Ask a Vet: Do I really need to brush my dog's teeth?

Washington Post

3 days ago

Q: Do I really need to brush my dog's teeth at home? And if so, how often?
A: In short, yes, you should be brushing its teeth daily — especially if you own a small-breed dog. If this is unmanageable, a weekly brushing paired with a daily chew-based dental product is better than no brushing at all. While you and your dog probably both dread the task, this is more than a matter of fresh breath and sparkling teeth.
Regular oral care can prevent serious infections of the mouth that can cause pain and prevent dogs from eating — and decrease the need for costly veterinary procedures that require anesthesia. And yes, it can help with that breath thing, too. Here's what you need to know about dental disease in dogs, and how to make brushing more palatable for both of you.
Anyone who's been close to a panting dog knows about 'dog breath.' Sometimes it's because of something a dog just ate, such as a few prime litter fritters from a cat's litter box (a popular menu item for my black Labrador, Bodhi).
But more often, a dog's bad breath results from periodontal disease — disease of the gums and structures that stabilize the teeth — which affects at least 80 percent of dogs over 3 years old.
Under the right conditions, certain bacteria that are normally found in a dog's mouth can accumulate. These bacteria degrade protein in entrapped food, generating a mixture of foul-smelling substances, including sulfur compounds and 'death odor' molecules like putrescine and cadaverine.
But overgrowth of these bacteria can have worse consequences than bad breath, especially in dogs that are predisposed to periodontal disease because of older age, diet, diseases like diabetes, and breed.
To defend itself, the body sends fighter cells to the gum tissues. This cellular invasion leads to redness and thickening of the gums (gingivitis), creating pockets around teeth that — paradoxically — trap billions of bacteria in the form of plaque. The conditions also favor proliferation of 'bad' bacteria, which exacerbates the inflammatory response, creating a vicious cycle that can cause foul breath, tooth loss and pain.
A dog with bad periodontal disease may paw at its face, become less interactive, stop eating, or drop food from its mouth. In some cases, debris and dead bacteria accumulate as pus around a tooth root. When a large collection of pus (known as an abscess) forms, it can burst into the nasal cavity, so that 'snot' drains from a nostril. Abscesses of the upper molars can distort a dog's eyeball, affecting its vision. According to Maria Soltero-Rivera, a specialist in veterinary dentistry at the University of California at Davis, severe periodontal disease in small dogs can weaken the lower jaw so much that the jaw breaks with minor impact, such as jumping off a couch.
Like in humans, studies in dogs also suggest a possible link between periodontal disease and disease in important organs including the heart and kidneys. However, proving a direct cause has been difficult, as older dogs often have both periodontal disease and organ problems.
All of this sounds extreme and alarming, but the good news is, you can prevent a lot of it by properly brushing your dog's teeth daily. The World Small Animal Veterinary Association Global Dental Guidelines say that the best way to treat periodontal disease in dogs is through scaling and polishing by a veterinarian (deep cleaning below the gum line to remove tartar and plaque), followed by daily at-home tooth brushing. The deep cleaning requires general anesthesia.
But despite the proven effectiveness of daily brushing, a Swedish survey of nearly 60,000 dog owners found that only one in five owners who were instructed by their veterinarian to brush daily actually did so, even though they believed their dog's dental health was poor. The main reason given: Fido simply refused to cooperate. Soltero-Rivera adds that 'owners who ultimately succeed generally say that it takes them (and their dogs) about 3-4 months to build a habit.'
Small-breed dogs are particularly prone to periodontal disease, because of feeding regimes, overcrowding of teeth, the shape of the head, or other genetic factors. In one of the largest health care studies conducted in dogs (2.8 million U.S. dogs), Yorkies, toy poodles and dachshunds had the highest chance of periodontal disease. Small dogs also had professional cleanings under general anesthesia more often than large-breed dogs. Small breeds have the longest lifespans, and anesthesia is riskier for older dogs. Unfortunately (and primarily for genetic reasons), these same small-breed dogs are typically the least cooperative when it comes to tooth brushing — including one of Soltero-Rivera's own chihuahuas, Princess Olivia.
Proper brushing means targeting the outside surfaces of the gum line; brushing the teeth themselves does little to address periodontal disease. Although pet toothbrushes — including electric versions — are available, soft human toothbrushes work fine. Dog toothpaste is not necessary, but the flavors are designed to appeal to dogs, so using your finger or some gauze to spread a pea-size amount on the teeth before brushing can act as a reward. Gradually increase the amount of time you spend brushing as tolerated over 2 to 4 months. See the webpage of the UC-Davis Dentistry and Oral Surgery Service for a fun instructional video (and one for cats!).
The good news is that the burgeoning pet ownership trend has generated a vast array of dental home care products. Companies have found all sorts of creative ways to deliver these products into a dog's mouth — including diets, chews, water additives and antibacterial gels. When used daily, some products can reduce periodontal disease and bad breath. Soltero-Rivera recommends chew-based products that you can indent with your nail (hard chews can break teeth).
Nevertheless, proper daily tooth brushing remains about three times more effective than a dental chew or dental diet. Combining weekly brushing with daily use of chew-based products may be better than no brushing, reducing the need for potentially risky and costly anesthetic procedures. (A scale-and-polish treatment in the U.S. can cost owners more than $1,000 if extractions are required. Although anesthesia is essential, most dogs do not need antibiotics, which add expense and can cause vomiting, diarrhea and antibiotic resistance).
Perplexed by the plethora of home care products? The Veterinary Oral Health Council, which includes several board-certified veterinary dental specialists, approves products using an evidence-based approach and lists them on their website. Your veterinarian can also provide personalized recommendations based on your dog's risk factors and temperament, and your lifestyle and budget.
Jane Sykes is a professor of veterinary medicine at the University of California-Davis. She is a board-certified specialist in small animal (dog and cat) internal medicine with a special interest in infectious diseases. In addition to her veterinary degree, she has a PhD from the University of Melbourne, an MBA from the University of Georgia, and an MPH from Kansas State University, and is a Distinguished Fellow of the National Academies of Practice. She is the proud owner of two Labrador retrievers (Flora and Bodhi) and an orange tabby cat (Freckles).