17 Feb What is a COHAT? Why We Don’t Just Call it a “Pet Dental Cleaning”
Why a COHAT is More than a Pet Dental Cleaning
A Comprehensive Oral Health Assessment and Treatment (COHAT) is a thorough assessment of the oral cavity of your pet with the formulation of a treatment plan to address any disease that may be present. The following description will demonstrate that calling the procedure just a dental cleaning misses many of the essential steps in the evaluation of the oral cavity.
When a dental cleaning is performed, the opportunity to fully assess our pets’ mouths and address potential disease processes is missed. When a pet dental cleaning is performed without a comprehensive evaluation by a veterinarian and their staff our pets will often have dental disease go undiagnosed and often remain in pain.
Teeth have been compared to icebergs. There is more tooth structure below the gumline than what is visible above it, just like icebergs hold most of their mass below the surface of the water. Cleaning the teeth is a vital part of a COHAT, but without fully evaluating dental structures and surrounding bone below the gumline, a significant amount of disease will be missed.
What is a COHAT?
The COHAT is a multistep procedure, which does not start in the mouth.
Step One: A thorough examination of the entire patient is performed followed by a review and discussion of the medical and dental history with the pet owner. This valuable information may provide clues to specific dental issues related to their normal routine and potentially provide insight to systemic problems.
Step Two: A complete blood panel is necessary prior to anesthesia to evaluate internal organ function. The results of this blood panel are a critical part of a COHAT to be sure a patient is a good candidate for general anesthesia. Animal Dental Care and Oral Surgery has a complete state-of-the-art, in-hospital laboratory where the majority of our patient blood panels are performed. If any more specialized tests are required, we frequently utilize an outside laboratory that is dedicated to veterinary patients with results typically returned the following day.
Step Three: Following the blood panel, a pre-anesthetic sedative is administered 20-30 minutes before the induction of anesthesia. These sedatives also have pain relief properties that will minimize a patient’s discomfort prior to any part of the COHAT that may cause pain, such as tooth extractions. Giving these medications in advance allows us to use less general anesthetic agents and improve the overall safety of the procedure.
Step Four: An intravenous catheter is always placed prior to anesthetic induction, which allows for the direct administration of anesthetic induction agents, as well as any additional needed medications before, during and after anesthesia. Intravenous fluids are always given via this catheter throughout the procedure. These fluids help maintain a patient’s blood pressure while under anesthesia and will help prevent dehydration after the procedure. Patients are attached to state-of-art anesthetic monitoring devices that evaluate critical parameters, such as blood pressure, heart rate, respiratory rates, blood oxygen saturation levels and many other values. Animal Dental Care and Oral Surgery has a dedicated Certified Veterinary Technician under veterinary supervision monitoring our patient’s at all times during the anesthetic portion of the COHAT.
Step Five: Once the patient is under general anesthesia, the intraoral portion of the COHAT begins with full mouth dental radiographs. It is not possible to provide quality veterinary dentistry without dental radiographs. Studies have shown that 40% or more of the oral pathology (disease) of our veterinary patients will go undiagnosed without dental radiographs. Radiographs allow for assessment of the teeth and supporting structures below the gum line that are not visible during the initial conscious oral exam.
Step Six: The oral examination by a veterinarian includes a detailed evaluation of the soft tissues of the oral cavity, including the tonsils, pharynx (back of the mouth), the tongue, the roof of the mouth and the mucosa and gingiva lining the oral cavity. The structures are evaluated for abnormalities, such as ulcerations, swellings, oral masses or areas of inflammation. The teeth are then evaluated. Each individual tooth is examined for any abnormalities including periodontal pocketing, mobility, discoloration, fractures, or tooth abrasion, to name a few.
Step Seven: All oral examinations and radiograph evaluations at Animal Dental Care and Oral Surgery are performed by one of our board-certified veterinary dentists with our trained staff members recording the results in a detailed dental chart. While the veterinary dentist formulates a treatment plan based on these results, a dedicated dental assistant will perform a complete ultrasonic scaling and polishing of every tooth–this is described in greater detail below. Our board-certified dentists then call the patient’s owner to review the treatment plan, answer any questions they may have and obtain their permission to proceed. It is our promise to our clients that we will never perform any dental procedures without their consent.
Step Eight: Before any specific treatments are performed, the mouth is disinfected using an oral antiseptic rinse. Dental plaque and calculus are removed from the patient’s teeth and the area immediately below the gumline (gingival sulcus) with an ultrasonic scaler. Plaque accumulation below in the gingival sulcus is the first battleground of the body’s defense against periodontal disease. Hand curette instruments are often used to help clean plaque and calculus from the gingival sulcus. Once the teeth have been scaled, they are polished using a pumice paste. Plaque easily attaches itself to roughened areas. Polishing removes any surface irregularities, which in turn decreases plaque retention. The oral cavity is then thoroughly rinsed to remove debris or excess polishing pumice. A final rinse with an oral antiseptic is then performed.
Step Nine: If additional treatments are indicated and the pet owner has permitted us to perform them, they are then completed at that time. The majority of treatments, such as periodontal therapy, root canal treatment or surgical extractions can be performed on the same day. Once these are completed, the anesthesia portion of the COHAT is finished. The patient is still monitored closely by the doctors and staff for a number of hours until they are able to go home with their owner.
Step Ten: At the time of discharge a trained staff member will review with the pet owner the entire procedure up to that point. Radiographs and the findings of the dental exam are reviewed, as well as any additional procedures that were performed. All needed aftercare is discussed and follow up examinations are scheduled. Quite often pet owners will schedule the next COHAT procedure for 6-12 months later.
Step Eleven: The final, critical part of the COHAT is to demonstrate and help the pet owner start to perform daily at-home dental care. There are many excellent dental homecare treatment options available. The best option has always been and will remain daily brushing with a veterinary-approved, pet toothpaste. Some pets will not allow brushing. If that is the case, our staff members will thoroughly review the many other beneficial treatment and prevention products and techniques available.
Why is Anesthesia Required for a COHAT?
Although we do not enjoy the process, we all know that humans are able to remain awake for the majority of our routine dental procedures and do not require anesthesia. Unfortunately, our veterinary patients will not allow a COHAT to be performed without general anesthesia. Dogs and cats will simply not allow all of the vital components of a COHAT to be performed without it. Trying to perform a COHAT on awake veterinary patients will only cause them undue stress and anxiety and any painful oral disease will go undiagnosed and untreated.
Pain-Free, Healthy Mouths!
Ultimately, our goal is to provide our patients with a pain-free and healthy mouth. Dental disease is the most common and frequently diagnosed medical condition in our pets. Left untreated, it will always progress and make the oral cavity a constant battleground. As you can now see, a COHAT is never just a pet dental cleaning. It truly is a comprehensive evaluation and treatment of our beloved pet’s overall dental health and will only improve their quality and length of life with us.
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