Comprehensive Oral Health Assessment and Treatment (COHAT): Scaling, Polishing, Charting, and Periodontal Assessment

COHAT — Comprehensive Oral Health Assessment and Treatment — is the modern standard of care for veterinary dentistry, replacing the outdated term "dental" or "dental cleaning." The distinction is not semantic: an awake "dental" (sometimes offered for grooming or fear-free handling) is purely cosmetic — it removes visible supragingival calculus but cannot assess or treat subgingival disease, where the real pathology lives. The American Veterinary Dental College (AVDC) and AAHA explicitly state that comprehensive dental care requires general anesthesia with a cuffed endotracheal tube, periodontal probing and charting of every tooth, and intraoral dental radiographs. Anything less is substandard of care.

Why General Anesthesia Is Non-Negotiable

An awake animal cannot tolerate:

• Subgingival scaling beneath the gingival margin (the most disease-relevant area)
• Periodontal probing of every tooth surface
• Dental radiography with precise positioning
• Extractions and other oral surgery
• Water and aerosol control — without a cuffed endotracheal tube, bacteria-laden water and calculus debris aspirate into the airway, causing aspiration pneumonia.

General anesthesia with a cuffed tube protects the airway, allows thorough subgingival work, and provides analgesia for painful procedures. A light plane of anesthesia is required so that the oral pain reflex (jaw withdrawal to probing) is abolished.

The COHAT Sequence

The procedure follows a defined order so that no step is missed:

1. Pre-anesthetic exam, bloodwork, and stabilization — confirm the patient is a safe anesthetic candidate; place IV catheter; initiate fluids if indicated.
2. Induction and intubation with a cuffed endotracheal tube.
3. Initial oral examination and charting — with the patient anesthetized, examine every tooth, the oral mucosa, tongue, palate, oropharynx, and tonsils. Note gross pathology: fractured crowns, missing teeth, oral masses, foreign bodies, clefts, malocclusion.
4. Supragingival scaling — ultrasonic scaler plus hand scalers remove calculus above the gingival margin from all surfaces of every tooth. The ultrasonic tip with continuous water cooling is the workhorse; hand scalers address stubborn deposits.
5. Subgingival scaling and root planing — use a curette (or a subgingival ultrasonic tip at low power) to remove subgingival calculus and plaque biofilm and to smooth the root surface (root planing). This is the most important step for treating periodontal disease — calculus above the gumline does not cause inflammation; the subgingival biofilm does.
6. Polishing — a prophy paste (fine grit for routine use; medium or coarse for heavy stain) in a rubber prophy cup on a slow-speed handpiece smooths the enamel surface and removes the smear layer of scratches left by scaling. Without polishing, the roughened enamel accelerates plaque re-attachment. Polishing is not a substitute for scaling — it removes only the microscopic scratches and stain, not calculus.
7. Subgingival rinsing / flushing — flush the sulci with sterile saline or a 0.12% chlorhexidine solution to dislodge residual calculus and bacteria and to inspect the field again.
8. Periodontal probing and charting — now that calculus is removed, probe every tooth surface (six sites per tooth in dogs: mesiobuccal, buccal, distobuccal, mesiolingual, lingual, distolingual; fewer for some teeth) and record probing depths, furcation grades, recession, mobility, and any defects. Some clinicians probe before scaling to detect baseline pockets; either sequence is acceptable as long as both are done.
9. Dental radiographs — full-mouth or at minimum of pathology-identified teeth; radiographs reveal root pathology, periapical lucency, bone loss, retained roots, and FORLs that are invisible to the naked eye. Studies show full-mouth radiographs find pathology in approximately 28% of dogs and 42% of cats with clinically normal-appearing teeth.
10. Treatment — extractions, periodontal surgery, restorations, or other therapy as indicated by the assessment findings. Local anesthetic blocks (maxillary, mandibular, infraorbital, middle mental) provide analgesia and reduce anesthetic requirements.
11. Recovery — monitor the patient through recovery, provide multimodal analgesia, and schedule a recheck and home-care discussion.

Periodontal Disease Staging

The American Veterinary Dental College staging system is the standard for classification and is tested on the VTNE:

Key clinical findings assessed per tooth: probing depth (free gingival margin to pocket base), gingival recession (CEJ to free gingival margin), furcation grade (I-III, described in the previous section), mobility (0 = normal, 1 = horizontal <1 mm, 2 = horizontal 1-2 mm, 3 = horizontal >2 mm or vertical), and radiographic bone loss (measured from the cementoenamel junction to the alveolar crest).

Dental Charting

Charting is the legal medical record of the oral exam and the basis for treatment planning. Every tooth is documented for:

• Present or absent (and if absent, why — extracted, congenitally missing, or avulsed)
• Fractured crown (uncomplicated = not into pulp; complicated = pulp exposed)
• Mobility grade (0-3)
• Probing depth per surface (recorded in millimeters; ≥4 mm in dogs or ≥2 mm in cats is abnormal)
• Furcation grade (I-III)
• Gingival recession (millimeters)
• FORLs (cats) — graded I-V based on extent of resorption
• Restorations, crowns, or other prior treatment
• Soft tissue findings (masses, ulcers, gingival hyperplasia)

A complete chart is signed by the technician and the veterinarian and is part of the medical record.

A VTNE trap: polishing does not remove calculus — it smooths enamel and removes the smear layer of micro-scratches left by scaling. A second trap: a clinic that offers "anesthesia-free dentals" is providing substandard care — subgingival disease is missed, the airway is unprotected, and painful procedures cannot be performed. A third trap: a cuffed endotracheal tube is mandatory — a uncuffed or no tube risks aspiration of bacteria-laden water and calculus debris.