Figure 1: The “Bass” tooth brushing technique utilizes a 45-degree angle of the brush to allow bristles to enter the sulcus and sweep in a back-and-forth motion. When it comes to preventing progression of periodontal disease, tooth brushing is the least expensive and most effective home-care method to help avoid the need for future extractions. And since it’s that time of the year to make resolutions, I will share mine with you. Well, it’s actually the same one I make every year. My recurring New Year’s resolution is to consistently ensure all the mammals in my household are getting their teeth brushed daily. I must confess, though, I usually fall off the brushing bandwagon a few weeks into January, as there are quite a few mammals in the Lewis household! When clients ask me whether I brush my own pets’ teeth daily, I tell the truth, as I’ve never been good at lying. I tell owners I do not brush my pets’ teeth daily, and as a result, I need to perform anesthetic cleanings more frequently to prevent gingivitis from progressing to a more serious periodontal attachment loss. Gingivitis, a condition that is easily reversible, is the first step toward attachment loss, which is much more difficult to reverse. One study has looked at brushing compliance in client-owned dogs.1 In this study, pet owners were provided a toothbrush, dentifrice (toothpaste), instructions, and a demonstration of daily brushing technique after a professional dental cleaning under anesthesia was performed. Follow-up phone calls to 51 owners six months or more after a visit for a dental cleaning showed 53 percent of them reported they were still brushing several times a week. Thirty-eight percent of clients were no longer brushing at all. How frequently should pet owners brush their pets’ teeth? One randomized, controlled blinded study evaluated four brushing frequencies in beagle dogs: brushing daily; brushing every other day; brushing weekly; and brushing every other week. Results showed brushing more frequently had greater effectiveness in retarding accumulation of plaque and calculus, and reducing the severity of preexisting gingivitis. Based on the study results, the authors recommended daily brushing.2 Getting it done Overall, the most commonly recommended tooth brushing method is the “Bass” technique, which concentrates the bristles along the gingival margin and in the sulcus. With a soft- or extra soft-bristled toothbrush, the bristles are directed at a 45-degree angle toward the gingival margin (i.e. bristles angled upward on the teeth of the upper jaw and bristles angled downward on the teeth of the lower jaw), so that some of the bristles enter the gingival sulcus (Figure 1). While pressing lightly, use short back-and-forth strokes and maintain the 45-degree angle before repositioning the brush along the next group of teeth. Veterinary patients are reluctant to keep their mouth open, so it is best to brush while the mouth is closed, with access to the teeth gained by gently lifting the lips or pulling out the cheek. The “Stillman” technique is sometimes used in areas that recently had periodontal surgery to prevent trauma to the reattaching gingival tissue. This method involves placement of the bristles apical to the gingival margin and using a gentle sweeping motion in the coronal direction against the gingiva and crown of the tooth. Unlike the Bass method, the modified Stillman technique does not place bristles into the healing sulcus.3 Perform brushing after rinsing the bristles in water. Eventually, add a veterinary dentifrice (toothpaste), but revert back to simply water if patients try to eat the brush due to the taste of the toothpaste. When brushing is completed, the dentifrice can be applied to the mouth as a treat and to provide enzymatic or antiseptic benefits. Human toothpaste should not be used, as it may cause stomach upset if swallowed. Since patients may become uncooperative before completing the brushing process, prioritize brushing first in areas that collect the heaviest debris (usually the buccal surfaces of the caudal maxillary teeth). After addressing the high-risk areas of plaque accumulation, move to lingual and palatal tooth surfaces as the patient allows. When to start Brushing should be initiated at a young age to allow the patient to become accustomed to oral care. Before a toothbrush is introduced, the puppy or kitten should receive gum massages so they become accustomed to the experience of the mouth being manipulated. Though it seems to be counterintuitive, giving a treat after brushing may be a good thing in this case. Positive reinforcement for a pet that tolerates brushing can make the process much easier. Although not every dog or cat will tolerate brushing, pets can learn over time to enjoy the reward at the end of the process, if not the process itself. More and more evidence suggests maintaining a healthy mouth helps maintain a healthy body. Educating pet owners on brushing technique in the early stages of life provides the best chances of owner and pet compliance. Do you have tooth brushing-compliance techniques that have worked well for you? Feel free to share them with me at info@siloacademy.com. References 1 Miller BR, Harvey CE. Compliance with oral hygiene recommendations following periodontal treatment in client-owned dogs. Journal of Veterinary Dentistry 1994; 11(1): 18-19. 2 Harvey C, Serfilippi L, Barnvos D. Effect of frequency of brushing teeth on plaque and calculus accumulation, and gingivitis in dogs. Journal of Veterinary Dentistry 2015; 32(1): 16-21. 3 Miller BR, Lewis JR. Veterinary dentistry. In: McCurnin’s Clinical Textbook for Veterinary Technicians, 9th Ed. Elsevier: 2018. p. 1335. John Lewis, VMD, FAVD, DAVDC, practices dentistry and oral surgery at NorthStar VETS in Robbinsville, N.J., and is the founder of Silo Academy Education Center in Chadds Ford, Pa.
