Hi, everybody. Welcome back. We’re here at Nova Cat Clinic in Arlington, Virginia. My name’s Dr. Erica Barron. And this is Ellen Carozza, our head technician. She’s better, but she had pneumonia. So her voice isn’t very strong. So we’re going to do the best we can. Right?Sure can.Sure can. So today, since it’s dental health month, we’re not drinking coffee or tea because we’re in our dental suite. And we don’t drink coffee and tea in here, though I really would like a cup of tea right now. So we’re just going to talk you through, kind of show you what we do, during a dental– without a cat. Because we’re done with those already today. We did a good job and we finished them. So the first thing we do when a cat comes in for a dental is we do a pre-op exam. So we listen to them really well. We make sure they look like they’re bright, alert, and responsive. They’re happy and healthy. And then, Ellen sedates them. And she’s very good at that. And if she’s not here then I sedate them. I’m good at that, too. But she’s better. Because she does this special hold and she hugs them very tightly [laughter]. Do you want to talk about how you pre-medicate the cats?Well, basically the sedation that we use is a type of anesthesia. We’re not putting them under a deep plane of anesthesia just yet. They’re under a lighter plane of anesthesia so we can simply get an IV catheter in place and take any kind of necessary dental x-rays, which every single patient that we do dentistry on gets pre– x-rays before we clean teeth. And if we do any extractions we do post-dental x-rays to make sure that evverything has been removed, and the bone looks good, and such. Once the patient has those x-rays done then they’re put under general anesthesia when they’re actually intubated, put on the gas and oxygen, then we can go ahead and finish up the procedure.So once they’re sedated and we start hooking them up to monitors and have an IV catheter in them, we’ll go ahead and take x-rays. Ellen and our assistants are amazing at taking really great x-rays. So one of the nice things about here is most of our cats are about the same size. It’s not like we have a brachycephalic dog. It’s not like we have one of those little smushed-face dogs and then we have like a hound dog, and then you have an Afghan or something like that. Most of their skulls are very similar. So we’ve gotten very fast, and very efficient, and very good at taking lots of different e-rays of the mouth, quickly. So you can see here, Ellen has it set up how– this is a cat skull head. It’s not the real skull. It’s fake. But the patient just stays here. We’re able to move this expensive dental machine around [laughter] and take x-rays that will go up on the wall. There’s a very nice screen, that’s quite large, on the wall that we can manipulate to look very close at all of the roots to determine which teeth actually need to come out. Because remember, same with us, you can only see 50% of the tooth. 50% are in under the gum. So there could be a lesion hiding under one of the teeth. And we don’t know until we x-ray it.Pretty much. So that’s one of the major important things. If you decide to shop around for dentistry. Because everyone’s always telling me, “It’s so expensive.” Well, there’s a lot involved in dentistry in a pet that is more involved than with people. Your pet does need to be under general anesthesia for a real, appropriate dental [inaudible] to occur. They must have dental x-rays every single time. Because 90% of the problem is underneath the gum line. So if you’re looking to set the crown, half the time the roots can be really infected or even dissolving, especially in cats. Cats don’t get cavities. Cat’s actually, actively dissolve their teeth when they start having periodontal disease. So we want to make sure that, that is healthy, as well. So sometimes it can be a little tricky. We can get a cat in that we think might not have any extractions. We do general x-rays, we’re like, “We need to make a phone call [laughter]. We got some extractions.” Or we can have a cat that comes in that has horrible gingivitis and a have a doctor that says, “Think we might have several extractions here.” We can go ahead and do the x-rays and they might have great bone, and great roots, but the gum line is just severely infected. So we got to clean that out and get all of that under control, as well. So it all depends upon the cat. Every single patient is different.And a lot of time when we take x-rays, if they have a really big, thick piece of calculus, which is kind of like cement– think of it as really hard tarter– that’s stuck on, it kind of looks like a barnacle, sometimes we’ll have to then clean that barnacle off and retake the x-ray just to make sure it looks healthy. I mean, there’s some cats– I know there’s been cats where I’m like, “You guys, it’s going to be like 7 or 8 extractions.” Then Ellen’s like, “There’s none.” And we have to do a little happy dance. Because we’re happy for the pet. We’re happy for your pocketbook. And we’re happy that we don’t have to–Right? Your cat will get to keep its teeth.Yeah. That’s what everybody just wants at the end of the day. The disease Ellen was talking about, some people call “corals,” other people call them, “tooth resorption.” And it’s a very pain process in cats. And some cats actually completely stop eating when they start getting these lesions in their teeth because it’s so painful. So that’s why dental care in cats is such a big deal.And remember, it’s not your fault if it occurs.No, and it’s not the cat’s fault, either. It’s probably genetic. So they can blame their parents [laughter].So after we’re done taking dental x-rays, your pet’s hooked up to our anesthesia machine, they have oxygen going to them, they’re hooked up to the ECG, they have a pulse oximeter going on the entire time, and blood pressure. They have IV fluids going. And then we go and we get our ultrasonic scaler out, which is this wonderful machine that’s–It’s the same as the thing that we get on our teeth when we go.[crosstalk] at the dentist. Plus, it’s cleaning teeth very quickly. After that then they get a polishing done.Where are the fun heads?The fun heads.We have special, fun polishing heads.This one’s a giraffe.It’s a giraffe.Yeah. There’s a tiger, flamingo.A tiger, [inaudible]. They’re [the same thing?]. Actually, Dr. Wootton took one with her the last time she went to get her teeth cleaned because it was so fun. And she got here dentist [laughter] to use one of these in her mouth.Well, you got to have some fun when you clean teeth.Yeah. So they’re fun little zoo animals. They all have names. I don’t remember what the names are.[inaudible] Florence the Flamingo.Something funny like that.But when you do use, um, an ultrasonic scaler, or every hand scaling, you do have to polish the teeth because we wanna get rid of those micro-abrasions that we’re causing when we’re cleaning the teeth to prevent further plaque and tarter from building up. At that point, when everything’s clean, if there’re extractions, that’s when they occur. Every single patient is given their own, sterile set of equipment. The gum lines are prone to pocketing.Yeah. I’m not going to open this up and show you all the pieces. But we use something called a periosteal at will help us make– I’m getting ahead of myself. First we’ll use an explorer, which kinda looks like a dental pick. And we go around the teeth and make sure there’s no pockets. We also make sure there’s no holes in the teeth. If we do determine that we need to make pockets to extract teeth is, what will do is, we’ll use a blade. And then we’ll use something called a periosteal, which helps us push the gums and the gingiva back. Because one of the things– just like in people– is you don’t make more gum. You have what you have. So we want to try to save as much as possible. And also, I don’t know when the last time was is you had some cuts in your gums.It hurts.It bleeds a lot and it hurts. So we try to be very careful and try to peel it away. And then, that’s when we use our dril.. I always feel like I make my dad proud when I use the drill because I’m like, “I’m using a power tool.” We use the drill to help drill just a little bit of the bone away to help gt the roots out. Then we use all the other dental instruments to kind of elevate the mouth– the elevators. And then, we’ll use extractors. Sometimes we use something called conceal, which if kind of like putty. And it helps kind of reform that little hole so theirs no dry sockets or anything. Then we suture it back up. I made that sound really easy. It’s not easy.It does. It takes a lot [laughter]. The typical dental, with extractions, can take anywhere from 45 minutes to 2 and a half hours, depending upon the extent of the work that we do. There are some instances in cats that need full-mouth extractions. Well, you’re going to the dentist for that if we see that occur. Because they’re going to do it in half the amount of time, plus that’s all they do all-day long.They’re much faster than I am. That’s all they do. And they’re very good at it. And they have special training to be as quick as they are.I know. I think we have a dental coming that we have, like, 6 plus extractions.We have one on my bay that’s, like, 8. So we should definitely buy lunch that day [laughter]. While we’re doing the dental it’s very important that we’re cognizant of what’s going on around us. So the most infected area of a cat’s mouth is the mouth. That’s why it you ever get a cat bite, the way their teeth are, the point of the way they bite, is to infect things. Because they’re pointed teeth that come to and end. And then things close around them. They have the most bacteria in any part of their body in their mouth. So we have to be really careful, and wear masks, and wear gloves, and make sure everyone’s following good protocols to make sure that when we do clean these dirty mouths that we’re not getting any secondary issues from it. That’s why, if you get a cat bite, it’s very important to go to the doctor right away and start on antibiotics– even if they have a “clean mouth.” Because just the stuff that grows in their mouth is not normal flora for us.[inaudible] was not a fun thing.No, no. Not at all. So let’s talk about what happens when we wake them up.Well, of course when we wake them up what we do is, they’re on oxygen for a little while. We want to get rid of the gas out of the body. We start cleaning up and disassembling, basically, everything around them. Of course, the patient is always on a piece of thermal warming equipment throughout the whole procedure, because we want to make sure that they stay warm. And then one of the anesthetics that we use, it’s reversible. So we go ahead and reverse that anesthetic and the cat gently wakes up from the procedure. And they’re actually able to recover pain-free. And so on top of it, while we’re recovering the animal– if the pet had extractions or if they have significant periodontal disease, we’ll go ahead and do some laser therapy to make the area heal faster and bring down some inflammation that we actually caused from cleaning the teeth. Because if we do a really deep, subgingival cleaning if that pet has some periodontal pockets, we’re going to have some significant swelling. And we want to get rid of as much swelling as possible.It’s very important. We also give them an injectable form of antibiotics, an injectable form of pain medication. Depending on the pet sometimes it’s not an injectable form of pain medication, sometimes it’s an oral opioid that we use instead. And then we stare at them for a couple hours. I mean, right now we’re staring down a couple cats over there that had dentals.Yeah, 3 of them [laughter].We just stare and make sure they wake up slowly.And they get snacks.Some of them will go potty here. Some cats won’t. My cat never goes to the potty anywhere but home. Ever. That’s like his rule.He’ll wait for it [laughter].When Cosmo used to be a blood donor at school he would be there for, like, 18, 20 hours. He wouldn’t go. And then the minute we got home it would be like–“Got to use the bathroom.”It was really funny.Never peed in public.No [laughter]. So and we just stare at them. I mean, one of the things we really like to do is, we like to do a slow, steady recovery. We want them to just relax into waking up and be comfortable. Make sure they’re pain free. And that’s part of why we stare at cats so much here.We stare at cats [laughter].We do. That was one of the things–It’s very important because, actually, the post-operative care is the highest time that you can have a problem after a procedure.With any anesthetic procedure that’s the highest time, even for healthy patients. That’s why we stare at cats a lot after anesthesia. We just sit there and watch them. We monitor them. That’s better than saying we stare at them, I guess. We monitor them post-op. But that is true. That’s when the highest rate of surgical complications occur across the board. But besides from that, some cats need dentals yearly. Some cats don’t. Some cats need them every 6 months. Some cats need them less than that. It’s all very cat-dependent. I don’t think there’s anything wrong with bringing a cat in yearly for a dental cleaning, because I know if I went more than a year without a dental cleaning that’s pretty gross, and I brush my teeth a couple times a day.How do you feel about home dental care for cats?I think it’s great if you can do it. I’m also a realist and I realize most people can’t do it. I know I can’t do it with my cats. What are your feelings about it?Well, everybody always says, “You should be brushing your cat’s teeth.” Well, if you can’t do it at the minimum of 3 times a week, then it’s obviously not for you. The dental treats that are out there– some of the biscuits aren’t big enough, I don’t think, for cats to really chew– like those Greenies, it’s like “cat crack.” They’ll swallow them whole. Some cats will swallow the [inaudible] whole. Some cats won’t. I used to remember cats used to love the dog [inaudible] because the biscuits were so big.Yeah. They used to chew on them.And they were really abrasive. But it’s dog food, they should be really having it.Yeah.But I think it’s the same formula. But if you can get your cats to eat it and the actively chew on the biscuit versus just swallowing he biscuit whole, it might help. There are times that we actually will send patients home with special perio-powder that actually helps break down the food in the mouth better so it doesn’t adhere to the teeth as fast, and also an antiseptic ointment, sometimes, that specifically for the mouth, especially if your cat has really significant periodontal disease. We want to get that inflammation to calm down and the bacteria levels to go down even more. But if you’re honest with us and say, “There’s no way I can do something for my cat’s mouth,” let us know. Because then we’re going to be more on top of letting you know that, “I really think you need to have a dental done every 6 months.” And some cats we do label them, “Highly recommend a yearly dental cleaning,” because of–Especially fancy cats. Fancy cats seem to be more prone to having gum and teeth issues. And there’s some cats who they have something called stomatitis, or inflammation of their gums. And one of the ways you work on them is you extract all their teeth. And I know that sounds really–Extreme.–severe or something, but–They’re so happy afterwards. They’re so happy when it’s gone.They’re so happy. And for me, any time there’s a disease, if there’s something I can do to stop the disease, or cure the disease, it’s usually my route. Because I want the disease to stop hurting the animal. But, yeah, this is how we do dentistries. Are there any questions, Sophie? No? That’s because we answered them as we went, because we [inaudible] [laughter]. I’m sure that’s exactly why. Do you have anything else you want to talk about dentistry, Ellen?Nope, I think we kind of hit the nail on the head. Like I said, it’s so important that if you’re shopping around, make sure that your pet is getting dental x-rays. Make sure you know what kind of anesthesia that’s used. Make sure that they’re on IV fluids, that they’re being monitored, and ask questions. And ask to see the dental x-rays that your pet has had taken. One thing that we pride ourselves in is we actually attach pictures on our pets’ go home sheets to let them know exactly what teeth were diseased, what will degrade, what you need to know about. Because you really should be involved in your pet’s dental health.And then, if we ever do something and we take an x-ray– I’m thinking of that one, I can’t think of that cat’s name. He’s really cute– I was like, “I don’t know what’s going on up here?” I took an x-ray, I was like, “It looks like he has two canines. I think he should see the surgeon.” We’re the first person to tell you when we think it’s in your pet’s best interest to see a specialist or a secondary person. Because we just really want what’s best for your cat. Sophie, there’s a question?Yup. Beverly, on Facebook would like to ask, “In regards to a cat with stomatitis, where full-mouth extraction is needed, is there something a regular veterinarian with x-ray ability can perform or is an oral surgeon the best route?”An oral srgeon is likely the best route. But I can’t speak for everybody. Because there’s some general practitioners who are very good at dentistry and they can do a full-mouth really fast. I can’t. I wouldn’t want to do a full-mouth, right now. I’ll do most of a mouth, but not a full-mouth.And sometimes, depending upon how well the patient does under anesthesia, sometimes it has to be staged. It really depends upon the cat. Usually, under anesthesia, a cat has a maximum happiness of about 2 hours. And at the 2 hour mark, things start to change. The body starts to cool a little bit faster. We start to see differences with blood pressure, etc. So you try to move as quickly as possible, but try to be as efficient and safe as possible under anesthesia. So sometimes the patient let’s us know what we’re able to accomplish during a procedure.And sometimes it’s easier to do a bunch of extractions, like a full-mouth or just this whole side, versus sometimes when you have 4 or 5 extractions. And we’re just like, “Okay. You have to take out this one. And then two down here. And then one here. And then one here. And then one here.”Right. And there’s also the possibility of a jaw breaking under the procedure, especially when you’re taking x-rays. You can be like, “We have a problem.” And if we take out certain teeth without fixing something first, well there’s a more chance that maybe the jaw could actually break. Because believe it or not, the cat’s lower jaw is really dependent on those lower canine teeth.Yeah, like 50% of the bottom of the mouth is the two canines. And when you start drilling, if there’s any disease or if it’s [inaudible] down here in the mandible, then it’s really easy for them to have a broken jaw. It’s not hard to fix. It happens to everybody. But it’s something you don’t want to happen. And also, if you’re seeing oral surgeon I’m sure they probably have better tricks to fix a lower jaw than we do if it happens to them. We’ve all done it. And it’s fixable. And cat’s are fine. We just have to fix it and monitor them. And most of them never have an issue with it. That being said, if it were my cat and we had to do more than 5 or 6 extractions, I’d rather have a good dentist. I mean, there’s not a lot of veterinary dentists. Most people don’t go to vet school and say, “Hey, I want to be a veterinary dentist.” Because it’s a lot of training and it’s a lot, a lot of work. And most of us don’t choose to do that. And I’m very thankful for those who do. Are there any other questions? All right. Well, thanks so much for spending this time with us. If we can help you in any way let us know. And feel free to let us know if you have any other questions or if you have any topics you want us to talk about. We’re going to try to do a couple in the next couple weeks while I’m still here. Thanks. Bye.
top of page
.png)
Search
bottom of page
Comments