I get some great questions from clients. They inspire me with article ideas and keep me in tune with diabetic pet owners and their concerns. I enjoy interacting with our readers, and oftentimes the questions I am asked are worthy of a newsletter. I bet if one person has this question and takes the time to write me, there are likely lots of folks with a similar question. Today’s question we’re asked if its okay to have a dental cleaning for a diabetic senior.
I do enjoy reading your articles as they arrive in my email, and you have helped me in the past. I want to get your thoughts on having my 14 year old Westie’s teeth cleaned. He’s had 5 skin infections in the past 8 months and where I once had his blood sugar fairly regulated, between the low hundreds and rarely over 225, he is all over the place now. One day he was over 500! He just had a check-up and his vet told me that his heart and lungs are in good shape and he acts like a puppy. His last blood panel, close to a year ago, was good with liver and kidney function. My vet suggested having his teeth cleaned as his back teeth have extreme tartar and his gums are inflamed. He stated the skin infections could be getting worse due to the worsening tartar. I use enzymes and try to brush his teeth but I’m fighting a losing battle. My concerns are with his age and diabetes if teeth cleaning is safe. However I feel it is a catch 22 if I don’t have his teeth cleaned as we all know the health of one’s mouth is a telltale sign to the rest of the body. He had a healthy mouth until after his diabetes diagnosis. He was diagnosed 3 years ago. I am his pancreas and he is my little trooper.
First of all, I adore that you call yourself his pancreas. Indeed you are!
Since he doesn’t have complicating factors such as severe heart issues, and I might have considered it even then, I would definitely have his teeth cleaned. Age is not a disease! Also, your vet will likely run a current blood panel prior to the procedure to reassess his metabolic functions. I anesthetize old timers and patients with heart disease, diabetes or other issues frequently. Would I prefer to anesthetize a young healthy pet with no complications? Sure. But young healthy pets don’t often need to be anesthetized. I do a lot of dentals in my own vet practice. I don’t see diabetes nor his advancing years as a contraindication to anesthesia at all. We just need to monitor the blood glucose closely before, during and after the procedure.
If the gums are inflamed, they likely are causing him discomfort. We don’t want him to be in pain! Additionally, the infection in the mouth is very likely affecting his glucose regulation. I think oral infection and urinary tract infections are 2 of the most common infections for diabetic pets, but any infection can cause insulin resistance. As I said, I do lots of dentals in my own practice, and we take full mouth digital dental X-rays on all the dental patients. It’s not uncommon to find an abscessed root on dental X-ray that looks perfectly fine if you were to simply look at the tooth. Clients often tell me that their senior pets act like puppies again after a dental. If your vet can see inflammation and significant tartar, it is definitely worth cleaning the teeth!
When we anesthetize diabetics we take a few extra precautions. We monitor the blood glucose very closely. And of course we must have an IV catheter in place in case we need to give any emergency drugs such as dextrose. Frankly, in my own practice, I never anesthetize a pet without an IV catheter in place, no matter the age, no matter how “perfectly healthy” a pet is. An IV catheter is a “safety net”. Additionally, I have the emergency drug calculations done prior to anesthetizing a pet. If a pet is having a complication, I don’t want me or my staff fumbling with calculators while figuring out dosages as precious time passes. I’m quite “Type A” about monitoring everything we can monitor when a pet is under anesthesia. We Type A personalities can be quite irritating to those who love us in day to day life, but we are the ones you want anesthetizing your pet!
Now, do you give insulin the morning of the procedure or not? There are 2 schools of thought on this topic. Some vets will have owners feed a small meal and give half the insulin the morning of anesthesia. That’s valid. I personally do not routinely have owners feed or give insulin the morning of the procedure. However, I make sure I perform the procedure first thing in the AM. Any diabetic is first on the surgery docket, which is typically 8:30 or 9:00 at my practice. Then once the pet is awake I will give a snack and a bit of insulin. If the procedure had to be in the afternoon, rather than first thing in the morning, then I likely would give a light meal and a half dose of insulin in the morning. Each situation may be slightly different. I don’t know that there is a right or wrong way to address morning insulin so long as we diligently check blood glucose and are prepared to give IV dextrose should the blood glucose drop under anesthesia. If the blood glucose is extremely high, I might consider a fraction of a dose of insulin even without the morning meal. Again, I prefer to have patents off food prior to anesthesia, but I make sure a diabetic is done first thing!
Why do I prefer my way – anesthesia first thing in the morning and no insulin nor breakfast? My fear is that if we give insulin before anesthesia on an empty stomach we may have hypoglycemia during anesthesia. If we give insulin, we typically need to give a bit of food. I don’t like giving food before anesthesia because many anesthetics and narcotics can cause nausea. I don’t want pets vomiting or regurgitating under anesthesia as that could result in aspiration of the vomitus which could lead to pneumonia. In fact, about a year ago in my own practice, I started giving an IV injection of Cerenia at the onset of anesthesia for all of my patients who are anesthetized. Cerenia is an anti-nausea medication. Looking back, I’m glad I adopted this protocol because the incidence of inappetence and/or nausea the day post-operatively has definitely decreased. I know this because my staff calls surgical and dental clients the morning after anesthesia to check on my patients.
Be sure to chat with your veterinarian ahead of time to formulate a game plan for the day of his anesthesia.
Once you’ve had his teeth cleaned and his gums are healed, you can continue the home dental care. There’s nothing like a little elbow grease to keep his remaining pearly whites in good shape. Do let the inflammation resolve once the tartar is gone before you re-start the home care. If you try to brush the teeth when the gums are inflamed it may hurt him.
Have a question or comment? Post below or email me at firstname.lastname@example.org. I always enjoy hearing from my readers!
NOTE: Consult your veterinarian first to make sure my recommendations fit your pets special health needs.