The nature of anesthesia brings risk in general. In veterinary medicine, during dental procedures, pets are often placed in vulnerable positions which can lead to increased risk of injury and medical complications.
These risks can be minimized or entirely avoided with careful consideration, and proper training and continuing education of staff. Listed are a few of the more common injuries that can occur during a dental procedure.
Aspiration Pneumonia
Aspiration pneumonia in pet patients occurs when the patient inhales a foreign substance and develops lung inflammation and infection as a result.
The most common occurrence during dentistry is water and debris entering an unprotected airway, hence allowing fluid and debris to enter the lungs. This can occur from an underinflated tracheal tube, or repositioning during the procedure that allows fluid to enter the airway.
Aspiration pneumonia can also occur if the patient vomits or regurgitates during anesthetic recovery.. To reduce the incidence of dental-related aspiration pneumonia, maintaining the patient on their back during the procedure, and avoiding repositioning has proven to not only lessen the risk of aspiration but also lessens the amount of anesthesia needed during the procedure.
In addition, antiemetic medications given during the premedication phase can help reduce the incidence of post-anesthetic nausea and vomiting. Caution should be taken during the recovery phase to wait until the patient is alert and responsive enough to deflate the cuff and remove the tracheal tube.
Tracheal rupture
Tracheal rupture in dogs and cats are more frequent during dental procedures than any other medical procedure. Seventy-five percent of tracheal ruptures are thought to be associated with oral surgical procedures with the incidence more common in cats than dogs.
Tracheal injury can cause symptoms such as mild dyspnea, and even death. The most likely cause of tracheal rupture is thought to be due to an overinflated tracheal cuff, as well as failing to detach the tracheal tube from the anesthesia hose during repositioning, which can cause a torque on the inflated cuff resulting in a tear of the dorsal membrane of the trachea.
Another common cause of tracheal rupture is a patient that is not adequately anesthetized and coughs or lunges upward during intubation, tearing the trachea.
Pressure from an overinflated cuff can cause pressure necrosis of the trachea, showing delayed symptoms of inflammation and scarring.
Avoiding over-inflation of the cuff, using new tracheal tubes, testing the cuff to ensure proper inflation prior to use, avoiding repositioning as much as possible, and ensuring a level plane of anesthesia prior to intubation can help minimize the risk of tracheal rupture.
Artery Damage during Tooth Extractions
Arterial damage to arteries such as the palatine artery which runs the length of the mandible can accidentally occur during routine tooth extractions where the instrument can slip from the practitioner’s hand.
These injuries can be mild to more severe requiring surgical intervention.
The most effective way to avoid this type of injury is to implement extraction techniques involving gingival flaps where the roots are exposed, and more easily undermined, and extracted.
Written by: Dr. Tammy Powell, DVM
