Читать книгу The Veterinary Dental Patient: A Multidisciplinary Approach - Группа авторов - Страница 84

The only critical piece of equipment is a toothbrush. There are numerous veterinary brushes available,¹ which should be selected based on patient size. Double‐ and triple‐sided^2,3 and circular feline brushes⁴ are effective products and should be considered along with the standard veterinary brushes (Figure 5.3). This author does not recommend “finger brushes” as they do not generally address the subgingival areas of the teeth; additionally, they significantly increase the chances of the owner being bitten. Gauzes and washcloths are not recommended for the same reasons (Holmstrom et al. 1998).

Human toothbrushes may be substituted, with soft‐bristled brushes typically being recommended. A child's toothbrush is often the correct size for small patients and may be more effective than the larger veterinary version. An infant brush may work best for toy‐breed dogs, cats, or juvenile patients.

Figure 5.3 Double‐headed toothbrushes have certain benefits in plaque control.

Figure 5.4 Mechanized toothbrush used in dogs.

Mechanized (sonic⁵ and rotary⁶) brushes are superior to standard brushes for humans (Deery et al. 2004; Moritis et al. 2008) (Figure 5.4). These products are also likely superior for use in veterinary patients, and may make the process more time efficient, which is important in animal patients for acceptance reasons. In addition to the numerous human product options, there is currently a mechanized veterinary brush on the market.⁷ One concern with these brushes is that the movement/vibration can feel strange and may scare the patient (Holmstrom et al. 1998). Secondly, one has to be careful and avoid situation when hair around the mouth becomes entangled in a mechanical brush. This author recommends initiating brushing very slowly with a standard toothbrush, and then progressing to a mechanical type after acceptance is achieved.

There are a number of veterinary toothpastes available,⁸ which may increase acceptance by the patient (Figure 5.5). They often contain a calcium chelator⁹ in order to decrease the accumulation of dental calculus (Liu et al. 2002; White et al. 2002; Hennet et al. 2007). However, remember that calculus is largely nonpathogenic (Wiggs and Lobprise 1997), so the paste is not a significant player in the reduction of plaque and gingivitis. Consequently, palatability can be increased by using alternative flavorings (Wiggs and Lobprise 1997; Niemiec 2008), such as tuna juice (especially for cats), garlic powder (in small amounts), and beef broth. Dipping the brush in a canned food that the pet enjoys may also be considered on initiation of home brushing.

Antimicrobial products¹⁰ are also available (see later). They improve plaque and gingivitis control when used in combination with brushing, and should be considered especially in high‐risk patients or in cases of established periodontal disease (Overholser et al. 1990; Maruniak et al. 1992; Eaton et al. 1997; Hase et al. 1998; Hennet 2002; Stratul et al. 2010). Human toothpastes and products that contain baking soda should be avoided as they typically contain detergents and fluoride, which may cause gastric upset or other issues if swallowed (Wiggs and Lobprise 1997; Niemiec 2008).