The Use of Antibiotics in Veterinary Dentistry
The AVDC endorses the use of systemic antibiotics in veterinary dentistry for treatment of some infectious conditions of the oral cavity. Although culture and susceptibility testing is rarely performed on individual patients that have an infection extending from/to the oral cavity, the selection of an appropriate antibiotic should be based on published data regarding susceptibility testing of the spectra of known oral pathogens.
Patients that are scheduled for an oral procedure may benefit from pre-treatment with an appropriate antibiotic to improve the health of infected oral tissues. Bacteremia is a recognized sequela to dental scaling and other oral procedures. Healthy animals are able to overcome this bacteremia without the use of systemic antibiotics. However, use of a systemically administered antibiotic is recommended to reduce bacteremia for animals that are immune compromised, have underlying systemic disease (such as clinically-evident cardiac, hepatic, and renal diseases) and/or when severe oral infection is present.
Antibiotics should never be considered a monotherapy for treatment of oral infections, and should not be used as preventive management of oral conditions.
Veterinary Dental Healthcare Providers
The American Veterinary Dental College (AVDC) developed this position statement as a means to safeguard the veterinary dental patient and to ensure the qualifications of persons performing veterinary dental procedures.
Primary Responsibility for Veterinary Dental Care The AVDC defines veterinary dentistry as the art and practice of oral health care in animals other than man. It is a discipline of veterinary medicine and surgery. The diagnosis, treatment, and management of veterinary oral health care is to be provided and supervised by licensed veterinarians or by veterinarians working within a university or industry.
Who May Provide Veterinarian-supervised Dental Care The AVDC accepts that the following health care workers may assist the responsible veterinarian in dental procedures or actually perform dental prophylactic services while under direct, in the room supervision by a veterinarian if permitted by local law: licensed, certified or registered veterinary technician or a veterinary assistant with advanced dental training, dentist, or registered dental hygienist.
Operative Dentistry and Oral Surgery
The AVDC considers operative dentistry to be any dental procedure which invades the hard or soft oral tissue including, but not limited to, a procedure that alters the structure of one or more teeth or repairs damaged and diseased teeth. A veterinarian should perform operative dentistry and oral surgery.
Extraction of Teeth
The AVDC considers the extraction of teeth to be included in the practice of veterinary dentistry. Decision making is the responsibility of the veterinarian, with the consent of the pet owner, when electing to extract teeth. Only veterinarians shall determine which teeth are to be extracted and perform extraction procedures.
Dental Tasks Performed by Veterinary Technicians
The AVDC considers it appropriate for a veterinarian to delegate maintenance dental care and certain dental tasks to a veterinary technician. Tasks appropriately performed by a technician include dental prophylaxis and certain procedures that do not result in altering the shape, structure, or positional location of teeth in the dental arch. The veterinarian may direct an appropriately trained technician to perform these tasks providing that the veterinarian is physically present and supervising the treatment.
Veterinary Technician Dental Training
The AVDC supports the advanced training of veterinary technicians to perform additional ancillary dental services: taking impressions, making models, charting veterinary dental pathology, taking and developing dental radiographs, performing non surgical subgingival root scaling and debridement, providing that they do not alter the structure of the tooth.
Tasks that may be Performed by Veterinary Assistants (not registered, certified, or licensed): The AVDC supports the appropriate training of veterinary assistants to perform the following dental services: supragingival scaling and polishing, taking and developing dental radiographs, making impressions and making models.
Tasks that may be Performed by Dentists, Registered Dental Hygienists and other Dental Healthcare Providers:
The AVDC recognizes that dentists, registered dental hygienists and other dental health care providers in good standing may perform those procedures for which they have been qualified under the direct supervision of the veterinarian. The supervising veterinarian will be responsible for the welfare of the patient and any treatment performed on the patient.
The AVDC understands that individual states have regulations that govern the practice of veterinary medicine. This position statement is intended to be a model for veterinary dental practice and does not include infornation for all 50 states.
Adopted by the Board of Directors April 1998; revised October 1999 and September 2006.
Link to AVMA Summary Report by State - Authority of veterinary technicians and other non-veterinarians to perform dental procedures
Companion Animal Dental Scaling Without Anesthesia
In the United States and Canada, only licensed veterinarians can practice veterinary medicine. Veterinary medicine includes veterinary surgery, medicine and dentistry. Anyone providing dental services other than a licensed veterinarian, or a supervised and trained veterinary technician, is practicing veterinary medicine without a license and shall be subject to criminal charges.
This position statement addresses dental scaling procedures performed on pets without anesthesia, often by individuals untrained in veterinary dental techniques. Although the term Anesthesia-Free Dentistry has been used in this context, AVDC prefers to use the more accurate term Non-Professional Dental Scaling (NPDS) to describe this combination.
Owners of pets naturally are concerned when anesthesia is required for their pet. However, performing NPDS on an unanesthetized pet is inappropriate for the following reasons:
1. Dental tartar is firmly adhered to the surface of the teeth. Scaling to remove tartar is accomplished using ultrasonic and sonic power scalers, plus hand instruments that must have a sharp working edge to be used effectively. Even slight head movement by the patient could result in injury to the oral tissues of the patient, and the operator may be bitten when the patient reacts.
2. Professional dental scaling includes scaling the surfaces of the teeth both above and below the gingival margin (gum line), followed by dental polishing. The most critical part of a dental scaling procedure is scaling the tooth surfaces that are within the gingival pocket (the subgingival space between the gum and the root), where periodontal disease is active. Because the patient cooperates, dental scaling of human teeth performed by a professional trained in the procedures can be completed successfully without anesthesia. However, access to the subgingival area of every tooth is impossible in an unanesthetized canine or feline patient. Removal of dental tartar on the visible surfaces of the teeth has little effect on a pet's health, and provides a false sense of accomplishment. The effect is purely cosmetic.
3. Inhalation anesthesia using a cuffed endotracheal tube provides three important advantages... the cooperation of the patient with a procedure it does not understand, elimination of pain resulting from examination and treatment of affected dental tissues during the procedure, and protection of the airway and lungs from accidental aspiration.
4. A complete oral examination, which is an important part of a professional dental scaling procedure, is not possible in an unanesthetized patient. The surfaces of the teeth facing the tongue cannot be examined, and areas of disease and discomfort are likely to be missed.
Safe use of an anesthetic or sedative in a dog or cat requires evaluation of the general health and size of the patient to determine the appropriate drug and dose, and continual monitoring of the patient. Veterinarians are trained in all of these procedures. Prescribing or administering anesthetic or sedative drugs by a non-veterinarian can be very dangerous, and is illegal. Although anesthesia will never be 100% risk-free, modern anesthetic and patient evaluation techniques used in veterinary hospitals minimize the risks, and millions of dental scaling procedures are safely performed each year in veterinary hospitals.
To minimize the need for professional dental scaling procedures and to maintain optimal oral health, the AVDC recommends daily dental home care from an early age. This should include brushing or use of other effective techniques to retard accumulation of dental plaque, such as dental diets and chew materials. This, combined with periodic examination of the patient by a veterinarian and with dental scaling under anesthesia when indicated, will optimize life-long oral health for dogs and cats.
For general information on performance of dental procedures on veterinary patients, please read the AVDC Position Statement on Veterinary Dental Healthcare Providers, which is available on the AVDC web site (www.AVDC.org). For information on effective oral hygiene products for dogs and cats, visit the Veterinary Oral Health Council web site (www.VOHC.org).
For further information, send an e-mail message to the AVDC Executive Secretary (ExecSec@AVDC.org).
Removal or Reduction of Teeth as a Treatment for Canine or Feline Agression
Removal or Reduction of Teeth as a Treatment for Canine or Feline Aggression
When presented with an aggressive animal case where other corrective measures have failed (including but not limited to behavior modification) the veterinarian at his/her discretion may recommend full mouth extraction, crown reduction (to the gingival margin) or euthanasia.
AVDC understands that removal of crowns of teeth may be necessary in selected cases.
Full mouth extraction is an invasive procedure. Oral surgical techniques that minimize trauma must be used, and post-operative radiographs must be taken. Effective anesthetic techniques, monitoring, and pre and post-operative pain control measures must be used.
It must be understood that removal or reduction of teeth as a treatment for canine or feline aggression will not absolutely prevent injury to people or to other animals.)
Adopted by the Board of Directors, October, 2009
Crown Amputation in Sled Dogs
The American Veterinary Dental College expresses concern regarding the 'cutting' of canine teeth in sled dogs. It is felt that there are methods available that are more modern, less painful and associated with less complications. We would encourage the practitioners to adopt the currently accepted dental techniques.
Feline Tooth Resorption
Feline tooth resorption typically originates in the cementum, may progress into root dentin, and then either progress through the root, into the crown, or both. Tooth resorption that can be identified on oral examination is an indication for radiographic evaluation and treatment. Intraoral radiography is required to properly evaluate this condition. Whole-mouth radiographs are recommended to evaluate other teeth in the mouth. Complete extraction is the treatment of choice for teeth that have detectable crown resorption but no radiographic evidence of root resorption. Teeth with crown resorption but radiographic signs of advanced root resorption (and no concurrent periodontal disease, periapical periodontitis or stomatitis) may be treated by subgingival amputation. Either form of treatment should be followed by gingival closure. If there is radiographic evidence of root resorption, but no clinical resorption can be detected on oral examination, the tooth can be "monitored" or preemptively extracted. Restoration of these teeth is not recommended. Semiannual dental examinations are recommended for all cats with previous diagnosis of tooth resorption. Radiography should be repeated annually or more frequently as dictated by the oral examination.
The goal of orthodontic procedures in companion animals is to provide pets with a healthy and functional occlusion. The AVDC supports the AVMA policy regarding cosmetic procedures that enhance the appearance of show or breeding animals.