Toothbrushing

I've owned dog's most of my life and been a Westie owner since 1982. Bo and Maggie both suffer liver disease so it's important that I practice good oral hygiene with them and that they get the best of care to assure a long and healthy life. I have more than 20 documents that I can refer to for guidance with canine toothbrushing.

My first experience with tooth care was to keep our show Westie dog's teeth clean and free of plaque by scraping with a dental scaler; I knew no better. I now know much better through research and I practice daily preventive care with toothbrushing to avoid periodontal disease. In advanced periodontal disease, when plaque and tartar have built up on the teeth and below the gumline, bacteria can get into the bloodstream and adversely affect the liver, lungs, kidneys, and heart.

Periodontal disease affects about 80 percent of dogs over two years old and 85 percent of dogs over five years old. This disease is slow to develop as opposed to happening over a few days. It causes ulceration and recession of the gums, loss of supporting tissue and ligaments and erosion of the bone, that all hold the teeth. It is called periodontitis and it is not reversible. The precursor of periodontitis is gingivitis; a painful inflammation of the gums caused by tartar buildup; it is reversible. Dr. M. Lynne Kesel, DVM notes in her book for the small animal technician (Ref. 22) "in about two days the average person or animal would have enough bacteria [on teeth] to cause inflammation of the gingival." Dr. Kesel's discourse on periodontal disease is excellent.

Bacteria in the mouth combine with calcium-rich saliva and food debris to form plaque. Plaque, which forms on the teeth in just a few hours after eating, consists of about 80 percent bacteria. It starts as a sticky buildup to form a dull off-white coating on the tooth at and under the gumline. In some cases, plaque can form under the gumline while the exposed crown of the tooth looks clean.

As the plaque builds up it mineralizes and forms tartar (dental calculus) that causes the gums to recede and a pocket forms under the gumline. A self-perpetuating cycle forms with the pocket allowing the formation of more plaque and tartar that opens the pocket even more. Eventually the gums become inflamed as white blood cells defend against the onslaught of bacteria. The pus, dead tissue, food debris, and bacteria create a foul odor and when the dog chews, fragile tissue and capillaries are torn and bacteria from the periodontal infection enter the bloodstream. That's why periodontal disease is a danger to the dog's organs.

The signs of a dental problem are: foul breath, inflamed gumline, red, swollen, tender, and bleeding gums. Foul breath can be caused by other problems and an abscess due to a cracked tooth could cause it. The difficult-to-see white plaque is revealed readily with bright sunlight, a Xenon flashlight, or blacklight. With blacklight, the clean crown shows as a brilliant white and plaque appears brown. I cover the dog's eyes to prevent the blacklight's ultraviolet rays from entering the eyes. A blue or red disclosing solution applied to the teeth will also show plaque.

If your dog has plaque and tartar, daily brushing will not remove it. In fact, if there is plaque and tartar then there is probably inflamed gums and any attempt to start brushing would cause pain to the dog. The dog would then associate the brush with pain and you would not have a willing patient. It is not advisable to scrape the teeth yourself with a dental scaler--you might cut the gums and scratches in the enamel promote faster formation of plaque. Dr. Kesel states, "Every time a scaler touches the tooth, there are at least microscopic (or even visible) scratches in the surface." A trip to your veterinarian would be in order for an exam of the complete mouth. Be aware that the vet has to anesthetize the dog to clean the teeth. If the gums show signs of distress, the vet will use a periodontal probe to determine the depth of the pocket; a deeper pocket indicates more of a problem at which point X-rays might be called for. To remove plaque and tartar the vet uses a special scraper and an ultrasonic scaling instrument. The teeth are then polished to smooth scratches and a fluoride treatment might be used to strengthen the enamel. Veterinarians recommend cleaning every 6 to 18 months depending on the individual dog where genetics, diet, fresh water availability, salivary gland action, and mouth geometry play a part. Dog's mouths have other problems a vet will look for such as lip-fold dermatitis and cracked and broken teeth. Maggie had lip-fold dermatitis that was removed with laser surgery by Dr. Williams. Bo has deep developmental grooves in his upper fourth premolars that terminate in 2 mm. deep holes at the biting surfaces. These teeth are very susceptible to breaking with chewing on bones and the holes trap food debris. A pioneer in veterinary dentistry, Dr. Charles A. Williams, said that it's not uncommon for him to have patients with cracked and chipped fourth premolars when the groove is deep. It cost 173 dollars to have Dr. Williams bond one of Bo's fourth premolars that chipped when he took a first bite of his first ever and last bone. Luckily I was supervising him or the damage might have been worse and I rushed him to Dr. Williams.

Diet plays a large part in plaque and tartar formation where moist, sticky canned food sticks to the teeth at the gumline, whereas, kibble provides some scrubbing action. I personally have noted this when I had to discontinue prescription kibble for Bo and Maggie and go to natural food and special high-quality canned foods. Bones, proper ones and the right size and quantity are a deterrent to plaque formation but this feeding requires study and know-how. I don't think bones are effective for cleaning the incisors at the front of the mouth or between some teeth or where teeth are missing. Also, bones are chewed with the molars and premolars at the back of the mouth. Cooked chicken bones are brittle and could cause a perforation whereas raw chicken bones are said to be chewable. Again, chicken bones tend to line up with the intestine and are carried "south" with the intestine's action but too many at one time could result in them bunching up, skewing and causing a blockage. See the website <www.rawmeatybones.com> for more information. I believe bones and rawhide chews should only be given with supervision. Cold clean water in a stainless steel bowl and changed many times a day will benefit the dog's teeth by helping to wash away food debris. I keep the bowl in the bathroom where I see it readily and I change the water about four times a day or when the dogs want it changed. Maggie will lay outside the bathroom door if the water isn't fresh when she wants it and they both come running when I clang the bowl on the side of the sink four times to let them know it's been changed. We have good water from an aquifer down 450 feet and an analysis shows it has no copper. A test program has shown that beef rawhide chews contribute to cleaning the teeth but no mention was made for rawhide's ability to clean between the teeth or under the gumline or at the front teeth. Dr.Williams displays this hoof in his office as a warning that chewing on it might lead to damaged teeth.

Toothbrushing is recognized as a positive step in avoiding periodontal disease. There is no general agreement but from what I have learned, the teeth should be brushed daily since plaque forms in just a few hours after eating. I am a devotee of using electric toothbrushes that are quiet, produce a counter-rotational (oscillating) motion, and have soft round-ended bristles to brush at and below the gumline and between the teeth. The electric toothbrush allows the teeth to be brushed with very little hand motion on the part of the owner so concentration can be centered on applying the brush properly to the teeth and gums. I have not tried any electric toothbrushes that have a motion in three directions; that may be a tickle factor to the dog. I have been using the Braun Oral-B for 13 years and never had to have the dogs' teeth cleaned.

I use Petrodex poultry flavored enzymatic toothpaste formulated for dogs. It doesn't foam and it doesn't need rinsed. Toothpaste for humans is not meant to be swallowed and may cause stomach upset. Baking soda is sometimes suggested but it has a high sodium content and it may cause a health problem for dogs, especially those with a heart condition. After using the toothpaste, I apply Nolvadent chlorhexidine rinse to the brush for its fungicidal and bacterial action and to further clean the teeth. Since I have well water I apply fluoride to the teeth about once a month to harden the enamel. It also helps to inhibit plaque, desensitize the dentin and pulp and minimize bone and tooth loss.

I don't brush the incisors at the front of the mouth (tiny breeds need it) nor do I brush the inner surfaces of the teeth and I've had no problems. The incisors are cleaned when the Westies do self-grooming and the inner surfaces of the teeth are constantly rubbed and cleaned by the tongue. I do have to pay attention to the back of the lower fang-like canine and the front of the upper canine. Some smaller breeds have a problem with plaque on the insides of the upper canines. The tooth most likely to develop plaque before any other is the fourth premolar, that large tooth in the upper jaw toward the back of the mouth as shown in the photograph. The parotid salivary duct washes calcium-rich saliva directly over it.

The second brush I use is the Ultra-Sonex Plus and it works on an ultrasonic frequency of 1.6 million cycles per second. Ultrasonic waves are transmitted from a transducer in the handle to the brushhead and the bristles. The bristle vibration amplitude is microscopic and unseen so the brush has a built in sound device to let you know that it's on; a red indicator light also comes on. This brush requires that a toothpaste or oral rinse be used on the brush to couple the ultrasonic waves to the teeth and soft tissue and the brush must be in motion so I use Nolvadent and a back and forth motion. Theoretically, gingival fluids in the sulcus can also conduct the ultrasonic waves into the area under the gumline. The bristles of this brush are not as supple as the Braun's so I first wet the bristles and flex them against my own teeth and gums. When I use the brush, I tilt the bristles at a 45 degree angle at the gumline. In this photograph, the brush is shown on its way to the gumline at the fourth premolar. A replacement package of three brushes includes a small, compact, and regular size.

Another brush that I use in the hole of Bo's fourth premolar is a battery operated "flosser", the soniPick sonic interdental plaque remover by Sonex. It vibrates at 18,000 strokes a minute. In this photograph, the tips of the tufts (bristles) are in the two millimeter deep hole that terminates at the bottom of Bo's deep developmental groove in the fourth premolar. The soniPick comes with three tuft sizes-thin, medium, and thick and the tufts are round ended and side textured. The instructions indicate that the tufts can be used to clean gum pockets. Dr. Williams was keen to learn of this "tool" and said he would keep it in mind in his recommendations to patients who would benefit from its use.

MY ROUTINE

When I brush the dog's teeth I maintain the same routine, as dogs are comfortable with routine. I do it on the kitchen counter next to a window for good light and the height is just right. I put the dogs side-by-side on a non-skid rubber mat. I examine the Braun Oral-B's brush to make sure there is no foreign matter on it and that the bristles are not splayed. I start brushing with nothing on the brush as the dogs don't lick and I concentrate on the canines and the fourth premolar; Bo is always first. I do about 10-12 seconds on each side and then I repeat with Maggie. I gently push the lips out of the way but I don't do it by grabbing a bunch of hair.

Then I put a small dab of Petrodex on the brush and spend about 12 seconds on the left side of the mouth. I repeat with the right side. Bo likes the taste of the poultry flavor and licks furiously which allows me to brush the lower molar. When I use the the Petrodex on Maggie, Bo comically licks at her mouth to get some of it and then he takes advantage of my position and plants some kisses on me. Then I repeat the process with Nolvadent on the brush; it's surprising how much the brush will hold. Following that, I use Nolvadent on the Ultra Sonex Plus. I wet the brush with water and check the bristles against my gums before using it on the dogs since the bristles are not supple. I repeat the process with each dog but I only use this brush for about eight seconds on the canines and eight seconds on the fourth premolar because of the ultrasonic waves. As required, I use the soniPick in Bo's remaining fourth premolar hole when the Braun Oral-B can't clear stubborn debris. There's only one fourth premolar to do now that he chipped the left one with the $173 bone. That finishes the toothbrushing after having done about 4000 oscillations of scrubbing action on the teeth with the Braun Oral-B.

SOME ADDITIONAL POINTS

Some points on my technique - when I use the Braun Oral-B I go over the canines and fourth premolar; then I let go of the lips and let them close over the brushhead just as I do when I brush my own teeth and close my lips over the brushhead. I believe the Braun Oral-B's bristles go under the gumline all by themselves due to the nature of the design and the supple bristles. Since I use Nolvadent as the conducting fluid with the Ultra Sonex Plus, the dogs don't lick and this might be the best brush for a beginner to start off with; plus it doesn't make noise. If, one day, the dogs or I don't feel up to par, I only go over their teeth with the dry Braun Oral-B.

I continue with their care by using a slicker to brush the hair on their heads as I look for ticks. They don't have fleas. I inspect and smell their ears, and look at and clean their eyes. I also clean their private parts with a very wet, warm cloth and pat them dry. Onto the floor they go for treats. I finish by rinsing the brushes in very hot tap water; occasionally I need to rinse the Braun Oral-B with an oral irrigator to remove deep-down debris. I hold the brushhead down to lessen the chance of water seeping in around the shaft. I make sure to wipe the shaft dry and I never leave the brush on the handle. Water in the brush might seep around the shaft and into the electrical mechanism when it's stored upright on the recharging stand. I do put an old brush, with the bristles cut off, on the shaft to protect it. I didn't used to be as careful and my first one failed (after a long time). I took it apart and found that it was rusty inside from slight seepage of water around the shaft as the brush stores upright. I don't have that problem anymore.

For about 17 minutes daily I have given my two Westies some preventive care, a health check and some cuddles and lots of love and love from them.

BATTERY ELECTRIC TOOTHBRUSHES

The electric toothbrushes I use are rechargeable (the "flosser" is battery powered) and have recharge stands that hold them upright. The electric toothbrush market has blossomed with battery powered brushes and I have seen five in the $5-$15 price range. I consider a quiet brush one that a dog will adapt to better than one that makes a lot of noise. I bought the Braun Oral-B and the Colgate Actibrush to test for loudness with a sound level meter. Both were noisier than the rechargeable Braun Oral-B with brand-new brushes, however the Actibrush was the quieter of the two. Brushes do get louder with hours of usage. I tested four new brushes and four old brushes on my rechargeable Braun Oral-B and the older brushes were about three times louder than brand new brushes. I think the battery-powered brushes will also get noisier with usage.

The Reach Power Brush can be had for about $10 after rebate. It has bristles that oscillate at 7000 oscillations per minute. It is advertised as having "Soft outer bristles [that] are ideal for massaging and cleaning along the gumline." Replacement brushes are about $5. It uses one AA alkaline battery.

The Braun oscillates at 7600 oscillations per minute and sells for about $10 after rebate. Three replacement brushes cost about $19. It has a two-year warranty. It is advertised as being "gentle on teeth and gums." It uses two AA alkaline batteries.

The Colgate Actibrush oscillates at 8000 oscillations per minute and sells for about $13 with replacement brushes at about two for $8. It is warranted for six months. No claim is made relative to its use on gums. It is advertised as having cup-shaped bristles. It uses two AA alkaline batteries.

The Crest Spinbrush sells for about $5. Replacement brushes cost about two for $5. It is said to have soft and medium bristles. It uses two AA alkaline batteries.

Braun is a trademark of Braun AG, Frankfurt/Main, Germany. Oral-B is a trademark of Oral-B Laboratories, Montreal, Canada. Ultra Sonex Plus and soniPick are trademarks of Sonex International Corporation of Brewster, NY.

ACKNOWLEDGEMENTS

Southern Maryland's Macintosh expert, Doug Phillips, came to my rescue and keeps me upgraded with newer models of used Macs. Doug keeps me on the straight and narrow when I get lost in computer land. Brandon Gorman helped me get this on the internet the first time when I was still unfamiliar with the program.

Dr. Charles A. Williams explained how bones pass in the intestine and how too many can bunch and skew and cause a block. Dr. Williams also allowed use of the photograph of the hoof.

Dr. Stephen Jaffe, DVM of the Fort Dodge Laboratories, Inc. gave me suggestions on the use of Nolvadent.

DISCLAIMER

I am not a vet or a vet tech. This paper simply relates what I have learned and found applicable to my Westies' best interest. You should consult with your vet about using these procedures. I wrote a shorter version on this subject when I was only using the Braun Oral-B; it was published in the summer 1993 issue of Westie Imprint as "A Home Dental Care Program."

ABOUT THE AUTHOR

James A. Nagy

45382 Locust St.

Piney Point, MD 20674-3110

301-994-2520

westies2@erols.com

REFERENCES

"Oral Power Tools" by Mary Lord, U.S. News and World Report, April 20, 1998.
"Canine Periodontal Disease" by Christine Wilford, DVM, AKC Gazette, June 1991 and, Step by Step: "A Routine Dental Procedure" by Elizabeth Bodner, DVM.
"Dental Care", Your Dog, A Newsletter for Dog Owners, Tuft Univ. School of Vet Med, Oct 1994.
"Bright Smiles" by Barbara L. Diamond, Dog Fancy, Nov 1998.
"Toothbrushing" by Susan H. Bertram, DVM, Dog Fancy, Feb 1999.
"Dental Care Makes a Difference", VetSmart Health Newsletter, Spring 1999.
"Clinical Evaluation of the Effect of an Ultrasonic Toothbrush on Plaque, Gingivitis, and Gingival Bleeding: A Six-Month Study" by Geza T. Terezhalmy, DDS, MA, et al, The Cleveland Clinic Foundation, Jan 1995.
"Electric Toothbrushes", Consumer Reports, Sept 1992.
"Save That Toothy Smile" by Jan Bellows, DVM, Dog Fancy, Oct 1992.
"Dog's Breath's No Joke" by Rita Calvano, Your Dog, Sept 2001 - relates kidney and gum disease could be the problem.
"Periodontal Disease: Good Oral Hygiene Practices Help Prevent Disease", Dog Watch, Oct 2001 - relates signs of disease.
"Comparison of a manual and a new electric toothbrush for controlling plaque and gingivitis" by Kaj Stoltze and Lena Bay, J of Clin Periodontology, 1994:21:86-90, ISSN 0303-6979.
"Train Your Dog to Accept Daily Dental Care", Dog World, Oct 2001.
"The long-term effect of an oscillating/rotating electric toothbrush on gingivitis: an 8-month clinical study" by G.A. van der Weijden et al, J Clin Periodontology, 1994:21"139-145, ISSN 0303-6979.
"Subgingival and interproximal plaque removal using a counter-rotational electric toothbrush and a manual toothbrush" by John W. Rapley/William J. Killoy, Preventive Dentistry, v25, no. 1/1994.
"Effect of chewing rawhide and cereal biscuit on removal of dental calculus in dogs" by Arthur Lage et al, JAVMA, v197, No.2, July 15, 1990.
Friskies Chew-eez beefhide treat data sheet.
"Caring for Your Dog's Teeth", Pet Care Report by Purina - describes types of teeth, purpose, and number.
"Dental Health" by Dennis Broske, Dog Fancy, June 1993.
"High-Tech Dentistry" by Betsy S. Siino, Dog Fancy, Feb 1991.
"Keeping Teeth Clean" by Forrest Rindels, Dog Fancy, March 1995 - defines tartar.
"Veterinary Dentistry for the Small Animal Technician" by M. Lynne Kesel, DVM - excellent reading.
"Small Animal Dentistry" by Colin Harvey, BVSc FRCVS, Dip ACVS, Dip AVDC and Peter P. Emily, DDS, Cert Perio, Honorary Member AVDC, P. 119, Fig. 4-15, Scanning electron microscopic view of the surface of a tooth. - shows a myriad of scratches.
"Electric Toothbrush Tops Study" by Rob Stein, The Washington Post, Jan 12 2003. About a study done by the Cochrane Collaboration group in Oxford, England that evaluates medical practices.

	BRUSHING DOG'S TEETH WITH ELECTRIC TOOTHBRUSHES
		A Personal Experience