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Why Dog Dental Care is Essential

To brush or not to brush? Are bones good or bad for your dog? Are those special dental biscuits and chews worth it? What is that weird liquid and does it actually DO anything?

On the eve of Pet Dental Health Month in Australia, we spoke to Dr Christine Hawke from Sydney Pet Dentistry who answered all the questions we (and probably you) have ever pondered about how to best keep our dog's chompers clean and healthy!

The most common dental problems I see in adult dogs in my practice are periodontal disease (gum disease) and tooth fractures. Interestingly, while dental cavities (caries or tooth decay) are really common in humans, they are rare in dogs due to differences in the shape of the teeth, the type of food they eat and the pH of the saliva. As long as you don’t feed them lollies or sugary treats, it is really unlikely your dog will ever get a cavity!

Home Dental Care Basics

Home dental care is the ONLY thing that will slow down the progression of gum disease - dental cleanings and extractions literally just clean up the disease is in the mouth at the time. Your vet can return the mouth to a pain free and healthy state but, without effective home dental care, disease will progress again afterwards.

Effective home dental care means that:

✔️ The time between dental cleanings will be longer
✔️ There will be less gum disease, which means the chance of losing teeth is reduced
✔️ The anaesthetic will be shorter, which is especially important for older pets
✔️ The cleanings will cost less

Sounds simple enough, right?

The problem is the sheer amount of conflicting information on dental care in pets. Pet stores and supermarkets present a confusing array of products. Rows and rows of chews, foods, toys, chemical rinses, water additives, sprays, pastes and gels. New ones coming out all the time, each promising to fulfil your pet’s dental needs. How can anyone make sense of this without a veterinary expert on speed dial every time they go shopping?

Where on earth do we start?

I find the easiest way to approach home dental care is to look at the basic cause of the problem – once we understand this, the solutions become pretty clear. You can then look at each product, think about how it works (if it does), and make your own mind up. Easy!

Let’s start with periodontal disease. Most people have heard it called gum disease or gingivitis
Plaque bacteria on the teeth cause gum inflammation. 

This is the filthy ‘scum’ layer that forms on the teeth, starting only hours after you brush them. If plaque is left undisturbed (for example, if you forget to brush your teeth for a couple of days) it hardens into tartar.

When your dog’s breath smells bad, you are smelling infection and pus accumulating around the teeth. Gums with gingivitis become sore, red, puffy and swollen, and may ulcerate or bleed when rubbed. The gums and the bone supporting the teeth start to recede and are permanently destroyed.

Other complications occur as well:

  • Constant showers of bacteria enter the bloodstream and spray the organs, including the liver, heart and kidneys.
  • Eventually, the teeth fall out. 
  • In some cases, the jawbone may fracture before this happens.
  • Painful abscesses may form deep in the bone.
  • Holes may open up between the mouth and nose (oronasal fistula). 
Periodontal disease is the most common disease in pet dogs in Australia, affecting 4 out of 5 adult dogs.

So, what are your options?

The aim of this article is not to just give a list of products, although some are mentioned as examples (note: I have no association with any of the companies mentioned). Products vary from place to place and come and go, so we’re going to focus on how they work, so you can cut through some of the marketing hype yourself. 

Every dog is different, so the days of using a cookie-cutter approach are over. You know your dog better than anyone. My job is not to just recommend a diet or dental chew to you, but to help you make the best decision for your pet in your own individual situation. Of course, your local vet is also there to help!

To assess any method or product for plaque control you should ask two questions – does it work, and is it safe?

#1. Does it work?

There are many products on the market which claim to have ‘dental benefits’ for dogs, however if they don’t control plaque bacteria, they are not going to affect periodontal disease – it’s that simple. Making the breath smell fresh doesn’t matter if the bacteria are still there, doing their dirty work.

You need to either REMOVE the bacteria (mechanical methods) or KILL the bacteria (chemical methods).

Some products (mainly diets) can also work by making it more difficult for the plaque to harden into tartar, but ideally you still want to combine this with another method that will mechanically remove the plaque. Some products work in both mechanical and chemical ways – a double whammy!

#2. Is it safe?

Even if a product is effective, that’s not much help if it is destroys the teeth at the same time. I once saw a dog with severely damaged teeth that had been cleaned with a common household product I use myself to clean the bath – there was no plaque present, and also no enamel on the few teeth that were left!!

I also see cases every single week of broken teeth due to dogs chewing inappropriate objects, and it is heartbreaking when dog owners have given these as chewing aids for the very purpose of helping their pet’s teeth.

The most common tooth fracture we see in dogs is a slab fracture of the upper carnassial tooth (the biggest upper cheek tooth) – this occurs when the dog bites down on a hard object (often a bone, stick or rock), and the whole side of the tooth flips up and outwards. 

This happen because the carnassial teeth are designed like a pair of scissors.
Scissors are not designed to cut through objects as hard as they are, and the tooth structure is actually a type of modified bone. 

If the dog bites hard enough on a bone, either the bone or the ‘scissors’ will break. Too often, sadly, the scissors lose out.

Okay, on to our options. I divide them into mechanical (removing the plaque) and chemical (killing the bacteria, or stopping the plaque from hardening into tartar).

Removing the Plaque: Mechanical Methods

Our mechanical options come in two main forms:

#1. Toothbrushing

I know you’re rolling your eyes (like this guy!). Hear me out. 
If your pet will allow it, tooth brushing is the single most effective way of controlling plaque.

That’s why human dentists get us to do it! People often underestimate how many dogs will accept (and even enjoy!) brushing if it is introduced slowly and associated with a reward. You don’t have to do it (no judgement), but if you try, your dog might just surprise you. If it doesn’t work, you have nothing to lose (as long as you keep the video off youtube, even your dignity will stay intact).

Brushing disturbs the layer of plaque forming on the teeth before it can harden into tartar. Ideally this should be done daily, or every second day if possible, given the timeframe we have before tartar forms. Check out our information sheet on the ‘slow and sneaky method’ for brushing your pet’s teeth for handy hints on getting started (link).

Toothbrushes need to have soft bristles as we don’t want to cause damage or discomfort – some made specifically for dogs are fine but others are too stiff. 

I often use human brushes with soft bristles (children’s brushes are good for smaller dogs). 

Training can be started with something delicious, such as peanut butter, pressed into the bristles (avoid sugar and salt). If you work up to toothpaste, it’s important to use toothpaste designed for animals, as human toothpaste is not designed to be swallowed (and dogs are not good at rinsing and spitting!). 

Besides, in flavours such as chicken, beef and tuna, toothpaste can help make brushing a treat!
Alternatively, oral antiseptics can be used (see below), or just water alone, especially if your dog doesn’t like the flavour, or has food intolerances or is on a restricted diet -- most of the benefit is actually from the brushing action itself.
If your dog chews on the bristles, they are just flossing as well! Some dogs even like power toothbrushes, but make sure you label theirs as they don’t like to share with dirty humans.

It is very important to have your pet’s mouth examined by a vet before commencing a brushing program.

The presence of any existing disease may make brushing painful and won’t fix any current problems – you can then start safely once any disease is under control.

#2. Chewing

Dogs love to chew, and this has the added benefit of helping to keep their teeth clean. Chewing has an abrasive action that helps remove plaque (think of it as physically wiping the tooth surface) – however it is important to offer something that is safe (not too small, hard or brittle) yet still effective.

Different dogs have different chewing behaviour, so what is safe and effective in one dog may be dangerous or ineffective in another.

Here are some important points:

  • Although regular dry foods are often touted as ‘good for teeth’, most simply shatter when bitten and therefore don’t require any actual chewing. Many dogs don’t even bother chewing regular kibble, preferring to ‘inhale’ it! 
  • This goes for any food, diets, toys or chews – if a dog doesn’t spend time chewing, the food or chew won’t work. 
  • If the chew treat is too small for the dog and is gone in a gulp, it won’t wipe the tooth surfaces. 
  • If your dog only chews on one side of his mouth, it won’t clean the other side. 
  • Just because it is a ‘natural’ diet, if it is cut into tiny pieces that don’t need chewing, it won’t clean the teeth. 
  • If the box says ‘chew toy with added dental benefits’ but there’s nothing for the teeth to rub against…you get the picture.

My general rules for choosing a ‘tooth-safe’ chew toy or treat are that it should be flexible (you can bend it), not too hard (you can dent it with your fingernail) or it will fall apart or crumble as it is chewed. 

Bear in mind that this does not rule out other potential issues such as choking or gastrointestinal obstruction. I’m not sure the perfect chew object exists for all dogs – if it does, I’d love to hear about it (my contact details are in the bio section of this article)!

You will need to experiment to find what works for your dog.

Commercial vs non-commercial products

You can choose to use whatever you like - commercial diets, natural products, food-based or chew toys, as long as they are effective and safe. The commercial diets tend to have more rigorous studies and clinical trials behind them as the companies will fund these, but if you think about the basic principles of how chewing works, you can adapt and trial all sorts of different foods with your dog. 

The proof is in how healthy your dog’s teeth and gums remain - your vet can assess this with you. If things are not working, then you may need to reassess your plan, regardless of how well the same diet or chewing regimen worked for your previous pets, or your neighbour’s dog.

Commercial complete dental diets are available that are designed with larger kibble that has been designed to mechanically clean the teeth as it is chewed – some of these are clinically proven to reduce plaque and tartar (examples include Hills T/D and Royal Canin Dental). As choice of diet may be affected by other health issues, it is a good idea to get professional advice on this - the best place to start is your local vet hospital.

Commercial treats chews and toys vary in quality and effectiveness, ranging from those with relatively rigorous scientific studies behind them (GreeniesOravet Dental Chews) to those that are less (or non) evidence-based. 

Most studies on edible commercial chews are based on these being fed daily. Great caution needs to be exerted when purchasing chews and toys as there really is no control over what can be promoted as a dental chew. 

Hard chew toys and treats such as deer antlers, hooves and hard plastic bones are dangerous for teeth and most have no dental benefit as they do not have any significant mechanical cleaning action. 

It is worth going back to the basics – will it clean the surface of the teeth down to the gumline, and will it flex, dent or crumble as your dog chews on it?

Bones are a very popular natural chew treat in Australia and have the added benefit of providing enjoyment and boredom relief. 

However they should be used with caution as there are some potential complications including tooth fractures and tooth root abscesses, gastrointestinal obstruction and perforation, and food poisoning (e.g. salmonella). Their effectiveness in controlling plaque is still controversial and even the experts remain divided on this topic. 

If you choose to use bones as part of your dental care program, follow these rules:

They need to have plenty of meat on them so there is something for the teeth to sink in and out of repeatedly, and you take them away once they have eaten the meat.

Some dogs may chew bones for years and never have a problem, whereas others chew in such a manner that makes them highly prone to dental damage. I see some dogs that break multiple teeth in succession. You should supervise your pet and remove any bones if concerned about their chewing behaviour.

Smaller dogs may also enjoy chewing on large pieces of meat without the bone, such as cheap cuts with sinewy, fibrous tissue (chuck steak, gravy beef, ox hearts)

Again, as with all chewing, it comes down to looking at the way your pet chews, and whether the surfaces of the teeth are being mechanically cleaned as they repeatedly move through the meat. I recommend human-grade meat as this is less likely to have issues with bacterial contamination, and advise hygienic handling.

Killing the Plaque: Mechanical Methods

Oral antiseptic preparations come in many forms, including rinses, pastes, gels and water additives.

There are no regulations controlling the claims made on these products, and not only do you need an effective ingredient, but at the correct concentration, in the right place, and sometimes for the right amount of contact time.

If a product seems too good to be true, it just might be. Some chemicals can also have side effects in dogs that have different medical conditions, or even be toxic if not used correctly. If in doubt, talk with your vet about what is suitable for your pet.

#1. Chlorhexidine

The gold standard oral antiseptic is chlorhexidine, which is a highly effective product for killing oral bacteria. I tend to reserve this for cases where inflammation is severe, as long-term use can lead to staining of the teeth, changes in taste perception, and increased rate of tartar deposition. Issues with bacterial resistance may also become an issue with widespread use, so there are arguments for limiting its use to those cases where it is truly warranted.

#2. Other Chemicals

Some commercial diets and treats have chemical additives to slow the maturation of plaque into tartar, making it easier for mechanical methods to work. The most common ones are polyphosphates, which bind salivary calcium, making it unavailable for incorporation into the plaque biofilm. This can be in conjunction with the mechanical effect of kibble design (eg Royal Canin Dental) or a stand-alone feature (eg Eukanuba Dental Defense).

There are so many other different chemical products available, and assessing their efficacy and safety is more complicated, so that my best advice is to consult with your vet before using these, especially if your pet has health issues.

Chemical products are, at best, an adjunct to mechanical plaque control - this is why your dentist doesn’t tell you to stop brushing and just rinse with a mouthwash.

Putting it all together for you and your dog(s)

When choosing methods or products for your dog’s dental care, each situation is different – not all dogs are the same.

Some final points:

✔️ Periodontal disease is the most common and hidden welfare issue in Australian dogs. Plaque control is your way of helping your dog avoid this.
No one product or method is 100% effective – even if you do everything perfectly you cannot guarantee your dog will never need professional dental care under anaesthesia (people who brush and floss and use mouthwash still need to see their dentist regularly for scaling and polishing).

✔️ Aim for at least one mechanical method, as physically removing the plaque is the best way of controlling it. 

✔️ Supplement this with chemical methods which make it easier to remove the plaque (by slowing accumulation of bacteria or it’s rate of hardening into tartar). 
✔️ Doing something is better than doing nothing, as long as what you are doing is effective and safe. 
✔️ Professional veterinary dental treatment under anaesthesia is the ultimate mechanical method of plaque removal - what we are trying with our homecare is to space out the need for treatment and minimise what is required. 
Your veterinary hospital is the best place to get advice on dental care for your dog. 

written by Dr. Christine Hawke (July 2019) for Australian Dog Lover (all rights reserved).

About Dr. Christine Hawke

Christine has been a vet since 1993, graduating with First Class Honours and the University Medal from the University of Sydney. After several years in small animal general practice (in both Australia and the UK) she was awarded her PhD in immunology and genetics in 2004.

Following a break to start her family she returned to the University of Sydney as a lecturer and small animal clinician. It was during this time that she was bitten by the dental bug!
Dr Christine achieved her Membership of the Australian and New Zealand College of Veterinary Scientists (MANZVCS) in Veterinary Dentistry in 2006 – this is by examination only.

Christine established Sydney Pet Dentistry the following year and has been devoted to providing excellent dental care to the pets of Sydney and its surrounds ever since.
She sees patients at 
Sydney Veterinary Emergency and Specialists (Rosebery) &
North Shore Veterinary Hospital (Artarmon).

She does NOT see patients at the RSPCA (NSW) but she loves working there with the shelter patients to give them happy, healthy mouths prior to adoption.

Christine has at various times over the past decade, been President of the Australian Veterinary Dental Society and President of the Dentistry Chapter of the ANZCVS. She is passionate about education, teaching all aspects of small animal dentistry to vets and vet nurses both privately (in-clinic) and through various education providers.

When she gets a spare moment or two, Christine loves hanging out with her family, which includes two awesome children (Ella and Henry), her handsome Devon Rex cats (Johnny and George) and the latest addition to the family, a crazy Cavoodle (Jack). Ironically, she is allergic to cats, but can’t imagine life without them!

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