DENTAL HYGIENE

Dental Report Card | Innovations in Preventative Dental Care
Brushing Your Pet's Teeth | OraVet| Hill's prescription t/d diet
Dental Health Q and A
New! Canine Porphyromonas (i.e. Periodontal) Vaccine

PERIODONTAL DISEASE IS A MAJOR HEALTH RISK FOR YOUR PET.

• It is the most common disease in small animal practice.

• It is PAINFUL. Most frequently, pets with oral pain “suffer in silence”.

• It is PREVENTABLE (the term for prevention is “prophylaxis”).

• Treatment is a catch-up game to get problems under control when there may already be permanent damage to the oral cavity or internal organs.

Pets with routine dental care typically live longer and healthier lives.  Pets with dental disease constantly release bacteria from their mouth into their bloodstream (i.e. bacteremia), resulting in inflammatory changes in the heart muscle, liver, and kidney tissue in otherwise healthy animals.  This problem may be exacerbated in pets that already have other existing disease.

• Gingivitis: inflammation of the gingiva (i.e. gum line) only.
• Periodontitis: inflammation and disease of all structures that support the teeth.
• Plaque: a “biofilm” consisting of 80% bacteria and bacterial toxins, 20% cellular debris and food remnants. It is plaque (especially below the gum line) that causes gingivitis and periodontitis. 

• Calculus (i.e. tartar): is mineralized plaque that cannot be brushed off

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Dental Report Card

One of our veterinarians may give you a dental report card for your pet at his/her exam. This is to help you understand what level of dental disease your pet has and what treatment is necessary to minimize progression of oral discomfort and disease.

	q    Nice Job! No sign of plaque or calculus Home dental care is needed to maintain these healthy teeth and gums.  Brushing your pet’s teeth regularly (3-4 times per week) is ideal.  There are also products available to help make home dental care easier if brushing is not an option.
	q     Stage 1 – Mild Gingivitis The margin of attached gum is inflamed and swollen.  Plaque covers the teeth.  Home dental care is needed.  If there is no improvement, dental cleaning is needed within the next year to remove current plaque buildup.
	q     Stage 2 – Moderate Gingivitis The entire gum line is inflamed and swollen.  The mouth is painful and odor is noticeable. Dental cleaning to remove calculus is needed within the next month.  A calculus control diet and/or home dental care are needed afterward for prevention.
	q     Stage 3 – Severe Gingivitis The gums are cherry red and bleeding – they are damaged by infection and calculus.  A sore mouth and bad breath are evident.  Dental cleaning to remove calculus is needed immediately.  A calculus control diet and/or home dental care are needed afterward to prevent reoccurrence.
	q     Stage 4 – Periodontal Disease Chronic infection is destroying the gums, teeth, and bone.  Bacteria are spreading through the body via the bloodstream and may damage the kidneys, liver, and heart.  Dental cleaning to remove calculus is needed immediately.  Some teeth may be loose and need extraction.  Home dental care afterward is necessary for future prevention.

Innovations in Preventative Dental Care

	Prescription Diet t/d® (Hill’s Pet Nutrition): Dogs and Cats This is a very effective dental diet with a fiber matrix technology that scrubs the entire exposed tooth surface to reduce plaque tartar, and stain. There are scaled down over-the-counter versions marketed as Science Diet® Oral Care™ diets.
	OraVet™ (Merial): Dogs and Cats This is a unique oral hygiene product that provides an invisible barrier to prevent plaque and tarter accumulation.  It electrostatically adheres to the tooth’s surface and will not disappear after tooth brushing or eating hard food.  It is odorless, tasteless, and only needs to be applied ONCE PER WEEK. It has been shown to reduce plaque by 22% to 46% over an 8 week period compared to patients not receiving the product.
	C.E.T.® HEXtra™ Premium Chews (Virbac): Dogs Only These rawhide chews are covered with 10% chlorhexidine, combining the mechanical plaque-removal action from chewing with the bacterial, fungal, and viral fighting ability of chlorhexidine.  After at least one minute of contact time the chlorhexidine will bind to the teeth and gums and continue to be effective for up to 24 hours.  Chorhexidine is the most effective plaque-inhibiting substance in people.
	C.E.T® AquaDent™ and Oral Hygiene Rinse™ (Virbac): Dogs and Cats AquaDent is a drinking water additive that helps freshen your pet’s breath and prevent plaque accumulation. C.E.T. Oral Hygiene Rinse combines 0.12% Chlorhexidine and Zinc Gluconate in a plaque-fighting formulation that may be used with or without brushing. It also contains Cetylpyridinium chloride for fresh breath fast. A unique bent-stem applicator is also included for easy administration.
	MAXI/GUARD® OraZn™ (Addison Labs): Dogs and Cats This is a zinc product in an oral preparation. Zinc helps to heal gum tissue, reduce halitosis (i.e. bad breath), and decrease inflammation.  A pea-sized amount of this tasteless gel can be applied daily to the outer surface of the upper molar teeth.  The bathing action of the oral cavity then distributes the product throughout the mouth.
	DenTees™ Stars and Chews (DermaPet): Dogs and Cats These are digestible dental treats that contain sodium hexametaphosphate, acetic acid, grapefruit seed extract, and clove. They work by binding minerals, thus preventing their use in the formation of tartar from plaque.
	DentAcetic™ Wipes (DermaPet): Dogs and Cats These dental swabs contain ingredients similar to DenTees™ and are used to wipe the teeth daily. Clove helps prevent pain while cinnamon and clove help to deodorize pets’ breath.

The Veterinary Oral Health Council (VOHC) was created in 1997 to certify veterinary dental products that effectively control plaque and calculus in cats and dogs. Look for “VOHC certification” to know if the dental product “claim” has been scientifically proven.

Brushing Your Pet's Teeth

Step 1: Desensitizing to your Finger

Train your pet to accept your fingers in its mouth by gently rubbing its gums.  Place dentifrice (i.e. toothpaste) on your finger and rub along the gum-line.  You only need to do the lip-side of the teeth.  Dogs and cats do not develop tartar as easily on the tongue-side of the teeth.  Thus, this process can be done with the mouth closed (i.e. teeth interlocked).  Do this daily and continue this until your pet accepts this treatment without a fuss.  Talk gently and be patient.  Make this fun.  Offer a treat or play after this procedure.

Step 2: Desensitizing to the Toothbrush

Once your pet has accepted your fingers, now is the time to start the introduction of a toothbrush.  You should use a commercially produced brush made for dogs and cats, which has extremely soft bristles, or a human pediatric toothbrush.  Start by introducing the brush only in the mouth.  Be aware that your pet may be frightened at first.  Be patient and talk softly.  Start by placing the brush on one or two teeth along the gum-line and hold the brush at a 45-degree angle to the tooth and gum.  Gradually work around the mouth.  This too may take a few weeks for your pet to accept.  You can reach the back upper teeth easily by placing the brush under the upper lip while holding the muzzle shut with your other hand.  If your pet refuses to accept this then return to using your finger for a period of time before reintroduction of the brush.

Step 3: Brushing with Dentifrice

Use a dog/cat dentifrice only.  Human toothpaste is not recommended.  Human toothpaste tends to froth and cause stomach upset.  Force the toothpaste DOWN INSIDE THE BRISTLES.  If you place the paste on the top of the brush your pet will just lick it off.  Daily brushing is best because plaque mineralizes into tartar in 24-48 hours.  Once plaque becomes tartar it cannot be brushed off, only scaled off professionally.  Many studies have documented the need for daily brushing as the most effective way to control plaque.  After a few weeks you should be able to brush almost all of the teeth without your pet resisting or struggling.  Some owners can brush the tongue side of the teeth also.  By using patience and gentle manipulation most pets will accept this procedure.

Step 4: Beyond Brushing

Tooth brushing is still the “gold-standard” of disease prevention in the mouth.  However, we realize that there are certain obstacles to tooth brushing that are not always easy to overcome.  Fortunately, there are now effective alternatives to brushing (see Innovations in Preventative Dental Care).  Or use one or more of these products in addition to brushing for even better results.

Step 5: Dental Prophylaxis and Treatment

As with humans, annual dental cleaning and treatment is often necessary even if you are brushing your pets’ teeth daily.  We will help you decide when this is appropriate.

Canine Porphyromonas (i.e. Periodontal) Vaccine

Periodontal disease ("periodontitis") is inflammation and infection of the gums and bone around your pet's teeth, eventually resulting in the loss of these teeth.  It is the most common disease among dogs, affecting more than 8 out of 10 over 3 years of age!  It is caused by bacteria that can live in the absence of oxygen (i.e. anaerobic) under plaque, tartar, and deep in diseased gum tissue and bone.

Periodontitis is PAINFUL and we need to recognize that for our pets.  Just because our pets will quietly tolerate pain, doesn't mean they should have to.

Remarkably, after years of research along with laboratory and field trials, Pfizer Animal Health has created the first and only vaccine to aid in the prevention of canine periodontitis!  By vaccinating against the three main types of anaerobic bacteria that cause periodontal disease, we can help prevent the pain and other negative health implications associated with chronic dental infection and tooth loss.

The group of anaerobic bacteria responsible for most of the periodontal bone destruction are called Porphyromonas.  The vaccine contains killed versions of the Porphyromonas denticanis, Porphyromonas gulae, and Porphyromonas salivosa.  Thus the name Canine Porphyromonas Vaccine.  These three types comprise approximately 75% of the bacterial population in the diseased gum pockets and are not normally found in the aerobic (i.e. oxygen-rich) environment of healthy gum tissue.

It's important to remember that this vaccine is not a replacement for routine home care (i.e. tooth brushing, OraZn, OraVet etc) or regular prophylactic cleanings by your veterinary healthcare team.  The importance of this routine preventative care cannot be overstated.  Think of the canine porphyromonas vaccine as part of a complete dental care program for your dog.

• How often will my dog be vaccinated?
  Your dog will initially receive two doses of the Porphyromonas vaccine, given three weeks apart.  It is currently recommended to booster this annually thereafter.

• When is it safe to vaccinate my dog?
  This vaccine can help dogs of all ages.  Safety was demonstrated in dogs 7 weeks of age and older.  Most puppies will be vaccinated toward the end of their vaccination series.  However, since each dog is an individual with a unique medical history, your veterinarian's approval is required before having it administered.

• What if my dog already has periodontal disease?
  Periodontal disease can progress to four different stages.  There can even be different stages of involvement in different teeth within the same dog's mouth.  Appropriate periodontal therapy (i.e. dental treatment under anesthesia) should be administered to restore health to the teeth; however, all teeth can potentially benefit from the Porphyromonas vaccine.

• If my dog receives the vaccine, are cleaning and brushing still necessary?
  The Porphyromonas vaccine should be used as part of a total dental care package that includes at-home care and professional cleanings.  Even with the use of the Porphyromonas vaccine, tartar and plaque may still develop.

• What are the possible side effects of the Porphyromonas vaccine?
  As with any vaccine, the potential for side effects after vaccination exists.  If you notice anything unusual, contact your veterinarian.  For more specifics: Adverse Reactions to Vaccinations

Click here to view a video on how the Porphyromonas vaccine works.