by Dr. Daniel T. Carmichael
Taking Care of your Pet’s Teeth at Home
The consequences of poor dental health go way beyond bad breath. Periodontal infection can lead to serious health concerns ranging from tooth loss to organ failure. It’s also no secret that dental problems are common in animals – studies have shown dental problems to be the most common problem in both dogs and cats, with periodontal disease at or near the top of the list. When our animal patients receive good dental care, they undoubtedly live longer and better lives.
The specific dental problem that we strive to prevent is periodontal disease, and the “cause” of periodontal disease is related to the presence of plaque bacteria on the tooth surface. The goal of dental home care is to retard the accumulation of plaque and calculus on the tooth surface. Plaque bacteria can colonize a clean tooth in a period of 24 – 36 hours. This means that within just a few days following professional dental cleaning, the pet’s teeth are already starting to accumulate the bacteria that will again cause periodontal inflammation and disease. The good news is that home care can prevent this.
Dental home care for the veterinary patient starts at the veterinary office. Patients must be evaluated for the presence of dental disease, and treated, if necessary, prior to beginning a home care program. The fact is that 80% of dogs over the age of three and at least 50% of cats have significant periodontal disease that requires immediate professional treatment. Professional dental treatment, performed when needed and under general (inhalant) anesthesia, is the cornerstone of preventative dental health for our patients. On average, dogs and cats benefit from an annual prophylaxis (cleaning) starting at the age of three, but each patient needs to have its dental program individualized.
Many dental problems in dogs and cats are painful. For patients with painful dental problems, home care is contraindicated. In fact, the discomfort caused by trying to brush a painful tooth may adversely condition the pet to future attempts at home care. This is why home care should be instituted only after appropriate professional treatment has established a clean and healthy mouth (except in the youngest and healthiest of patients). This concept especially applies to the institution of a textured dental diet. Ideally, dental home care programs should be instituted with the puppy or kitten before any dental pathology has started.
What to Do
Look for the VOHC seal
The Veterinary Oral Health Council (VOHC) exists to provide an objective means of recognizing commercially-available products that meet pre-set standards of effectiveness in controlling the accumulation of dental plaque and calculus (tartar) in dogs and cats. The VOHC does not test products itself. Companies wishing to have a product reviewed submit a detailed report of the testing that has been performed using VOHC protocols and standards. If, after detailed review of the submission, the VOHC agrees that the product meets its pre-set standards, the product is awarded the VOHC seal. There may be commercial products available without the VOHC seal that are effective, but we can be sure that products that have earned the VOHC seal are truly effective and can be recommended without hesitation. More information on the VOHC, and the products that have earned the VOHC seal, can be found at www.vohc.org.
Brush those teeth every day
Daily tooth brushing is the best thing you can do at home to promote good oral hygiene. Brushing the teeth once a week, or every three days is not enough. A daily tooth brushing is necessary because plaque bacteria can re-colonize the tooth surface in a period of 24 – 36 hours.
The basic tools of tooth brushing include a toothbrush and toothpaste. The toothbrush should be soft bristled, and a battery-powered toothbrush (Hartz Mountain, Secaucus, NJ) for dogs has been found to be a good performer. The vibrations of the battery-powered toothbrush seem to be well tolerated by most dogs. Another appropriate choice is simply a soft-bristled, children’s toothbrush that is available at most drug stores and supermarkets. The traditional pet toothbrush, long-handled and double ended, can be cumbersome for small breeds but is appropriate for large and dolichocephalic (long faced — like Greyhounds) breeds.
The toothpaste should be thought of as a flavoring to enhance acceptance of the toothbrush. Studies in humans show the use of dentifrice does not contribute to the instant mechanical plaque removal during manual tooth brushing. The mechanical action provided by the use of a toothbrush is the main factor in the plaque-removing process.
How to brush
To start, place a small amount of toothpaste on the finger and let the pet sniff and lick it. If there is positive interest in the flavor of the toothpaste, use it. If the pet is not interested in the toothpaste, brush the teeth without it. Do not use human toothpaste because it contains fluoride that should not be swallowed. Concentrate on the buccal (outside) surfaces of the teeth. Go slowly, and be patient. If things aren’t going well, wait a few hours before trying again. The toothbrush should be held at a 45° angle to the tooth surface, with the bristles pointing toward the gingival (gum) margin. This allows the cleaning of the gingival sulcus (under the gums) during the tooth brushing process. Work the toothbrush in a circular motion concentrating around the canine tooth and upper fourth premolar tooth. Try for 15 seconds on each side of the mouth.
Feed a dental diet
There are several commercial diets that have been shown to significantly impact periodontal health compared to “regular” dry food diets. This isn’t just marketing hype — studies document significant reduction in the plaque, calculus and/or gingivitis index for the foods tested. The mechanism of action for these dental foods is based on either enhanced textural characteristics of the kibble to provide for mechanical cleansing of the teeth (such as Hills T/D, Hills Oral Care, Purina Veterinary Diet DH, and Friskies Feline Dental Diet), or chemical coating of the food with polyphosphate (such as IAMS Dental Defense and Eukanuba Adult Maintenance Diet for Dogs). The polyphosphate coating works by binding and chelating minerals in the saliva to make them unavailable for the development of calculus. Therefore, the diets that utilize enhanced textural characteristics can reduce plaque as well as calculus, whereas the chemical coated diets are effective only against calculus. Another dental diet, Royal Canin’s Dental DD, combines the mechanical and chemical properties of textural enhancement with pyrophosphate coating. With the incidence of periodontal disease so high in dogs and cats, there are few reasons why anyone would choose to not provide a diet that promotes good oral health.
Offer appropriate chew treats
Rawhide treats and other consumable items are readily available to pet owners and are effective in the control and removal of plaque and tartar from dog’s teeth. Rawhide is highly digestible, and has not been observed to cause the digestive problems that conventional wisdom ascribes to them in the numerous scientific studies documenting its effectiveness. It has also been shown that coating rawhide treats with calcium sequestering substances such as sodium hexametaphosphate can further enhance plaque and tartar reduction. Chew treats that have earned the VOHC seal of approval include: Del Monte Tartar Check Dog Biscuit: Small and Large Sizes, Friskies Cheweez Beefhide Treats, Greenie Edible Dog Treats – multiple sizes (Note: this is the “Old” greenie product that has had some controversy regarding gastrointestinal problems), Hartz Flavor Infused Oral Chews: Large Dog and Small Dog sizes, Vetradent Dog Chews, and Feline Greenies.
There are chew toy-type products on the market today that are not recommended due to their tendency to cause tooth fracture. Products such as “nylon bones,” cow hooves, and “real bones” are too hard and often are associated with slab fracture of the carnassial teeth in dogs. Tennis balls are notorious for causing attrition (mechanical wearing of the tooth surface) and are also not recommended.
Apply a barrier sealant
OraVet (Merial, Duluth, Georgia) is a biologically inert polymer that bonds to the surface of teeth and inhibits plaque and calculus adherence. The product is very easy to apply on anesthetized patients after dental prophylaxis and must also be applied weekly at home to maintain the protective barrier. A study by Gengler and co-workers has documented the effectiveness of OraVet in plaque and calculus removal. OraVet should be thought of as another tool in the home care armamentarium that can be used in conjunction with tooth brushing and everything else mentioned to promote periodontal health.
Oral rinses and gels
Chlorhexadine gluconate, formulated as an oral rinse or a gel, is an excellent oral disinfectant. The chlorhexadine will bind to gingival tissue, and can then exert its anti-bacterial effects over a 24 to 48-hour period. Chlorhexadine kills the bacterial pathogens that contribute to periodontal disease and halitosis, and bacterial resistance does not develop. Chlorhexadine can cause staining of the tooth surface that is reversible. Chlorhexadine is recommended in chronic cases of periodontitis; instruct the owners use chlorhexadine twice a week, with “regular” tooth brushing on the other days.
MaxiGuard (Addison Biological Laboratory, Fayette, Missouri) is an oral gel that contains zinc ascorbate. Zinc is antibacterial and ascorbic acid (Vitamin C) is necessary for collagen production. In a study in cats, there was a significant decrease in plaque, gingivitis, and anaerobic periodontal pathogens in the group treated with zinc ascorbate gel.
A vaccine to prevent periodontitis
Dental home care is traditionally thought of as what we can do at home to prevent the accumulation of plaque and calculus on the tooth surfaces. Recently available is a novel approach to preventing periodontitis (periodontal bone loss) in dogs. Recent studies have shown that the most commonly isolated periopathogens from the oral cavity of dogs with periodontitis are three species of the black-pigmented anaerobic bacteria: Prophyromonas gluae, P. salivosa, and P. denticanis. A bacterin (vaccine) has been created (Porphyromonas Denticanis-Gluae-Salivosa Bacterin, Pfizer Animal Health, New York) that has been shown to be safe in field studies, and effective in experimental models. The experimental studies offer a “reasonable expectation of efficacy” for use in the real world. This now available “periodontal disease vaccine” will provide veterinarians with an innovative tool to add to our arsenal in the fight to prevent this most common disease of dogs, and should be incorporated into a total home care program.