Integrative dental care

Dental disease is the most common health problem seen by veterinarians. Introducing an integrative dental care program can help.

Dental disease is the most common health problem seen by veterinarians. It has a strong genetic component. Some breeds, such as Abyssinian cats, have a tendency to develop severe gingivitis, while brachiocephalic breeds often have overcrowded, maloccluded, problem-prone teeth. Some pets may need very little dental care, yet others might require full cleanings under anesthesia once or even twice a year.

The diet question

Diet is another major and often controversial contributor to dental disease. One commonly repeated myth is that “dry food cleans the teeth.” This is patently false. First, as most veterinarians have observed, many pets simply swallow dry food whole. If they do manage to chew a few pieces, the kibbles simply shatter, and do no good for supra- or sub-gingival tooth surfaces. A survey of 1,350 dogs failed to demonstrate that dogs had better periodontal health when eating dry rather than moist food. However, conflicting research suggests that pets eating wet food are likely to have more dental deposits and periodontal disease than those that eat dry food.iii Holistic veterinarians understand that each animal is an individual, and the diet must be tailored to those individual needs. Studies need to be carefully evaluated as to the funding and methods used.

Specially designed dental foods have very large kibbles designed to fracture so that the fragments do abrade some tartar off the teeth.iv However, the major ingredients of most such diets are typically of poor quality (by-product meal, corn gluten meal, corn meal or ground yellow corn). Plus, these foods suffer from all the usual problems of dry food: heat processing, the potential for bacterial or fungal contamination, high carbohydrate levels and low moisture. Because of the health risks associated with dry food in cats (such as obesity,v feline diabetesvi and FLUTDvii), they are unsuitable as the sole diet, although they may have some utility as treats.viii Given that 85% of dogs eat dry foodix and half of them are overweight, and that low carbohydrate diets have been shown to enhance weight loss,x the connection between dry diets and ill health in dogs cannot be dismissed.

Fighting oral disease in pets can seem like a losing battle. We know that within hours after cleaning, bacteria start to re-colonize the surface of the teeth. They secrete substances to attach themselves more firmly, and to protect themselves from the immune system. If this plaque is not removed, minerals in the saliva turn it into hardened calculus (tartar) within 48 hours. Some of the substances secreted by the bacteria result in gingivitis that can progress to local and systemic disease if untreated. Many a cranky or lethargic older pet has become happy and playful again after hidden dental problems were corrected.

Regular dental care

Excellent pet dental health requires regular veterinary care as well as a commitment to home care from the client. If the pet already has dental disease, the first step is to clean the teeth under anesthesia.

• One incentive to clients is to emphasize how much easier it is to keep pets’ teeth clean than to cope with the alternatives: increased risk of bacterial endocarditis, pulmonary disorders, renal disease, hepatic disease, polyarthritis, polyvasculitis, auto-immune disorders, discospondylitis, endotoxemia,xi and virtually guaranteed expensive dental extractions in the future.

• Another incentive is to demonstrate the presence of bacteria or tartar that is not easily seen. Since tartar fluoresces, a blacklight will show its presence. Subgingival bacteria can be demonstrated by a new product call Ora Strips. These measure thiols produced by bacteria in active infections. Since oral infections may go through active and quiescent phases, a borderline suspect would be a good case to use the strips on for home monitoring. One vet reported on VIN that the false positive rate was zero after 1,000 tests.

Get clients to brush

The best way of removing plaque and preventing dental disease at home is by brushing the teeth. Brushing removes plaque on the outside of the crown (above-gum portion) of the tooth and, if done properly, on most of the subgingival surface. It also stimulates the gums to keep them healthy. However, plaque can still accumulate below the gum line; so the need for an annual check-up and cleaning, if necessary, still needs to be communicated as an essential part of a pet’s health program. One recent product involves a test strip that clients can insert into the gum to indicate infection in an apparently normal mouth. Regular use of this product can be an incentive for clients to keep brushing teeth and to seek professional care if the infection persists.

Veterinary technicians can show clients how to brush their pets’ teeth, but the effort may still turn into a battle at home. You may want to teach, or have clients learn, techniques such as Tellington TTouch, Healing Touch for Animals, acupressure, massage, Reiki, or other hands-on modalities to help reduce their pets’ stress. Flower essences are also very helpful: ten minutes before brushing, give a few drops of Rescue Remedy or other emergency formula, then repeat as needed. It is useful to have the owners take some, too. Here are a few more tips to help owners:

• Use a finger brush, never a human toothbrush or even a pet brush on a stick; an unintentional jab can injure the gums.

• Never use force or excessive restraint to get the pet to accept brushing. The idea is to make it a pleasant experience. A gradual approach that accustoms the animal to brushing is best. Clients should start working with their puppies and kittens as soon as possible.

• Use a toothpaste designed for pets; most dogs and cats love the taste. Human toothpaste is not appropriate for pets; additives such as fluoride can cause gastric irritation, or worse. It’s best to encourage clients to brush every day; then if they miss a day, it’s not a crisis. However, if the plan is to brush every other day, a missed session gives plaque a good head start.

Products to prevent dental disease

When dogs and cats are truly healthy, they are less likely to have significant dental disease. Excellent nutrition, homeopathy, TCVM (Traditional Chinese Veterinary Medicine) and other individualized healing approaches to can go a long way toward maintaining dental health.

There are many dental care products marketed for pets. Oral rinses, gels and water additives can help but, depending on the dog, may not control plaque by themselves. The vast majority of treats, meanwhile, contribute little or nothing to dental health, even if they are labeled “Tartar Control”. No proof of effectiveness is needed to put such a label on a treat; it’s primarily a marketing gimmick.

Products approved by the Veterinary Oral Health Council at least have passed minimum required protocols to prove their efficacy. Carrying these products can help achieve client compliance with brushing, and your staff can discuss proper home care with clients when they purchase the products.

Most dog chews, including nylon, rubber, rawhide knots and bones, hooves, and large bare bones do little to reduce plaque accumulation, although they are better than nothing.xiii However, hard-textured bones can fracture teeth; and broken teeth are a source of infection and pain to the dog. Any bone, cooked or raw, can splinter, risking perforation of the gut. And if a dog swallows a large chunk of any bone or chew, it could cause a life-threatening intestinal blockage. Excessive feeding of bones may create an impaction.

Rawhide strips and pig ears may mechanically abrade off some tartar, but be aware they add quite a bit of fat to the diet; and contamination of such treats with Salmonella or other pathogenic bacteria is common.

Raw bones

Many people recommend a raw meat diet or raw bones for the prevention of dental problems. They point to wild carnivores as the model for this feeding style. However, cats have been developing odontoclastic resorptive lesions since the time of the Egyptian pharaohs, and African wild dog skulls exhibit just as much periodontal disease as their domestic counterparts. No diet is a substitute for proper dental care.

Many holistic practitioners report that they see less dental disease in pets that are fed homemade and raw diets. While there are some risks associated with feeding raw meat and bones, they can be mitigated, and there are proven benefits.

Experimental dogs that were fed 1/2 oxtail once per week for four weeks did not form any calculus; and the calculus the dogs had initially was greatly reduced.xvi While oxtails aren’t common at grocery stores anymore, local butchers may be able to order them; beef and bison oxtails can be purchased online as well. Chicken or turkey necks can provide a similar chewing exercise for smaller animals.

Another study compared whole, raw bovine trachea, esophagus and attached muscle and fat versus the same food minced. Plaque and gingival inflammation were increased with the minced diet, as well as when the food was tube-fed.xvii The presence of food in the mouth, let alone the food’s character, appeared to be largely irrelevant. In fact, it was reported that feeding whole, meaty, raw tissues had a beneficial effect: “There is reasonable evidence that… foods requiring vigorous prehension and mastication are preferable for dogs and cats.” Raw tissues provide this essential exercise.

Neither wet food, kibble nor a ground raw meat diet require any great effort in prehension or mastication. The negative effects of the ease with which these foods are consumed are highlighted in reference to captive carnivores:

“Animals need more ‘hassle factor’ per mouthful of nutrients. The literature contains hundreds of references to the food habits of feral carnivores and, therefore, the appropriate menu is readily available. Convenient prepared diets, those without sufficient ‘hassle factor’, are ruining the mouths and compromising the health of our animals. Carnivores in their natural habitat eat rabbits, mice, rodents, birds, etc., in toto (i.e., connective tissues, viscera, organs, cartilage, and bones)…. The masticatory apparatus of carnivores was designed to be used, and used aggressively and ferociously. If the animals don’t use their dentition and mastictory apparatus, they will in time lose it.”xviii Dogs and cats are structurally similar or identical to their wild relatives. They too need regular stimulation of their jaws and teeth to keep them healthy. However, it’s important to note that large carnivores do not typically consume the bones or hooves of their prey (unless it’s small or young). They gnaw on the cartilage and bone ends with their incisors, but the axial skeleton and large leg bones are left mostly intact.

Bone guidelines for clients

Here are some guidelines that can be handed out to clients for safely feeding pets raw “meaty” bones, such as chicken or turkey necks or backs, and oxtails or knuckle bones for larger dogs:

  • Start small; it takes time to develop the necessary neck and jaw muscles, and strengthen the periodontal ligaments.
  • Give bones just once or twice a week.
  • To kill surface bacteria, dip bones in boiling water for one to two minutes.
  • Only give bones on a full stomach.
  • Use only appropriately sized, cancellous bones, such as vertebrae — no long bones. For cats and small dogs, give only one or two vertebrae at a time. Use a mallet to break the bones within the muscles to facilitate chewing for very small mouths. Kitchen or poultry shears can be used to divide the vertebrae; some butchers will cut them for you.
  • Remove uneaten bones after 30 to 60 minutes.
  • Always supervise the pet’s bone-related activities.
  • Have a staff member stay current on local sources of organic meat and bones, so you can advise clients where to obtain them.

Proper dental care is fundamental to optimal health and well being. It’s not easy to convince clients to put in the effort, but if you and your staff concentrate on thorough, practical education, everyone wins.


iLogan, et al., Dental Disease, in: Hand et al., eds., Small Animal Clinical Nutrition, Fourth Edition. Topeka, KS: Mark Morris Institute, 2000, p. 487.

iiHarvey et al., Correlation of diet, other chewing activities and periodontal disease in North American client-owned dogs, J Vet Dent. 1996 Sept;13(3):101-105.

iiiGowar JP, Reiter AM, Jodkowska K, et al. Influence of diet on oral health of cats and dogs. J Nutr. 136: 2021S–2023S, 2006.

ivHand MS,Thatcher CD, Remillard RL, et al. Small Animal Clinical Nutrition, 4th Edition. Topeka KS: Mark Morris Assoc. 2000, p

vZoran DL. The carnivore connection to nutrition in cats. J Amer Vet Med Assoc 2002 Dec 1;221(11):1559-1567.

viRand J. Current Understanding of the Pathogenesis of Feline Diabetes Mellitus & Principles of Therapy. Proc ACVIM, 2009.

viiForrester, S. D., Roudebush, P.: Evidence-based management of feline lower urinary tract disease. Vet Clin N Am Sm An Practice. 2007;37: 533,

viiiO’Rourke JT. The relation of the physical character of the diet to the health of the periodontal tissues. Am J Orth Oral Surg. 1947;33:687.

ixLaflamme DP, Abood SK, Fascetti AJ,  et al. Pet feeding practices of dog and cat owners in the United States and Australia. Am Vet Med Assoc. 2008 Mar 1;232(5):687-94.

xBierer TL, Bui LM. High-Protein Low-Carbohydrate Diets Enhance Weight Loss in Dogs. J. Nutr. 134: 2087S–2089S.

xiDeBowes LJ. The effects of dental disease on systemic disease. Vet Clin North Am Small Anim Pract. 1998 Sep;28(5):1057-62.

xiiASPCA Poison Control.

xiiiC E Harvey, F S Shofer, and L Laster. Correlation of diet, other chewing activities and periodontal disease in North American client-owned dogs. J Vet Dent. 13(3):101-5 (1996).

xivWatson ADJ. Diet and periodontal disease in dogs and cats, Aust Vet J. 1994;71:313-318

xvSteenkamp G, Gorrel C.Oral and dental conditions in adult African wild dog skulls: a preliminary report. J Vet Dent. 1999 Jun;16(2):65-8.

xviBrown MG, Park JF. Dental calculus in experimental beagles. Lab Anim Care. 1968;18(5):527-535.

xviiWatson 1994, op cit.

xviiiFagan DA, Edwards MS. Influence of diet consistency on periodontal disease in captive carnivores. Fagan, D.A. – Diet consistency and periodontal disease in exotic carnivores. Proc Am Assoc Zoo Vet.1980a.

xixWhy don’t wolves eat all that they kill?

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Dr. Jean Hofve earned her Doctor of Veterinary Medicine at Colorado State University. In addition to conventional veterinary training, she studied veterinary homeopathy, homotoxicology, Reiki, and other holistic modalities. She has researched pet food and feline nutrition for more than two decades, and is an expert on holistic pet health and the commercial pet food industry. She is an official advisor to AAFCO, the organization that sets pet food rules and standards in the U.S. and Canada. Dr. Hofve co-authored the books Holistic Cat Care and Paleo Dog.