twelve year old shih tzu with grade three periodontal disease and a grade two over six cardiac murmur with stage B1 MMVD on echo, our vet is recommending a full COHAT under anesthesia within the next two months and i am wrestling with the risk benefit in a way that the published material is not helping me think through cleanly, looking for the version of this calculation from owners and vets who have specifically navigated dental work in a senior small breed with a known cardiac finding

Daisy is twelve and a half and she is my first dog so the senior medicine piece is all new territory for me. We have been brushing her teeth a few times a week since she was three, our vet had warned us that shih tzus are a high periodontal risk breed and we took it seriously, but at her annual two weeks ago the dental exam came back at grade three periodontal disease anyway, two visible pockets on the upper premolars and chronic gingivitis along the lower jaw. our vet was kind about it but firm, the brushing slowed the progression and did not prevent it, that is what the breed does, and we are now at the point where the conservative path is no longer enough and she needs a full COHAT under anesthesia within the next two months.

The piece that is complicating the decision is her cardiac picture. fourteen months ago at her annual her GP heard a new soft murmur, grade two over six, and referred us to a cardiologist. the echo showed stage B1 MMVD with normal heart function, no enlargement, the cardiologist said monitor not treat and we have been on the annual recheck path since. she is clinically asymptomatic, full energy, normal respiratory rate at rest, eats well, plays. so on paper she is a healthy senior with a known but stable cardiac finding. but on the procedure consent form she would be a twelve year old toy breed with documented cardiac disease going under general anesthesia, and that combination of words is what is keeping me up.

What is confusing me about the published material on this. the consumer facing dental content treats senior dental under anesthesia as either totally safe with modern protocols or as a meaningful risk that should push you toward anesthesia free alternatives, and both framings feel like extremes that are not engaging with the actual question. our vet has been good about explaining the modern anesthesia protocol in general terms but did not go deep on the cardiac specific risk modeling, partly i think because the answer involves the cardiologist and we have not done that consult yet. the anesthesia free dental practitioners market hard to owners in exactly my position and i am suspicious of the marketing but the underlying worry about putting a cardiac senior under general is real and worth taking seriously.

Specific questions for owners and vets who have navigated this. one, what does the actual anesthesia risk profile look like for a stage B1 MMVD dog at twelve with no clinical signs, is the right framing close to a healthy senior with the right pre op workup, or is it meaningfully higher and worth a cardiology pre op consult specifically for the procedure rather than the annual recheck. two, on the procedure itself, is the staged approach where you do the worst quadrants now and the rest in four to six months actually a thing veterinary dentists recommend, or is it the worst of both worlds because you are paying for anesthesia twice. three, is anesthesia free dental ever the right call for grade three perio with a cardiac complication, or is the consensus from people who have actually done both that it cosmetically cleans visible tartar and does not address the periodontal disease that is the actual problem. i can hold the patient learning posture if i know what the actual decision tree looks like, but right now i am operating on two extreme framings from the internet and one general recommendation from our GP, and i want the version that the field actually uses