There are two main reasons for referrals overall; the first is your pet requires specialized care only offered by a veterinary dentist oral surgeon, and the second is that your pet requires care that is outside of your veterinarian’s comfort level. A Veterinary Dentist™ has both completed a residency and passed all components of the American Veterinary Dental College (AVDC) board examination. In addition to extractions, board-certified veterinary dentists must exhibit competency in oral surgery (oncological, trauma, cleft palates), endodontics (Root Canal Treatments and Vital Pulp Therapy), prosthodontics, restoratives, and orthodontics. General Practitioners, on average, can perform anesthetized oral exams, review dental radiographs, perform COHATs, and extract teeth, but if you are looking for options for preserving fractured or non-vital teeth, need a jaw fracture repaired, or other more advanced options, then you need a Veterinary Dentist.

Dentist oral surgeons spend every workday in the oral cavity of pets; as such, they are very proficient at everything in the mouth, including extractions. It is possible your pet “only” needs extractions, but it could be that it is a specific tooth that your veterinarian is not comfortable extracting or that the amount of extractions is too much for what they can comfortably attempt in a procedure; as such, referring to an expert is the safest thing for your pet.

It is the removal of visible calculus with hand instruments on an awake patient. Often, they are marketed and sold as “anesthesia-free dentals or cleanings,” but in Ontario, they must legally be called cosmetic as there are no health benefits.

This is purely cosmetic, and it gives you, the pet parent, a false sense of having helped your pet. In fact, while it looks good, it does not address any of the disease associated with or resulting from plaque and tartar accumulation or the pain from periodontal disease. It can also be dangerous; these are sharp instruments being used on an awake patient, and it can lead to trauma or injury with one slip or movement from your dog.

No. If it is between doing nothing or a cosmetic intervention, I recommend doing nothing. This is a situation where the risks do not outweigh the benefits, as there are no health benefits at all. It will be stressful for your pet, it will not address any of the disease in your pet’s mouth, and it will not lead to the diagnosis of any periodontal concerns, but it will look good and make you believe you helped when you did not.

A COHAT is done by veterinary professionals, and anesthesia allows for a full, thorough assessment of your pet's mouth. It will enable the diagnosis of any periodontal disease and either the treatment or the creation of a treatment plan. It includes dental radiographs to assess the whole tooth and allows for the probing of gingival pockets. A cosmetic cleaning only removes the visible calculus on the crown of the tooth, while a COHAT allows for subgingival plaque and calculus removal as well as a thorough cleaning of all surfaces of the teeth.

In my opinion, the difference cosmetic cleaning companies market and try to capitalize on the most is that they offer an anesthesia-free option, while a COHAT requires anesthesia. Since anesthesia is the most commonly verbalized concern or fear by owners, pet parents need to understand why anesthesia is necessary.

This is not a simple answer, which is why I have a handout solely dedicated to anesthesia, so please consider reading that next for more information. Overall, I can tell you that although anesthesia is not a benign intervention and it is not risk-free, it is necessary for a COHAT, and the risks are almost always outweighed by the benefits of a COHAT. Talk to your vet about your fears and concerns; they can explain all we do to minimize any risks and how they would address concerns if any arose.

If your pet has any disease that increases their risk, talk to your vet about what their specific needs are or how the anesthesia plan might need to be altered for your pet. If needed, discuss a referral to a specialist for a recommendation on how to manage their disease or where an anesthesiologist can administer anesthesia if that is safest.

Costs can quickly add up, and I understand that it is a factor in decision-making. I truly believe it is best to put money towards a COHAT or saving for one rather than spending it on a cosmetic option.

As a pet parent myself, I also find it stressful to have my pet under anesthesia, so I understand exactly what you’re feeling. But as a veterinarian and a veterinary dentist specifically, I also know how much they benefit from and need COHATs for their health. This is why my little chihuahua was anesthetized every 9 months for her COHATs, despite the stress I felt while she was under; the anesthesia risks were much smaller than the benefits of a healthy, pain-free mouth.

Pets are tough; most of them will not show any overt signs of oral pain. I can tell you as a dentist who sees several cases a day: our pets will continue to eat and play despite having a painful mouth or tooth. Their option is to have a sore tooth and eat or have a sore tooth and be hungry; they will eat. In my experience, once I treat the cause of oral pain, owners frequently report a positive change in their pet’s overall attitude and energy, and I often hear, “I did not realize they could have all this energy!” Every pet is different, and it will change from one pet to another, but many of my patients feel better after their COHATs, and their owners frequently notice a positive change.

There are many things found on an awake oral exam that can cause pain, for example, a fractured tooth, gingivitis (red gums), or gingival recession (root exposure). However, many things cannot be appreciated on awake oral exams that could be causing oral pain in your pet, for example, carious lesions, a non-vital tooth, an impacted tooth, or deep probing (bone loss). I recommend a COHAT to assess your pet's oral health and treat any disease that might be present, thus removing the pain. Stage 1 periodontal disease can be reversed, and more advanced disease can be treated at the same time, so whether or not your pet is painful, the COHAT will be beneficial. It will reset your pet's oral health and give your veterinarian all the information they need to make recommendations moving forward.

A COHAT should be followed by daily oral home care where possible and, on average, a yearly COHAT to stay ahead of any disease and allow your pet to have a pain-free mouth year-round. I can tell you that a cosmetic cleaning would not address any oral pain and would not lead to any diagnosis of the disease that might be causing oral pain.

Yes. Daily oral home care is an integral part of keeping companion animals’ mouths healthy. I encourage all pet parents to find a routine that works for them and integrate toothbrushing into their pets’ lives. Alongside toothbrushing, there are diets, water additives, treats, and toys that can be combined with toothbrushing to help manage plaque and calculus at home.

The goal of toothbrushing is to disrupt the plaque biofilm that forms on your pet's teeth, just like yours, and prevent it from mineralizing into calculus (tartar). Since plaque appears within hours and calculus can form in as little as 24 hours, disrupting the plaque biofilm daily is critical to staying ahead of plaque and calculus buildup. Daily toothbrushing means you disrupt the biofilm every day and significantly reduce calculus formation on your pet's teeth long term.

You’d be surprised. First, I would ensure your pet does not have a painful mouth because we do not want a negative experience for you or them. To do so, either start when they are a puppy or a kitten or after a COHAT (see COHAT handout) so you know that any periodontal disease that could be painful has been evaluated and treated. If your pet had oral surgery, make sure you follow your veterinarian’s directive about when toothbrushing can be started.

Second, start slow. Make it as positive as possible, make it routine, and do not give up after one or two tries. Pets are smart; they will quickly learn that a toothbrush means food or a favorite activity afterward and will learn to either love it or at least tolerate it. And yes, you can feed after toothbrushing!

Having said that, I want you to have a good relationship with your pet, and if toothbrushing is a fight, then that is not the goal. What I suggest instead is working up to a routine that works for both pet and pet parent.

My main tip is not to attempt to brush their teeth like you do your own. In an ideal world, we would brush all the surfaces of every tooth in our pets’ mouths every day, but that isn’t realistic. Instead, focus on the outside surfaces and keep your pet’s mouth closed. This means you are not trying to open their mouth, there is no chewing, and most of all, you don’t touch their tongue.

Using your non-dominant hand, gently keep your pet’s mouth closed by putting your index finger on their muzzle or head and your thumb under their chin; try not to cover their eyes. With gentle pressure, keep their mouth closed and slip the toothbrush inside the cheek on one side. Brush back and forth a few times, then switch sides and do a few more back and forth. Finish by doing a few swipes of the front teeth if you can. Follow this with a lot of praise, their favorite treat, a meal, or a favorite toy/activity.

Keep in mind that cavities are extremely rare in pets; they are never reported in cats and less than 5% in dogs. So toothbrushing can be done before a meal, and the meal can be the treat for sitting through toothbrushing. Toothpaste can be used, and sometimes that is enough of a treat. In some cases, the toothpaste leads to a lot of licking and prevents actual brushing, so understand that the motion and action of the bristles is what removes the plaque. Soaking the toothbrush in water is just as effective, and you do not need the toothpaste.

The first time you brush, you might only touch one tooth and follow that with a reward. The next day, work on getting a swipe on one side and then a few swipes the following day. Slowly, over the next few weeks, you will be able to brush more efficiently, and your pet might even be excited for it to happen since it means food, treats, or something fun is about to happen. Keep trying and make it a routine part of your day, and before you know it, you will be toothbrushing daily!

Many veterinary clinics sell pet toothbrushes, and some pet stores have them as well. Overall, pet toothbrushes tend to have long handles to help you reach the back of their mouths, and they come in different sizes since a cat, a pug, and a Labrador will not need the same size. You can find one that works for you. Realistically, any soft-bristled toothbrush or pediatric toothbrush is appropriate.

Do not use toothpaste meant for humans. There are several dog and cat toothpastes sold at both veterinary clinics and pet stores. Feel free to use the one your pet prefers as a treat or pick one, like vanilla or mint, that is formulated for pets and has a smell you enjoy. As I mentioned, toothpaste is not necessary if it gets in the way, but it can be a great way to make it positive for your pet if they enjoy it.

The short answer is no. The purpose of toothbrushing is to disrupt the plaque biofilm that forms on teeth. The motion of the bristles of the toothbrush rubbing on the teeth is the best way to do this at home for pets.

There are some products and pet diets that can also help reduce plaque. However, there are plenty of products that claim to clean your pet's teeth, and it can be very overwhelming and confusing for pet parents to know what is truly helpful.

As a veterinary dentist, I can tell you that toothbrushing is the best way, and I strongly encourage all pet parents to make it part of their daily routine.

I also don’t want you to give your pet anything that could damage their teeth, be risky for their health, or be a waste of your money. As such, I suggest you visit the Veterinary Oral Health Council website (vohc.org), where they have a list of approved products that have been researched and proven to do what they claim on the label.

Nothing will have the same effect as the bristles of a toothbrush contacting your pet’s teeth; if it did, our dentists would recommend it. Although some chews might help reduce some plaque (see vohc.org), most don’t play a significant role in specifically reducing plaque buildup.

Even if chewing had some benefits, this would only be for the main chewing teeth and would not provide any benefit to the others.

Most of all, many chews, even some marketed for pets and sold at pet stores, are dangerous for pets as they can break teeth. As a dentist who sees fractured teeth every day, I know how much misinformation is out there regarding what is appropriate for our pets to chew, and I understand that finding the right options can be difficult.

My advice is that anything you offer your pet should have a nice bend or fully break when force is applied at both ends, and you should be able to indent it with your thumbnail. All bones and antlers are too hard and should not be given to any pet as they will fracture teeth.

Daily. The plaque biofilm forms quickly and starts solidifying into calculus as early as 24 hours, so toothbrushing should be done daily. Pets can quickly learn a routine, and if you stick with one and make it positive, you will soon find that they might be the ones reminding you it’s toothbrushing time.

No. Toothbrushing will not remove the need for COHATs; if it did, we wouldn’t need to go to the dentist. Toothbrushing is a great way to manage oral hygiene at home, and even with the best methods and compliance, it will never be perfect. Just like you and I brush our teeth, we still go to the dentist as well, and it should be the same for your pets. Daily toothbrushing is what you can do at home to help your pet, but they should still get a yearly COHAT with their veterinarian or a veterinary dentist.

Please understand that cosmetic cleanings (awake teeth scaling offered by some groomers and other similar companies) are dangerous and offer no health benefits. See our Cosmetic Cleaning handout for more information and know that daily toothbrushing at home is safe and helpful but does not replace or remove the need for COHATs.

Yes, I have brushed my dogs’ teeth over the years. One of them would get overly excited if anyone went in the bathroom in the evening because they thought it was toothbrushing and treat time. My technician’s cat waits on the counter at 7 pm to get his teeth brushed so he can have dinner afterward. I get plenty of videos of clients showing me their excited pets for toothbrushing.

I am not perfect and do not expect my clients to be perfect with toothbrushing either; I am only asking you all to try with my tips.

COHAT stands for Comprehensive Oral Health Assessment and Treatment(s). It is the term we use in veterinary medicine to encompass everything that is done in the oral cavity while your pet is anesthetized. It is often referred to as a “dental cleaning,” “dental,” or “prophy,” and although cleaning is part of a COHAT, it is not the only part, which is why COHAT is preferred. A COHAT includes a tooth-by-tooth and oral exam noted in a dental chart, cleaning of each tooth including the gingival pockets (below the gumline), polishing, and making a treatment plan for each tooth. A COHAT should also include full-mouth intra-oral radiographs and the review of those radiographs for periodontal disease staging and treatment planning.

The oral exam looks at every part of your pet’s mouth: the tongue, gingiva, mucosa, palate, pharynx, lymph nodes, and more. It notes, for example, any redness, swelling, abnormal growths, or pigment. The tooth-by-tooth exam looks at each tooth individually, noting any periodontal pockets, gingival recession, enamel abnormalities, and tooth fractures, to name a few.

The dental radiographs show a 2D image of the teeth and surrounding structures. We can see each tooth root and the surrounding bone and evaluate them for several factors including bone loss, tooth resorption, root fracture, pulp chamber widths, and more.

By taking both the visual exam and radiographic interpretation together, each tooth can be staged for periodontal disease, endodontic concerns can be evaluated, and a treatment plan can be made for each tooth. Teeth that are in periodontal disease stage 1 will be treated with the cleaning part of the COHAT, while those in more advanced stages or with other concerns will likely require further treatments.

The COHAT includes cleaning of the teeth, which is a treatment. A dental cleaning is the removal of all plaque and calculus above and below the gumline. This is done with an ultrasonic scaler and hand instruments: scalers and curettes. The curettes are used in the sulcus, under the gumline, while the scalers are used on the crown of the teeth.

Once the cleaning is complete, each tooth is polished to smooth out the surface because removing the rough surface helps reduce plaque accumulation after the cleaning.

Periodontal disease is staged in 4 categories. Pets fall into stage 1 when even mild gingivitis is present, and thus that is disease. The good news is that stage 1 periodontal disease is reversible because gingivitis is present but there is no attachment loss yet. It is the ONLY reversible stage; the treatment part of the COHAT takes care of that with the cleaning. We treat stage 1 periodontal disease by thoroughly removing the plaque and calculus and resetting your pet’s oral health.

This should always be followed by daily oral home care to prevent the re-accumulation of plaque and calculus, as this will cause gingivitis and put them back in stage 1 periodontal disease.

Prophy is short for prophylaxis and is widely used in veterinary medicine and by pet parents to refer to a dental cleaning. This is incorrect, as by definition prophylaxis means to prevent disease. The cleaning is not prophylactic; once there is gingivitis, it is a treatment. This is an important distinction, as early treatment is the best prevention for advanced disease.

No. Your vet might offer it as optional, or possibly not offer them at all, but it is my professional opinion as a veterinary dentist that every COHAT should always include intra-oral dental radiographs. A thorough visual tooth-by-tooth exam is integral to a COHAT but still incomplete, as it doesn’t show inside the tooth, the roots, or the bone. The dental radiographs complete the picture.

If your pet is getting a COHAT or you are discussing one with your vet, make sure to inquire about dental radiographs. It should be part of your pet’s assessment; otherwise, disease will be missed.

This is a good discussion to have with your veterinarian before a COHAT. Usually, an awake oral exam can be done, which can give your veterinarian an idea of some concerns they might find. They can discuss with you what options might be available based on what they see.

Teeth in stage 4 will need to be extracted; this means there is too much bone loss and preserving them would not be possible.

Teeth in stage 3 might require extraction or root planing. Root planing is a deep cleaning of the root surface of a tooth that has attachment loss. Root planing can be "closed," where the instrument slides below the gumline without an incision, or "open root planing," where the gingiva around the tooth is incised to expose the roots fully. A curette is then used on the roots to thoroughly clean them, and the gingiva is sutured closed around the tooth. The goal of root planing is to create a clean surface for the gingiva to reattach to the tooth. Teeth in stage 3 that aren’t extracted will need to be monitored closely moving forward, and the next COHAT might be recommended sooner. Daily oral home care will be important once your pet has healed.

Stage 2 teeth might need a deeper clean with root planing and closer monitoring moving forward. You might be asked to pay closer attention to those areas when doing toothbrushing at home.

Fractured teeth with pulp exposure will require treatment. If they are noted on an awake exam, they could be referred to a veterinary dentist for a root canal treatment or extracted.

Teeth that have tooth resorption will likely need to be extracted. Resorption is progressive, irreversible, and painful once it reaches the gumline.

Other issues such as oral growths, gingival enlargement, enamel abrasions, abscesses, and tooth discoloration have various treatment options depending on the issue and can be dealt with by a general practice veterinarian or a veterinary dentist. As a dentist, I usually see the more advanced issues, but having good discussions with pet parents is important. Ensuring your vet can reach you to discuss their findings is crucial on the day of the COHAT so they can explain everything and help you make a treatment decision for your pet.

Yes! Even the best-behaved, most gentle, and well-trained pet would never allow a COHAT to happen awake. It would also be incredibly stressful, not to mention pretty much impossible to attempt awake. If you think of everything that happens when you go to the dentist and how you are asked to sit still with your mouth open or asked to hold or gently bite your x-ray sensor; no pet would allow that.

While your pet is anesthetized, we can do the full COHAT and make sure that every area in the oral cavity is assessed, each tooth is radiographed, and every surface of the teeth is cleaned while maintaining their safety by protecting their airway and removing the risk of movement while we treat them.

Anesthesia is a big part of a COHAT and often a concern for pet parents; please refer to the anesthesia handout to see if we can ease some of your concerns.

Multiple factors come into play to answer this question. The breed and size of your pet play a big role; small breeds and brachycephalics usually require COHATs more frequently due to crowding of their teeth. Also, because they are smaller, even 1mm of bone loss is significant compared to 1mm in a large breed. Home care is also a factor, as daily toothbrushing can greatly decrease plaque and calculus accumulation and help extend the time between COHATs. General individual predispositions and sensitivities are also a factor; some pets are simply more sensitive to plaque and calculus and develop gingivitis more quickly than others.

Overall, an annual COHAT is ideal for most pets. In small breed dogs, every 6-9 months might be best, and large breeds might get away with 18 months. But pets need to be evaluated individually; the goal of a COHAT and home care should be to stay ahead of periodontal disease so that every COHAT is done while still in stage 1 and the COHAT is the treatment so no further treatments, like extractions, are needed.

Awake oral exams can help determine if a COHAT is recommended, but keep in mind that a COHAT is a complete assessment and is the only way to get a complete picture. Where possible, keeping to a yearly COHAT schedule is best.

No! These are purely cosmetic and offer zero health benefits. In Ontario, they must legally be called “cosmetic.” See our Cosmetic Cleaning Handout for all the information about them and why I strongly believe you should not purchase these services.

The American Veterinary Medical Association defines anesthesia as “a controlled unconsciousness; where your pet's level of consciousness is controlled so they don't feel pain and don't move.” This can be done and maintained with injectable and/or inhaled drugs and, in dentistry, always with local anesthesia as well. 

We carefully keep your pet unconscious so they cannot feel anything while we work, and we then take care that they recover peacefully and pain-free.

From your pet’s perspective, nothing; they are unconscious. For me and my team, a lot happens; after your pet is sedated and induced, we first secure the airway by placing an endotracheal tube and starting them on oxygen and anesthetic gases. Then we place and secure all our monitoring equipment, position them comfortably, and make sure to keep them warm. While they are anesthetized, they are carefully monitored and the sedation level and drugs are adjusted based on their response. We monitor their heart rate, respiratory rate, ECG, temperature, expired CO2, oxygen saturation, and blood pressure constantly throughout anesthesia. As such, while the technician keeps your pet asleep and monitors them, I get to work with taking x-rays, doing the oral exam, cleaning, polishing, and any oral surgery. Then your pet is weaned off the drugs and slowly wakes up. Throughout this, we make sure your pet is comfortable and pain-free.

The risks of anesthetic-related death were estimated to be 0.05% (1 in 1,849, 95% confidence interval [CI] 0.04–0.07%) in dogs and 0.11% (1 in 895, 95% CI 0.09–0.14%) in cats. So although the risk is not zero, it is quite low. Other risks that are a side effect of the anesthetic drugs or complications from the procedure or the anesthesia include things like hypothermia and hypotension. These are managed by me and my team by adjusting the drugs and adding support drugs as needed. Close monitoring and acting quickly if there are changes in the pet’s condition is a key part of administering anesthesia. Anesthesia or sedation is never risk-free, but our protocols are adjusted based on every pet’s need to minimize the risks and manage your pet’s response. Keep in mind that not addressing your pet’s oral health and leaving periodontal disease, fractured teeth, resorbing teeth, or oral growths also has risks and consequences including pain, infection, anorexia, and possibly even death if something like a malignant mass is left untreated.

Although anesthesia can be scary and feels like an avoidable risk, it might only feel that way as you don’t obviously see the risks of not pursuing an oral treatment for your pet. A balance needs to be found, and the small risks of anesthesia are outweighed by the risks of leaving oral disease; as such, proceeding with anesthesia is almost always more beneficial than avoiding it.

1 - Brodbelt DC, Pfeiffer DU, Young LE, et al. Results of the confidential enquiry into perioperative small animal fatalities regarding risk factors for anesthetic-related death in dogs. J Am Vet Med Assoc 2008;233:1096–104

COHATs, oral surgery, and many of the oral treatments I do can take more than a few hours, so your pet is usually under for a few hours when they come to see me. Managing your pet’s anesthesia and adjusting our protocols based on their needs plays a vital role in all anesthesia treatments, and so long as your pet is stable, there are no more risks if anesthesia is long. There is always a dialogue with either the anesthesia technician or the anesthesiologist; if your pet is truly not responding well to anesthesia, we can stop the procedure and wake them up and revisit it at a later date. Your pet’s well-being is always my priority, and we always put them first.

Having said that, in my career, I have only had to abort less than a handful of surgeries due to a pet’s poor response. With proper monitoring, response to any changes, and keeping your pet’s well-being as our top priority, anesthesia, even a long one, can be done safely.

This is a discussion I encourage you to have with your vet as every pet is different. There are medical conditions that require anesthetic considerations to be taken; however, they may not prohibit anesthesia altogether. Although I focus on teeth and oral health, I know pets are not walking mouths and must be considered as a whole, so making sure your pet is healthy enough for a procedure is important. Having pre-anesthetic blood work is crucial, as well as working up any abnormalities; for instance, a pet with a heart condition could be seen by a cardiologist to better understand what anesthetic considerations need to be taken.

As a specialist working in a referral center, I frequently get referred cases with comorbidities (other diseases). This is where working as a team with other specialists and an anesthesiologist is an important part of decision-making for anesthetic protocols. If your pet has a medical condition that worries you, discuss it with your primary care veterinarian and consider a referral to a specialist if needed. Alternatively, make sure to discuss the specific risks that might apply to your pet, how they will be mitigated by the team, and what it will mean for your pet.

Oral care and hygiene for pets is complex, but overall, since pets cannot speak or sit still with their mouth open for prolonged periods, it would be impossible to diagnose or treat them without anesthesia. My goal is always to make sure your pet has a clean, pain-free mouth, and to do a COHAT, I need them to be anesthetized. To fix a fractured tooth, remove an oral growth, mend a broken jaw, or extract a tooth, anesthesia is necessary for me to treat your pet.

Toothbrushing is something that can be done in between COHATs to help maintain your pet's oral health. It helps minimize plaque and calculus and can prevent severe periodontal disease. Doing so might reduce the amount of oral surgery your pet will need from me and help reduce the anesthesia time, but it does not remove the need for an anesthetized yearly COHAT. Similarly, only offering appropriate chews and toys to prevent fractured teeth is also ideal.

Although there is a lot of marketing for all sorts of products that supposedly help reduce plaque and calculus, you should always refer to the VOHC (vohc.org) for the ones that are proven to help. Also, know that cosmetic cleanings offer no medical or health benefits and are not a good option for your pet.