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Sunday, October 18, 2015

Diabetes, Hypothyroid, Age, And Dental Cleanings

This email came from Jim....
 
I thought your article was very informative. However, my 12 year old dog does have diabetes which is now under control. Previously, it wasn’t due to her thyroid. For the past 8 months she has been on Levothyroxine .2mg and she gets 9 units of Vetsulin twice a day after each meal. She is perky, energetic and runs down my apartment hall at full gallop to go outside. My vet thinks it’s too risky to have her go under anesthetic because of her condition, but I am leaning towards getting her teeth cleaned because I think the risk of dental disease might be far worse in the long run. I know your not my vet, but I would really appreciate your thoughts on my situation.
 
This is definitely a situation where I would rely more on your vet's opinion than my own. In principle there is no reason why a dog with stable diabetes and controlled hypothyroidism shouldn't be able to undergo anesthesia for a dental cleaning. I've had patients with these diseases and we've continued to clean their teeth year after year. Age alone isn't a reason to avoid a dental, and I routinely do dogs older than yours. Even dogs with low-grade heart murmurs can safely undergo anesthesia for routine procedures. 
 
However, I don't want to specifically recommend that for you because I would want to know your pet's entire health situation including heart, lungs, and recent blood tests for kidneys and liver.   It also depends on what kind of anesthesia and monitoring is used. A pet induced with propofol, maintained with sevoflurane gas, and monitored with ECG, pulse oximeter, and blood pressure is going to be at less risk than a pet maintained on isoflurane gas and minimally monitored. Dental cleanings are very important as periodntal disease can be painful and spread bacteria throughout the body.  Correlations have been made between severe dental infections and increased risk of kidney disease, liver disease, and heart murmurs.  So there are a lot of factors in play here making it impossible for me to give you a straight answer. 
 
Talk to your vet in more detail, ask what kind of anesthesia and monitoring they do, and specifically why your vet feels that the risk isn't worth doing the procedure.  I do have patients with severe health conditions where I have decided that they are at an increased anesthesia risk to the point of making a dental more risky than not doing it.  But those are by far the exception rather than the rule at my practice.
 
 

5 comments:

  1. Maybe Jim could try anesthesia free teeth cleaning? It is offered for a very reasonable rate where I live, the dog is awake the entire time, but really would depend on how the dog is with being handled ;)

    Sorry I wasn't sure if I could post a link to resources, but there are a few great sites that detail the procedure with a quick google search. Maybe a better option for Jim?

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    1. Anesthesia free dental cleaning has been uniformly and resoundingly denounced by the majority of veterinarians, especially dentistry specialists. It's NOT the same level of cleaning, has its own risks, and is not something I recommend.

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  2. I do agree it is not the same level of cleaning, and probably not the best for a dog who has severe build up and infection. But for a dog who has no other choice? Wouldn't it be better than no treatment at all??

    I have never had to have any dogs teeth cleaned in 25 years of dog ownership, so I can't speak from a personal perspective.

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    1. It's actually a very good and valid question, Niomi. The problem is that the majority of specialists agree that is is NOT better than no treatment at all. The biggest problem with dental tartar and periodontal disease is below the gums. The nasty calculus that is so obvious is not the major issue, and cleaning that off gives a false sense of security, plus can irritate the gums and seed bacteria into the blood stream. The more severe issue is the calculus and disease that accumulates below the gums and along the roots. There is no way to do a thorough job of cleaning this without anesthesia.

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  3. I've got to agree with Chris here - there is growing evidence and concern that anaesthesia-free dentistry may constitute negative, or at least questionable welfare (certainly across the pond in the UK)! It doesn't solve any dental issues at all other than cosmetic ones.

    I've had to deal with a few cases lately of older dogs with concurrent issues - in my experience it's better to do a shorter (well-prepared and managed) anaesthetic at this point even with other disease, than to wait a couple of years and be potentially forced into disaster-management with more severe dental issues and a longer time under anaesthetic.

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