Terminology and scope
Merck describes "prophy," "prophylaxis," and "dental" as colloquial terms that are "fraught." It lists COHAT, COPAT (comprehensive oral prevention, assessment, and treatment), and oral ATP as more descriptive alternatives [1]. Of the sources cited here, only Merck uses the COHAT label [1]. The step-by-step cleaning sequence below comes from a peer-reviewed Today's Veterinary Practice article by Brook Niemiec and Kymberley Stewart [2]. The assessment detail comes largely from a cat-specific Journal of Feline Medicine and Surgery review by David Clarke and Anthony Caiafa [3]. None of the cited sources gives an anesthetic drug protocol or doses.
Before anesthesia
Clarke and Caiafa set out a four-stage oral examination [3]:
- a review of the presenting problem with the owner
- an extraoral physical exam of the head and neck in the awake patient
- an awake intraoral exam
- a repeat extraoral and intraoral exam under general anesthesia
They stress a whole-body exam before the head and neck are examined [3]. Their history list includes signalment, diet, medications, household and outdoor access, previous dental work, and the current home care routine. They say the home care routine helps predict how complex treatment will be and how well the owner will keep up home care [3].
Merck describes the awake exam as a precursor to the anesthetized one. It cautions that the findings should be read carefully, since only outer tooth surfaces are visible and results depend on patient cooperation [1]. The awake exam can capture occlusion, obvious tooth trauma, calculus, inflammation, foreign material, and abnormal tissue growth. Merck calls symmetry "the key to the conscious oral examination" [1]. Merck adds that occlusion is easiest to judge awake or under sedation before intubation [1]. Clarke and Caiafa note that a cat resisting strongly may need to go straight to the anesthetized exam [3].
For the workup, Niemiec and Stewart say a thorough preanesthetic exam supports safer anesthesia and a reasonable estimate of time and cost [2]. Clarke and Caiafa call it "prudent, especially in the senior cohort" to run hematology, biochemistry, T4, and urinalysis before anesthesia in cats [3].
Anesthesia and airway protection
Clarke and Caiafa list a minimum standard for the anesthetized feline exam [3]:
- perioperative IV fluids
- patient monitoring that includes core temperature
- gas anesthesia with the airway protected by a cuffed endotracheal tube
Niemiec and Stewart describe general anesthesia as essential for both health and welfare reasons. They say monitoring must be excellent because procedures are long and patients are often older [2].
The Swedish survey authors, citing guidelines, wrote that intubation is generally not possible in an animal that is only sedated, which leaves the airway unprotected [4]. They also note that one retrospective study they cite found canine post-anesthetic aspiration pneumonia in 0.17% of cases, with dental procedures not linked to higher risk [4].
Niemiec and Stewart also describe low-stress handling and multimodal analgesia, including dental blocks at every extraction site. They say postoperative analgesia matters because pain is harder to control when analgesia is not given before the inciting event [2].
Cleaning sequence under anesthesia
Niemiec and Stewart note that protocols and terms vary, and they recommend the following order [2].
| Step | What the authors describe [2] |
|---|
| 1. Preanesthetic exam and workup | Supports safer anesthesia and a cost estimate |
| 2. Anesthesia and monitoring | Monitoring level must be excellent |
| 3. Chlorhexidine lavage | Lowers bacterial load for patient, staff, and environment |
| 4. Supragingival scaling | Usually with an ultrasonic scaler |
| 5. Subgingival scaling | Ultrasonic with a subgingival tip; hand curette if attachment loss is present |
| 6. Polishing | Smooths the tooth to slow plaque attachment |
| 7. Sulcal lavage | Chlorhexidine, saline, or lactated Ringer's solution |
| 8. Oral exam and charting | Probe and explore every surface of every tooth |
| 9. Dental radiography | Full mouth recommended; at minimum, all pathology |
| 10. Treatment planning | Client contacted for consent before additional therapy |
On step 5, the authors wrote that "unless the subgingival plaque is completely removed, minimal to no medical benefit has been achieved" [2]. They explain that subgingival tips are thinner and run at lower power because they work on cementum-covered roots rather than enamel [2].
Clarke and Caiafa describe plaque scoring with a disclosing solution, which they say is performed in research studies and may also guide assessment of home care. Calculus scoring follows. They also describe using an explorer after scaling and polishing to check for residual subgingival calculus [3].
Probing, charting, and radiographs
Probing
Merck describes probing at six sites per tooth for a circumferential assessment [1]. Clarke and Caiafa describe two or three sites on the buccal surface and two or three on the lingual or palatal surface [3]. Both stress gentle pressure, and Clarke and Caiafa note that inflamed tissue is easy to penetrate [1][3].
The sources give different normal values for cats:
- Merck states that "the normal accepted probing depth for the dog is 1-3 mm and for the cat is 0.5-1 mm" [1].
- Clarke and Caiafa state that healthy feline sulcus depth is 0 to 0.5 mm and that anything over 0.5 mm indicates a periodontal pocket [3].
- Niemiec and Stewart define pathologic pockets as over 3 mm in dogs and over 1 mm in cats [2].
Charting
Merck describes recording sulcus depth, furcation exposure, and mobility for each tooth on a dental chart [1]. Clarke and Caiafa add the following items [3]:
- bleeding on probing
- discharge
- hyperplasia or ulceration
- gingival recession
- plaque and calculus scores
- crown and root pathology found with an explorer
Niemiec and Stewart illustrate why visual inspection alone falls short with a patient whose first molar looked only mildly inflamed but had a 12-mm pocket on probing [2].
Merck grades whole-mouth calculus and gingivitis on 0 to 3 scales and stages periodontal disease 0 to 4 by attachment loss [1]:
- Stage 2: under 25% loss
- Stage 3: 25% to 50% loss
- Stage 4: over 50% loss
Each of these stages has a matching furcation stage in multirooted teeth [1].
Radiographs
According to Merck, radiographs are needed to judge the full extent of disease and to avoid both inappropriate treatment and missed disease that is not visible on exam [1]. Niemiec and Stewart call them "mandatory for proper diagnosis and treatment" [2]. The Swedish survey authors, citing the guidelines, say radiographs should precede every extraction. They add that radiographs should be repeated afterward to confirm that no roots remain and that no iatrogenic fracture occurred [4]. For cats, Clarke and Caiafa note that many tooth resorptions sit below the gumline and are found only on radiographs [3].
Treatment decision points
Merck describes treatment as scaled to the degree of attachment loss. Options range from scaling and polishing for gingivitis, through closed and open periodontal therapy, to extraction [1]. Niemiec and Stewart say a cleaning plus home care is enough only when all of the following apply [2]:
- no pathologic pockets
- little or no recession
- mild or no radiographic bone loss
- no mobile teeth
They say any of the following findings calls for more than closed root planing, with flap surgery or extraction as the options [2]:
- deeper pockets
- class 2 or 3 furcation
- bone loss over 50%
- pathologic mobility
Merck places the threshold for open surgery at pockets "> 5-6 mm deep" [1]. Niemiec and Stewart describe extraction as typically the best therapy for nonstrategic, severely diseased teeth. They note that clients choosing periodontal surgery must commit to diligent home care and rechecks [2]. Merck adds that teeth mobile from attachment loss should be extracted [1].
On timing, Niemiec and Stewart consider staging the procedure acceptable if it is expected to run beyond 3 hours [2]. Clarke and Caiafa describe two options [3]:
- treating under the same anesthetic, after consulting the owner
- recovering the patient so that findings, costs, and prognosis can be discussed and treatment scheduled
Team roles and current practice
The Swedish survey authors note that in Sweden veterinary nurses may anesthetize patients and perform dental cleaning [4]. Extractions are classed as surgery for veterinarians, although simple extraction of mobile single-rooted teeth may be delegated after radiographic evaluation [4]. The authors quote the AVDC position that "only veterinarians shall determine which teeth are to be extracted and perform extraction procedures." They also report that the RCVS bars veterinary nurses from extractions [4].
That survey was a validated questionnaire sent to 3,657 veterinarians and 1,650 veterinary nurses, with response rates of 32% and 38% [4]. Key findings [4]:
- Of veterinarians whose clinics did dental cleaning, 72% had access to dental radiography.
- Of veterinarians reporting extractions at their clinic, 30% said they had no such access.
- Cleaning under sedation was more common in smaller clinics and among older professionals.
The authors caution that the results come from a Swedish context and may not generalize. They also note that they did not ask about intubation [4].
For aftercare, Niemiec and Stewart report that plaque attaches within 24 hours of cleaning. Without home care, bacterial counts return to pretreatment levels in about a week [2].
