Shaping the future of animal health
Dentistry & Oral health

Homecare strategies

 

photo86.jpg
Photo 86 - Most dogs and cats will
accept daily tooth brushing following a
period of habitation.

Homecare is the term employed to describe methods used to remove or reduce the accumulation of plaque by the pet owner in the home environment. Effective homecare will prevent, or at least reduce, the incidence of periodontal disease and caries (dental decay). Meticulous, frequent homecare is crucial for successful treatment of ongoing periodontal disease. Professional periodontal therapy, unaccompanied by homecare measures, is not sufficient to treat or prevent periodontal disease.

The accumulation of plaque on the tooth surfaces can be controlled by mechanical as well as chemical means.

 

 

Mechanical plaque control

Toothbrushing


Toothbrushing is known to be the single most effective means of removing plaque (Photo 86). Studies have shown that in dogs with gingivitis, daily toothbrushing is effective in returning the gingivae to health (ref. : 1,2). In a four-year study using the Beagle dog (ref. 3), it was shown that, with no oral hygiene, plaque accumulated rapidly along the gingival margin with gingivitis developing within a few weeks. Dogs that were fed an identical diet under identical conditions, but that were subjected to daily toothbrushing, developed no clinical signs of gingivitis. In the group that were not receiving daily toothbrushing, gingivitis progressed to periodontitis in most individuals. Meticulous toothbrushing every other day can maintain clinically healthy gingivae (ref. 2). However, most owners will be unable to brush well enough to maintain clinically healthy gingivae by brushing every 
other day (ref. 4). Brushing once a week has been shown to have no significant benefit (ref. 1). In summary, daily toothbrushing must be the recommendation.

Three requirements need to be fulfilled for toothbrushing to be effective, namely :

1. A cooperative animal
2. A motivated owner
3. An owner who can technically perform the brushing    


Moreover, the owner needs to be continuously motivated and encouraged. This can be achieved by phone calls and regular professional check-ups.

The teeth and gum margin are brushed in a circular motion using a soft nylon bristle tooth brush. The brush is angled at 45° so that the bristles will enter the space between the gum and the tooth, and shallow periodontal pockets. The circling motion should ensure that all cracks and crevices in and around the teeth are cleaned. Use a veterinary toothpaste as human toothpaste contains agents that are irritant and/or toxic when swallowed.


Some Practical suggestions :

  • Start dental homecare as early in life as possible as prevention of disease development is the aim. Moreover, it is far easier to train young animals to accept dental homecare than middle-aged or older animals.
  • Make the animal comfortable and approach from the side rather than the front. 
  • Start with just a few teeth and gradually increase the number of teeth cleaned each time until the whole mouth can be cleaned in a single session.
  • The mouth does not need to be opened. It is mainly the buccal (outer, towards cheeks and lips) surfaces of the teeth, especially at the gum margin, which need brushing.
  • When your animal is comfortable with having the buccal surfaces of all its teeth brushed, an attempt should be made to open the mouth and brush the other surfaces of the teeth. If this is not accepted, there is every reason to continue with daily brushing of the buccal surfaces. 
  • Offer a reward at the end of the procedure, e.g. a game or a treat such as a rawhide strip.
  • Include toothbrushing as part of the daily grooming routine. Homecare is more likely to be acceptable to an older dog if it is introduced as an extension of a pre-existing routine e.g. evening meal, walk, grooming. Also, you are more likely to remember a consistent routine.
  • You can sit small dogs and cats on your lap whilst brushing, at the same time cuddling them to reduce their apprehension; alternatively one person cuddles and restrains whilst a second performs the toothbrushing.
  • The use of a "grooming table" type situation may be better accepted by some dogs.

 

Adjunctive measures


While mechanical removal of plaque by means of toothbrushing is the mainstay of human dental hygiene, most owners do not regularly brush their pets' teeth. Consequently, mechanically reducing plaque accumulation by means of dietary abrasion becomes an important part of prophylactic dental care in the dog and cat. Periodontal disease has been linked with aspects of diet. Several studies have investigated the local effect of diet on plaque formation and development of gingivitis in the dog. A coarse diet may reduce plaque accumulation on some teeth and on some tooth surfaces (ref. 5). A study performed over a six-month period investigating oral cleansing by dietary means, showed that dogs consuming a test diet had significantly less plaque, calculus, and gingival inflammation than the control group (ref. 6). Similarly, the daily use of a dental hygiene chew has been shown to reduce accumulation of dental deposits and reduce gingivitis in both short and long term studies (ref. : 4,7,8,9,10). The efficacy of a dental hygiene chew with a rubbery rather than hard texture has also been demonstrated (ref. 11).

In summary, the use of products aimed at encouraging chewing activity seems to be beneficial, probably by maximising the self cleansing effect of function and physiological stimulation of salivary flow and composition. However, none of the products in this category are as effective as toothbrushing. It is recommended that dogs and cats should be encouraged to chew these products daily, preferably shortly after eating their main meal.

The chewing of bones cannot be recommended; the hazards outweigh any possible benefits. Chewing on hard bone is likely to lead to tooth fractures, often with pulp exposure, and gingival lacerations. Softer bones will be chewed and swallowed, often causing digestive problems, or become impacted on or between teeth. Raw bones are also potential sources of infection for animals and owners (Sarcocystis, Toxoplasma, Campylobacter, Salmonella etc.).

 

Chemical plaque control

Chlorhexidine has been shown to be the most effective antiplaque agent to date. Its main disadvantage is that it stains the teeth. Moreover, its effectiveness is reduced by the presence of organic material. So, for best results, chlorhexidine should be used in combination with tooth brushing that physically removes plaque and reduces tooth staining. To summarise, there is as yet no magic bullet that we can feed our pets to prevent periodontal disease. Daily tooth brushing remains the single most effective means of restoring inflamed gingivae to health and of then maintaining clinically healthy gingivae. Optimal homecare consists of daily tooth brushing with pet toothpaste. The use of chemical plaque retardants without brushing is indicated in situations where brushing is not tolerated, e.g. due to pain immediately postoperatively, but every attempt should be made to get the animal to accept tooth brushing as quickly as possible. The use of dental diets or dental hygiene products as an adjunct to brushing is also beneficial and is recommended. In situations where the owner is either unable or unwilling to mechanically or chemically clean the teeth each day, the daily use of adjunctive measures may still provide some benefit.