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An RDH's best friend: a guide to your dog's oral health.

As dental hygienists, you are experts on the oral disease processes occurring in your patients, but how much do you know about your dog's mouth? It is important to be aware of the diseases wreaking havoc in your pet's oral cavity and how similar or different these conditions are in comparison to those in humans. Your pet's health depends on it. This article will discuss how oral diseases develop in canines, how they are treated, and how you can provide your pet with at-home preventive care.

Although caries is a more prevalent disease for humans, dogs still have a risk.' There are multiple reasons why dogs have a lower caries incidence than humans. First, dogs have a conical tooth shape and wider inter dental spacing with less area for food impaction and stagnation.' Secondly, most dogs' diets include little fermentable carbohydrates compared to humans.' Thirdly, dogs have a higher salivary mean pH of 7.5 compared to 6.5 for humans, which helps to buffer acids produced by bacterial fermentation of carbohydrates.' Finally, dogs have a relatively low level of salivary amylase to break down starches retained in and around the teeth.' Despite these natural defenses, caries in dogs is still an ongoing struggle for owners and veterinarians.

Even though dogs have many natural protective mechanisms against caries, the most common tooth surface to form decay is the occlusal surface of molars caused by Streptococcus mutans. (2), (3) Caries in dogs starts out as lesions that are diagnosed through similar means as for humans. Initially, it is diagnosed through clinical observation and investigation of discolored areas of teeth. (2) Next, health of the enamel is assessed using an explorer or probe. (2) To confirm the extent of the decay, radiographs can be taken. (2)

Periodontal disease is more common in dogs than dental caries. (4) Dogs are most closely related to humans when it comes to gingivitis and periodontitis than any other anima1. (5) As in humans, anaerobic bacteria can be found in the periodontal pockets of dogs. (5) Porphyromonas gingivalis, Prevotella intermedia, Treponema denti-cola, Tannerella forsythia, A. actinomycetemcomuitans, Campylobacter rectus and E. corrodens have all appeared subgingivally in studies of dogs and humans. (5) Some of the most common bacterial species found in humans and dogs are Porphyromonas and Fusobacterium. (5) The major bacterial difference in dogs is the catalase-positive form of P. gin givalis and Porphyromonas gulae. (6)

The prevalence of oral diseases differs among breeds in dogs. (7) Although dental caries is rare in dogs, it appears to be most common in German Shepards, according to the American Veterinary Dental Society. (8) As far as periodontal disease is concerned, the small breeds are more susceptible. (7) Small breeds often have malocclusion predisposing them to plaque accumulation, which can lead to calculus deposition and periodontal disease. (7) Furthermore, other studies show that some small breed dogs as young as one year of age had calculus deposits. In these cases, the malocclusion is often caused by persistent deciduous teeth in the young dog's small oral cavity. (7) All dogs, whether large breed or small breed, tend to have an increased susceptibility to calculus and periodontal disease with increased age. (7)

Just as in humans, oral health in dogs is linked to their overall systemic health. (9) For instance, an increase in circulation levels of inflammatory cytokines from periodontal disease can increase insulin resistance in humans with diabetes. In diabetic dogs, it has been reported that control of blood sugar levels was restored with insulin therapy following periodontal treatment. (9) A positive correlation between periodontal disease and heart and liver conditions in dogs appears to exist as wel1. (9) Systemic diseases can also manifest in a dog's oral cavity, further strengthening their connection with one another. (10) For example, a dog with leukemia may present with hemorrhagic spots, ulcers on the mucosa or gingival hypertrophy. (10) It is clear that numerous connections of the oral cavity to other organs in the body are being discovered in animals just as they are in humans.

Clinical procedures to prevent caries can be performed on dogs similar to those for humans. It is extremely important for dogs that have recently erupted permanent teeth at the time of spay or neuter to have a thorough oral exam. If a dog has deep occlusal pits with no decay present, then a pit and fissure sealant can be placed to prevent decay. (1) There is not a set amount of time for dogs to have their teeth cleaned professionally; it varies for each animal's needs. Even with professional preventive services, if at-home care is not performed properly, dogs can still be susceptible to caries.(1)

Pfizer's Porphyromonas Denticanis-Gulae-Salivosa Bacterin vaccine for prevention of periodontal disease in dogs was licensed by the U.S. Department of Agriculture in September 2006. (11) Although it has now been discontinued, it was designed to aid in the prevention of periodontitis in healthy dogs by reducing bone changes associated with P. gulae, P. salivosa, and P. dent/can/s. In 2011, it was discontinued based on a study that determined there was no long-term reduction in the progression of periodontal disease. (11) Dogs typically receive periodontal assessment and treatment services at the same appointment while the dog is sedated or anesthetized. Due to the necessity of anesthesia to perform an oral or dental examination, veterinary dentists are limited to what they can know about the canine's oral health before treatment. This requires veterinary dentists to assess, diagnose, determine the need for surgical treatment and complete the treatment all in one appointment. Many owners do not want their dogs to be given anesthesia more than once within a short period of time. In this case, the animal's gingival tissue cannot be assessed post-treatment. (6)

When anesthesia is going to be used during a dog's dental treatment at a veterinarian's office, a few precautions should be kept in mind. When planning the dental treatment, a pre-anesthetic exam will be performed. This involves taking vital signs and doing blood work to determine if there are any systemic conditions that could be problematic. (12)

Since the lungs, liver and kidneys play a role in removing anesthesia from the blood, anesthesia may pose a risk to the dog. (13) Heart disease and advanced age should also be considered. (14) Some veterinary offices are starting to offer dental cleanings without anesthesia for animals with health problems. Although dental exams and cleanings are more thorough when animals are unconscious, prophylaxis while unanesthetized may be a good alternative for dogs with severe systemic conditions. (14) When the health of the animal allows for it, anesthesia is a great way to ensure both optimum oral care and comfort.

The 2013 AAHA Dental Care Guidelines for Dogs and Cats sets the gold standard for veterinary dental team performance of dental procedures on animals. (15) The professional veterinary dental appointment starts out with a comprehensive oral exam and a full set of radiographs.(15) The teeth are then scaled both supragingi-vally and subgingivally either by hand or by ultrasonic, subsonic or piezoelectric scalers followed by hand instrumentation. (15) The guideline advises against using rotary type scalers due to the possibility of roughening the enamel excessively.(15) After scaling, prophy paste and a low-speed hand piece are used to polish the animal's teeth. (15) Subgingival irrigation follows to flush out the oral cavity, and sealants may be placed if indicated. (15)

Additional steps may be necessary if oral disease or abnormalities are present in the animal's mouth. Unacceptable probing depths indicating disease vary depending on the dog's size and the tooth in question. (15) In a medium-sized dog, a probing depth greater than 2 mm is typically considered to be abnormal. (15) If the attachment loss of the animal's gingiva is more than half of the root support, periodontal surgery or extraction is indicated. (15) Contents of a typical dental surgical pack are listed in the box. Periodontal surgery and extractions can be performed by a properly trained veterinarian or referred to a specialist. (15) If caries is evident, a composite resin can be used to restore the tooth. (1) If the decay is advanced, an extraction may be indicated.(1) Endodontic therapy is even an option in some cases.(1) Furthermore, biopsies are indicated for suspicious masses found either by direct examination of the oral cavity or by analyzing the full set of radiographs taken at the appointment. (15) Tissue samples are sent to a pathologist to be examined. (15)

As for humans, a home care regimen is imperative to maintain a dog's oral health. Many dog owners neglect home oral hygiene procedures for their dogs because a dog's teeth are not easily visible like humans'. "Most pet owners don't lift up the lip and examine their pet's mouths," says John Huff, DVM, a board certified veterinary dentist in Denver, "and they may not recognize when their pets have oral pain." (16) Some dogs may resist owners' opening their mouth, which can deter the owner from performing oral hygiene at home. (16) Another reason may be lack a knowledge about what type of toothbrush, toothpaste and dental chews to use. (16)

A dog that has never experienced toothbrushing may snap at the owner or become anxious the first time. The owner should perform small steps each day to instill trust with the dog. The first step to gaining the dog's trust is to gently massage the dog's upper and lower lip each day for 30 to 60 seconds each. Once the dog becomes comfortable with this practice, the owner can gently start massaging the gingiva and teeth daily. Once the dog allows the owner access to the mouth, a toothbrush and toothpaste can be introduced and used. (16)

Determining what type of toothbrush to use on a dog is extremely important in order to correctly remove biofilm from the teeth and stimulate the gingiva. There are two options for toothbrushes: a small soft bristle children's manual toothbrush or a small plastic fingertip brush. The best option depends on how easily the owner can maneuver a brush in the dog's mouth. If a dog does not allow any type of bristle brush, a 2x2 gauze wrapped around the owner's finger is a great alternative to successfully remove/disturb biofilm. (17) The proper brushing technique is as follows: "Hold the toothbrush at a 45-degree angle to the teeth and brush in a circular motion to remove plaque." (16) This technique is similar to the Bass method used by humans. (16)

Once the owner has selected a method for biofilm removal, choosing toothpaste is the next step. Human toothpaste should never be used for dogs. Detergents, abrasives and fluoride in human toothpaste can be harmful to canines. (16) Many human toothpastes also contain xylitol, which is toxic to dogs. Xylitol consumption in dogs can lead to a dangerous insulin release from the pancreas, potentially resulting in hypoglycemia. (18) Toothpaste specifically produced for dogs should be used. It is recommended to use paste with flavors such as beef, peanut butter or poultry. Pet toothpaste contains special enzymes that chemically remove biofilm, which significantly reduces the time of brushing. (18)

The frequency of brushing differs slightly from humans. Unlike brushing human teeth for two minutes twice daily, dog's teeth can be brushed for less than a minute once daily or several times per week. (17) However, smaller breeds with a short snout (e.g., pugs) need more frequent brushing as opposed to other breeds. (17) "Their teeth are often crowded together, which allows more plaque to accumulate and increases their risk of developing periodontal disease." (17) Daily removal of biofilm reduces the risk of developing periodontal disease.

In addition to brushing, dental chews for dogs have been proven effective in reducing biofilm and calculus accumulation. (19) Dental chews can be an alternative method if the dog does not allow the owner to brush their teeth. Chewing is a self-cleansing mechanism that helps increase saliva flow. (19) Just like in humans, saliva in dogs is an important natural defense mechanism against oral diseases. A study was performed that concluded humans do not benefit from vigorous chewing due to anatomy and structure of teeth. Dogs, on the other hand, have a scissor bite that benefits from vigorous chewing on dental chews.(19)

Clinical treatment of oral diseases can benefit dogs very much as it benefits humans. There are many pet owners who think they are doing a great job of taking care of their furry friends; however, many owners may be unaware of the oral diseases to which their pets are susceptible. That is why being an RDH comes with such great benefits like helping to educate and provide services for our human patients, as well as their four-legged family members. A phrase often attributed to a dog is, "man's best friend." That is why dogs' oral health should be taken just as seriously as their systemic health, since the two coincide with one another.

Numerous connections of the oral cavity to other organs in the body are being discovered in animals just as they are in humans.

Contents of a Typical Dental Surgical Pack (15)

* Explorer * Scalpel

* Probes * Sharpening supplies

* Mouth mirror * Needle holders

* Scalers * Retraction aid

* Curettes * Elevators

* Scissors m Root tip picks and forceps

* Hemostats * Extraction forceps

* Thumb forceps

Many dog owners neglect home oral hygiene procedures for their dogs because a dog's teeth are not easily visible like humans'.

The faculty mentor for this edition of Strive is Tricia S. Barker, RDH, MEd, clinical assistant professor of Comprehensive Dentistry, Program in Dental Hygiene, Louisiana State University School of Dentistry.

References

(1.) Hale F. Dental caries in the dog. Can Vet J. 2009; 50(12): 1301-4. Available at: www.ncbi.nlm.nih.gov/pmc/articles/PMC2777300/.

(2.) Animal Dentistry and Oral Specialists LLC. Tooth cavities in dogs. Available at: www.mypetsdentist.com/site/view/113263_ToothCavitiesinDogs.pml.

(3.) Jiang J. Scienceline. Is it really true that a dogs mouth is cleaner than a humans mouth. Apr. 2008. Available at: http://scienceline.org/2008/04/ask-jiang-dogmouth/.

(4.) Yamasaki Y, Nomura R, Nakano K, et al. Distribution of periodontopathic bacterial species in dogs and their owners. Arch Oral Biol. 2012; 57(9): 1193-8.

(5.) Senhorinho GN, Nakano V, Liu C et al. Occurrence and antimicrobial susceptibility of porphyromonas spp. and fusobacterium spp. in dogs with and without periodontitis. Anaerobe. 2012; 19(4): 381-5.

(6.) Harvey CE. Management of periodontal disease: understanding the options. Vet Clin North Am Small Anim Pract. 2005; 35(4): 819-86.

(7.) Kyllar M, Witter K. Prevalence of dental disorders in pet dogs. Vet. Med. - Czech 2005; 50(11): 502-3.

(8.) American Veterinary Dental Society. Website. Available at: www.avds-online.org/info/cavities.html. Accessed Mar. 7, 2013.

(9.) De Simoi A. Systemic implications of periodontal disease. Vet Focus. 2012; 22(3):26.

(10.) Anderson JG, Arzi Boaz, Verstraete FJM. Oral manifestations of systemic disorders in dogs and cats. JVCS 2008; 1(4): 117.

(11.) Pfizer Discontinues Production of Veterinary Periodontal Disease Vaccine for Dogs - DVM. N.p., Apr. 6 2011. Available at: http://veterinarynews.dvm360.com/dvm/BreakingNews/Pfizer-discontinues-production-of-veterinary-perio/ArticleStandard/Article/detail/719560.

(12.) Becker M. Are you afraid of anesthesia. HealthyPet. 2012; Winter: 24-6.

(13.) WebMD. Available at: http://pets.webmd.com/dogs/anesthetics-anes-thesia-dogs. Accesssed Mar. 7, 2013.

(14.) Kerns N. Anesthesia-free teeth cleaning for your dog. The Whole Dog Journal. 2004; Nov.

(15.) Holmstrom SE, Bellows 3, Juriga 5, et al. 2013 AAHA Dental Care Guidelines for Dogs and Cats. American Animal Hospital Association. 2013; pp 8-9.

(16.) Fuller M. Clean healthy teeth". HealthyPet. 2012; Winter: 9-11.

(17.) Brushing your dog's teeth" American Society for the Prevention of Cruelty to Animals. Mar. 2013. Available at: www.aspca.org/Pet-care/virtual-pet-behaviorist/dog-articles/brushing-your-dogs-teeth.

(18.) Ward E. Dental disease in dogs. VCA Animal Hospital. Mar. 2013. Available at: www.vcahospitals.com/main/pet-health-information/article/animal-health/dental-disease-in-dogs/742.

(19.) Bjone S, Brown W, Billingham J, et al. Influence of chewing on dental health in dogs. School of Psychology, Animal Science: University of New England. Available at: www.une.edu.au/ers/staff-profile-doc-folders/wendy-brown/bjone-et-al-ava-2005-dental-paper.pdf.

Carla Chimenta, Whitney Arceneaux, Margaret Mundell and Lindsay Sliman are senior dental hygiene students at the LSUHSC School of Dentistry.
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Title Annotation:strive; registered dental hygienists
Author:Chimento, Carla; Arceneaux, Whitney; Mundell, Margaret; Sliman, Lindsay
Publication:Access
Geographic Code:1USA
Date:Apr 1, 2014
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