Lecture 11: home care

Question 1

Home care communication is importnat because

Answer 1

Client compliance is critical to success, and can only be achieved through client communication and education
Client education is an important way to evaluate the client’s willingness to perform homecare and the patient’s willingness to accept it
It should begin before the prophylaxis as client compliance regarding homecare affects the decision to save a tooth or extract it

Question 2

Home Care Considerations at Discharge Post-Procedure

Answer 2

pain management
Antibiotics
Diet

Question 2

Pain management before being sent home from a dental

Answer 2

Top up before discharge
Make sure to send appropriate pain control home

Question 3

What to do for at home pain managment

Answer 3

Pills may be more difficult for clients due to sore mouth
Consider liquid analgesics
May require more than one kind of analgesic – owner to call if they feel their pet is painful on current protocol

Question 4

Antibiotics for dental procedures

Answer 4

Not necessary for all dental procedures
Liquid medications may be easier for client to administer
Also dependent on veterinarian preference

Question 5

What should the client watch for

Answer 5

Post-anesthesia – may be more sleepy than normal with reduced appetite for up to 24 hours
Bloody oral discharge – consider protecting rugs, furniture, etc.
Unusual behaviours
Pawing at mouth – may need e collar to allow gums to heal
Lip smacking
Head rubbing or shaking
Hiding (cats) or attention seeking (dogs)

Question 6

Diet post op

Answer 6

Reduced appetite is common for the first 12-24 hours after anesthesia
If inappetence persists, need to re-evaluate the patient
If the pet has had extractions, soft food is usually recommended for 5-14 days depending on the procedure
Canned food
Soaked kibble

Question 7

Why encourage homecare?

Answer 7

Maintain oral health
Improved mastication
Oral problems are detected (and treated) earlier
Decreased bacteremia
Oral hygiene procedures are easier
Increased life span
Increased bond between owner and pet
Increased quality of life
Time between oral hygiene procedures in increased
Decreased oral infections
Increased bond between client and staff
Relieves oral pain

Question 8

When to follow up for a dental

Answer 8

Regular follow up and monitoring - differs by clinic:
1-2 days after prophy (phone call)
7-10 days after procedure (exam to assess healing, discuss homecare again)
Every 6-12 months (oral exam)

Question 9

Factors for success of a dental post op

Answer 9

Adequate education in product use
Cooperative patient
Owner compliance
Reasonable goals for the owners
Home care products are acceptable to the owner and the pet
Regular follow up and monitoring

Question 10

What type of home care products are there

Answer 10

Brushing with/without enzymatic toothpaste
Dental diets
Dental treats
Dental rinses, gels, and water additives
Chew toys

Question 11

Mechanical mechanism of action is

Answer 11

most important!
Brushing – most effective method of plaque prevention!
Certain dental diets and treats

Question 12

Chemical action of removing plaque is

Answer 12

Veterinary enzymatic toothpastes
Certain dental diets and treats
Dental rinses, gels, and water additives

Question 13

How soon does plaque form on teeth and how to negate it

Answer 13

Plaque begins to build on the teeth within 6-8 hours after scaling so brushing teeth by owners is very important
Recommend daily brushing - gold standard
Replace the toothbrush regularly; one toothbrush per pet

Question 14

What toothbrush would you use for different sizes

Answer 14

Adult toothbrush – large and medium dogs
Child toothbrush – small dogs
Proxabrush – cats and very small dogs
CET cat tooth brush – cats and very small dogs
Fingerbrush – pets that don’t tolerate a regular toothbrush, not as effective as toothbrushes but better than nothing
Electric toothbrush – may work in some patients
Waterpik or pipe cleaner – for full furcation exposure exposure

Question 15

How to demonstrate brushing for owners

Answer 15

To demonstrate proper brushing techniques to owners it must be presented both verbally and visually
This can be accomplished first with the use of a model, then a demonstration animal can be used
Either the clinic cat, your own pet, or the client’s pet
You should demonstrate correct technique then have the owner attempt brushing in your presence so that you can assist them
If there have been extractions, this is best done at the 7-10 day post-dental visit

Question 16

How to start introducing a brush to a dog

Answer 16

Start with simple touching of the lips and slowly advance to complete and correct brushing
Desensitize and counter-condition the pet to the procedure
Go slowly, and keep the pet below threshold
If they are pulling away or seem nervous (avoiding eye contact, lip licking, yawning, excessive blinking, or panting) – go back a step and go more slowly
Keep sessions short
Associate sessions with positive rewards (food, play, affection, verbal rewards)

Question 17

Why is introduction to the toothbrush important

Answer 17

If you do it correctly, this should be fun, and the pet should look forward to it!
This will increase client compliance, because the pet enjoys it
Show the client how to hold their pet while brushing the teeth (generally seated and approaching from behind)
May be able to progress through several steps in one session

Question 18

What steps do you use to introduce a toothbrush

Answer 18

Start with gentle touching of the face and lips
Then progress to lifting the lips
Keep the mouth closed (do not need to separate the upper and lower arcade)
Show the toothbrush to the pet
Let them sniff and lick it
May want to add flavour to the toothbrush via flavoured pet toothpastes or chicken/ beef broth or water from tuna/salmon can
Gently swipe the teeth with the toothbrush initially
Progress to correct brushing technique over time

Question 19

Brushing technique

Answer 19

Brush at a 45 degree angle to the tooth
The toothbrush bristles should be placed at the gum margin where the teeth and gums meet
The movement should be in an oval pattern
Focus on pulling the plaque towards the crown and away from the gumline
Be sure to gently force the bristle ends into the area around the base of the tooth as well as into the space between the teeth
Ten short back-and-forth motions should be completed, then the brush should be moved to a new location
Cover three to four teeth at a time
Brush all surfaces if possible, but at least labial and buccal surfaces

Question 20

What to use to brush a dogs teeth and what sides

Answer 20

Equipment = toothbrush + cooperative pet +/- enzymatic tooth paste
Usually just brush the buccal aspect of the teeth
In very patient pets, can open the mouth to brush the lingual and palatal surfaces of the teeth
Can use a toy or dental chew as a prop to hold open the mouth for brushing

Question 21

Toothpaste is

Answer 21

Use of an enzymatic toothpaste in combination with brushing enables both mechanical and physical techniques of plaque prevention
The best pet toothpastes contain enzymes that help control plaque
The flavor of pet toothpastes will help make brushing fun for the pet
Avoid human toothpastes because pets cannot spit! They often contain compounds which should not be swallowed like baking soda, detergents, salt, or fluoride

Question 22

Dental rinses are

Answer 22

Reduces bacterial load in the oral cavity reducing plaque accumulation
Binds to the salivary pelicle and is released over a prolonged period of time
Ingredients are antibacterial:
Chlorhexidine
Zinc

Question 23

Drinking water additives are

Answer 23

Clinical studies show that adding dental water additives such as CET Aquadent® or BreathaLyser® in conjunction with regular hoe dental care significantly reduced plaque and tartar accumulation as well as halitosis
Chlorhexidine and Xylitol*

Question 24

Xylitol is

Answer 24

Xylitol is a hydrogenated carbohydrate that has an antibacterial effect by inhibiting the uptake of glucose in the mouth by bacteria thereby reducing its growth which results in reduced plaque formation in humans and animals

Question 25

Xylitol Toxicity with dental rinses

Answer 25

The amount of xylitol present in a dental rinse is well below the toxic dose for dogs
3 grams/kg = hypoglycemia

Question 26

Dental gels are

Answer 26

A lot of these products state that they can be used alone but optimally they should be used in conjunction with brushing
It is an alternative – if the animal will not tolerate brushing
Most need clinical trials

Question 27

Dental gels contain

Answer 27

Muco-adhesive containing:
Zinc ascorbate - heals gingiva by stimulating collagen production and increasing bond strength between collagen fibers
Also has a slight antibacterial action
Taurine – a sulfur amino acid, chelates with malodorous sulfur compounds produced by bacteria in the mouth reducing halitosis

Question 28

1-TDC is

Answer 28

1-TetraDecanol Complex
Fatty acid with anti-inflammatory properties for periodontal and joint health
Some veterinary dentists recommend snipping off the top of gel capsule and applying to gums daily

Question 29

Dental diets are

Answer 29

Several specialty diets available
Formulated to slow the formation of tartar and remove plaque
Balanced diets
t/d by Hills Prescription Diets
Dental by Royal Canin
Dental Health by Purina Veterinary Diets

Question 30

How do dental diets work

Answer 30

Several mechanisms of action depending on product:
Large palatable kibble that doesn’t crumble to promote chewing action
Fiber matrix scrubs the tooth as it chews
Tartar reducing agents – polyphosphates that bind calcium and decrease calculus formation
Plaque reducing agents

Question 31

Who would you NOT give a dental diet to

Answer 31

Not appropriate for pets with severe dental disease
Pain when chewing
Swallowing kibble whole
Not appropriate for pets that are missing numerous teeth, particularly the carnassial teeth(chewing teeth)

Question 32

Dental chews are

Answer 32

Primarily mechanical action
Huge number of products available
Ensure product contains enzymatic function - antibacterial/antiplaque rather than components that only act to freshen breath (ie: chlorhexidine)
Chlorophyll/eucalyptus/sulfur binding components only freshen breath and do not combat the source of halitosis

Question 33

What would you look out for with dental chews

Answer 33

For small patients, may be a source of unwanted calories
Not appropriate for “gulpers” – possible foreign body!
Careful in pets with previous dental extractions – can they still chew it?
Look for VOHC seal to reduce tartar or plaque or both

Question 34

How do you determine what is a good home care product?

Answer 34

VOHC seal of approval
Read the claims critically and look for research that proves those claims – not testimonials
Determine if the research shows:
Compliance
Safety
Effectiveness
Ease of application and implementation

Question 35

Home Care is NOT:

Answer 35

A treatment for established disease
A substitute for regular professional examinations and treatment
Using human toothpaste
Giving hard or inappropriate chew products
Giving treats that are high in calories/fat/carbohydrates
Anesthesia free cleanings
Fingernail oral hygiene