8 Year old needs dental cleaning and possible extraction/orthodontics for lower fangs

New here and just looking for some advice!
I just noticed that my 8/yo kitty Charlie (my little soul mate) has an issue with his teeth. Somehow, I hadn't noticed that his bottom fangs were puncturing the roof of his mouth/gums. Obviously this has been happening for a long time (they're 8 year old teeth...) I feel horrible for not noticing, but he is just as happy and seemingly healthy as ever, so it did not occur to me.
A week or so ago, I noticed he was moving his mouth a little more after eating (like trying to shift food from inside his lip or something) this could be totally unrelated, or innocent, but it made me take a look just in case, which is when I noticed the issue.
Whisked him off to the vet. She was surprised, but not horrified. I am about to leave the country for a month so I told her I didn't want to have him undergo anything now if it could wait. She said there was no imminent danger and that since he is eating and the spot does not look too inflamed or infected at all, it would be fine to wait.
She said when I come back from my trip, he should come in for a dental cleaning to make sure his mouth was clean and free of bacteria.
Here is kind of where my question lies. I have read that I should have several tests done (blood panel, urinalysis, chest xrays and BNP) done beforehand to make sure he is healthy enough to go under anesthesia. Assuming all is good, I have also read to only accept the use of Sevoflurane gas, and NOT Ketamine. I want to do this the safest way possible. I can not imagine losing my baby! I want to make sure I know what to ask for and what we should do. He has reacted badly to antibiotics in the past, so I also have to be careful about what he receives for aftercare.
Another thing is that my SO and I are expats living in Korea. My vet is good and speaks English, but sometimes I don't think she is very thorough or up to date on things. (For example, she's seen Charlie many times and never looked in his mouth to have seen this issue - we've been going to her for almost 4 years.)
Eventually Charlie will either have to have his bottom fangs extracted or have orthodontics put in to reposition his teeth so they don't continue to puncture.
Has anyone ever had this issue before? Any further tips on anesthesia or things I should know?
Thank you for anyone who took the time to read this. I am very upset that he has to go through the stress and pain of this, but mostly, I am terrified of losing him before his time.

I hear you about worrying about having him put under to have this done.  I'm also a worrywart and don't know what I would do if anything happened to any of mine .

Normally, bloodwork is all that is necessary before a dental, but even that cannot 100% guarantee the outcome.  That being said, probably 99.9%  of the time, everyting turns out great. 

I HAVE seen this issue of the fang not being positioned correctly before, and usually pulling the tooth (or I think both the upper and lower is what works best, otherwise if you pull one, the the opposing fang starts going thru the gumon the other end.) is what is done.  As you said, though, it's a little disconcerting that your Vet never noticed this issue before with his mouth. 

I wish I had some tips.  The only thing I can tell you is not to worry about him not having his tooth (or teeth).  Many cats get along just fine without ANY teeth.  (unless they go outdoors...it's kind of hard to protect yourself without any teeth)

Thank you for your response! I appreciate your reassurance that everything is usually fine. I wish a simple dental cleaning didn't have to carry a life risk >.<
I am very confused about his fangs. I pay such close attention to every part of him that I am having a hard time believing that he has been this way since his adult teeth came in.
Might it be possible that the gum tissue his teeth are poking into could possibly be swollen, due to gingivitis or something? I thought perhaps, instead of the teeth simply 'being too long' or poorly positioned, it may be that his gums have swollen and that's why they're poking now.
His teeth and gums do look pretty healthy for an 8 year old, (having never had a cleaning) but his breath has gotten a little smelly. Not too bad, but a little stronger recently. The vet did say he might be experiencing some gingivitis, just at an early stage.
I know regardless he will have to do the cleaning, but hopefully we can avoid extraction or orthodontics.
The main thing, whatever we have to do, is that he makes it all through it and can live without pain! (Though he seems completely unbothered at the present time.)
I'll try to stop worrying so much in the meantime :-/
Thanks so much for your reply - believe me it has helped!

My cat Pushy has had to have a couple of teeth extractions. He did just fine, but I understand your concerns about the operation and your vet. I'm surprised she didn't notice this sooner, and as far as I know, I look in the mouth is an essential part of a routine check-up.
Cats can do just fine missing a few teeth. I even met a sweetie who had all his teeth out due to an autoimmune disease. He nommed up his wet food no worries.

Both of my kitties have had teeth removed, one has had 2 removed the other one 5.  They both came through fine.  I remember when one had a fang removed the vet had me bring her back for a recheck two weeks later.  She wanted to make sure the remaining fang wasn't hitting the opposite gum.  Luckily it wasn't, if it had been I probably would've had that one removed as well.  The vet said it would have eventually develop a hard callus on the gum but it would have been painful until that callus formed.

Thank you for your post! My rescue cat I adopted ~8.5 months ago had 4 teeth extracted before I adopted her. One was a front fang. I didn't realize to worry about how the tooth is hitting the gum...she makes a cute, funny face when she is feeling her empty front tooth space (or that's what it looks like). She usually chews fine without a problem. My baby is getting a dental cleaning tomorrow morning. I will ask about the Sevoflurane gas. Good luck to your kitty!!! I hope both our cats make it through the anesthesia. Mine is skinnier than she should be due to health problems recently, but in case it was caused by a gum infection or abscess because of her bad teeth, I want to hurry up with the dental cleaning so it doesn't happen again. Post an update about your cat later, please.

Pushylady - thank you for your response! Yes - I definitely do not feel like my vet is very thorough. In my experience with my vet in Canada, there was always a eyes/ears/teeth/heart and bodily pat down of the cat whenever I would visit. My vet here does none of those things unless I ask her to. It's immensely frustrating. Unfortunately, she is one of the best in Korea, having been educated in the U.S. and the fact that she speaks English. We are waiting on  work transfer to get back to North America, so hopefully that pans out soon. I'm tired of relying on this vet for the health of my precious kitties.
Hopefully if Charlie has any teeth removed, he can get through it with no problems. Thank you for your reassurance!!

Denise- Thank you for sharing your experience! I am glad to hear your kitties came through the experience with no problem... it really puts my mind at ease! (There are so many horror stories out there... that really aren't helpful to me right now.)
Also, about the callus. Since Charlie is 8 and has had his adult teeth his whole life, I am assuming that if this has been a longtime issue, perhaps he has formed said calluses? The areas where the fang appears to 'puncture' certainly doesn't look inflamed or bloody. I wonder if maybe if the soft tissue has 'gotten used to it' that maybe he might be alright to continue as he is. I guess the vet will be able to tell during the cleaning one way or the other, if the fangs are causing him any discomfort.
Thank you so much for your response.

Bonitababy - I hope your sweet kitty has a good cleaning and is feeling 100% better soon! I am glad to hear the loss of her fang doesn't cause her any trouble. Also happy that I was able to share the info about Sevoflurane with you. I read that the injection type (Ketamine) is not as safe so it's best avoided if possible. I am sure your vet will take all of the precautionary measures beforehand to make sure kitty is safe to be anesthetized. Insist on it as she's been unwell lately. You're right that it's important to have the cleaning done as it can lead to other things. Even though I know this am still so nervous about my boy. He is an immensely happy cat but gets very nervous and stressed outside of his comfort zone. :-/ I worry too much, but he really means the world to me!
Best of luck with your baby - I am sure she will get through that cleaning no problem and probably be glad she had it if she's been having tooth pain! Please update on her progress. I am also interested in knowing about recovery and just how she fares after waking up. All the best!!!
 

Thanks, @Dominique Leduc! My precious baby is at the vet hospital right now. I'm a bundle of nerves over her waking up from the anesthesia. This morning I was starting to regret that I'd pushed the dental cleaning date back up since she was really ill just a month ago, but I really want to know what's going on in her mouth -- if she has any abscesses, more teeth needing removing, gum infections, etc. It was hard this morning because she kept trying to lead me to the kitchen to get food, but I'd had to take away all her food bowls before I went to sleep as they can't eat past midnight before the cleaning. Fortunately, the vet is using Sevoflurane and they did the blood testing and said they are proceeding and will call me if they need to do any extractions. I consented to x-rays. I will definitely update later about how my baby reacts afterwards and if she's out of it for a while or not after I bring her home. I just bought a new ball track toy for her & a face massager, so I'll put them out after she gets back home. Hopefully, they'll help her forget all about today's bad experience quickly! 

@Bonitababy  My heart goes out to you right now for you and your little one..! I have no doubt she will be just fine, though. I just really empathize with what worry I am sure you're feeling. But I am optimistic for you!
Thanks for filling me in on the 'before' stuff as well.
I am sure she will be a little stressed and confused, but I think given some healing time she will feel so much better because of this. And she will really appreciate all of the toys and treats you got for her. She will just be happy to be back at home with her mommy.
I wish you all the best with the outcome and hope everything goes as smoothly as possible! Do post how she's doing. Stay calm. =^.^=

Hi @Dominique Leduc! Thank you! Just wanted to post an update that my Bonita baby is doing great! I had a good vet! She was under propofol & then sevoflurane. The vet texted me updates too before and after. My baby's mouth just really needed a dental cleaning. They said everything else was fine and even though I had authorized x-rays, they said there was no need. I'm so glad that they didn't just go ahead with the x-rays anyway. They said my baby's previous extraction sites where her 4 teeth were removed look good. When I picked her up, they said she might be out of it and seem dopey, but she wasn't at all! She was alert and bright-eyed when I picked her up with just a little bit of a medicated look. She raced out of her carrier the second I opened the door. =) I gave her a small meal of freeze-dried Orijen treats & treats because they said to give 1/2 the usual so she doesn't eat too fast and then throw up because of the hunger from being starved all day. An hour later, I gave her some kibble, then after another hour, I put out a little more kibble for the night. It was sad watching her constantly going to her food bowl areas to look for food, but great that the dental cleaning is done with and over! It was tough not being able to feed her yesterday morning. I knew she must have been so confused why all her food bowls were gone and I wouldn't give her food. Another good thing is that they were able to test my baby and everything looks good -- blood tests, fecal, urine too I think. They also finished her comprehensive exam and checked her ears too. I have to go home and look through the paperwork to check over everything.

I really hope that your cat also has no trouble with the dental cleaning & recovers quickly too! Please post an update as well! 

EDIT: Oh, and my baby is SO picky that even though she was obviously hungry and hunting for food, when I did put out a bowl of a little wet food, she sniffed it and still walked away. Kept looking around for her kibble and held out from eating the wet food for an hour until I brought out a little kibble. *sigh* It can be hard having a picky eater.