Toothbrushing and home dental care

WSAVA guideline

Key findings

• Gold standard: "tooth brushing has been proven to be the most effective means of plaque control" (Hale 2003); active homecare works best rostrally, passive (chew-based) caudally — combine both (§5).
• Technique: brush at 45 degrees to the tooth's long axis, at the gingival margin, circular motion; buccal surfaces with mouth closed; to open the mouth, thumb behind the lower canines (safest spot); progress to palatal/lingual surfaces if accepted.
• Frequency: once a day is ideal; established periodontal disease requires daily brushing, twice daily may be recommended; suspending for as little as a month returns gingivitis to no-therapy levels (Ingham & Gorrel 2001).
• Toolkit training steps (GDC): (1) touch the face/lift the top lip; (2) touch the teeth — start with a canine, add one tooth daily; (3) massage the gumline with a finger brush ± paste (tuna juice/chicken stock can aid acceptance); (4) transition to a toothbrush (child's soft brush ideal; expect a backward step); (5) brush inner surfaces if possible (finger behind the lower canine) + annual checkups. Best start: 6–7 months of age or after a professional cleaning; <2 minutes/day; allow a few weeks.
• Compliance: even motivated owners reach ~50% compliance at 6 months (Miller & Harvey 1994); keys — start early, go slow, be consistent, make it positive; counsel owners about bite risk; thiol test strips improve compliance.
• Materials: soft nylon brushes sized to patient (child's/infant for small dogs, cats); gauze/washcloths not recommended (cannot clean subgingivally); veterinary pastes improve acceptance, but mechanical action removes plaque; human toothpastes NOT recommended (detergents + fluoride → gastric upset/fluorosis).
• VOHC: seals only for "helps control plaque"/"helps control tartar"; council of nine veterinary dentists/dental scientists + non-voting Director; reviews company-run studies, does not test products; prefer peer-reviewed evidence and/or the seal.
• Dental diets/chews: one dental diet reduced plaque and gingival inflammation ~33% over 6 months (only diet with a published gingivitis effect); best as the main food, declining but measurable benefit at 75/50/25% of calories; compressed wheat, cellulose and rawhide chews have good evidence; no dental chew has a VOHC plaque seal in cats.
• What NOT to use: antlers, hooves, nylon bones fracture teeth (BVDA — esp. maxillary fourth premolar; "dent with a fingernail" test); standard dry food and raw bones may reduce calculus but do not decrease periodontitis risk (wild dogs: 41% periodontal disease, 48% fractured teeth; feral cats: 61% periodontal disease, 9% calculus).
• Adjuncts: chlorhexidine rinse — effect up to 7 h, no resistance except *Pseudomonas* spp., poor palatability; zinc ascorbate gel (tasteless); delmopinol chews (weaker than chlorhexidine); water additives generally insufficient (biofilm up to 500,000× more antiseptic-resistant).

Recommendations

• Daily homecare recommended — plaque accumulates in 24 hours; without it professional therapy is severely limited

  Expert consensus (Dental Guidelines Committee)

• Toothbrushing is the gold standard: 45° angle, gingival margin, circular motion, once daily (twice daily in established disease)

  Expert consensus

• Train pets gradually with positive reinforcement (5-step toolkit), from 6–7 months or after a professional cleaning; never force it

  Expert consensus (GDC Toothbrushing Toolkit)

• Combine active (brushing, best rostrally) and passive (chews/diets, best caudally) homecare

  Expert consensus

• Select products with peer-reviewed evidence and/or the VOHC seal; they must clean to and below the gingival margin

  Expert consensus

• Avoid hard chews (antlers/hooves/nylon bones), raw bones, standard-dry-food reliance, human toothpastes and baking soda

  Expert consensus

• Discuss homecare at the first (puppy/kitten/vaccination) visit with the whole staff; consider chlorhexidine rinses in high-risk patients

  Expert consensus

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