Wednesday, August 8, 2012

Why does dental care cost so much?!?

Closeup of black cat's teeth
Our own Mr. B is 10 months old. His teeth are pretty good, but he already has a tiny bit of buildup on his upper premolar.
Most people do not realize that the quality of dental care can vary from veterinary hospital to veterinary hospital. Contacting a veterinary hospital and asking what they charge for teeth cleaning may not give you the whole picture. Many veterinary hospitals will tell you that they cannot give you a good estimate for a dental procedure before examining your cat, and there is good reason. As a rule, until a veterinarian performs an exam under anesthesia, we do not have the whole picture of the cat’s oral health and can only offer a range of possibilities, not an exact quote. Often, the whole picture does not emerge until after dental x-rays are taken.

At Exclusively Cats Veterinary Hospital, we take pride in the quality of our care and are happy to discuss treatment plans with you, making sure that you have a clear understanding of exactly what fees and services you are paying for.

As an educated pet owner, there are questions that you should ask when getting a quote for dental services:

1. Are there any additional charges associated with a teeth cleaning, such as labwork, tooth extraction, x-rays, medications or other after-care? The estimate for treatment that we give you is comprehensive. We even try to anticipate all the extractions that may be needed. You may want to clarify whether an estimate for teeth cleaning that you receive elsewhere includes everything, or whether the clinic you called gave a minimum estimate over the phone and might add additional charges to the estimate once you are in the office.

Various Blood Tubes
Bloodwork is one of the best ways to get information about a cat's health

2. Will preanesthetic bloodwork be done? We check labwork on each pet prior to the dental procedure to highlight any health issues that could compromise the anesthetic procedure. The type and extent of labwork will vary based on the age and health of the patient, and also may depend on prior labwork that we have recently evaluated.

3. Will my pet be given IV fluids? An IV catheter allows instant access to the circulatory system if an emergency situation should arise. Anesthesia over time will decrease the blood pressure. Fluid therapy supports kidney function during anesthetic procedures and keeps the blood pressure in a safe range while your cat is asleep. Any time that a cat is having teeth extracted, we place an IV catheter. Also, patients of a certain age will routinely receive IV fluids. If at any time we feel that our dental patient may be a critical anesthetic risk, we will place an IV as well, for the safety of your pet.

Four Handed Dentistry - more than one person caring for your cat's teeth
Four-handed dentistry!

4. Who will be performing the procedure and what is their level of training? Any dental surgical procedure should include a minimum of 4 hands (a veterinarian and technician). Our most experienced and well-trained technicians assist the doctor during dental procedures and only our veterinarians perform extractions. In some cases with highly critical patients, a second or third technician may be required to ensure the safety of the cat.

Dogs and cats experience dental disease in markedly different ways. At a practice that sees both dogs and cats, it is common for the veterinarian’s experience to be primarily canine dentistries, whereas our veterinarians have 100% of their experience with feline dental procedures. Since Exclusively Cats Veterinary Hospital opened its doors, our staff members have performed over 5,000 feline dental cleanings and oral surgeries. There have been multiple instances in which veterinarians from other hospitals have called to consult with or ask advice from our doctors about complex or difficult feline dental cases.
Heska veterinary pulse oximeter
Pulse and oxygen monitor

5. What type of vital signs monitoring will be performed, and who will be performing the monitoring? Different veterinary hospitals monitor anesthesia different ways. Our patients’ heart rates, blood pressure and oxygen delivery are monitored throughout the procedure by a technician. In higher risk patients, an EKG and blood gas level are also monitored. The entire time that the veterinarian is working on your cat’s mouth, a technician is by their side, assisting and monitoring, and in critical risk patients, one or more additional technicians will be at hand to help ensure the safety of your pet.

Feline Skull Model
Dental models and x-rays are used to help explain what happened during the procedure

6. What kind of discharge information will you receive and from whom? If your cat has any kind of abnormality observed during the dentistry, the dental technician will discuss the dental x-rays and findings with you at the time of the discharge appointment.

7. What type of anesthesia will be used? We use isoflurane gas anesthesia for our dental patients. Isoflurane is an extremely safe anesthesia –the gas begins to leave the system as soon as the cat exhales for the first time after the gas is turned off. Some injectable anesthetics remain in the system for hours after use, with no way to counteract it if there is an emergency. Each patient has a breathing tube inserted into their trachea to keep water from entering the lungs during the dental procedure. Each cat is given a pre-surgical sedative to help decrease the amount of anesthesia needed and increase safety. We had a client report to us that they were changing veterinarians because their 4-year-old cat died under anesthesia while having a dental procedure performed elsewhere. At Exclusively Cats Veterinary Hospital, we have never lost a patient under anesthesia for dentistry.

8. Will my cat be sleeping on a heated blanket during the procedure? Low body temperature is a very high risk during dental procedures. Since anesthesia lowers body temperature and the water from the dental procedure can lower temperature even more, every dental patient at our hospital is placed between two warm circulating water blankets to keep their body temperature normal.

Feline dental x-ray with two normal teeth and one resorptive tooth
The tooth on the far right is missing above the gumline but there is still a root remaining

9. Will dental films be taken and reviewed by a veterinarian? Considering that 80% of pets over 3 years of age have some degree of dental disease, most of it below the gumline where it cannot be seen, estimating for dental care even after examining the mouth is difficult. The real dental exam happens while the cat is sleeping, once large amounts of tartar have been removed and each tooth has been probed and x-rayed. In some cases a tooth that looks healthy or is missing above the gumline may be developing problems at the root – if we only looked at the part of the tooth that could be seen above the gum, you might find your cat with a painful abscess within weeks to months after a thorough tooth cleaning. That is why x-rays are so important. Every dental procedure that we perform will have dental films taken.

In many cases, we have found areas where tooth remnants have been left behind by other hospitals where x-rays have not been taken. These remnants can cause pain, or become infected and cause more serious issues. In some cases, we have had other veterinarians refer patients to our office for a repeat dentistry within days of having a dental procedure performed elsewhere. In these cases, we do invite the referring veterinarian to sit in on the dentistry for educational purposes.

Feline Dental Chart
Feline Dental Chart

10. Will dental charting be done to record the health of the teeth for future knowledge? This allows us to track changes in each tooth’s health so that we can take action before there is irreversible disease and the tooth must be extracted.

Class II Feline Oral Resorprtive Lesion (Cat Cavity) - FORL
Cat "cavities" start below the gum instead of at the crown

11. Will nerve blocks be used if teeth are extracted? Just as your dentist uses novocaine prior to working on one of your teeth, we use numbing drugs to reduce post-operative pain in your cat.

12. Will pain medication be given? Anyone who has had a wisdom tooth extracted knows how painful a tooth extraction can be. We give 2 different pain medications (a short-acting and then a long-acting) to ease this burden for your cat.

13. How long will your cat be observed after the dental procedure? At our hospital, the post-surgical patients are housed in the main treatment area where they can be observed from the time they are finished with their procedure until they are discharged. There are a number of instances where we have been able to make a cat more comfortable after surgery because we have been monitoring the cat throughout the afternoon, where a cat in a separate kennel area may not have had the need for additional comfort noted.

14. Will an ultrasonic scaler be used to clean the teeth or manual scaling techniques or both? Hand scaling (picking off the buildup on the tooth by hand) is not as effective as ultrasonic scaling to remove buildup on the teeth, but using an ultrasonic scaler alone could cause tooth damage if large amounts of buildup are present. We manually remove large chunks of calculus (tartar) from the teeth first, and then remove the microscopic amounts with the ultrasonic scaler.

15. Will polish be applied to the teeth after cleaning? Scaling the teeth leaves behind tiny scratches that become an anchor for buildup to form. Polishing removes these scratches and smoothes the surface of the tooth so that it is harder for buildup to gain a foothold.
Box of Oravet sealant and applicators
Oravet Barrier Sealant


16. Will fluoride be applied to the teeth after polishing? Fluoride helps strengthen the enamel of the tooth as well as adhering to pores in the tooth that can be painful when exposed to air.

17. Will sealant be applied to the teeth after polishing? We apply Oravet sealant to the teeth after the procedure to seal the gumline and provide more resistance to future buildup.

Applying Oravet barrier sealant to an orange and white cat
Painting the teeth with a protective sealant
At Exclusively Cats Veterinary Hospital, we do all of these things. We have had many people report to us that their cats had a change in personality (for the better!) after we performed a dental treatment for their cat. Some previously antisocial cats have become more social; some quiet, older cats have had an increase in energy and a new interest in play.

We recently had a client who chose to take her cats elsewhere for a surgical procedure in order to save $100. After the procedure was over, she learned that she was not getting the services that she thought she was paying for and had to call our office several times in the weeks following the procedure to ask questions about post-surgical complications. She ended up spending that $100 and more (both at the other hospital and then later at ours) in order to make her cats feel better.

We take pride in the skill of our staff and the care and thoughtfulness that we can provide for each patient. It is always your prerogative to choose where you seek your veterinary care and decide what is best for your pets. Our ambition is to help you achieve your health goals for your cats however you allow us to do that.


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