Question 1

WHAT KIND OF ANESTHESIA DO WE USE? IS IT SAFE?

Accepted Answer

Anesthetic safety is of the utmost importance for our patients, and we have a wide range of medications available to use. We carefully choose an anesthetic plan tailored for each individual patient that we see. For significantly anxious patients, we may recommend an oral medication that is given at home before coming in for a procedure. Patients are given a preanesthetic medication injection on the day of the procedure. This usually includes a pain medication as well a medication to help reduce anxiety. 
When starting the anesthetic procedure, our patients are given an induction agent, which is a short-acting anesthetic drug. We have several options of agents to use for this purpose. Taking into consideration the specific needs of your pet, we use the agent that we feel is going to be safe and effective. Once the induction agent is given, it allows us to pass a tube, called an endotracheal tube, into the pet’s airway. The endotracheal tube helps to keep the patient’s airway open and protected from fluid and debris that are produced during the procedure.
During anesthetic maintenance, the patient is given oxygen through the endotracheal tube. Mixed with the oxygen is a small amount of anesthetic gas, called sevoflurane, which is a drug that keeps the patient asleep during the procedure. Sevoflurane is the anesthetic gas that we use at ADSN because of its rapid induction and recovery characteristics. This also gives us better control over a patient’s depth of anesthesia during a procedure.
We have an arrangement with a board-certified veterinary anesthesiologist, Dr. Martin Kennedy. Dr. Kennedy is available for anesthetic planning prior to procedures for patients with special needs or concerns. He can live-stream our anesthetic monitoring equipment and be present virtually to assist with anesthesia if necessary. We also have direct access to a veterinary cardiologist, Dr. Scott Forney, for cardiac consultations prior to anesthesia, when needed.

Question 2

WHY ARE OUR EXAM PRICES SO HIGH?

Accepted Answer

As a board-certified veterinary dentist, Dr. Hewitt has dedicated many years of his time to advanced training in diagnosing and treating a wide range of dental and oral health issues in animals. During his residency in veterinary dentistry, Dr. Hewitt has had extensive training in dentistry, radiology, oral diseases, and oral medicine & surgery. He has also had extensive training in veterinary anesthesia. In addition to his dental training, Dr. Hewitt has 28 years of experience in general practice, which allows him to see a patient from multiple viewpoints, and appreciate patients as a complete system, especially when a patient has possible or confirmed non-oral health conditions.  
Many of his patients are referred to him by their primary veterinarian. Most veterinarians, with some exceptions, were provided very limited dental training in veterinary college. In fact, many veterinary colleges only teach the minimum of basic dentistry knowledge to veterinarians in training, and only since 2020 have veterinary colleges been required to provide dental training to veterinary students at all. Other veterinarians were provided more extensive dental training during veterinary college, or by doing continuing education after graduating from veterinary college. Veterinarians refer their patients to us for many reasons. Some patients are referred in order to determine what the best treatment options are for their pet’s oral disease. Some patients are referred because they have oral problems that their veterinarian is not equipped or trained to treat properly. Some patients are referred because of complications from previous dental procedures. Some patients are referred because they have had problems with anesthesia or have health conditions that make anesthesia challenging. Some patients are referred because their veterinarian is trying to determine if a patient’s problem is related to oral disease or something else.
The specialty exam appointment is typically much longer than appointments in a general practice. During a patient’s initial exam, the pet’s health history is reviewed, and a physical exam is performed in addition to the oral exam. Dr. Hewitt then educates clients on their pet’s dental problems and any problems that may be related to their oral health or risk of anesthesia. During the exam, clients are provided with recommended treatment, and alternative options if there are any. Any special anesthetic concerns are addressed. Recommended pre-anesthetic planning and laboratory testing will be discussed, based on each pet’s specific condition. Clients are given the opportunity to ask any questions and are provided with the ability to contact Dr. Hewitt after the exam with any additional questions that were not answered at the time of the exam.

Question 3

WHY ARE OUR PROCEDURE PRICES MORE THAN GENERAL VETERINARIANS?

Accepted Answer

As a board-certified veterinary dentist, Dr. Hewitt has dedicated many years of his time to advanced training in diagnosing and treating a wide range of dental and oral health issues in animals. Dr. Hewitt has also had extensive training in anesthesia. Some patients are referred to him by their primary veterinarian for treatment of oral diseases that they are not comfortable treating, do not have the equipment or skills to treat, or simply are not certain what the best treatment is. Other clients come because they would prefer to have oral diseases treated by a veterinarian with advanced training and experience. Veterinarians also refer patients with special medical needs, when the veterinarian is not comfortable performing anesthesia on the pet. Every dental procedure performed in our office includes comprehensive anesthetic care and monitoring. Every patient is also evaluated by advanced imaging with Cone-beam CT which provides an accurate 3D image of the facial bones and dental structures, in addition to full-mouth radiographs with every procedure. For patients with special anesthetic needs, we have rapid access to consultation with a board-certified veterinary anesthesiologist, both for pre-anesthetic planning and consultation during anesthetic procedures. Our dedicated staff strives to provide the best service and communication to our clients and the best care for our patients.

Question 4

HOW MUCH DOES A ROUTINE DENTAL CLEANING COST?

Accepted Answer

First, it is important to understand that more than 80% of pets over the age of 3 have periodontal disease. Many of these pets require additional treatment above and beyond a basic dental cleaning procedure. Anesthetic services included with all procedures include IV catheter placement, IV fluids, pre-anesthetic medications, induction agent injection, sevoflurane anesthesia, comprehensive anesthetic monitoring with advanced equipment, and the attention of multiple dedicated licensed staff technicians. The dental evaluation includes a complete oral exam and imaging with both dental x-rays and 3D imaging using Cone-beam CT. The dental procedure includes scaling and polishing the teeth both above and below the gum line, as well as a courtesy nail trim.  
For dogs, a basic dental cleaning procedure at our facility costs $1,450, if the pet has recently had appropriate blood work, does not need any additional treatment, and does not have special anesthetic needs. For cats, a basic dental cleaning procedure at our facility costs $1,150, if the pet has recently had appropriate blood work, does not need any additional treatment, and does not have special anesthetic needs. These prices do not include pre-anesthetic bloodwork or other testing, if needed. Please be aware that many pets need additional treatment, other than a basic cleaning, during a dental procedure. Any additional treatment will increase the cost of the procedure. We strongly recommend that you schedule a dental exam at our office prior to scheduling a dental procedure. This will allow us to provide you with a more accurate cost estimate based on your pet’s oral health and anticipated treatment needs.

Question 5

HOW MUCH DOES A ROOT CANAL COST?

Accepted Answer

Many patients are referred to our hospital because of broken or internally diseased teeth. For teeth that have disease of the living tissue inside the tooth, called the pulp, the best treatment is usually root canal therapy. Root canal therapy allows for the damaged or diseased tooth to continue to be a functional and comfortable part of the mouth. When a root canal is appropriate to perform, the cost will depend on which tooth is damaged, the health of the tooth, and other factors. A root canal procedure includes a complete anesthesia package with IV fluids, pre-anesthetic medication, anesthesia maintenance, comprehensive anesthetic monitoring, comprehensive pain management, a complete oral exam of all teeth, imaging of all teeth with both dental x-rays and 3D imaging with Cone-beam CT, root canal procedure, and post-op pain medication. The complete cost of a root canal, depending on multiple factors, will be between $2300-$3600. If a dental cleaning procedure is also needed during the root canal, there is additional cost. These costs do not include the initial exam/consultation fee, any required pre-anesthetic lab work, or consultation with our veterinary anesthesiologist (if needed). These are services that are typically performed prior to the day of the root canal procedure.

Question 6

CAN WE DO A PET’S DENTAL PROCEDURE WITHOUT CT AND RADIOGRAPHS? WHY NOT?

Accepted Answer

As a dental specialty practice, it our responsibility to provide you and your pet with the highest standard of care when it comes to dentistry. Studies show that up to 2/3 of dental problems cannot be detected without imaging. For us to provide you with the most accurate diagnosis and treatment plan for your pet’s dental health, imaging is performed during all of our procedures. Imaging includes dental x-rays and 3D imaging with Cone-beam CT. Each of these gives important information regarding the teeth and bones. In some patients that have had recent diagnostic quality dental radiographs, we do not need to repeat the dental radiographs. Some pets that have had dental x-rays have not had adequate number or positioning of x-rays previously taken to be appropriately diagnostic, or the x-rays are not recent enough to be acceptable. For these patients, the x-rays will need to be repeated.

Question 7

WHAT MAKES US A SPECIALTY CLINIC?

Accepted Answer

In addition to veterinary college and many years of general practice experience, Dr. Hewitt has completed a residency in veterinary dentistry, which includes advanced training in diagnosing and treating a wide range of dental and oral health issues in animals. In order to be considered a specialist, a veterinarian must be board certified by a recognized specialty veterinary college. Becoming a specialist requires completion of a comprehensive residency in the specialty field, along with successful completion of a board certification exam provided by the college. The American Veterinary Dental College has a comprehensive written, bench, and practical exam. Dr. Hewitt passed the certification exam and became a board certified veterinary dentist in June 2018. In Nevada, only veterinarians that have completed a residency and passed a board certification exam from a specialty college can refer to themselves as a specialist.
Learn more at:  Animal Owner Resources – AVDC.org

Question 8

DO WE DEAL WITH PETS WITH UNDERLYING HEALTH ISSUES IN A DIFFERENT WAY THAN A REGULAR GP?

Accepted Answer

Dr. Hewitt has been in the veterinary field for over 30 years and has extensive training in anesthesia, including high-risk patients with underlying health issues.
While we cannot speak to the protocols of other practices, if we have a patient that is at a higher risk for a dental procedure or has had previous anesthetic concerns or complications, we have the ability to consult with Dr. Martin Kennedy, a board-certified anesthesiologist.  Dr. Kennedy is available for anesthetic planning prior to procedures for higher-risk patients. He can live-stream our anesthetic monitoring equipment and be present virtually to assist with anesthesia.
We also have direct access to a veterinary cardiologist, Dr. Scott Forney, for cardiac consultations prior to anesthesia when needed.
In addition, Dr. Hewitt also has the ability to collaborate with other veterinary specialists, such as oral surgeons, radiologists, and internal medicine specialists to provide the best comprehensive care plan for complex cases.

Question 9

WHY DO WE START OUR PROCEDURES IN THE AFTERNOON, BUT WE HAVE PATIENTS DROP OFF IN THE MORNING?

Accepted Answer

We typically have our procedure patients check in on the morning of the procedure to allow proper time to prepare each patient for their individual procedure. Some patients have complex anesthetic protocols that require medications to be given well before the procedure time. Each patient is examined on the day of the procedure to confirm that there are no new problems or concerns that will affect the anesthesia. An early check-in also allows time for Dr. Hewitt to speak directly to the owner regarding the procedure and answer any last-minute questions or concerns that the owner has. If any additional pre-anesthetic diagnostics need to be performed it will allow time for us to obtain results, and pre-anesthetic medications can be administered. Having your pet with us in the morning allows us to be more efficient and get your pet home to you as soon as possible. 
If an early check-in is not possible, we can be flexible and work with your schedule with the understanding that if your pet is dropped off is later in the day, Dr. Hewitt may be with another client or procedure and may not be available to speak with you in person. If a client drops off a pet later than the normal check-in time and has questions, Dr. Hewitt will call the client to answer their questions prior to their pet’s procedure.

Question 10

DO WE ACCEPT PET INSURANCE?

Accepted Answer

Unlike health insurance for people, most pet insurance companies do not pay the provider directly. For most plans, the client pays the hospital services and is then reimbursed by the pet insurance company. Therefore, unlike in human medicine, clients can use any pet insurance with any hospital. One exception is for Trupanion Pet Insurance, which has something called Express Pay, where the company pays their part of the bill directly to the hospital. With Trupanion Express Pay, the payment arrangement must be set up and approved by Trupanion prior to the day of the procedure being performed. If you are using Trupanion Express Pay, please inform us prior to the day of the procedure. Last minute requests may not be immediately approved by Trupanion, and the client will be required to pay the entire cost and be reimbursed by the insurance company.
Our hospital does not sell, promote, recommend, or have a financial interest in any individual pet insurance company. Many pet insurance companies have strict limitations on what dental procedures are covered. Many companies will not reimburse for what they consider “routine” procedures, treatment for periodontal disease, or treatment of congenital (birth defect) problems. Most pet insurance companies will provide pre-approval for what they will or will not cover. If you use a pet insurance, ask them about the pre-approval process. The company will want a copy of the estimate for services, and some companies also have a form that needs to be filled out.

Question 11

CAN WE ACCEPT PAYMENT PLANS? WHY NOT?

Accepted Answer

Our office does not provide any direct payment plans or financing. For clients in need of financing options, we do accept Care Credit. Care Credit is a financing program for medical services. More information and pre-approval can be found at  https://www.carecredit.com/

Question 12

CAN WE DO A PATIENT’S DENTAL PROCEDURE WITHOUT ANESTHESIA?

Accepted Answer

It is understandable that, as a pet owner, the thought of putting your pet under anesthesia can be scary. When a dental procedure is performed, the purpose is to identify and treat oral disease. The calculus (tartar) on the surface of the teeth, although unsightly, causes limited harm for most pets. The health problems and pain associated with most dental diseases in patients come from problems located below the gumline. 
Non-anesthetic dental procedures allow for cleaning of the calculus from the surface of the teeth, only. Without anesthesia, it is impossible to identify problems below the gumline, let alone treat them. While non-anesthetic dental cleaning makes the surface of the teeth look better, it does nothing to treat the health problems caused by dental disease. In fact, non-anesthetic dental cleaning gives the pet owner a false sense of security that they are improving their pet’s oral health, while allowing the true dental disease below the gumline to continue getting worse. This is similar to taking a car with an engine problem to a car wash, rather than a mechanic. After the car wash, it looks nice, but doesn’t work any better. In addition, non-anesthetic dental cleaning can be very stressful for pets. Think of how most pets react when their owners try to brush their teeth, and magnify that by many times. If an attempt is made to clean diseased areas while awake, it can also result in pain for the pet.
General anesthesia during a dental procedure allows for appropriate exam, probing, and imaging of all teeth. Dental imaging, such as dental x-rays and Cone-Beam CT, are invaluable diagnostic tools when it comes to dental health. More than half of dental problems in veterinary patients are present below the gumline, which cannot be seen without imaging. It is impossible to obtain adequate intra-oral images if the patient is not under anesthesia. Without proper imaging, many harmful dental problems can go undiagnosed. Treatment of dental problems, including deep cleaning, extractions, and other treatments cannot be performed on awake pets.
Non-anesthetic dental cleaning procedures take advantage of a pet owner’s fear of anesthesia, and make the owner feel that they are providing health care for their pets. In reality, many of these procedures are doing more harm than good, and are ignoring the real dental problems that exist, allowing them to get progressively worse. It is more important to focus on anesthetic safety and precautions, in order to provide appropriate diagnosis and treatment of dental diseases.

FAQ Guide

WHAT MAKES US A SPECIALTY PRACTICE?

WHAT KIND OF ANESTHESIA DO WE USE? IS IT SAFE?

DO WE TREAT PETS WITH UNDERLYING HEALTH ISSUES?

DO WE ACCEPT PET INSURANCE?

DO WE HAVE PAYMENT PLANS?

CAN WE DO A PATIENT’S DENTAL PROCEDURE WITHOUT ANESTHESIA?