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Dental Cleaning
Day of the COHAT
The following steps occur on the day of the scheduled COHAT:
Drop off- You will meet with the veterinary technician that will work closely with your pet during the COHAT. The technician will go over the consent forms, estimate for COHAT, and answer any last minute questions that you may have.
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Pre-operative Exam- On the day of the scheduled COHAT, your pet will have a pre-anesthetic exam by the veterinarian to ensure that there have been no significant changes from the original physical exam. This is an important step for us to feel comfortable that your pet is ready for anesthesia
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Preoperative medications- The morning of the COHAT, your pet will receive medications for pain and nausea. It is important to give pain medications to help control discomfort before, during and after the procedure. Pain control is most effective when started before pain begins. Pain medication also helps calm an anxious pet so that entry into anesthesia is a smooth process. Because medications and anesthesia can cause nausea, the preemptive nausea medication will help keep your pet feeling comfortable before and after surgery by limiting nausea.
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IV Catheter Placement, and IV fluids- Prior to anesthesia, your pet will receive an intravenous catheter to allow us the ability to give intravenous fluids. Intravenous fluids are an important aspect of anesthesia safety, as it helps maintain a normal blood pressure. Please note that we will shave a small amount of fur in the area of the IV catheter so that we can prep this area in a sterile manner.
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Anesthesia induction and Anesthetic Monitoring- When ready to begin the COHAT, your pet will receive an injectable anesthetic medication through their IV catheter. An endotracheal tube will then be placed into the trachea which will deliver both an inhaled anesthetic gas and oxygen to maintain the anesthetic plane. Monitoring vital parameters throughout the procedure is important. To accomplish this, your pet will be monitored by an anesthesia monitoring system, which will give us input on information like heart rate, respiratory rate, blood pressure, and oxygen/carbon dioxide levels. While the procedure is being performed by the veterinarian/technician team, another technician will stay with your pet at all times to monitor the vital parameters as well.
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Intra-oral Radiographs- To get started on the COHAT, we will take intra-oral radiographs. About 80% of dental disease is not visible to the naked eye. Radiographs help us look underneath the gum line where we can undercover hidden fractures, tooth root abscesses, loss of supportive alveolar bone, and unerupted teeth
Charting- We will thoroughly examine the crowns (visible portion) of each tooth and chart our findings. The charting parameters include how much tartar is on each tooth, the amount of gingivitis on the gums, the depth of gingival pockets, crown fractures, pulp exposure, attrition (damage from teeth rubbing against each other), enamel defects, furcation, and persistent deciduous teeth.
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Supragingival Calculus Removal- This is removal of the tartar you can see on the crown. We use an ultrasonic scaler to remove this tartar, like your dental hygienist does.
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Subgingival Cleaning- This part of the COHAT removes the tartar underneath the gum line. When tartar builds up underneath the gum line, the bacteria will cause destruction of surrounding alveolar bone and tooth loss. This bony destruction results in pain, and is one of the most important reasons why we perform COHATs- to prevent chronic dental pain.
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Polishing- After scaling, we will smooth out small defects and irregularities will be smoothed out by polishing the teeth.
Sulcus Irrigation/Lavage- This is done to remove the excessive polish and other debris found between the gingiva and the tooth. Water, air, and/or antibacterial solutions are used to accomplish this.
Tooth extraction- After we have performed the steps outlined above, we will determine if dental extractions are needed. We base this decision on the information gathered thus far in the COHAT. If a tooth is mobile, non-vital, fractured, has resorptive lesions, causing pain, or has an abscess, then extraction is the best option for your pet. The decision to extract a tooth is not taken lightly. We will call you during this time of the COHAT to explain our findings and let you know if and why we recommend extraction.
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Extraction of a tooth can be difficult, and is considered oral surgery. Dogs and cats have a big, deep root system- one that is genetically designed to keep the tooth strong when hunting. Their tooth roots are much bigger, and more strongly attached than our human teeth. In order to extract teeth, we start by doing a nerve block to give an added level of pain control. Next, we often need to create a gum flap, to move the gum tissue away from the area of surgery. We then use a high speed drill to cut double or triple rooted teeth into individual root segments. We use dental instruments to dig or drill around each root segment until we are able to get each section of tooth loose enough to pull it out. This can take some time in larger teeth. After removing a tooth, we take a second set of radiographs to verify complete removal of the tooth. The gum flap is then carefully stitched back together to cover the extraction site. At times, we may use specialized products in the gingival flap to help with bleeding or promote healing.
Doxirobe Application- Some teeth may have deeper pockets, but not require extraction In these cases, we will place an injectable antibiotic gel into the pockets (the space between the gingiva and the tooth). Doxirobe gel helps the gingiva re-attach the tooth, and the goal is to decrease the size of the gingival pocket.
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Recovery- After the COHAT is complete, we will turn off the gas anesthetic, and allow your pet to wake up. When ready, the endo-tracheal tube will be removed. Your pet is monitored very closely in recovery. We will continue to monitor vital signs throughout the afternoon of surgery.
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Discharge- Pets are discharged to go home typically mid to late afternoon. At the time of the discharge, you will again meet with the technician who will review COHAT findings and discuss at home care instructions.
