AAHA-accredited veterinary hospitals must anesthetize and intubate all dental patients under a new standard of care that challenges the practice of anesthesia-free cleanings seen increasingly in the industry.
The rule, part of the updated 2013 AAHA Dental Care Guidelines for Dogs and Cats, applies to cleanings and any other dental procedure.
"The guidelines state that general anesthesia with intubation is necessary to properly assess and treat the companion animal dental patient,” said Kate Knutson, DVM, president of the American Animal Hospital Association. "Because AAHA practices are expected to practice the highest level of veterinary excellence, AAHA’s leadership felt it necessary to update this dental standard so that they reflect best practices outlined in the guidelines.”
The standard, released publicly today after being disseminated to member hospitals, was approved in June by the AAHA board of directors.
The policy has the support of the American Veterinary Dental College.
"Dental experts agree with and endorse AAHA’s new mandatory standard regarding anesthesia and dentistry,” said AVDC president Jan Bellows, DVM, Dipl. AVDC, Dipl. ABVP.
Any AAHA practice scheduled for an accreditation evaluation on or after Nov. 1 is required to follow the standard. AAHA accredits more than 3,200 hospitals.
The policy shift came under fire from Josh Bazavilvazo, the founder and CEO of Pet Dental Services, which performs 15,000 teeth cleanings a year without anesthesia. He predicted that some AAHA-accredited hospitals he works with would drop their membership in protest.
"The veterinarians are very displeased with the new mandate—being told how to practice veterinary medicine,” Bazavilvazo said. "The AAHA board does not have its finger on the pulse of the everyday practice of medicine.”
Pet Dental Services, based in Costa Mesa, Calif., employs 25 full-time veterinary dental hygienists over 11 states to perform what Bazavilvazo calls "preventive maintenance” in between routine anesthetic procedures with radiographs.
AAHA acknowledged that some members may end their affiliation.
"Whenever we pass new standards there will be members who won’t [abide] and won’t be able to receive accreditation,” communications manager Kate Spencer said. "It won’t necessarily surprise us if not everyone complies.
"The vast majority of what we’ve heard is positive.”
AAHA’s updated guidelines note that intubation is essential to prevent the aspiration of water and debris during dental procedures. They also state that anesthesia ensures patient health and safety by permitting "immobilization without discomfort, periodontal probing, intraoral radiology, and the removal of plaque and tartar above and below the gum line.”
When anesthesia is used, "One trained person is dedicated to continuously monitoring and recording vital parameters, such as body temperature, heart rate and rhythm, respiration, oxygen saturation via pulse oximetry, systemic blood pressure, and end tidal CO2 levels,” according to the guidelines.
Furthermore, warming devices must be used to prevent hypothermia and the caudal oral cavity must be suctioned and packed with gauze to prevent aspiration.
Anesthesia-free dental cleanings are a popular choice of pet owners fearful of putting their cat or dog under the control of powerful sedatives.
Los Angeles-based Houndstooth hires certified veterinary dental technicians to conduct nonanesthetic cleanings both at veterinary clinics and in a client’s home. Operating in eight states, Houndstooth technicians use comfortable positioning, "gentle relaxation techniques” and "pet whispering skills” to ensure results comparable to routine cleanings, according to the company website.
While pets with advanced periodontal disease and other complicated conditions are not candidates, anesthesia-free cleanings are the way to go for the vast majority of cats and dogs, Houndstooth co-owner Kathy Shafer said.
"Let’s be very clear when we talk about anesthesia,” Schafer said. "We are all for anesthesia when it is appropriate.”
She equated anesthesia to life support.
"Would you want your 12-year-old daughter or 14-year-old son put on a life-support system for a routine dental?” she asked. "We have people call us and say, ‘I would let my dog’s teeth rot out of their head before I put them under anesthesia.”
She pointed to the inherent risk of anesthesia as a reason to avoid it when possible.
"Last week a client’s 8-year-old cat flat-lined—died—during a routine dental” while under anesthesia, she said.
Why the cat died is unclear, but Shafer said Houndstooth paid for a necropsy, the results of which are pending.
The American Veterinary Medical Association’s Position on Veterinary Dentistry stops short of requiring the use of anesthesia.
"Sedatives, tranquilizers, anesthetics or analgesics are commonly used during veterinary dental procedures to provide restraint and reduce animal pain and suffering,” the policy states.