Things I Tell Clients
I thought I would share some of the messages I impart to pet owners of a frequent basis. Please feel free to use or adapt these comments and analogies if you think they would be helpful to you in your efforts to educate your clients and get informed owner consent.
The Prime Directive
People might expect that my main objective, as a veterinary dentist, is to save teeth. That is not the case at all. Often one of the first things I tell owners is that my Number 1 objective that comes above all else is I want to provide their pet with a mouth free of pain and infection. I go on to say that in most cases, domestic dogs and cats do not need teeth. They do not have to hunt and kill their own meals. They do not have to chew raw meat from a carcass. They do not have to establish or defend territory or breeding rights. They do not have to protect themselves from larger predators. Their food is dead, in the bowl and ready to swallow. They have a roof over their heads and walls/fences around them and owners to protect them. So, the things dogs and cats need their teeth for in the wild are taken care of by being domesticated.
While they may not need teeth, they need and deserve a mouth free of pain and infection. While preserving a functional set of healthy teeth is a worthy objective, sometimes it is not a practical or possible one. I tell owners that dogs and cats do far better with no teeth than they do with bad teeth.
Rather than focusing on preserving teeth, we need to work towards optimizing oral health and if that means removing teeth, so be it.
What colour is my hankie?
If you have watched my video on periodontal anatomy and disease (https://vetdentedu.ca/2023/02/18/periodontal-anatomy-and-disease-in-dogs-and-cats/), you will know that periodontal disease is a largely hidden problem, going on below the gum line and out of view in the conscious patient.
To help people understand this I will tell them that I have a handkerchief with me and then I ask them what colour it is. Of course, they have no idea what colour it is or even which pocket it is hiding in. I explain that periodontal disease is the same.
Until I have their pet anesthetized, I have no way of knowing if there are any periodontal pockets, where the pockets are or how deep they are. Therefore, any treatment plan/estimate we develop prior to anesthesia is tentative and subject to change once we have the pet anesthetized, can probe, explore, and radiograph to find the full extent of the situation. Then we review all the findings with the owners, adjust the plan/estimate based on those new findings to ensure that we have informed owner consent.
And it is not just periodontal disease that is hidden. Cysts, subgingival root fractures, tooth resorption, retained roots, endodontic disease and more can all be going on with no outwardly visible signs on conscious examination. More on the importance of intra-oral dental radiographs can be found here – https://vetdentedu.ca/2022/08/02/why-veterinarians-must-do-whole-mouth-intra-oral-dental-radiographs-and-why-owners-must-insist-on-this/.
Daily Or Forget It
We always ask clients what level and type of dental home care they are providing for their pet. Many will indicate that they are brushing their pet’s teeth, but when asked for details it is common for them to say that they are brushing 2-3 times a week or a month. While their heart might be in the right place, they really are not doing any good.
If you brush your teeth before going to bed (and I certainly hope that you do), when you wake up in the morning, your teeth are wearing fuzzy little sweaters. That is the plaque that forms overnight as you sleep. That is how fast plaque accumulates. If it is not mechanically removed (by tooth brushing) daily, it thickens, becomes more tenaciously attached, harbours more pathogenic bacteria and starts to accumulate minerals from the saliva to form calculus (tartar). Once plaque is mineralized, it cannot be removed with a toothbrush and so the game is lost.
For a tooth brushing to be of value it needs to be done daily to mechanically disrupt and remove the immature plaque film and keep ahead of calculus accumulation. The other benefit gained from tooth brushing is the physical massaging of the gingiva. This stimulates the gingival fibroblasts to produce more collagen, which is the main structural protein for the gingiva and is what makes healthy gingiva so tough and resilient and tightly braced against the tooth.
For people who are brushing infrequently, we will give them instruction on how to train their pet to enjoy and look forward to this as a daily activity.
Tooth brushing can be very beneficial, but like all things, it will only help if it is done right and that means doing it daily.
The same goes for any other home plaque control strategy, such as giving a VOHC-Accepted dental chew or using a VOHC-Accepted plaque-retardant water additive. To be effective, they need to be used daily.
Home dental care will never be enough on its own.
Owners are sometimes surprised to learn that their pet needs dental care despite the fact that they have been providing home plaque control. Even if owners are doing all the right things (using appropriate products and strategies on a daily basis) it will never be enough on its own. I explain that I brush my own teeth twice daily, I floss daily, and I still see my hygienist and dentist every 6 months for professional assessment and a thorough cleaning. They always find plaque and calculus accumulations to remove despite my own daily home plaque-control regimen. With that in mind, it is not surprising that many animals require dental care on an annual basis to keep ahead of trouble.
Prevention CANNOT Treat Disease.
One more thing about home plaque control – it CANNOT treat disease. Prevention is for prevention, not treatment and most home plaque control products and strategies will be worse than useless when used in the face of established disease. For more on that, have a look at this post – https://vetdentedu.ca/2023/04/20/tooth-brushing-can-be-bad/.
The Knee-Cap Rule
I already have a post on this issue – https://vetdentedu.ca/2022/08/02/the-knee-cap-rule/. And there is this pdf from the FDA, put out in 2010 – https://vetdentedu.ca/2023/01/03/fda-warning-against-giving-dogs-bones/. Here is their 2015 version – www.fda.gov/ForConsumers/ConsumerUpdates/ucm208365.htm
I have been telling people for years (decades really), that dogs should not be given hard toys to chew on or play with. The above link to the FDA bulletin outlines ten very good reasons why dogs should not be given natural bones to chew on/eat.
I recommend that you print this information, in full colour and give it to all of your dog-owning clients. It is especially important to include this information in Puppy kits so that you can inform new or first-time dog owners of the dangers of natural bones before they establish a bad habit.
Note that the first danger of natural bones listed is fractured teeth. Unfortunately, it is not just natural bones that are hard enough to break teeth. Nylon toys, compressed raw hide toys, dried cow hooves, deer antlers, dried bull penises (Bully Sticks) rocks and so many more items are plenty hard enough to fracture any tooth in any dog. So, what can we allow our canine patients to chew with any level of confidence?
I tell clients that there is nothing that is ‘safe’ but there are some things that are ‘safer’ (i.e., less dangerous) if used appropriately. To judge an item, they should apply the “Knee-Cap Rule”. Simply stated, if you would not want me to hit you in the knee-cap with it, don’t let your dog chew on it. For small dogs, I will modify and say, if your small dog would not want me to hit them on the knee-cap with it, don’t let him/her chew on it.
Clients seem to be able to visualize this well and take it to heart. Another criteria they can apply would be “If you would not chew on it yourself for fear of damaging your own teeth, do not let your dog chew on it.
Here is the pdf version of this post – link.