In general, dentistry which requires the surgical extraction of diseased or abscessed teeth requires specific training and a whole other level of dental expertise in the diagnosis and surgical extraction of diseased teeth. Lay dentists are legally unable to perform dental surgical extractions and they must refer patients to veterinarians.
Every dentistry requiring extraction includes the same steps that are performed in routine cleaning. Full oral inspection, full dental x-rays, scaling and polishing are performed first. We often discover by probing around teeth and with x-rays that many teeth have abscessed roots, severe bone loss around roots, sometimes making them loose if they are single rooted teeth, or firmly held in by the other roots which have not abscessed. In cats, we often see resorptive lesions (cavities) at the crown gum interface as well as extending below the gum line and eroding the roots. We determine which teeth are diseased and require extractions and set about to plan the surgical extractions.
Removing a tooth requires the additional pain control provided by regional nerve blocks with local anesthetics such as bupivacaine. This is the same as the “freezing” a dentist will use on us to numb the area before repairing a cavity. Once we have applied the nerve block the surgical extraction can proceed without having to resort to a deep plane of gas anesthesia for pain control. This is one reason why, despite dental procedures often being quite lengthy, the patient recovers quickly because they have been on a sufficient but low level of gas anesthesia. The freezing takes hours to wear off which is why pets seldom wake up roughly after having dentistry done…they can’t feel any pain.
To extract a double or triple rooted tooth, which is the majority of teeth in a cat or dogs mouth (only incisor, canines and some of the tiny rear molars have single roots), requires careful, precise and patient work. A gum flap is created and the gums elevated to reveal the bone around the tooth, then a portion of the bone is burred away to expose the root and the tooth is split (bisected or trisected) with a dental drill bit so that each of the roots can be removed separately. We use instruments called elevators to carefully weaken the periodontal ligament which holds the root into the boney socket, then elevate and remove each root separately. Once all of the tooth has been removed, the sockets are flushed out with antiseptic and the gum flap is closed with fine suture material. It may take anywhere from 10 minutes to 45 minutes to surgically extract a tooth, so you can see why if a pet requires many teeth to be removed, these can be lengthy ( and more expensive) procedures.
Once all teeth have been removed the patients mouth is thoroughly rinsed of blood and debris, the anesthetic gas is turned off and they are transferred to recovery where they are extubated and monitored closely. When fully recovered they are sent home with an anti-biotic and medications to control post dental inflammation and pain.
So you can see from this description why dentistry when it is more than simple cleaning, involves a great deal of thorough investigation, planning, expertise and time under a general anesthetic. This is why you don’t want your pet’s teeth to ever get this bad…it can seriously affect your pet’s health and it will end up costing a considerable amount to remedy the problems created by poor oral health. The benefits of performing dentistry at any stage of dental disease are enormous in improving the quality of a pet’s life, especially as they age. People are often amazed at the change, for the better, in a pet’s attitude (pain gone), energy level (no longer dealing with low grade infections), appetite (it doesn’t hurt to eat any more) and breath (they can sleep on your pillow at night without you gagging). Happy pet, happy owner!