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Re: dentals?

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  • acrocat@rocketmail.com
    Here s my schpiel on dentals: My first choice would be to have it done by a dentist (a DADVC if you re in the US or Canada) at a
    Message 1 of 10 , Apr 4 11:29 PM
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      Here's my schpiel on dentals:

      My first choice would be to have it done by a dentist (a DADVC
      <http://www.avdc.org/> if you're in the US or Canada) at a specialty
      hospital with an anesthesiologist and a critical care specialist
      <http://acvecc.org/> and cardiologist on premises. That would be hard
      to find outside a university, but that's the dream combo for me. After
      that, I'd like a dentist and a critical care specialist with a cardio on
      premises. Vets get very little dental training in school, and as I
      don't have my own GP do my dental work, I avoid having my animals' GP
      do theirs. Dentists are few and far between, though, so in some areas
      you have no choice.

      At any GP, the range of care can be surprising. At one hospital you may
      have a technician do the cleaning and even the dental extractions, all
      while he or she is also supposed to be monitoring anesthesia. At
      another, you may have a GP vet who's done extra training in dentistry
      (externship, continuing ed, etc.) do all of the dental work with a
      dedicated technician anesthetist doing the anesthesia. These might cost
      the same, BTW. So my questions before a dental would be:

      Who does the dental? (It's ok for the tech to do the cleaning, as the
      hygienist does yours, but a vet should have hands-on at some point. )

      Who monitors the anesthesia? (You want a dedicated person who is doing
      nothing but care for your cat.)

      What do you monitor during anesthesia? (You want an ECG, pulse ox, blood
      pressure, temperature at a minimum. If they can monitor end-tidal CO2,
      that is a fantastic sign!)

      What if my cat's blood pressure gets too low? (Heart kitties can't get
      too much fluid, the usual choice for low BP. They should have a plan for
      cats with anything more than very mild disease.)

      Will my cat have an IV catheter? (Yes, yes, yes, yes. Run from anyone
      who will not put an IV in a heart kitty!)

      What kind of anesthesia do you use? (Here you're mainly looking out for
      two no-nos: one is ketamine, which can cause problems for heart
      patients, and the other is "boxing down" or "masking down." These
      involve forcing a fully alert cat to breathe in anesthesia and oxygen,
      either by putting the cat in a plexiglass box and pumping gas in, or by
      forcing a mask over the face. Cats find this terrifying and, rarely,
      have died from the stress.)

      Can you do nerve blocks? (This is like the Novacaine you'd get at the
      dentist if you needed an extraction. A nerve block allows them to keep
      the anesthesia light because they are blocking the pain signal right
      from the jaw, and it also means the cat won't wake up in pain. This
      would only be necessary for extractions. The ability to do nerve blocks
      is a good sign that they are a progressive practice.)

      What kind of pain meds do you use for extractions? (You're just looking
      out to hear that they do use pain meds. If extractions are planned, the
      pain meds should start before the extractions. Please note that the fact
      that a cat eats after a dental is not a marker of how much pain s/he is
      or isn't in. Eating is key to survival, and they'll eat despite pain
      most of the time. Don't withhold pain meds because s/he's eating!)

      Can you do dental x-rays? (Only go someplace where they can do x-rays.
      Cats get a lot of below-the-gumline disease and x-rays are needed to see
      if the teeth are healthy, and if any extractions are done, to make sure
      the tooth was completely removed.)

      That's all I can think of off the top of my head :) Hope this helps.
      Adriann



      PS On a personal note, my current cat has had multiple FORLs and had
      several GP dentals w/ extractions. When I took him to the dentist, she
      easily pointed out all of the bits of root that had been left behind
      during these dentals (teeth with these lesions can crumble under the
      gumline) that were imbedded in his gums. She had to dig around in all
      four quadrants of his mouth for them. I was mortified and felt terrible
      -- how painful that must have been! :( I learned my lesson about not
      having x-rays done ...



      [Non-text portions of this message have been removed]
    • s.theye
      Hi Lyn, Thanks for clarifying regarding Trixi s HCM. Yep, Jack is on Plavix, so I would have to stop it 5 days prior to the dental. Hope Sauce and Milli are
      Message 2 of 10 , Apr 5 7:33 AM
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        Hi Lyn,

        Thanks for clarifying regarding Trixi's HCM.
        Yep, Jack is on Plavix, so I would have to stop it 5 days prior to the dental.
        Hope Sauce and Milli are doing OK today.

        best,
        Shelley

        --- In feline-heart@yahoogroups.com, elfinmyst@... wrote:
        >
        > Hi
        >
        > Yes, Trixi has had advanced HCM since being a kitten. She was at risk but
        > she needed the tooth out because it had a neck lesion. She sailed through
        > the operation. I can't remember if she was on plavix at that time though, but
        > that would be a consideration as it thins the blood so that might be an
        > issue.
        >
        > My other HCM boy Maxi was neutered and came through it ok. I don't think a
        > dental takes long and there are some safer anaesthetics for heart cats,
        > though I don't know their names. Someone else might.
        >
        > Lyn
        >
        >
        > _www.myfurkids.co.uk_ (http://www.myfurkids.co.uk/)
        >
        > [Non-text portions of this message have been removed]
        >
      • s.theye
        Hi Adriann, Yes, that was very helpful. Thank you so much for the detailed, super-informative reply! I will have to think about all this. I have 2 possible
        Message 3 of 10 , Apr 5 8:02 AM
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          Hi Adriann,

          Yes, that was very helpful.
          Thank you so much for the detailed, super-informative reply!

          I will have to think about all this. I have 2 possible scenarios available and now know a bit more after discussing with my own vet but have additional questions for her and the cardiologist after reading through your post.

          I do have the option of having it done at a vet school, with a dentist.
          OR I can have it done at our regular gp clinic.

          After discussing with our regular vet, she told me that a tech does the cleaning, she recommended a certain tech on a certain morning because she is fast, and she herself monitors anesthesia and everything else. But I am not sure who does the extractions, if any are needed, so I want to follow up after reading your post, to see if the vet herself does them, then is the tech monitoring the anesthesia, vitals, etc? I hadn't thought about that.
          The cardiologist will discuss the anesthesia protocol with my vet and the cardiologist actually is familiar with this clinic and told me she has a lot of confidence in them which is good. I believe Profanol (sp?) and Isoflurane. They do do dental x-rays, but I have a few more questions now to ask them for sure about the monitors for ecg, CO2, nerve blocks, etc.

          I did mention worrying that his heart might beat slowly and irregularly and she, my vet, mentioned they keep atropine on hand if that were to happen.

          I guess I need to find about a bit more about both scenarios. The pros for my own vet are the driving distance is shorter so less stressful for Jack. I can bring him in just before dental so possibly less time for him to be stressed waiting. I am not sure how it works at the vet school. I hope he could go morning of and not have to stay the night prior, etc.
          But having all of the state of the art and board certified staff would be a strong argument too....but they do have students too, so not sure if students do any part of the procedure.

          Thanks so much,
          Shelley



          --- In feline-heart@yahoogroups.com, "acrocat@..." <acrocat@...> wrote:
          >
          > Here's my schpiel on dentals:
          >
          > My first choice would be to have it done by a dentist (a DADVC
          > <http://www.avdc.org/> if you're in the US or Canada) at a specialty
          > hospital with an anesthesiologist and a critical care specialist
          > <http://acvecc.org/> and cardiologist on premises. That would be hard
          > to find outside a university, but that's the dream combo for me. After
          > that, I'd like a dentist and a critical care specialist with a cardio on
          > premises. Vets get very little dental training in school, and as I
          > don't have my own GP do my dental work, I avoid having my animals' GP
          > do theirs. Dentists are few and far between, though, so in some areas
          > you have no choice.
          >
          > At any GP, the range of care can be surprising. At one hospital you may
          > have a technician do the cleaning and even the dental extractions, all
          > while he or she is also supposed to be monitoring anesthesia. At
          > another, you may have a GP vet who's done extra training in dentistry
          > (externship, continuing ed, etc.) do all of the dental work with a
          > dedicated technician anesthetist doing the anesthesia. These might cost
          > the same, BTW. So my questions before a dental would be:
          >
          > Who does the dental? (It's ok for the tech to do the cleaning, as the
          > hygienist does yours, but a vet should have hands-on at some point. )
          >
          > Who monitors the anesthesia? (You want a dedicated person who is doing
          > nothing but care for your cat.)
          >
          > What do you monitor during anesthesia? (You want an ECG, pulse ox, blood
          > pressure, temperature at a minimum. If they can monitor end-tidal CO2,
          > that is a fantastic sign!)
          >
          > What if my cat's blood pressure gets too low? (Heart kitties can't get
          > too much fluid, the usual choice for low BP. They should have a plan for
          > cats with anything more than very mild disease.)
          >
          > Will my cat have an IV catheter? (Yes, yes, yes, yes. Run from anyone
          > who will not put an IV in a heart kitty!)
          >
          > What kind of anesthesia do you use? (Here you're mainly looking out for
          > two no-nos: one is ketamine, which can cause problems for heart
          > patients, and the other is "boxing down" or "masking down." These
          > involve forcing a fully alert cat to breathe in anesthesia and oxygen,
          > either by putting the cat in a plexiglass box and pumping gas in, or by
          > forcing a mask over the face. Cats find this terrifying and, rarely,
          > have died from the stress.)
          >
          > Can you do nerve blocks? (This is like the Novacaine you'd get at the
          > dentist if you needed an extraction. A nerve block allows them to keep
          > the anesthesia light because they are blocking the pain signal right
          > from the jaw, and it also means the cat won't wake up in pain. This
          > would only be necessary for extractions. The ability to do nerve blocks
          > is a good sign that they are a progressive practice.)
          >
          > What kind of pain meds do you use for extractions? (You're just looking
          > out to hear that they do use pain meds. If extractions are planned, the
          > pain meds should start before the extractions. Please note that the fact
          > that a cat eats after a dental is not a marker of how much pain s/he is
          > or isn't in. Eating is key to survival, and they'll eat despite pain
          > most of the time. Don't withhold pain meds because s/he's eating!)
          >
          > Can you do dental x-rays? (Only go someplace where they can do x-rays.
          > Cats get a lot of below-the-gumline disease and x-rays are needed to see
          > if the teeth are healthy, and if any extractions are done, to make sure
          > the tooth was completely removed.)
          >
          > That's all I can think of off the top of my head :) Hope this helps.
          > Adriann
          >
          >
          >
          > PS On a personal note, my current cat has had multiple FORLs and had
          > several GP dentals w/ extractions. When I took him to the dentist, she
          > easily pointed out all of the bits of root that had been left behind
          > during these dentals (teeth with these lesions can crumble under the
          > gumline) that were imbedded in his gums. She had to dig around in all
          > four quadrants of his mouth for them. I was mortified and felt terrible
          > -- how painful that must have been! :( I learned my lesson about not
          > having x-rays done ...
          >
          >
          >
          > [Non-text portions of this message have been removed]
          >
        • s.theye
          Hi All, Jack had his dental last Monday morning and came through just fine! I wanted to thank you all for your input and advice because I was so nervous about
          Message 4 of 10 , Apr 29 6:34 AM
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            Hi All,

            Jack had his dental last Monday morning and came through just fine!
            I wanted to thank you all for your input and advice because I was so nervous about putting him under anesthesia. He was diagnosed as a kitten with probable HCM and he is now 6 years old. I was so afraid to do this, but we got through it and I am going to try to be more proactive about brushing now, because he builds up tartar quickly.

            I first asked my vet about all of the criteria on Adriann's in depth list, which I think should be archived on this site (!), and everything checked out so I decided to have it done there instead of the vet school. I wasn't sure if I was making the right decision necessarily, but the driving distance was half, and I was hoping I could stay with him before and afterwards since it would be in a relatively smaller setting. That was really important to me. He was first so she started almost right after we arrived, and I got to sit with him as he woke up until we went home. Since he rarely leaves home, and pants when he gets afraid or stressed, I really appreciated being able to be with him afterwards.

            He did end up having FORLs on both of his lower canines, so he had 2 crown amputations. That alone made me glad I decided to let him get a dental. I had no idea he had them. He had severe tartar on his upper teeth, but his gums looked fine afterwards.

            I did have to take him off Plavix for 5 days prior and 5 days afterwards. He just started back up on it Friday pm. He was sent home with Buprenex for pain. And he is still on antibiotics.

            He was back to normal that evening (!) except for a little grogginess from the Buprenex maybe, and I have been waiting to update you all because I wanted to be sure he continued to do well.

            So THANKS to you all. I definitely have a new respect for vet dentistry. I guess x-rays
            are so valuable as far as identifying potential problems and pain that might not otherwise be noticed. Jack's regular vet and cardiologist worked together on a plan for anesthesia too.

            Shelley and Jack

            --- In feline-heart@yahoogroups.com, "s.theye" <veery@...> wrote:
            >
            > Hi,
            >
            > I have been searching the archives and the internet, but I have decided to ask-
            >
            > I was wondering what the collective wisdom of the group is concerning routine dentals for heavy tartar build up and gingivitis with our HCM cats? My vet and the cardiologist think a dental would be good for Jack since his HCM seems stable right now. He had his most recent echo on Feb. 6 of this year. Of course I am freaking out at the thought of anesthesia. In the past my vet and one time a holistic vet have picked the tartar off his teeth manually, but he seems to build up tartar somewhat fast I think. My vet says that we really don't know if he has anything bad going on below the gum line without x-rays.
            >
            > He went in for his last echo on Feb. 6th. 2012, his previous echo was 9 months earlier, June 2011. Heart was basically the same. He has mild LV thickening and moderate left atrial dilation and was put on Plavix and atenolol 2 visits ago, June 2011.
            >
            > He also went through some abnormal blood work last june, which I asked about here. His ALT went up and his triglycerides went up, I dragged my feet on ultrasound, not wanting to stress him, and they both went back down to normal 6 mos. later, I changed to lower fat diet for him which he is still on. Last blood work was normal.
            >
            > Anyway, at home, if I listen to his heart with my stethoscope his heart rate can get pretty slow, under 120, and when it does it can sound irregular to me. I mentioned this to the cardiologist and she said he could go in for an ecg first. I don't think he has ever had one so far. At the vet's office he is always nervous so of course they don't hear this
            > though I have mentioned it. This slower rate was one reason he is only on Atenolol once a day.
            >
            > He also can breath somewhat faster when awake, but resting is normal, so I think that's just him because he has been like that for a relatively long time now.
            >
            > He would need to come off plavix for 5 days prior to a dental, and maybe for a time afterwards, not sure though. That makes me a bit nervous.
            >
            > So between coming off plavix and just the general distress about anesthesia and his slower heart rate at home, etc. I am really worried. Plus feeling guilty that I have not been more aggressive trying to clean his teeth daily.
            >
            > I was reading about some oral gels, for instance Biotene, part of me wants to try something like that first, but the other part of me worries that maybe this is the time
            > to do a real dental, in case he has any of the hidden cavities, etc. We are already 2 mos. past echo. We were out of country for 10 days in March and my own vet said to wait to do dental until we came back, which was just last week....
            >
            > Sorry to have rambled, but just wanted to give some history.
            > Have many of you taken your heart kitties in for dentals when there wasn't a grave problem with teeth, just very heavy tartar, redness at gum line? How did they fare?
            >
            > Thanks so much,
            > Shelley and Jack
            >
          • Laurie Stead
            Wonderful News!  So glad it all went well.  I imagine Jack has a new spring in his step with his clean teeth :-)   Thank you for updating us! Laurie and
            Message 5 of 10 , Apr 29 6:40 AM
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              Wonderful News!  So glad it all went well.  I imagine Jack has a new spring in his step with his clean teeth :-)  

              Thank you for updating us!
              Laurie and Boo

              --- On Sun, 4/29/12, s.theye <veery@...> wrote:

              From: s.theye <veery@...>
              Subject: [FH] update- Re: dentals?
              To: feline-heart@yahoogroups.com
              Date: Sunday, April 29, 2012, 9:34 AM
















               













              Hi All,



              Jack had his dental last Monday morning and came through just fine!

              I wanted to thank you all for your input and advice because I was so nervous about putting him under anesthesia. He was diagnosed as a kitten with probable HCM and he is now 6 years old. I was so afraid to do this, but we got through it and I am going to try to be more proactive about brushing now, because he builds up tartar quickly.



              I first asked my vet about all of the criteria on Adriann's in depth list, which I think should be archived on this site (!), and everything checked out so I decided to have it done there instead of the vet school. I wasn't sure if I was making the right decision necessarily, but the driving distance was half, and I was hoping I could stay with him before and afterwards since it would be in a relatively smaller setting. That was really important to me. He was first so she started almost right after we arrived, and I got to sit with him as he woke up until we went home. Since he rarely leaves home, and pants when he gets afraid or stressed, I really appreciated being able to be with him afterwards.



              He did end up having FORLs on both of his lower canines, so he had 2 crown amputations. That alone made me glad I decided to let him get a dental. I had no idea he had them. He had severe tartar on his upper teeth, but his gums looked fine afterwards.



              I did have to take him off Plavix for 5 days prior and 5 days afterwards. He just started back up on it Friday pm. He was sent home with Buprenex for pain. And he is still on antibiotics.



              He was back to normal that evening (!) except for a little grogginess from the Buprenex maybe, and I have been waiting to update you all because I wanted to be sure he continued to do well.



              So THANKS to you all. I definitely have a new respect for vet dentistry. I guess x-rays

              are so valuable as far as identifying potential problems and pain that might not otherwise be noticed. Jack's regular vet and cardiologist worked together on a plan for anesthesia too.



              Shelley and Jack



              --- In feline-heart@yahoogroups.com, "s.theye" <veery@...> wrote:

              >

              > Hi,

              >

              > I have been searching the archives and the internet, but I have decided to ask-

              >

              > I was wondering what the collective wisdom of the group is concerning routine dentals for heavy tartar build up and gingivitis with our HCM cats? My vet and the cardiologist think a dental would be good for Jack since his HCM seems stable right now. He had his most recent echo on Feb. 6 of this year. Of course I am freaking out at the thought of anesthesia. In the past my vet and one time a holistic vet have picked the tartar off his teeth manually, but he seems to build up tartar somewhat fast I think. My vet says that we really don't know if he has anything bad going on below the gum line without x-rays.

              >

              > He went in for his last echo on Feb. 6th. 2012, his previous echo was 9 months earlier, June 2011. Heart was basically the same. He has mild LV thickening and moderate left atrial dilation and was put on Plavix and atenolol 2 visits ago, June 2011.

              >

              > He also went through some abnormal blood work last june, which I asked about here. His ALT went up and his triglycerides went up, I dragged my feet on ultrasound, not wanting to stress him, and they both went back down to normal 6 mos. later, I changed to lower fat diet for him which he is still on. Last blood work was normal.

              >

              > Anyway, at home, if I listen to his heart with my stethoscope his heart rate can get pretty slow, under 120, and when it does it can sound irregular to me. I mentioned this to the cardiologist and she said he could go in for an ecg first. I don't think he has ever had one so far. At the vet's office he is always nervous so of course they don't hear this

              > though I have mentioned it. This slower rate was one reason he is only on Atenolol once a day.

              >

              > He also can breath somewhat faster when awake, but resting is normal, so I think that's just him because he has been like that for a relatively long time now.

              >

              > He would need to come off plavix for 5 days prior to a dental, and maybe for a time afterwards, not sure though. That makes me a bit nervous.

              >

              > So between coming off plavix and just the general distress about anesthesia and his slower heart rate at home, etc. I am really worried. Plus feeling guilty that I have not been more aggressive trying to clean his teeth daily.

              >

              > I was reading about some oral gels, for instance Biotene, part of me wants to try something like that first, but the other part of me worries that maybe this is the time

              > to do a real dental, in case he has any of the hidden cavities, etc. We are already 2 mos. past echo. We were out of country for 10 days in March and my own vet said to wait to do dental until we came back, which was just last week....

              >

              > Sorry to have rambled, but just wanted to give some history.

              > Have many of you taken your heart kitties in for dentals when there wasn't a grave problem with teeth, just very heavy tartar, redness at gum line? How did they fare?

              >

              > Thanks so much,

              > Shelley and Jack











              .























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