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.