PERIODONTAL DISEASE P5
2013
It’s the most effective way that you can remove dental plaque, maintain oral hygiene, and control gingivitis. There are various toothbrushes in the market, and my recommendation is to use any good quality toothbrush. In certain cases, I recommend finger brushing or cotton buds to get started. I find cotton buds fairly useful in cats just to get them used to something in their mouth before progressing them to the toothbrush. Finger brushes, I’m not a big fan of, and I find them quite bulky. I don’t find the bristles effective. The ones with the rubber nipples in the end are, in my opinion, almost useless, but sometimes like them. So, it’s what you can do to get them going. I think a good quality toothbrush is definitely the way to go.
Regardless of what toothbrush you’re using, I would recommend an animal toothpaste. The reason is that human toothpaste contains various things like enzymes and fluoride and flavoring. So, the mint flavoring in our toothpaste can be quite powerful for an animal, and they don’t always like it. The frothing agents, they don’t like, but, as I said, the biggest concern is possibly the fluoride content.
So, an animal is going to swallow a toothpaste. Strictly speaking, a toothpaste doesn’t have many advantages in animal dentistry. The main advantage that that it’s flavorful. The animals like it. So, they tolerate toothrbrushing better. The Virbac toothpaste contains an enzymatic system, which is something that occurs in the saliva anyway, but it does help reduce plaque accumulation to a degree. I like their toothpastes purely because they’re nice flavors, and the animals like them, not because they’re sponsoring the webinar this evening. As I’ve said, I do find them effective.
The one thing that I tell my clients to do though is to squish the toothpaste into the bristles. I find if you put it nicely on the top like we do on our own toothbrushes, the animals lick them off, and it’s gone within a few seconds. They think they’ve had their treat, and they don’t compromise with tooth brushing. So, my own dog, after I finish brushing her teeth, I usually give her a bit of the paste as a treat afterwards, and she loves it. If she sees the toothpaste, she’ll come right away. She’s not keen on the tooth brushing, but she likes the toothpaste. So, that makes it quite peaceful.
The big thing is to always show the client how to brush the teeth. I always recommend that the mouth is closed, usually putting your hand across the muscles, and it depends on how compliant the dog is. So, always start at the back of the mouth and work forward. The front of mouth is very sensitive, and the minute that you go to the upper incisors, they’ll start sneezing or they’ll lick or wriggle. So, I always start at the back and go forward. If you don’t tell a client that, instinctively, they’re going to the front of the mouth and start brushing from the front because that’s the area that they can see.
I do everything with the mouth that I can see, start at the back and work forward. I gently, then, open the grip so that I can get to the gingival margin of the mandibular teeth because, remember, the maxillary premolars almost overlie the premandibular molars. So, you need to just open the mouth just slightly to be able to get to the gum margin on the mandibular teeth. Come forward. Once I’ve done everything on that side, I do the other side, and then come to the front to do the incisors.
Cats. This is my own cat, Charlotte. They’re not like dogs. I think cats tolerate tooth brushing unlike dogs. They quite like it, but cats, you need to get them in a headlock, tilt the head to one side. What you want to aim for in the cat is all the bristles are inside the mouth, but the head, the plastic part of the toothbrush is usually outside the mouth. I tilt the head slightly and pull back that lip with my thumb, gripping on the zygomatic arch and pulling the cheek back. I either do them on the ironing board or I wedge them in between my knees and do them on the carpet so that the front legs hopefully go into the cover of the ironing board and they come and pull my hands.
This is a nurse friend of mine. You can see the size toothbrush that she was using, and these were adult cats when they started brushing their teeth. They tolerate it extremely well, and you can see she’s taken the position of sitting on the floor, the cat wedged between her legs. The cat can’t move back there, and they feel quite secure because they can’t move to the side. So, that’s how I recommend tooth brushing cats.
I think we’ve discussed most of this. The three things that I would point out would probably be, I only recommend brushing the toothbrush once only all the teeth have erupted. The reason for that is until all the teeth have erupted, you’re getting changes in the mouth, and I think if there’s a deciduous tooth that’s starting to become loose, it can irritate the dog with the client’s tooth brushing. That’s not to say that the animal shouldn’t be getting its mouth cleaned. They should be getting used to their mouth handled, not to get used to the client putting bits of toothpaste on the deciduous teeth, but actually physically start using a toothbrush I usually recommend from 6 months of age.
Always warn the clients that the gums may bleed when they are tooth brushing, and this indicates that there is some gingivitis. If you don’t warn the clients, what happens is they think they’ve done something wrong, and they stop. They don’t come back and tell you, but they just stop. What I usually recommend is if the gingivitis is infecting in about three to five days, they should come back and see me so I can look at the area and see why that’s occurring. For my long term finds, they are tooth brushing every day. That’s one of the indicators that there’s a problem is when somebody gets a bleeding in an area, and it’s not reducing. I always get them to come back and see me.
I think getting owner compliance is difficult, and I appreciate that I’m in veterinary practice. So, immediately, I got much more bond with clients, but the clients that we get with periodontitis, a lot of the time, the disease just hasn’t been explained to them. So, they don’t understand why they’ve got to brush. They don’t understand benefits of tooth brushing, and so many times in practice, they would have been given chews. They would have been given water and all sorts of things, and they spend a lot of money on things. They think they’re doing what’s right for the animal. It’s just purely because they want to help, but they really haven’t been given the proper instructions.
I think it’s worth spending your time, and this is where nurses are invaluable in practice. They’ve got the time to spend with clients. They’ve got the time to actually show them how to brush to get them more used to tooth brushing, and clients are more open with nurses. They’ll often say, “The crazy lady old me that I’ve got to brush my cat’s teeth. How am I going to do it?” They don’t say that directly to my face. So, I do think nurses are invaluable here.
I do think it’s important that the client understands why they brush and that it’s not just about smelly breath. You are doing it to prevent potentially systemic disease. So, I think once they understand that, they’re much more like to get on board. If they’ve got the support and encouragement of the practice and all that information is constantly reinforced with frequent checkups, they will get bonded, and they will comply. It’s important that everyone in the practice is saying the same thing. There’s no point in you recommending tooth brushing and trying really hard, and the receptionist says, “Why don’t you just buy a bag of food? That’s going to be much better.” That’s when it gets laid down because unfortunately, human nature says we are all up for an easy option if we’ll save.
Sometimes, even if an owner is really, really compliant, they’re not going to be able to toothbrush. A lot of them can’t always cope with restraining their animal or with cats, they’re not used to gripping, getting them in a headlock. There are some animals that just won’t tolerate tooth brushing, but as the first line, I would always recommend tooth brushing.