Dentistry for dogs: importance of dental cleaning for dogs

Introduction

Periodontal disease (PD) is a very common problem in dogs that can affect their health, longevity and quality of life, as well as their relationship with the owner.1 It is detected in an estimated 9.3–18.2% of animals whose oral cavity is examined during a routine visit and in 44–100% of dogs that are anaesthetised suspected of having PD.²

Control of plaque bacteria is the cornerstone of PD treatment, and regular dental cleaning by a vet along with routine home dental care is the best way of achieving this.³

Dental cleaning for dogs: step by step

In veterinary medicine, the term dental cleaning refers to an examination of the oral cavity under general anaesthesia by a professional. It involves removing tartar and dental plaque from supragingival and subgingival areas of the teeth using manual and/or motorised instruments, then polishing the corresponding dental surfaces.¹

Dental cleaning for dogs can form part of:

• A PD prevention programme: recommended from the first year of life for small and medium dogs, and from the age of 2 years in large dogs
• Or, treatment specifically for this problem: from stage 1 (PD 1).¹

Ideally, the dental cleaning procedure should include: examination of the oral cavity in conscious patients, general anaesthesia, second visual examination, oral X-ray, chlorhexidine rinse, removal of supragingival and subgingival tartar, identification and removal of tartar and plaque residues, polishing, probing and rinsing of periodontal pockets, fluoride application (optional), periodontal treatment (if necessary), application of sealants (optional), and creation of a home care plan.^1,3,4

ANAESTHESIA

Concern about the anaesthetic procedure is probably the main reason why owners reject dental cleaning for their dogs. However, they must realise that it is impossible to perform even the lowest standards of dental cleaning on dogs without resorting to general anaesthesia.^1,5 Most patients undergoing dental cleaning are geriatric and have other comorbidities. Accordingly, these patients should receive a pre-anaesthetic examination tailored to the animal’s individual needs. The anaesthetic protocol must be adapted to each patient’s specific features, but irrespective of the protocol selected, all dogs must be intubated to prevent aspiration of fluids, tartar and other waste during the cleaning procedure.⁴

DISINFECTION

Rinse out the oral cavity with 0.12% chlorhexidine for 1 minute to reduce any aerosolisation of bacteria before removing tartar. It is also important for personnel involved in the procedure to wear face masks, gloves and protective eyewear.⁵ Whenever possible, special rooms should be set aside for dental cleaning and sterile operating rooms used for other procedures should be avoided.³

TARTAR REMOVAL

Removal of tartar (scaling) is an essential part of the procedure, as dental tartar acts as a matrix that retains plaque bacteria and substances that damage the teeth. In any event, overly aggressive scaling should be avoided to minimise damage to enamel. Tartar can be removed using manual scalers, forceps or ultrasound, with a combination being the best option.^3,4 

• When using ultrasonic cleaning, always maintain a good flow of water to prevent thermal damage, and only apply the technique to the same tooth for short periods to avoid damaging the surface. Some authors recommend no more than 5–7 seconds of continuous application, while others suggest 15 seconds, returning to the same area later if necessary.^3,4
• Removal of subgingival plaque is the most important part of dental cleaning for dogs, because it has been shown that removing supragingival tartar alone only has a cosmetic effect on PD; it does not achieve effective control of PD.^1,3 Traditionally, (and still today), this process was carried out using dental curettes, which is why it is also called curettage. Ultrasonic cleaning requires the use of special tips, since standard tips can damage the gums, pulp and periodontal tissues. Some authors recommend combining both types of equipment to remove subgingival tartar. In any case, manual subgingival scaling is considered a technically complicated procedure that requires the acquisition of the relevant skills.³
• After eliminating subgingival tartar, dry the tooth surface or use a dental plaque disclosing agent (carefully, as they can stain the materials or tissues they contact) to check for any remains of tartar.⁵ 

POLISHING

Both ultrasonic cleaning and manual scrapers can damage enamel, which increases the surface area available for the adhesion of plaque bacteria. While in human dentistry there is some debate as to whether excessive polishing can be harmful, it is still recommended in veterinary practice because dogs undergo far fewer dental cleaning procedures in their lifetimes than humans.^3,5

FLUORIDE APPLICATION

There is no consensus about whether fluoride should be applied to the tooth surface as part of cleaning. Advocates of its use argue that it has an antiplaque effect, antibacterial activity, increases tooth hardness and reduces tooth sensitivity. If used, the fluoride should remain in contact with the surface for 3 minutes if applied as a foam and 10 minutes when using a gel. After the application period, remove manually or with compressed air, but never rinse as it reduces its efficacy.³

SEALANT APPLICATION

Some dentists recommend the application of dental sealants once cleaning is complete to help prevent plaque formation. However, the beneficial effect of this procedure remains to be proven.³

ANTIBIOTIC THERAPY

The decision about whether to administer antibiotics after dental cleaning in dogs is left to the vet. Current recommendations are to limit their use to patients with a systemic condition that could compromise their state of health or when there is evidence of osteomyelitis. Intraoperative antibiotic therapy is also recommended in these situations. In addition, dogs with stage 4 PD may benefit from preoperative antibiotics.^1,4

HOME CARE

The last step in dental cleaning for dogs is to establish a home care plan. Cleaning will be of little use if it is not followed by regular dental care. General recommendations are for subsequent dental cleaning every 6–12 months, depending on the stage of the periodontal disease.⁵ 

Dry diets also help keep teeth clean thanks to the abrasive effect of the kibble against their surface.

Conclusions

The first step in maintaining good oral health is to be aware of its importance. So, regardless of the reason for consultation, an oral cavity examination is recommended on each visit to the clinic. It is the vet’s job to explain to owners the importance of these check-ups, so they understand why their dog needs regular dental cleaning, which also requires general anaesthesia, and that the procedure will be as safe as possible.  

References

1.     Bellows J, Berg ML, Dennis S, et al. (2019). 2019 AAHA Dental Care Guidelines for Dogs and Cats. J Am Anim Hosp Assoc; 55: 49-69.

2.     Wallis C, Holcombe LJ. (2020). A review of the frequency and impact of periodontal disease in dogs. J Small Anim Pract; 61: 529-540.

3.     Niemiec BA (2013). The complete dental cleaning. In Niemiec BA (Ed). Veterinary Periodontology. Willey Blackwell: 93-99.

4.     Holmstrom SE (2019). The complete prophy. In Holmstrom SE (Ed). Veterinary Dentistry A Team Approach 3rd Ed. Elsevier: 153-177.

5.     Stepaniuk K (2019). Periodontology. In Lobprise HB, Dodd JR (Bert) (Ed). Wigg’s Veterinary Dentistry 2nd Ed. Willey Blackwell: 81-108.