Anesthesia is an important topic to be discussed in veterinary dental practice. There are professionals, I hope the minority, who believe and do dental scaling under sedation or any anesthetic drugs. But it's perhaps are isolated cases and the majority do dental procedures under general anesthesia.

The dentistry professional needs to understand the principles of anesthesia because:

 In most cases he needs to pass information about the procedure with tranquility to the owner; in most cases he is the responsible to exam the patient and determine the general conditions (ASA classification of physical status).

 During the procedure he stays on the head of the patient and important anesthetics information are in the head (pupil, eyeball position, palpebral and corneal reflexes, pharynx and larynx reflexes, muscle tonus of mandible, responses to surgical stimulation, tissue perfusion and others).

 He is in charge of the dental procedure. So he knows when he will do something painful (i.e., dental extraction) or not painful like supra gingival scaling. It's important he advise the anesthetist when he will change between these procedures.

There are some particularities in the anesthesia to dental procedures.

1.  The big variety of patients (horses, zoo animals, dogs, cats, ferrets, rodents and others) and types of procedures. Then, specifics techniques are designed to each of them.

2.  The painful stimulus is always changing.

3.  Manipulation of the head and the tracheal tube.

4.  Use of water and others fluids in the oral cavity.

5.  Hypothermia.

6.  Small instruments inside the oral cavity.

7.  Dental procedures are not fast.

8.  Dental diseases and systemic diseases correlation.

There is a misunderstood between anesthesia and analgesia in veterinary dentistry practice. In other words, the fact of the patient is "sleeping" under general anesthesia doesn't mean it is not felling pain. Local anesthesia plays an important role in the pain control of dental procedures. So its use is welcome and should be stimulated in the most oral surgeries. The effective pain control doesn't limit itself to the surgery period but must be planned before dental procedure including proactive and a multimodal strategies that star with preoperative medications, anesthetic protocol selection, and continues into the postoperative period.

The use of local anesthesia helps:

1.  To offer analgesia to patient trans- and postoperative.

2.  To decrease the plane of general anesthesia.

3.  To reduce the collateral effects of some analgesic systemic drugs.

4.  To reduce the local inflammatory response.

In cats and dogs patients the main local anesthetics techniques are:

1.  Topic:

a.  Gingiva

b.  Mucosa

2.  Local infiltration:

a.  Subperiosteum

b.  Intrapulp

c.  Intraligamental

3.  Nerve block:

a.  Infraorbital block

b.  Maxillary block

c.  Inferior alveolar (mandibular) block

d.  Mental block

e.  Major palatine block

The main local anesthetics drugs are:

1.  Lidocaine 2%. The dose is 7mg/kg without vasoconstrictor e 9mg/kg com vasoconstrictor. Its length of action runs from 40 minutes to 2 hours and 3 to 5, respectively. PS: Epinephrine seems safe in cats and dogs.

2.  Bupivacaine 0,5%. The dose is 2 mg/kg. Its length of action runs from 4 to 8 hours, and up to 12 hours with vasoconstrictor.

3.  Mepivacaine 2% or 3%. The dose is 9mg/kg. Its length of action runs from 40 minutes to 2 hours and 3 to 5 with vasoconstrictor. His low ph leads to a better action in locals with inflammation.

4.  Prilocaine 4%. The dose is 9mg/kg. Its length of action runs from 40 minutes to 2 hours and 3 to 5 with vasoconstrictor.
 

References

1.  Beckman B, Legendre L. Regional nerve blocks for oral surgery in companion animals. Compend. Cont. Ed. Pract., v.24, n.6, p.439-444, 2002.

2.  Camargo J, Futema F, Miranda R. Bloqueios loco-regionais para procedimentos odontológicos em cães e gatos. Rev. Nosso Clínico, São Paulo, n. 68, 2009.

3.  Carvalho V, Gioso M, Ferro D, Martinez L. Como melhorar a analgesia no transoperatório em tratamentos odontológicos de cães e gatos. Rev Clínica Veterinária. São Paulo, n. 79, 2009.

4.  Gaynor J, Muir W. Handbook of veterinary pain management, Mosby, St Louis, 2002.

5.  Lantz G. Regional anesthesia for dentistry and oral surgery. J Vet Dent, v.20, n.3, sep, 2003.

6.  Rochette J. Regional anesthesia and analgesia for oral and dental procedures, in Holmstrom S (ed): Veterinary Clinics of North America (Dentistry). Philadelphia, Saunders, 2005, pp 1041-1058.