Dental care for small animal veterinary patients requires high-quality anesthesia and pain management. Dental patients often have significant comorbidities along with their need for dental care, continuing into the geriatric period. With appropriate preanesthetic preparation and perianesthetic management, these patients can still receive quality dental care to support them throughout their life. Robust pain management and techniques that decrease inhalant anesthetic minimum alveolar concentrations can help manage common comorbidities such as mitral valve disease and chronic kidney disease. However, complex patient status or advanced dental disease may present a challenge to the provider. For such patients, anesthesia-free dentistry is not recommended; instead, referral to a specialist team will reduce surgery and anesthesia time and enable use of advanced monitoring techniques.<\/p>\n
Take-Home Points<\/strong><\/p>\n <\/div><\/div><\/p>\n Pain interventions should be aligned with the degree of pain stimulus experienced by the animal.1<\/sup> Ideal pain management would consist of a preventive, multimodal approach, intervening in the pain pathway at multiple points and attempting to avoid any perception of pain by the patient.1-3<\/sup> To achieve this goal, a combination of oral, intravenous, locoregional, and nonpharmaceutical agents can be used to create a full complement of strategies to mitigate pain.<\/span><\/p>\n Analgesia has been proven to be more effective when administered preemptively (before the procedure) than postoperatively.4-6<\/sup> Oral preemptive analgesia and sedation are often achieved with premedication designed to be administered by the client before bringing the patient to the hospital.7<\/sup> Agents generally consist of gabapentin and trazodone, which have wide safety ranges. Pregabalin has also been investigated for preemptive use.8<\/sup> Although generally aimed at reducing anxiety and allowing for ease of obtaining intravenous access, gabapentinoids can also be administered before the procedure. Although NSAIDs are also powerful analgesics, they are reserved for postprocedure administration due to their potential to lead to renal insult if hypotension has been difficult to mitigate under general anesthesia. Acetaminophen (dogs only) is also being increasingly added to the armamentarium of perioperative oral pain control options.1,9,10<\/sup><\/span><\/p>\n NSAIDs provide excellent pain control for oral surgery, typically for 24 hours, and can be given intraoperatively or postoperatively (especially advantageous in the initial postoperative period when a patient may resent oral manipulation). NSAIDs should be used with aligned standards in feline patients (robenacoxib or low-dose meloxicam only) and in all patients with metabolic disease, especially renal impairment.11<\/sup> Preoperative testing (including CBC, serum chemistry, and urinalysis) and close intraoperative blood pressure monitoring are critical for minimizing any anesthetic complications.<\/span><\/p>\n Opioids are the mainstay analgesic for acute pain, and their safety index is favorable.12<\/sup> Full <\/span>\u00b5<\/span> agonists (e.g., methadone, fentanyl, hydromorphone, morphine) are commonly used during surgery. For postoperative pain control, buprenorphine provides a step-down partial <\/span>\u00b5<\/span>\u00a0agonist effect, but it can be a useful option to send home with patients or administer in a sustained-release formulation. Butorphanol is generally not <\/i>adequate for pain control because its effect size is limited.13<\/sup><\/span><\/p>\n Additional constant-rate infusions (CRIs) have been investigated to complement opioids. Dexmedetomidine (an <\/span>\u03b1<\/span>2<\/sub> agonist) has been shown to be as effective as morphine for postoperative pain control in dogs undergoing invasive surgery.3<\/sup> Ketamine, an NMDA (N<\/i>-methyl-D-aspartate) receptor antagonist, has been shown to effectively reduce scores indicating acute pain but also to prevent conversion to or treatment of chronic pain for oncologic palliative care.3<\/sup><\/span><\/p>\n Locoregional techniques are excellent for blocking transduction and transmission of the pain stimulus, beginning before any surgical stimulus is created until long into the postoperative period if long-term techniques are used.14<\/sup> Locoregional anesthesia reduces overall systemic drug consumption, recovery times, and inhalation anesthetic minimum alveolar concentrations (MACs).15<\/sup><\/span><\/p>\n Commonly used locoregional techniques include infraorbital, mental, and caudal mandibular blocks, which are best learned in a hands-on laboratory and are taught in most extraction courses. For a list from the <\/span>lead author, including a virtual option, see vdspets.com<\/span><\/a>.<\/span><\/p>\n Infraorbital block (<\/b><\/span>FIGURES 1 AND 2<\/b><\/span>):<\/b> If properly performed, the infraorbital block affects the ipsilateral maxilla teeth, as well as associated soft tissues.16,17<\/sup> The infraorbital canal runs rostrally just above the apices of the maxillary fourth premolar and exits the maxilla over the distal root of the third premolar. To approximate the dorsoventral location, imagine the fourth premolar being approximately the same size mesiodistally as corona-apically. Measure the width of the tooth and then that same distance dorsally from the cusp tip. The infraorbital canal is just apical to this point. Starting approximately over the second premolar parallel to the maxilla, advance the needle caudally, close to the maxillary bone. The depth is controversial; some veterinary dentists barely enter the needle into the canal, and others place the needle all the way caudally to the level of the second molar. These authors generally recommend insertion to the level of the medial canthus of the eye in mesocephalic and dolichocephalic dogs.16<\/sup> Correct placement can be confirmed by gentle lateral movement of the needle, allowing it to engage the canal wall.<\/span><\/p>\n In brachycephalic dogs and in cats, the infraorbital canal is very short, which may easily allow for orbital penetration.16<\/sup> The block will diffuse distally to the molars if a finger is placed over the foramen for 30 to 60 seconds after injection.17<\/sup><\/span><\/p>\n\n
What are the commonly used analgesics in dental patients?<\/h3>\n
Which locoregional techniques are commonly used in dental practice?<\/h3>\n
![\"\"](\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/10\/NiemiecHon_TVPNovDec25_DentAnesthFAQs_Fig1A-768x817.png\")
![\"\"](\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/10\/NiemiecHon_TVPNovDec25_DentAnesthFAQs_Fig1B-768x617.png\")
![\"\"](\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/10\/NiemiecHon_TVPNovDec25_DentAnesthFAQs_Fig2A-768x801.png\")
![\"\"](\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/10\/NiemiecHon_TVPNovDec25_DentAnesthFAQs_Fig2B-768x752.png\")
![\"\"](\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/10\/NiemiecHon_TVPNovDec25_DentAnesthFAQs_Fig2C-768x727.png\")