Paul Cooper BVSc MRCVS – President British Veterinary Dental Association (BVDA)

Did you know that there is a disease affecting
around 70% of all adult dogs and cats?

If this disease caused your pet to vomit, cough or have diarrhoea you would, I am sure, not only notice it, but want to have it treated. If this disease caused acute pain such that your pet was obviously limping or unwilling to move, you would likewise want to treat it.
However, if this disease just makes them a bit under the weather, a bit more dull than normal, less willing to walk, slower at eating, and gradually gets worse, you might either not notice it, or you might assume your pet is just ‘getting old’. How many of you shut an old dog out of the room when visitors arrive because of the smell, likely halitosis, and consider it normal?

The disease we are talking about is Periodontal or Dental disease. Many studies from the 1960s onwards have demonstrated the high percentage of pet dogs and cats affected. In all those decades the percentage has remained stubbornly the same. It appears that pet owners have come to believe that dental disease is inevitable and
progressive as their pets get older, and they just accept it.
Sadly their pets have little say in the prevention and treatment of their dental disease, largely suffering in silence. How many owners have had a tooth abscess – one of the most painful things in my personal experience- worse even than a broken wrist or ribs!
Many studies over the last 20- 30 years have shown a marked association between dental disease and other problems in the body, such as kidney disease and heart disease.
These associations are also being found in humans – the worse you have dental disease, the worse your general health is likely to be. Improving dental health is a really important task for all of us, humans, dogs and cats (and rabbits, horses etc etc).
Our pets have evolved into very stoic patients compared to humans. They will suffer in silence, since in the wild, the predators will naturally take the sick looking individual first as easy prey. All vets in practice will be able to recall patients who were ‘normal for age’ as far as their owners were concerned before treatment of their dental disease, but suddenly became young again following treatment.
Dental disease is probably the most under diagnosed diseases of dogs and cats. The reasons are complex, but in essence boil down to owners, and some vets, just not looking for it!
dental careIF YOU DON’T LOOK, YOU WON’T
SEE IT. ‘LIFT THE LIP’.
When we talk about dental disease, we are usually talking about Periodontal disease, which is commonly known as gum disease. The cause is a build up of plaque at the gum margin, which is a biofilm of bacteria, and elements of saliva and other components that acts almost like a living entity. Initially as a thin layer the bodies immune system holds it in check, but as it thickens, the type of bacteria in it change, and produce toxins.
pet dentalThese toxins trigger a furious battle with the body’s immune system,
resulting in inflammation of the gums, followed by loss of bone supporting the tooth, loss of gum tissue and ultimately loss of the tooth. Along the way there is pain in the mouth, smell (halitosis), and other effects on the body as the by-products of this battle spread through the blood stream.
Plaque is generally a thin layer of white or yellow ‘slime’ on the teeth, and under the gum line. Calculus, also known as tartar, on the teeth is what most people see when they do actually lift the lip and is not the cause of dental disease. It is mineralised plaque – calcium salts from the saliva settle on the plaque, just like the ‘fur’ or scale in a kettle. Calculus is important since it is a rough surface, and plaque can stick to it more easily than the enamel on the tooth surface. Just removing the calculus alone might make the teeth look good, but it does not help the progression of dental disease – plaque is the enemy, especially that below the gum margin!
So… how do we treat and prevent dental disease? A proper treatment
of Periodontal disease involves a professional examination, both conscious and under anaesthetic, of the teeth and oral cavity, followed by thorough cleaning of the teeth surfaces of all calculus and plaque, both the visible areas, and the hidden and more dangerous plaque and calculus under the gum line. This will be carried out using an ultrasonic scaler, hand scalers and curettes, and polishing using a fine paste to smooth the enamel surfaces and remove residual plaque above and (more importantly) below the gum line.
This can not be carried out properly without an anaesthetic, since you can only remove visible calculus with a conscious pet, and that is largely cosmetic. Modern anaesthetics are now really safe for pets, using the same injections, gas, and monitoring equipment used in human hospitals.
Over the years, I have personally anaesthetised very many late teen/ early 20s pets for dental treatments, and seen the benefits in their quality of life afterwards.
But… this professional cleaning is only the start – it merely ‘resets the clock’! Within 24 hours plaque starts to accumulate again – initially the thin stuff, containing bacteria the immune system can deal with, but it gradually thickens and more harmful bacteria colonise the plaque and so the cycle repeats.
cat dentalHOMECARE, HOMECARE HOMECARE,
HOMECARE, HOMECARE
This is the key to preventing periodontal or dental disease for the long term benefit of your pet. You would not, I hope, think that a 6 monthly visit to your dentist was all that was required to keep your own teeth and gums healthy?
Our dentists advise us to brush our teeth twice daily to remove plaque, and thereby prevent periodontal disease and keep our mouths healthy. The same applies to our pets, although given our busy daily lives, vets advise the once daily brushing of pets’ teeth.
When brushing your pets teeth, it should not be a fight, but rather a gentle minute or two of lifting the lip each side, and brushing the teeth. Your pet should worry about this no more than brushing the coat to remove some dirt. The act of brushing to physically remove the plaque is far more important than the toothpaste used.
dog dentalFlavoured toothpastes might make the brushing more acceptable to your pet, and those with chlorhexidine (an oral antiseptic) or an enzyme system will have some extra benefits on gum health, but 95% of the benefi ts are in the brushing. Please do not use
human toothpastes, some are toxic to dogs, and all are designed to be spat out, not swallowed.
There are many patterns of ‘pet toothbrushes’ on the market, but a cheap supermarket child’s brush with a smallish head and soft bristles will be just as effective. The method of brushing is shown on many on-line videos, but a good one is https://youtu.be/xPvaXJ-Ki3M – this is by Norman Johnson of DentalVets in the UK.

dentalAlthough brushing daily is the ‘gold standard’ ongoing homecare for our pets dental and oral health, we know from a number of human studies that about 1 in 4 people actually forget to brush their own teeth every day (yuck – how gross).
As a result of this forgetfulness, and also the perceived difficulty of owners to actually regularly brush their pets’ teeth daily, there are literally hundreds of products out there competing for your money and which promise to clean the teeth without brushing.
It is interesting that your pets teeth and gums, and your teeth and gums are broadly similar, and yet many of the products on the market which supposedly clean our pets’ teeth are not on the market for you and I. As long as the product does not have a specific medical claim for pets, there is no regulation to prove it works, unlike in the human field.
pet dentalAssuming we can’t remember to brush our pets’ teeth, or we don’t have time, or our feisty cat just says NO WAY, what else can we do? There are a number of categories, described below, of these products – but all only claim to REDUCE, not remove or stop plaque
and/or calculus, and all will really only be at their most effective when starting with a professionally cleaned mouth.
Statistically, dry food is better than sticky canned or pouch food. Dry food helps with the natural self cleaning action of chewing, unless of course your pet just hoovers it out of the bowl!
dog smileThere are diets from the major manufacturers that have proven dental benefits in clinical trials accepted by the international ‘VOHC’ (www.vohc. org) which reviews the evidence and approves products. Their logo will be on all products with proven benefits. Dental diets work either by having a fibrous texture that help clean the teeth, and/or a calcium binder to help reduce plaque mineralisation into calculus.
There are also proponents of raw diets which include chicken wings, meaty bones and other ‘natural’ ingredients, but although there is anecdotal evidence of their efficacy in keeping teeth clean, there is also clinical evidence of broken teeth, and gastro-intestinal problems in using these diets.
dog chewDental chews are popular, especially for dogs, but also for cats. They are intended to enhance the natural self cleaning of teeth during chewing, and a number have the VOHC Seal of approval. However, they will only work if your pet spends a long enough time chewing them! It is therefore essential to choose the correct size. Please remember with chews, if they are harder than the teeth, the tooth will break during chewing, rather than  the chew. This is especially seen with large bones, hard nylon shaped bones, deer antlers, stones and hard wooden sticks.
There are also water additives available to help reduce plaque. One of these has the VOHC seal, with proven benefits, although others do have some published evidence of efficacy.

There is a seaweed extract, both as a powder to put on the food, and also incorporated into a dental chew, which has recently received the VOHC Seal of approval to help reduce plaque and calculus.
In summary – please do look regularly at your pet’s mouth – Lift The Lip! If you see redness of the gums, lots of calculus on the teeth, notice a smell, then please visit your veterinary surgeon to discuss proper professional cleaning, and then consider how you are going to maintain healthy teeth and gums for your pet. Brushing is not as difficult as you think!

For more information please visite the website www.bvda.co.uk