Ensure a pre-anesthetic checklist has been performed to include thorough patient history, physical examination, lab work, chest x-rays, and prophylactic medication use has been considered, particularly in the senior patient.

Ensure all equipment is functioning properly and that all essential instruments are available and sanitized. Ensure the CPR plan and CPR medications are in place, as well as resuscitation status for each patient. 

Provide a safe heat source such as a warm air blanket.

Continually check the patient by placing your hand directly on the patient under the heat source. Include this step on your anesthesia monitoring sheet.

Ensure the patient is warm during the pre-anesthetic phase where a patient’s body temperature can lower.

1. During the onset of anesthesia while intubating, use caution when handling the tongue, ensuring it is not pulled forcefully. Gently place the patient in position – note; placing a pet on their back during the entire procedure minimizes anesthesia time and is an effective and expeditious way to perform a dental.

Ensure the tracheal tube is adequately inflated, and an aspiration guard or gauze is in place. Consider the use of intraoral suction to prevent aspiration of water and debris during the procedure.

Continually replace gauze as it becomes saturated with water. Continually check the tracheal tube during the procedure as it may need adjusting depending on the depth of anesthesia and tracheal relaxation

2. While under anesthesia, take before and after photographs of all areas of the mouth to show the pet parent, as well as keep for documentation in the medical record.

3. Begin by irrigating the pet’s mouth with a dilute Veterinary Oral Health Council approved Chlorhexidine based rinse such as CET. Evaluate the oral cavity, and remove obvious calculus at this time to expose gingiva and soft tissues.

4. Perform intraoral regional nerve blocks prior to probing the teeth and gingival tissues, as this procedure may cause pain in the anesthetized patient, requiring a deeper plane of anesthesia. 

5. Thoroughly probe and chart each tooth, and perform full-mouth radiographs

6. Clean the teeth, perform extractions, and required orthodontic procedures needed. Ensure hand scalers and a curette are employed to remove subgingival calculus, particularly where periodontal pockets have been identified.

7. Thoroughly irrigate and lavage away oral debris.

8. Polish all surfaces of each tooth and subgingival areas thoroughly and carefully.

9. Rinse the mouth and each tooth with air and water and ensure all debris is removed from the tongue. Take post-procedure photographs.

10. Finally, apply a plaque prevention gel or dental sealant

Recover the patient quietly and employ pain management and anti-inflammatory medication. The post-anesthetic patient should be monitored closely post-surgically.

Written by: Dr. Tammy Powell, DVM