1 / 29

Common dental frustrations and how to overcome them – part four

Common dental frustrations and how to overcome them u2013 part four

VetTimes
Download Presentation

Common dental frustrations and how to overcome them – part four

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Common dental frustrations and how to overcome them: The non-compliant owner Rachel Perry BSc, BVM&S, MANZCVS, Dipl.EVDC, MRCVS European Veterinary Specialist EBVS®, Dentistry RCVS Specialist, Veterinary Dentistry

  2. Toothbrushing • It is well established in human dentistry that toothbrushing is essential in reducing plaque and therefore preventing periodontal disease and caries • Powered toothbrushes may be more effective than manual toothbrushes Yaacob M. et al. Powered versus manual toothbrushing for oral health. Cochrane Database of Systematic Reviews 2014, Issue 6. Art. No.: CD002281.

  3. Toothbrushing in dogs and cats • There is also strong evidence that toothbrushing in dogs and cats remains the gold standard in plaque control and therefore periodontal disease prevention Gorrel and Rawlings. J Vet Dent 1996; 13 (4):139-143 Capík I. Acta Veterinaria 2010; 79 (4): 637-645 Watanabe et al. J Vet Med Sci 2016; 78 (7): 1205-1208

  4. Toothbrushing in dogs and cats • Effective brushing should occur ONCE DAILY • The efficacy depends on- • Motivation of the client • Knowledge of the client • Manual dexterity of the client • Compliance of the pet Gorrel and Rawlings. J Vet Dent 1996; 13 (4):139-143 Harvey et al. J Vet Dent; 2015; 32 (1): 16-21

  5. “We’ve tried brushing, but we couldn’t keep it up” • It is common to hear clients express they used to brush their pet’s teeth, or that they have all the kit at home, but never do it. • Cats are notoriously difficult

  6. A study of toothbrushing compliance in dogs • 6 month follow up after periodontal treatment at a university veterinary hospital • 53% reported to be brushing several times a week • 38% not brushing at all. Miller and Harvey. J Vet Dent. 1994; 11 (1): 18-19

  7. Who does what? • The more homecare the client provides, the less professional therapy under general anaesthetic you may need to provide

  8. Negotiation • Communicate this to the client • The outcome is a negotiation between yourself and the client- so that everyone is happy

  9. Barriers to toothbrushing • Patient compliance • Client’s lifestyle • Client’s motivation • Client’s manual dexterity • Try electric toothbrushes?

  10. What else can help? • Wherever possible use evidence-based veterinary guidelines in making choices • https://knowledge.rcvs.org.uk/evidence-based-veterinary-medicine/what-is-ebvm/ Roudebush P. et al. Evidence-based veterinary dentistry: A systematic review of homecare for prevention of periodontal disease in dogs and cats. J Vet Dent 2005; 22 (1): 6-15

  11. What else can help? • Do not believe manufacturers’ claims- ask to the see the evidence • Randomised, blinded, controlled trials in the target species • If it sounds to good to be true, it probably is!

  12. What else can help? • Veterinary Oral Health Council (VOHC) • Authorises the use of the “VOHC Accepted” seal® on products designed reduce plaque or calculus (tartar) or both • Manufacturers can submit clinical trial data on their products • Meeting efficacy criteria allows seal display on the product

  13. Dry vs wet diet • It is an erroneous belief that dry diets prevent periodontal disease, and wet foods cause periodontal disease.

  14. Raw diets • There is no evidence that a raw diet can improve periodontal health • Nieky van V & Matthew A. 2017, 'In Dogs with Periodontal Disease Is Feeding a Complete Raw Meat Diet More Effective Than a Complete Kibble 'Dental' Diet at Reducing Periodontal Disease?', Veterinary Evidence, Vol 2, Iss 2 (2017), 2

  15. Diet quality is important • It has been shown the overall quality of the diet may be protective for periodontitis in humans Chapple I. J Am Dent Assoc 2009; 140 (2): 178-184 Salazar CR. J ClinPerio 2018; 45 (7): 780-790

  16. Dental diets • Periodontal disease is caused by not only the periodontopathogen bacterial burden in the mouth but also the host’s immune response to those bacteria. • How do dental diets help?

  17. Dental diets • Reduction in plaque, calculus and gingivitis in both dogs and cats • Kibble shape and size- enhanced chewing • Texture- cleansing effect • Added ingredients to control calculus accumulation and halitosis Logan et al. J Vet Dent; 2002; 19 (1): 15-18 Clarke et al. J Vet Dent; 2010; 27 (2): 84-89

  18. Dental hygiene chews: dogs • Reduction in plaque, calculus, halitosis and gingivitis in dogs Brown and McGenity. J V et Dent 2005; 2 (1): 16-19 Quest BW. J Vet Dent 2013; 30 (2): 84-87

  19. Dental hygiene treats: cats • Reduction in plaque, calculus, halitosis and gingivitis in cats Gorrel C et al. J Vet Dent 1998; 15:135-138 Ingham KE et al. J Vet Dent 2002; 19 (4): 201-204

  20. Dental hygiene treats: cats • Cats’ dentition is designed to kill and chop, not a lot of grinding/chewing • Therefore a challenge to produce an effective chew

  21. Not all chews are created equal! • Supermarket or petshop brand chews are not equal to chews with published evidence of efficacy! • Specialist dental chews/treats

  22. Dental gels • Still require active application (not licking off paws, or eating in food!) • Reduce plaque, periodontal pathogens & gingivitis • Containing: • Chlorhexidine • Zinc ascorbate Hennet P. J Vet Dent 2012; 29 (2): 89-94 Clarke DE. J Vet Dent 2001; 18 (4): 177-183

  23. Barrier sealants • Can delay plaque re-accumulation after professional therapy Bellows J et al. J Vet Dent 2012; 29 (2): 89-94 Sitzman C. J Vet Dent 2019 (30) 3: 150-155

  24. However.. • Longer term studies required • Do we start dental diets earlier enough in the pet’s life? • Starting after periodontitis is established is too late • Do we recommend feeding enough of the dental diet? • A ‘snack’ of the dental diet may not be enough to make a difference

  25. Increasing compliance • Strengthen your recommendation by dispensing the diet/chew/gel- use a prescription label with clear instructions • Take ownership of the recommendation as part of the medical care plan for the patient

  26. Increasing compliance • Support your clients and pets- periodontal disease is managed, not cured • Nurse dental clinics • Follow-up phone calls • Dental check-up reminders

  27. Lastly.. • Do you brush and floss your teeth regularly? • Do you see the dentist regularly? • Do you need to see the hygienist for deep cleaning? • Even if clients can brush their pet’s teeth, they may still require professional therapy in addition • Dental diets and specialist dental chews can assist in the management of periodontal disease

  28. Summary • Daily toothbrushing remains the gold standard in plaque control to prevent periodontal disease. • Educate and motivate clients to help them achieve this. • Additional specialist dental diets and chews can help with plaque reduction. • Seek out published evidence to support manufacturers' claims regarding efficacy.

More Related