The Veterinary Dental Patient: A Multidisciplinary Approach. Группа авторов

is the most effective means of mechanically removing plaque (Hale 2003). Chew‐based products may be effective, but only if properly formulated. However, oral sprays, rinses, and water additives are in this authors opinion an insufficient means of plaque control, due to the tenacity with which plaque adheres to the teeth and the high resistance of the plaque biofilm to antiseptics (reported to be up to 500 000 times that of singular bacteria: Williams 1995; Quirynen et al. 2006).

      5.3.4 Types of Home Care

      There are two major types of home plaque control: active and passive. Both can be effective if performed correctly and consistently, but active home care is the “gold standard” (Hale 2003). Typical methods of active home care are brushing and rinsing. Passive methods are typically based on chewing behaviors via treats or specially formulated diets, though recently water additives have been introduced. It has been shown that active home care is most effective on the rostral teeth (incisors and canines) while passive home care is more effective on the distal teeth (premolars and molars) (Bjone et al. 2007; Capik 2007).

      5.3.4.1 Active Home Care

      Active home care is defined as the client actively participating in the removal of plaque. This can be achieved either by brushing or by rinsing/applying antiseptic/antiplaque solutions.

       5.3.4.1.1 Tooth Brushing

      When properly performed, tooth brushing is the most effective means of plaque control (Hale 2003). Therefore, while compliance is rare, all veterinarians should still promote tooth brushing for all patients.

       5.3.4.1.2 Materials and Methods

The only critical piece of equipment is a toothbrush. There are numerous veterinary brushes available,¹ which should be selected based on patient size. Double‐ and triple‐sided^2,3 and circular feline brushes⁴ are effective products and should be considered along with the standard veterinary brushes (Figure 5.3). This author does not recommend “finger brushes” as they do not generally address the subgingival areas of the teeth; additionally, they significantly increase the chances of the owner being bitten. Gauzes and washcloths are not recommended for the same reasons (Holmstrom et al. 1998).

      Human toothbrushes may be substituted, with soft‐bristled brushes typically being recommended. A child's toothbrush is often the correct size for small patients and may be more effective than the larger veterinary version. An infant brush may work best for toy‐breed dogs, cats, or juvenile patients.

Figure 5.3 Double‐headed toothbrushes have certain benefits in plaque control.

Figure 5.4 Mechanized toothbrush used in dogs.

Mechanized (sonic⁵ and rotary⁶) brushes are superior to standard brushes for humans (Deery et al. 2004; Moritis et al. 2008) (Figure 5.4). These products are also likely superior for use in veterinary patients, and may make the process more time efficient, which is important in animal patients for acceptance reasons. In addition to the numerous human product options, there is currently a mechanized veterinary brush on the market.⁷ One concern with these brushes is that the movement/vibration can feel strange and may scare the patient (Holmstrom et al. 1998). Secondly, one has to be careful and avoid situation when hair around the mouth becomes entangled in a mechanical brush. This author recommends initiating brushing very slowly with a standard toothbrush, and then progressing to a mechanical type after acceptance is achieved.

There are a number of veterinary toothpastes available,⁸ which may increase acceptance by the patient (Figure 5.5). They often contain a calcium chelator⁹ in order to decrease the accumulation of dental calculus (Liu et al. 2002; White et al. 2002; Hennet et al. 2007). However, remember that calculus is largely nonpathogenic (Wiggs and Lobprise 1997), so the paste is not a significant player in the reduction of plaque and gingivitis. Consequently, palatability can be increased by using alternative flavorings (Wiggs and Lobprise 1997; Niemiec 2008), such as tuna juice (especially for cats), garlic powder (in small amounts), and beef broth. Dipping the brush in a canned food that the pet enjoys may also be considered on initiation of home brushing.

Antimicrobial products¹⁰ are also available (see later). They improve plaque and gingivitis control when used in combination with brushing, and should be considered especially in high‐risk patients or in cases of established periodontal disease (Overholser et al. 1990; Maruniak et al. 1992; Eaton et al. 1997; Hase et al. 1998; Hennet 2002; Stratul et al. 2010). Human toothpastes and products that contain baking soda should be avoided as they typically contain detergents and fluoride, which may cause gastric upset or other issues if swallowed (Wiggs and Lobprise 1997; Niemiec 2008).

       5.3.4.1.3 Brushing Technique

Note that the ideal technique may only be possible in the most tractable patients. Clients should be encouraged to work toward this level of care, but to accept any degree of brushing as successful (Figure 5.6). Forcing home care on a patient is counterproductive and may decrease the client–animal bond (Holmstrom et al. 1998). Furthermore, coercing clients may drive them away from your practice (Holmstrom et al. 1998). Therefore, it is important to understand your clients and patients and tailor your recommendation based on the situation.

      The keys to achieving success with home tooth brushing are as follows (Niemiec 2013):

       Start Early: Young patients are more amenable to training (Holmstrom et al. 1998).

       Go Slow: Start with just holding the mouth, then progress to a finger, and finally start brushing slowly.

       Be Consistent: Make tooth brushing a routine.

       Make it a Positive Experience: Using food, treats, hair brushing, or playtime as a reward will greatly increase the likelihood of acceptance.

Figure 5.5 Selection of toothpastes.