Pet Oral Hygiene at Home

Toothbrushing for Your Pet

General comments about oral hygiene for your pet:  Oral health is a function of professional therapy and continual home care. One procedure without the other will result in failure. The type and amount of home care necessary depends upon the extent of oral pathology present.  This varies from animal to animal. Some pets get away with no home management while for others, even every other day cleaning may not suffice. Success depends on the degree of plaque control you are capable of providing between professional visits. After the professional cleaning, the burden of oral health care shifts to the owner. The gold standard of home care remains brushing of the teeth.  There are many unsubstantiated claims with regard to various products available for home care.  You may end up spending money on mostly useless products that may give you a false sense of security about what you are actually doing for your pet. Nothing substitutes for regular professional cleaning and tooth brushing.

PD will progress if preventative steps are not taken. To keep the teeth healthy and plaque free, a toothbrush must be used effectively. When asked which teeth are most important to brush, the appropriate answer is “all the teeth”. It is recognized that pets are not born to willingly accept tooth brushing, some refuse it, and some owners decline to provide it. This is understandable in many situations, however, pet owners often have unreasonable expectations about what the veterinary dentist can provide from a professional cleaning “once every year or two”. If you are unable to provide the necessary homecare, then more frequent professional cleanings are encouraged.

Many young dogs and cats will have gingivitis and calculus deposits before they are one year of age.  In general, the first professional cleaning should occur by 18 months of age. Almost all pets will benefit from a professional cleaning by the time they reach two to three years of age.

Brush my what?  It is recognized that pets are not born to willingly accept tooth brushing, some refuse it, and some owners decline to provide it. This is understandable in many situations, however, pet owners often have unreasonable expectations about what the veterinary dentist can provide from a professional cleaning “once every year or two”. If you are unable to provide the necessary homecare, then more frequent professional cleanings are encouraged. If you cannot provide either frequently enough, then your pet may be destined to have periodontal disease and it’s consequences. The same holds true for humans. The bacteria really don’t care whether they’re invading a human or animal, it’s the same process.

What are we trying to accomplish with pet toothbrushing? Toothbrushing is the mechanical removal of plaque and every attempt should be made to institute daily mechanical plaque removal.   The ultimate goal is to prevent gingivitis and periodontal disease. These conditions are related to each other and are essentially infections caused by plaque bacteria.  Plaque is a fancy name for oral bacteria.  After tooth eruption, the tooth surfaces are immediately colonized by bacteria.  Plaque rapidly accumulate as layers of a slime.  Plaque will cover all tooth surfaces within 24 hours of a professional dental cleaning.  Within two weeks, minerals will begin hardening on the plaque.   This is when the films become grossly visible and we term these hardened accumulations calculus.   Calculus is essentially many, many layers of bacteria that have hardened on the tooth surface.   Periodontal diseases are the result of interactions between plaque bacteria and the immune response developed by the host.  All infections start as gingivitis.  As infections become chronic, they progress beneath the gum line and cause tooth attachment loss (bone loss) and eventually tooth loss. The main problem is chronic infection. Gingivitis and periodontal diseases are seemingly innocent and are often taken for granted.  It is the chronic immune response to the plaque which supplies damaging enzymes and inflammatory mediators to the circulation.  It is this circulating inflammation that damages the heart, blood vessels, kidneys, etc.  Toothbrushing is by far the single most effective means of removing plaque.  It will not remove mineralized calculus once it has formed.  Most dogs and cats that have not received any form of oral hygiene will have gingivitis.  The recommendation should be daily toothbrushing, if the animal will allow it.

Periodontitis is characterized by the loss of attachment (bone) below the surface and it is always preceded by gingivitis.  Because the progression of periodontal disease is advanced by subgingival bacteria, which are, in turn, derived from supragingival bacteria, it necessarily follows that meticulous supragingival plaque control (toothbrushing) can reduce the risk for the development of or progression of periodontal disease.

Limitations on what you are able to do with a toothbrush: Scientific research has demonstrated that the best human toothbrushers still miss removing plaque on up to 20% of the tooth surfaces.  No toothbrush reaches between the teeth where most periodontal disease is known to begin.  Flossing accomplishes the brushing between the teeth. Even with flossing, some surfaces are missed and it is necessary for the dentist to professionally clean what we miss. Therefore, it is daily home oral hygiene in combination with professional cleanings that control plaque and the level of oral health care. One without the other will lead to eventual patient compromise.

It is almost impossible to look at the complete inner and outer surfaces of our pet’s teeth let alone insert a toothbrush into the mouth.  Attempting to thoroughly toothbrush the inside surfaces, especially on the back teeth , is virtually impossible.  For the lower teeth alone, there isn’t room between the tongue and tooth surfaces to safely and comfortably insert a toothbrush.   It’s already established that unless you can also floss, you are missing probably the most important tooth surfaces.

It is an established fact that 90% of humans are affected by periodontal inflammation and have existing periodontal pockets of equal to or greater than 4 mm.  This pocket depth will increase with age. Although the scientific research hasn’t been done on animals, experience tells us that this is at least as bad in our pets. Another limitation of toothbrushing is that the toothbrush will only reach 1mm below the gingival margin. Therefore, toothbrushing cannot keep the established pockets that most of us have clean.

Home pet dental care (toothbrushing):

  1. Is not designed to be a substitute for regular professional cleanings.
  2. Is not, by itself, an adequate treatment for established periodontal disease.

How often do we need to brush our pet’s teeth? There are animals, especially of the larger breeds, that tend toward a natural resistance to periodontal disease.  There are people like this as well.  For these rare individuals, toothbrushing every few days may be adequate.  For most of our pets, especially if they already have established periodontal disease (pocketing), if they are not brushed at least once a day, you may be losing ground and may as well not be doing it at all.

Do I need a toothbrush or can I use gauze or another material on my finger?  It is the mechanical action of the bristles that cleans the plaque.  Other objects like gauze and cotton swabs, may be better than nothing, however, they are significantly less effective than the bristles of the brush.

Do I need a special toothbrush to brush my pet’s teeth?  The answer to this is no.  What you do need is a brush with small bristles.  Hard-bristle brushes may cause more trauma to the soft gums.  Change toothbrushes as often as you do your own.  Match the size of the brush to the size of your pet.  A human pediatric or toddler brush will often work well.  There are also different sizes of brushes that fit over your finger (finger brushes).  Finger brushes do carry some risk of injury from being bitten.  A brush with traditional bristles should eventually replace the finger brush.

Can I just place or rub the toothpaste on the gums?  No. In spite of claims that the toothpaste actually does something to kill plaque bacteria, there is no strong research to support this.  You do not need toothpaste to accomplish plaque removal.  It is the mechanical action of the toothbrush bristles that accomplishes the cleaning…not the paste.

What is the purpose of the toothpaste? The benefit of the paste is that if your pet likes the flavor of the paste, we may be able to coax them into accepting the toothbrush. Like a child, it’s much easier to get them to brush their teeth if they like the flavor of the paste.

Which toothpaste should I use:  Do not use a human toothpaste, as they contain ingredients that cause an upset stomach or toxicity (fluoride). The main goal is to have something flavorful and that your pet likes. The flavored tooth paste may help the acceptance of brushing. The second goal is to provide something that is “safe” for your pet to ingest. This is an unregulated industry and many products contain ingredients that are not known and may be harmful. We recommend using brands that have withstood the test of time on the safety issue. We generally recommend the C.E.T brand (poultry, beef, vanilla flavors). Tuna water may also be used for cats.

Where should I focus toothbrushing: While brushing all tooth areas would be ideal, this is rarely accomplished. The inner surfaces of the teeth often have less plaque and calculus and not areas on which to focus early efforts.  For most pets, the tongue does a relatively good job of keeping this surface clean and most pets will not tolerate action on this side.  Eventually, you may be able to work-up to these surfaces on your pet. The areas of primary concern are the outside (labial) surfaces of the cheek teeth (premolars and molars), canine teeth and incisors.  If you only have seconds and need to know where best to focus your efforts, in general, attempt to brush the upper canine and cheek teeth.

Teaching your pet to tolerate tooth brushing: In general, dogs will be easier to use a tooth brush with than cats. Younger animals are more accepting than adults, but all can become accustomed to the routine. The results are worth your time and energy.  Key points are to go slow (take baby steps) and be patient as each step of the training process may take weeks.  Most dogs will eventually accept brushing.  A pet that resists brushing may be doing so because they have painful areas in the mouth. Try to make tooth brushing a pleasurable experience by following the session with praise, a treat, a game or play period. You might begin by using a good tasting substance (flavored toothpaste (C.E.T. brand…poultry, beef flavors) or tuna water for cats) as a treat several times a day on your finger. Over a number of days, progress to rubbing your finger at the gum line as your pet licks the treat. Build up to spending more seconds and minutes in the mouth and over the full range of teeth.  Eventually replace the treat on your finger with a soft bristled tooth brush. Special pet brushes are available; however, pediatric or human brushes also do a good job…whatever works adequately for you and your pet.

Toothbrushing techniques:  For dogs, it is sometimes easier to access the teeth on the side of the mouth with the lips closed.  Gently pull the commissure of the lips backwards and insert the brush.  Bristles are angled at a 45 degree angle to the gum-line and moved back and forth or in small circular motions.  Advance the brush forward in the mouth.  Slight angle changes may accommodate the changes in tooth surfaces.  Some pets accept a toy inserted into the front of the mouth.  This can aid in holding the mouth open and accessing the lower teeth.  Attempt brushing motions for 30-60 seconds on each side.

For cats, it may be best to massage/brush in a forward to back direction as this simulates their natural behavior when they rub against a person or object, inconspicuously marking the property with their saliva.

Tooth brushing and home care for your cat: Acceptance of tooth brushing is a little more difficult with cats than dogs.  Brushing can be accomplished in most cats.  A very gradual (and gentle) approach that may take 1-2 months is often necessary.  As for dogs, teach to accept the paste as a treat off your finger and gradually work up to licking the treat off a small tooth brush (cat finger brushes are best).  Work up to spending more & more time in the mouth and then brushing back and forth.  An excellent video on brushing teeth in cats can be viewed on the Cornell University Feline Health Center website: www.vet.cornell.edu/fhc/   go to feline health videos, then “brushing your cats teeth”.

Complete oral hygiene:  Remember that good oral hygiene requires a combination of “home care” as well as professional dental cleanings. The frequency necessary for professional dental cleaning will depend upon the individual patient’s needs.  A general recommendation is to have a professional cleaning performed every 12 months.  Some individuals might not require a cleaning once a year, however, especially with established periodontal disease, once every 12 months may not be near enough to keep infection under control.

Pet Dental Diets, Treats & Antiseptics

Dental diets, dental treats and chewing exercise:  There is no solid research that supports many of the dental health claims made by many manufacturers of diets, treats and chew objects for pets.  The masticatory forces on food can create frictional forces that are physically able to prevent accumulation of plaque, and even remove it. Where this beneficial effect occurs is at the incisal or cusp areas of the teeth. These same forces, however, are less effective at the gingival margin where the plaque and calculus accumulations are most important. Therefore, the natural cleaning forces of mastication, and the food type, are limited to the regions of the tooth that are at less risk for periodontal disease.

It is important to remember the evolutionary function of carnivores…they are meat eaters.  The function of carnivore oral behavior is to grasp, pull and hold prey. This is followed by cutting and tearing meat before crushing and gulping. Carnivore teeth are not designed to chew bones or other objects harder than the teeth.  Fractured teeth are a problem of epidemic proportions in our domestic canine population. Starving wild animals may elect to chew bones, however, they also can break their teeth which places them at a survival disadvantage (survival of the fittest). Dental treats and chew objects should be considered as only part of preventative dental health care. In conjunction with daily tooth brushing, dental diets and regular professional cleanings, toys and treats can play an important part of oral health care maintenance.

Strictly avoid bones (cooked or uncooked), cow hoofs, pig ears, hard & thick rawhides, plastic or nylon bones, plastic bottles, any antlers and large ice cubes. Tennis balls and other objects with abrasive surfaces should also be avoided as these have a sandpaper like effect on tooth structure that damages the tooth and may expose the pulp.  The flatter, softer rawhide chews have been shown to be safe and effective in reducing the rate of plaque accumulation.  C.E.T. Hextra rawhide chews contain chlorhexidine which enhances their effectiveness.  Kong toys are of a firm rubber design, come in a variety of shapes & sizes and some allow you to place cheese or peanut butter inside to improve acceptance. For cats, C.E.T. Oral Hygiene Chews for cats contain products that help provide antibacterial effects in the mouth.

Take note: you must always monitor your pet when they are chewing on anything.  Verify they’re not gagging, trying to ingest too much at one time or attempting to eat an inedible product. Please refer to Animal Dentistry & Oral Surgery’s article on Safe and Appropriate chew objects.  Using products with the Veterinary Oral Health Council (VOHC) seal of acceptance is recommended as these products have successfully met strict pre-set requirements for veterinary dental efficacy and safety.

Dental chew objects do not replace toothbrushing. They are generally inadequate in removing plaque in most pets and entirely inadequate in controlling plaque in areas of already established periodontal disease (pocketing).

How do pet dental friendly diets work and which ones are available?  History proves that improved nutrition is a major reason pets live longer and lead healthier lives. From a nutritional standpoint with pet foods, it is a wise decision to purchase the best food you can afford.  Dry foods are considered a little better than canned foods because they have some abrasive activity which helps remove plaque from the crowns of the teeth.  Soft foods will generally result in greater plaque accumulation than hard diets. Hard diets are less likely than canned foods to become packed between teeth and in the gingival crevices.  However, even on the harder diets, plaque and calculus does accumulate and periodontal disease is evident. Several commercial foods have received the respected VOHC seal of approval for demonstrating product effectiveness and safety. Dental diets can effectively reduce some plaque and calculus accumulation, but do not eliminate it. Hill’s prescription diet Canine and Feline t/d® and Science Diet Oral Care® are both balanced nutritionally and have a good “mesh type” effect.  Dietary fibers are arranged more parallel than many of the dry foods, and the kibble is larger, forcing the teeth to penetrate the kibble rather than shattering it, thus providing additional abrasive action to help keep the teeth cleaner above the gum line.  Eukanuba Dental Defense Diet, Friskies Dental Diet and Royal Canin Diets contain a chemical coating (polyphosphates) on their kibble. This chemical is activated in the mouth and safely delays calculus (tarter) build-up.  It is important to understand that dental diets have limited effectiveness and do not replace the need for tooth brushing and professional cleanings. This is especially important to appreciate for those pets that already have PD.

Pet Drinking Water Additives: There is relatively little scientific research to support the claims made by many manufacturers of water additives and oral sprays for adequate plaque control.  Where the desire is to make “evidence based” recommendations, the evidence for support of these products is low.  There are serious health risks associated with some of these products that are actually available over the counter.  Some of the sweeteners (Xylitol) used are known toxins for animals. It is recommended that additives only be used with your veterinarians’ direction. Oral bacteria produce gases which account for the halitosis (bad breath) associated with gum disease.  Various products are designed to reduce this oral odor, however, they may be doing nothing towards actually eliminating the bacteria (cause of the problem). Healthy Mouth® Anti-plaque Water Additive is the only VOHC approved water additive.

Oral Antiseptic Products: These are chemical plaque control products.  The only ones in this category worth mentioning are those containing 0.12% Chlorhexidine gluconate (CHX). CHX products are excellent for patients with established periodontal disease. CHX is the gold standard oral antiseptic and there is nothing close to comparing with it. CHX products are generally prescription products that should only be used under the direction of a veterinarian.  Antiseptic solutions are designed for twice a day usage and the gold standard ingredient is 0.12% Chlorhexidine gluconate. The rinse is applied by squirting a small amount inside the cheek on either side of the mouth. CHX is inactivated by organic matter.  Although CHX can stain the teeth, the staining is usually of the plaque and calculus, and is removable.  This is the most effective antibacterial (also antiviral) agent that can be utilized in the mouth and it works by binding to the teeth and other oral tissues. It is slowly released into the oral cavity over a 12 hour period.  Chlorhexidine rinses are also good for cats, however, some tolerate the flavor & others do not.

For the best results, use the chemical plaque control (CHX rinsing) to augment the effect of mechanical plaque removal (toothbrushing).

Several products contain zinc ascorbate. This has antiseptic properties, but also benefits gingival health by promoting collagen formation and epithelialization of ulcerated tissues.  Maxiguard™ oral formula (Addison Biological Laboratory) is an example of this type of product. It can also beneficial after oral surgery for its antimicrobial and healing promoting effects.

Safe and Appropriate Chew Toys for Dogs

Fractured pet teeth are one of the more common dental problems encountered by veterinary dentists. Broken teeth, more often than not, have exposed pulp tissues that subsequently become infected.  Just like for humans, apical infection (apical periodontitis, dental “abscesses”) will occur in a matter of time. They are painful and cause exposure of the body to chronic bacteria infusion and inflammation. In most cases, the problem is caused by dogs being allowed to chew on objects that are just too hard for their teeth. These objects may actually be harder than the teeth.  It is important to remember the evolutionary function of carnivores…they are meat eaters. The function of carnivore oral behavior is to grasp, pull and hold prey. This is followed by cutting and tearing meat before crushing and gulping. Carnivore teeth are not designed to chew bones or other objects harder than the teeth.  Starving wild animals often have only bones to eat, however, they also break their teeth, which places them at a survival disadvantage (survival of the fittest). Wild carnivores that do eat bones are usually doing so from freshly killed prey.  Fresh bones are softer, however, they still can lead to traumatized and fracture teeth. Dental treats and chew objects should be considered as only part of preventative dental health care (please refer to information on dental diets, chews and antiseptics).  In conjunction with daily tooth brushing, dental diets and regular professional cleanings, toys and treats can play an important part of oral health care maintenance.

Strictly avoid bones (cooked or uncooked), cow hoofs, pig ears, hard & thick rawhides, plastic or nylon bones, and large ice cubes. Tennis balls and other objects with abrasive surfaces should also be avoided as these have a sandpaper-like effect on tooth structure that damages and may expose the pulp. The flatter, softer rawhide chews have been shown to be safe and effective in reducing the rate of plaque accumulation. C.E.T. Hextra rawhide chews contain Chlorhexidine which enhances their effectiveness.

When trying to select safe chew objects for your pet, there are two good approaches:

  1. General rules of thumb.
  2. Use products approved by the Veterinary Oral Health Council (VOHC)

A. Rules of Thumb

  1. You want to be able to indent the surface with your finger nail.  Surface has some “give” to it.
  2. “Knee Cap Rule”: If you hit your self in the knee with the object and it hurts, it’s probably too hard/heavy for your dog.
  3. “Hammer Rule”: If you can drive a nail with the product, don’t allow your dog to chew on it.
  4. Also avoid objects with abrasive surfaces like Tennis Balls and Frisbees.
  5. If you cannot flex or break the product with your bare hands, it’s probably best to avoid it.
  6. Please take note: you should always monitor your pet when they are chewing on anything.  Verify they’re not gagging, trying to ingest too much at one time or attempting to eat an inedible product.

B. VOHC approved products
Although not all safe products have VOHC approval, using products with the VOHC seal of acceptance is recommended as these products have successfully met pre-set requirements for veterinary dental efficacy and safety.  A complete list of VOHC approved products can be accessed at www.vohc.org.