twelve year old miniature schnauzer with grade three dental disease and a grade two of six heart murmur, vet quoted twenty one hundred dollars for cleaning under anesthesia and im stuck on whether the risk is worth it

Olive is our 12 year old female miniature schnauzer, 17lb, ive had her since she was a 9 week old puppy and shes the dog of my adult life. at her wellness check last week our regular vet flagged her dental as grade 3 of 4 (significant tartar, mild bone loss on the dental rads, a couple of teeth she suspects will need to come out), and in the same visit she heard what she described as a new grade 2 of 6 left apical systolic murmur that was not present at the wellness check 11 months ago. she sent us for the dental quote and the cardiology referral on the same day. the dental quote came back at $2,100 (pre-anesthetic bloodwork, IV fluids, anesthesia with monitoring, scaling and polishing, dental rads, up to 4 extractions if needed, antibiotics and pain meds to go home). the cardiology consult is $480 and were on the schedule for next week.

where my head is at. the dental disease is real and i know untreated grade 3 leads to grade 4 and from everything ive read the systemic load of chronic dental infection is genuinely bad for older dogs especially with any cardiac component. i get that. what i dont know how to evaluate is the anesthesia risk side of the equation for a 12 year old schnauzer with a brand new murmur of unclear etiology, where the cardiology workup hasnt happened yet. the vet was honest with me, she said she wants the cardiology clearance before she puts olive under and shes not willing to schedule the dental until after the echo, which i appreciate. but she also said depending on what the cardiologist finds, were going to be having a quality of life conversation about whether to do the dental at all, and that conversation is what im trying to prepare for.

the anesthesia free dental question, which i know is going to come up in the comments. our groomer mentioned a mobile anesthesia free dental service that comes to her shop monthly and charges $185, and the dental hygienist working with them is a vet tech with what shes calling a feline and canine dental cert. i looked into it and i cant tell if this is a real option for a dog like olive or if its a sales pitch dressed up in scrubs. my gut says the people who can sit a dog still through a real scaling without sedation are not actually getting under the gumline, and that the procedure mostly cleans the parts of the teeth that look bad in photos without addressing the parts that matter clinically. but i havent talked to anyone whos actually done it and id rather hear from someone who has.

questions. one, anyone whos navigated the dental vs anesthesia risk decision with a senior small breed dog with a new murmur, what did your cardiologist actually say and how did that conversation shape your call. two, the anesthesia free dental question above, real option or marketing, please be specific if you have actual experience. three, what would you ask the cardiologist at the consult that would meaningfully shape the dental decision (im going to ask about the murmur grade, the suspected lesion, and anesthesia risk stratification, but is there something else specific i should be asking). four, if the cardio workup ends up showing early stage B1 or B2 MMVD or similar, did anyone go ahead with the dental anyway with the cardiology team coordinating on the anesthesia plan, and what did that look like in practice. thank you, this is a stressful one and im trying to make the right call for her