vet quoted us $1,800 for full dental on our 12 year old shih tzu with a grade 3 heart murmur and the anesthesia-free place at the pet store is $190, and i know what reddit will say but i need actual help thinking through what the risk numbers actually are for a dog his age with his heart

Mochi is 12 years and 4 months, shih tzu, 14lbs, generally pretty healthy for his age, but at his last wellness exam in march his vet picked up what she described as a grade 3 of 6 heart murmur that she had not heard at his october visit. she sent us to the cardiologist who did the echocardiogram and diagnosed early mitral valve disease, stage B1, which she said does not require medication yet but does require us to be careful with any future anesthesia and to do a cardiac clearance before any procedure. ok, fine, mochi is otherwise great, that all made sense.

then last week we are at his dental check and his vet says he needs a full dental cleaning under anesthesia, probably 2 to 4 extractions in the back, and the quote came in at $1,820 with the pre-anesthesia bloodwork and the cardiac clearance recheck and the actual procedure. she said honestly the dental disease at his age is also a cardiac risk because the bacteria from the gums get into the bloodstream and stress his heart, so the dental is actually somewhat important specifically because of the murmur, which i did not know.

i went home and looked at our budget and then drove past a place at the pet store in the next town over that does "anesthesia-free dental cleaning" for $190, walk in, no appointment needed. i know what the answer is going to be and i have read enough on here to know reddit is going to tell me anesthesia-free is theater, but im struggling with the actual numbers part. our vet quoted the anesthetic mortality risk for a dog mochis age with a stage B1 murmur at "low single digits" which she said was higher than a young healthy dog but still well under 5%. the alternative she described as "ongoing dental disease driving inflammation and probably contributing to the murmur progression over the next 1 to 3 years."

the question i actually have for anyone who has walked through this. how did you think about the risk of anesthesia in a cardiac senior vs the risk of NOT doing the dental, because the framing i keep seeing online is "anesthesia is safe with modern protocols" which is true for healthy dogs and i dont think generalizes to a 12 year old with a heart murmur. and second, is anesthesia-free dental actually 100% useless or is there a version of it (maybe at-home brushing plus dental chews plus the cheap cleaning) that gets you 40% of the benefit for 10% of the cost, because that might be the right answer for a dog who has maybe 2 to 4 good years left. i am not trying to be cheap, i am trying to figure out what the right call is for him specifically