a domesticated animal, these teeth are more important to his overall health than his canines.

Step Six: Clean Below the Gumline

To the left, a hand scaler is used to remove calculus deposits under the gumline. A sonic scaler can’t reach this area when pockets exist. To the right, an application of Doxirobe gel is given; Doxirobe is an antibiotic gel that helps eliminate bacteria in small pockets.

Step Seven: X-rays

You may have noticed Sundown appears to be missing teeth. Dr. Vickers needed to make sure the missing teeth were not impacted below the gumline or poised to cause any other problems. The best-case scenario: there are simply no teeth below the gum. To the left, the tech is placing the film to x-ray missing teeth in order to rule out cysts and impactions. To the right, the dental x-ray machine takes images. To our relief, Sundown is simply missing teeth and will not need invasive extraction surgery.

But if such extraction was needed, we gave permission ahead of time to go ahead with what was needed. It is important to find out what your vet’s notification protocol is if they encounter an unexpected problem or complication.

Step Eight: Recovery

Sundown was monitored for several hours after the procedure. As previously mentioned, it is important to have someone monitoring your dog at all times during and after the procedure. This is how severe complications are avoided. Here are the before and after photos:

Give your dog a couple days before you resume brushing. If you see bleeding, wait another couple of days. It is important to resume brushing as soon as possible (without bleeding) and to be consistent! The less you do at home, the more that will need to be done at the vet. We will show you the proper way to brush your dog’s teeth in an upcoming part of this oral-health series.

Many thanks to the wonderful folks at Avenues Pet Hospital in San Francisco for providing us with these fantastic pictures to show what you should expect during a teeth cleaning. They are truly top-notch!