Effectiveness of a Vegetable Dental Chew on Periodontal Disease

Effectiveness of a Vegetable Dental Chew on Periodontal
Disease Parameters in Toy Breed Dogs
Clarke DE, Kelman M, Perkins
N
Summary:
Sixteen toy breed dogs completed a parallel, 70-day two-
period, cross-over design clinical study to determine the
ffict of a vegetable dental chew on gingivitis, halitosis,
plaque, and calculus occumulations. The dogs were
randomly assigned into two groups. During one study
period the dogs were fed a non-dental dry diet only and
during the second study period were fed the same dry
diet supplemented by the daily addition of a vegetable
dental chew. Daily administration of the dental chew
was shown to reduce halitosis, as well as, signtficantly
reduce gingivitis, plaque and calculus accumulation and
therefore may play a signtficant role in the improvement
of canine oral health over the long-term. J Vet Dent 28
@); 230 - 235, 2011
lntroduction
Periodontal disease is a significant problem in clientowned dogs' with toy breeds being over-represented.'' While
there are many factors that contribute to its prevalence,
accumulation of a bacterial plaque biofilm is the initiating
u
cause and thus plays a key role in its pathophysiolo gy.o During
the initial stages of plaque formation, the bactena are usually
the resident flora of the oral cavity and include predominantly
aerobic , gtam positive colony forming non-motile cocci.t
When plaque is not removed from the tooth surface, it
is constantly bathed in saliva and will minerahze to form
dental calculus.t Calculus, per se, is not the primary cause of
periodontal disease, but once formed, it immediately becomes
covered with dental plaque, thus advancing the disease process.
contact with the gingival margin, initiates an
Plaque,
or
inflammatory response, termed gingivitis, which results in
gingival edema and a potential increase in the periodontal
sulcus depth. Left untreated, there is a shift in the subgin gival
Figure
1
sealants2o, clindamy
cttf', and chlorhexrdrne"-t' . While
it
is
generally accepted that toothbrushing in humans is the most
effective method of plaque removal, it is not the most common
method in the dog, as few owners are diligent in brushing their
dogs' teeth over the long-term and many dogs will not tolerate
daily brushin g.28-30 Since a major limiting factor in providin,_e
adequate canine dental home eare is owner compliance, an eas)'
option, such as feedrng a daily dental chew, may contribute to
an improvement in canine oral health.
The purpose of the study reported here was to evaluate the
effectiveness of a vegetable dental chew" on reducing halitosis.
gingivitis, and dental substrate accumulation in toy breed do.,es.
Material and Methods
Sixteen toy-breed dogs, six males, ten females, age
7 .7, median - 6.3), and weighing
5 .7 , median - 5.6) were selected.
Dogs needed to satisfy the following criteria to be selected
for enrollment in the sfudy: consenting owners, toy breedfull dentition, normal occlusion, clinically healthy with
respect to a complete physical examination, fulI blood, and
urine evaluations. Eighteen teeth were used for evaluations:
maxillary third incisor teeth (I031203), maxillary canine teeth
(1041204), maxillary third premolar teeth (I07 1207), maxillary
fourth premolar teeth (108/208), maxillary first molar teeth
(1091209), mandibular canine teeth (3041404), mandibular
third premolar teeth (307 1407), mandibular fourth premolar
teeth (308/408) and mandibular first molar teeth (3091409).
Dogs were housed individually and provided their
respective diet once daily and water ad libitum. TWo different
3 to l4-years (mean 4.I to 8.4-kg (mean :
feeding regimes were used: a negative control group fed a dr1'
dietb and a test group receiving the same diet with the addition
of a daily vegetable chew. A11 dogs were given their daily food
at 4 pm and the vegetable chew between 8 pm - 12 pm. No
plaque or calculus control treats, chews, chew toys, or dental
hygiene products were provided to the dogs for the duration of
the study, other than the vegetable chew.
The chew has a unique Z shaped design, intended to
enhance prehension and prolong chewing time (Fig. 1). The
ingredients of the chew included corn starch, glycerin, so)-a
protein, rice flour, sorbitol, corn derivatives, water, and potassium
sorbate with no meat products. There were no active anti-plaque
or anti-calculus or agents, meat products in the vegetable cheu's.
Vegetable chew".
J VET DENT Vol 28 No.
bacterial population towards a larger proportion of anaerobic
bacteria, resulting in an increase in volatile sulfur compounds
and halitosis.'
Regardless of the disease stage, plaque control is critical
to therapeutic success.n Numerous mechanical and chemical
methods have been proposed for plaque control and its effect
on periodontal health in the dog, including toothbrushing'o-o',
dental chews with and without enzymesl3-l8, gelstn, barrier
4
Winter 2011
Figure
2
Study overview including diet allocation and dental examinations.
Day
-14
Food
Accustomization
Day -7
Chew
Accustomization
Blood/U rine
and
Clin ical
Exam ination
Day 0
Day 28
Day 56
Gingivitis/
Halitosis
Evaluation
Gingivitisi
Plaque/
Calculus/
Halitosis
Evaluation
ivitis/
Plaquei
Calculus/
Halitosis
Evaluation
Dental Scaling
Allocation to
Groups
Diet +/- Vegetable Chew
Diet
At the beginning of the study (Days -14 to -7), all dogs
underwent clinical and oral examination and had blood and
urine analyzed. A11 dogs were fed the dry diet for l4-days in a
pre-study, acclimation phase (Fig. 2). At Day -J, aII dogs were
given a vegetable chew to ensure acceptance for a minimum of
2-mtnutes. In a previous study, it was shown that dogs need to
be acclimated to a chew prior to commencement of the study
in order to achieve ideal compliance from the outset.lS At Day
0, each dog was anesthetrzedusing buprenorphine' (0.007 5 mgl
kg), acepromazineo (0.04 mglkg), and atropine" (0.06 mglkg)
premedication SQ. A cephahc intravenous cathether was placed,
fluids' commenced at 10 mllkglhr, anesthesia induced with
alfaxaloneg (2.0 mg/kg) IV and maintained via endotracheal
tube with isofluranen in oxygen (ILlmtn). Following anesthesia,
all dogs had gingivitis evaluated. A Williams periodontal probe
was placed subgingivally on the buccal side of each evaluated
tooth and based on visual assessment a numerical gingivitis
score was given using a modification of a previously designed
method3l: 0 - no inflammation and no bleeding on probing; 1
- inflammation and no bleeding on probirg; 2 - inflammation
and delayed bleeding on probing;
3-
inflammation and
immediate bleeding on probing. The sum of the gingival scores
was divided by the number of evaluated teeth (n - 18) to obtain
a mean
G ing
gingival score for each dog.
The teeth were thoroughly and completely scaled' followed
by polishing with a fine grade pastei supra- and subgingivally.
After polishing, halitosis was evaluated using a digital halimeterk.
Three separate measurements were obtained by placing the
collection tube into the dog's mouth over the tongue to the level
of the maxillary fourth premolar teeth and manually holding
the mouth closed. The halimeter collected oral breath for
l80-seconds and gave a quantitative measurement. This was
repeated twice with 30-second intervals between collections.
The individual readings were summed and averaged in order to
obtain a mean mouth halitosis score.
Following this anesthetic episode, each dog was allowed
to recover from anesthesia in individual cages and eventually
returned to their owner. Each dog began the study according
to the "clean tooth model" since the absence of plaque was
confirmed with 2 % erythrosein'. On Day 0, each dog was
randomly allocated into two groups of eight. One group was then
randomly allocated to be the negative control, while the other
group received the vegetable chew. On Day 28,the groups were
interchanged, so each dog effectively acted as its own control. At
Days 28 and 56, gingivitis, halitosis, plaque, and calculus were
evaluated and scored under general anesthesia using the same
regime as described above. The same scorer (DEC) was used at
all evaluation times and was blinded to the feeding regimens and
the scoring order. Dogs presented to the scorer were randomly
selected from each group at each evaluation time.
Plaque evaluation scores were determined using a method"
that was modified" to visually assess plaque coverage and
thickness on the buccal surface of the evaluated teeth aided by
applying 2 % erythrosine, immediately rinsing with water, and
gently drying the tooth with air. The tooth crown was divided
horizontally into gingival and coronal halves and each half
assigned a numerical score for both plaque surface areacoverage
(0 no observable plaque; 1 <25 %;2 - between25 and 50
:
-
%; 3 - between 50 and 7 5 %; 4 : > 7 5 %) and plaque thickness
(0 - no observable plaque; 1 : pink to light red; 2 - red;3 : dark
red)). The individual coverage and thickness scores from the
gingival half of the tooth were multiplied to obtain the "gingival
half score". The coverage and thickness scores from the coronal
half of the tooth were multiplied to obtain the "coronal half
score". The gingival and coronal half scores were added to
obtain the total tooth score. The sum of the 18 gingival half
scores was divided by the number of evaluated teeth (n - 18) to
obtain a"mean gingival score" for each dog. The sum of the 18
coronal half scores was divided by the number of evaluated teeth
(r - 18) to obtain a"meancoronal score" for each dog.The sum
of the 18 tooth scores was divided by the number of evaluated
teeth (r - 18) to obtain a "mean mouth score" for each dog.
Calculus evaluation scores were based on visual assessment
coverage and thickness on the buccal surface of
of calculus
J VET DENT Vol. 28 No. 4 Winter 2011
Figure 3
Figure 4
Mean gingivitis scores*
Mean halitosis scores.
9
o
O
a
120
0)
^^
Jz
1 15
@
(n
'a
o
r
30
(d
'o
.g
=
(t
Cg
(d
c
(g
c)
C)
28
100
Non-dental
Diet
Veggie Chew*
*{= Statistically Significant
the evaluated teeth following removal of the plaque and 2 %
erythrosine by gentle toothbrushing, rinsing with water, and
gently drying with air.3o The tooth crown was divided vertically
into mesial, central , and distal thirds and each section assigned a
numerical score for both calculus surface area coverage (0 - no
observable plaque; 1 : < 25 %; 2 - between 25 and 50 %; 3 between 50 and 7 5 %; 4 : > 7 5%) and calculus thickness (0 - no
calculus present; 1 : < 0.5-mm;2: > 0.5-mm). The individual
coverage and thickness scores from the mesial section of the
tooth were multiplied to obtain the "total mesial score", which
was repeated for the central and distal sections. The total mesial,
central , and distal scores were summed to obtain the "total tooth
score". The sum of the 18 total tooth scores was divided by the
number of evaluated teeth (r - 18) to obtain a "mean mouth
score" for each dog.
Aggreg ateddatasets were created for analysis.' Histograms
were inspected for each of the variables to check for normality.
Halitosis was right skewed and was log transformed prior to
analysis. A11 other variables showed histograms consistent with
normal distributions. Baseline measurements for gingivitis and
halitosis were entered as a covariate. Data was analyzed in an
approach approprtate for crossover designs. Analyses were
performed using PROC mixed with fixed efflects coding for
treatment, period, and sequence and a random effect coding for
arnmal nested within sequence. Repeated-measure ANOVA and
analysis of variance tests were used. Data is expressed as mean
+ SEM. P values ( 0.05 were considered significant.
Results
The time taken by each dog to consume the chew ranged
from 2.2 to lO-minutes (6.82 + 2.31). Three dogs chewed for
of < 5-minutes
and 13 dogs chewed for between 5.9
to l0-minutes. The chewing time on the left and right sides of
the mouth was 1.1 to 6.0 -minutes (3.28 +I.27) and 1.1 to 5.5
anavetage
J VET DENT Vol. 28 No.
4
Winter 2011
Veggie Chew
minutes (3 .54 + 1.20), respectively (Table 1).
The mean gingival score was lower (II.25 %) when the
dogs were given the chew (1 .I2 + 0.05) compared to when they
were fed only the dry diet (1.26 + 0.05). There was a significant
(P - 0.0137) reduction in mean gingival score when the dogs
received the vegetable chew. There was no association between
the pre -trtal gingival score and subsequent scores during the
tnal (P - 0.87) fTable 1 and Fig. 3].
The mean halitosis score was lower (6.6 %) v{hen the dogs
were given the chew (3 .40 + 0.23) compared to when they were
fed only the dry diet (3 .64 + 0.23), however this result was not
significant (P :0.41) fTable 1 and Fig. a].
There was evidence of a significant sequence effect on
plaque, therefore a restricted analysis was performed using
only data from the first period to avoid any possible impact of
a sequence effect on the results. The mean plaque score was
lower (37 %) when the dogs were given the chew (3.00 + 0.54)
compared to when they were fed only the dry diet (4.76 + 0.39).
There was a significant (P : 0.014) mean reduction in plaque
when the dogs received the vegetable chew (Table 1 and Fig. 5).
There was evidence of a significantsequence effect on calculus,
therefore only data from the first period were analyzed. The
mean calculus score was lower (70.2 %) when the dogs were
given the chew (0.50 + 0.24) compared to when they were fed
only the dry diet (0.50 + 0.24). When the dogs received the
vegetable chew, there was a significant (P - 0.0005) mean
reduction of calculus accumulation (Table 1 and Fig. 6).
A sequence effect between the first and second groups was
observed with respect to plaque and calculus accumulation.
While there is no definitive current scientific explanation,
possible reasons for this observation include an effect related
to deposition of some matertal from the dental chew on the
tooth surface during chewing which is not removed during
scaling and polishing, or modification of the microbiological
Table
1
Comparison of gingivitis, plaque and calculus indices, and chewing times in dogs fed a vegetable chew.
Left Side of Mouth
Dog
ID
Gingival
Scores
1
2
3
4
5
6
7
8
I
10
11
12
13
14
15
16
00
144
1 00
1 22
078
122
1 22
.1
11
100
1.11
1.00
111
100
1 00
1 89
1 00
1
Plaque
Scores
Calculus
Scores
489
070
0 04
0,56
8.56
085
044
093
022
170
256
18.1
093
070
0 00
0 85
0 56
161
239
2.2
411
339
267
2.72
350
633
3 89
372
3.78
517
306
228
Right Side of Mouth
Chew Time
(min)
31
45
3,9
33
31
32
31
21
11
40
11
60
25
4.1
46
2,8
Gingival
Scores
Plaque
Scores
133
133
1.11
078
067
089
1 33
133
122
1 44
100
078
100
1.1 1
133
100
378
289
2.67
200
339
294
2 72
350
444
7,61
522
550
378
606
589
256
or local immunological environment resulting rn a decreased
bacterial population. Clinically, there is no evidence that a nonmedicated dental chew should have any long-lasting effect on
the reduction of plaque and calculus accumulation for a period
of time after cessation of the chew. Any residual plaque deposits
that may be attached to the tooth surface should have been
removed following scaling and polishing. The accumulation
of plaque is independent of previous accumulations as well
as independent of the gingivitis present or halitosis present,
leading to a possible conclusion that chewing may result in
of the local immunological environment, or
microbial populations. Certainly, this result warrants further
scientific investigation.
Calculus
Scores
Combined Mouth
Chew Time
(min)
063
44
056
55
067
41
033
3,9
019
3.9
019
36
0.37
2,8
070
21
104
11
2 67
39
204
1'1
126
3B
026
3B
000
41
085
46
030
40
Gingival
Scores
233
277
2,11
200
145
211
255
244
222
2,55
200
1 89
200
211
3 22
200
Plaque
Scores
Calculus
Scores
Chew Time
B 67
1.33
75
4 50
060
10 0
5 06
123
8.0
4 28
089
750
104
72
70
6.33
063
6B
5 39
130
622
0,92
7 94
274
59
42
22
79
13 94
523
911
385
2.2
922
219
9B
7.56
096
64
1123
000
8.2
8.95
170
91
484
086
6,8
giving a dental chew twice daily to Beagle dogs, which also
demonstrated a significant difference between mean plaque
scores for maxillary and mandibular teeth when compared to
A significant reduction in plaque was also
demonstrated in another study where Beagle dogs were fed a
dental hygiene chew once daily." However, in two other studies
in small breed dogs (mean - 7 kg), no significant reduction in
plaque accumulation was reported with the same chew,tz,zz yat
feeding the same chew to Iarge dogs (minimum 23 kg), did
show significant reductions in plaque accumulation.to'3s
a control group."
modification
Figure 5
Mean plaque scores*,
Discussion
Dental plaque has been shown to be the primary contributor
to the initiation of gingivitis and in the development of calculus
in dogs.' An assumed hypothesis and general belief amongst
veterinarians and pet owners is that when a dog chews, there
is a direct inverse correlation between time spent chewing the
product and accumulation of dental substrates present on the
tooth surface. It is also assumed that tf a product is able to
demonstrate a significant reduction in plaque accumulation, a
logical consequence ofevents wouldbe a decreasedhost immune
response proportional to reduced bacterral load, inflammation
and gingivitis, and reduced calculus accumulation.
There has been considerable research time and funds
dedicated to investig atrng the most efficient methods of
preventing the accumulation
of
I
a8 40
q)
f
o
(d
o-
E
o
35
dental deposits utilizing
mechanical techniques. The effects of a dental chew have been
reported in a number of breeds, other than toy-breed dogs. A
significant reduction in plaque was achieved in one study by
(min)
Non-dental Diet
.
Veggie Chew*
= Statistically Significant
J VET DENT Vol. 28 No. 4 Winter 2011
The chew used in this study was specifically designed
with ingredients, chew srze, shape, and texture for toy-breed
dogs and for a market sector preferring not to feed a meatbased chew. The chew was formulated with the vegetable
ingredients, corn starch, glycerin, soya protein, rice flour,
Figure 6
Mean calculus scores"
18
sorbitol, corn derivatives, water, and potassium sorbate, into
a unique Z-shaped design, intended to enhance prehension
and increase chewing time. The palatability of the chew was
16
14
excellent and all dogs chewed with consistency throughout the
study. There was no observed change in the dogs' health or
stool consistency throughout the study.
As dogs were selected from the general population, some
commenced the study with gingivitis and therefore, a predetermined gingival index. Paired /-tests were used to compare
gingival and halitosis indexes between the two sequences of
dogs prior to the start of the tnaI. The results indicated that
there was no statistical difference between the sequence groups,
with respect to either of these parameters, which supports the
hypothesis thatthere was no difference between these randomly
allocated groups at the start of the trial.
Owners were asked to record the total time spent chewing
the vegetable chew, as well as the proportion of chewing on
each side of the mouth. Each owner reported that the dogs
chewed on an individual end of the chew, with the opposite end
being extra-oral and visible, making it possible for the owner to
record the side of the mouth on which the chewing was done.
The total chewing time was therefore believed to be accurate,
as well as the proportion attributed to each side.
Halitosis is a commonly diagnosed condition affecting
dogs and is often the first clinical sign of dental disease noticed
by the dog's owner.'u Halitosis at any point in time may be
an indicator of periodontal disease since bacterta associated
with periodontal disease, in particular Porphyromonas sp.,
Bacteroides sp., Fusobacterium sp. and spirochetes produce
volatile sulfur compounds."-o' Voltatile sulfides arise from a
number of different locations, including plaque biofilms on the
teeth, the oral tissues including the tonguo, gingiva, pharym,
tonsils, and reflux from the stomach. We have hypothesized
that the halitosis reading would be primarily associated with
the accumulation of plaque on the tooth surface and as such,
it would be significantly reduced by cleaning the teeth and
reducing plaque accumulation by the daily offering of a
vegetable chew. In one previous study, gingivitis was associated
with elevated levels of oral malodor.o' In this study, we did not
confirm this observation, with some dogs recording a dramattc
decrease in halitosis (up to 90 oh reduction), but in others there
was a smaller decrease or no decrease at all. Discrepancies
between individual dogs and the lack of a significant decrease
overall may be best explained by a disproportionate reduction
of plaque bacteria associated with the teeth, compared to the
levels of sulfides generated from the other surfaces (tongue,
pharynx, gingiva, stomach, etc). This was consistent with
a previous review, which suggested the majority of plaqueproducing volatile sulfurs are found on all surfaces within the
oral cavtty.4' Therefore, the reduction reported in this study
may only reflect the removal of plaque on the teeth while
the greatest proportion of halitosis is produced by bactena
J VET DENT Vol. 28 No.
4
Winter 2011
3
o
3
12
U)
1o
f
O
(6
o
08
c
(6
C)
04
02
00
Non-dental
Diet
. = Statistically
Veggie Chew*
Significant
elsewhere in the oral cavity.
Plaque accumulates on the tooth surface immediately
following cleaning. Mechanical abrasion of the tooth surface
immediately after cleaning results in minimal accumulation
of plaque and in turn, a reduction in calculus accumulation.
If
calculus is reduced" there is less roughened surface area
for further plaque to accumulate, and in furn, less calculus
accumulates, effectively providing a self-regulating process.
We propose that a chew that directly acts to prevent plaque
accumulation should have a direct and indirect effect in reducing
calculus accumulation and gingivitis, thereby improving the
oral health of the individual dog.
The significant plaque and calculus reductions reported here
are consistent with recent sfudies on meat-based chews, which
have published plaque reductions in the range of 13.1 - 38 oh'ou't'e'22'3s
and calculus reductions in the range of 45.8 - 63.3 oh.15-\t'22'44
However, tt is difficult to accurately compare these reductions,
as each study uses a different base diet and different trtal design
making direct comparisons inappropriate.
Client owned toy-breed dogs are predisposed and as such,
over-represented in the cohort of dogs that are affected by
periodontal disease.o' Anecdotally, these dogs ate often fussy
eaters and difficult to pill and administer dental homecare.
Toothbrushing, the gold standard of human dental homec ffia,
is often ineffective in controlling plaque in dogs based on
difficulty administering the technique or poor compliance.
Therefore, a product that can be easily administered by the
owner and is readily accepted by the dog should increase
and improve oral health. In this sfudy, we found the unique
vegetable dental chew to be very well accepted, reducing
dental substrates and gingivitis. Thus, the daily addition of the
vegetable chew should decrease the prevalence of periodontal
disease and improve the oral health in toy breed dogs.
"
o
"
d
'
I
e
n
'
,
k
I
'
Hills Science diet (small breed maintenance), Hills, Topeka, USA
C.E T. VeggieDent Chews, Virbac Animal Health, Fort Worth, USA
Temgesic Injection, Reckitt Benckiser, West Ryde, NSW Australia
A C.P.2, Delvet,
Seven Hills, NSW Australia
Atropine Injection, Apex Laboratories, Somersby, NSW, Australia
Hartmans, Baxter, Old Toongabbie, NSW, Australia
Alfaxan-CD RTU, Jurox, Rutherfor{ NSW Australia
Isorrane, Baxter Healthcare, Old Toongabbie, NSW, Aushalia
21
Warrick JM, lnskeep GA, et al Effect of clindamycin hydrochloride on oral malodour,
plaque, calculus and gingivitis in dogs with periodontitis VetTherapeutrcs 2OOO; 1 5-16
22
Rawlings JM, Gorrel C, Markwell PJ Effect on canine oral health of adding chlorhexidine to
a dental chew J Vet Dent 1998; 15. 129-134
23
24
Hull PS, Davies RM The effect of a chlorhexrdine gel on tooth deposits in beagle dogs J
Small Anim Pract 1972, 13'.207-212
25
Hamp SE, Lindhe J, Loe H Longterm effects of chlorhexidine on developing gingivltis in
the beagle dog J Perrodont Res 1973; B: 63-70
26
Tepe JH, Leonard GJ, et al The long term effect of chlorhexidine on plaque, gingivitis,
sulcus depth, gingival recession and loss of attachment in beagle dogs J Periodontal Res
1983; 18.452-458
27
Gruet P, Gallard C,
2002,19: 11-14
28
Mandoki S, Berkowttz H, et al Evaluation of the effects of brushing on the removal of dental
plaque J Clin Dent 1998; 9: 57-60
29
Van der Weijden GA, Timmerman MF, et al Relatronship between the plaque removal
efficacy of a manual toothbrush and brushing force J Clin Periodontol 1998; 25.413-416
30
Miller BR, Harvey CE Compliance with oral hygiene recommendations following periodontal
treatment of client-owned dogs J Vet Dent 1994, 11 : 1B-19
31
Loe H The gingival index, the plaque index and the retention index systems J Periodontol
1967,38: 610-616
Sonic scaler, NSK, Japan
Polishing paste, Dentalaire, California, USA
Halimeter, Interscan Co., Chatsworth, California, USA
Plaque disclose gel, Professional Dentist Supplies, Bayswater North, Australia.
SAS Institute, SAS Campus Drive, Cary, NC, USA.
Author lnformation
From Dental Care for Pets, 81 Belgrave-Hallam Road,
Hallam, Victoria, Australia,3803; Virbac Animal Health
(Kelman), 361 Horsley Road, Milperra, NSW, Austraha,2214;
andb AusVet Animal Health Services Pty Ltd (Perkins), 30
Plant Street, Toowoomba, Queensland, Austraha, 4350. Email:
dav id@dental
c
are
forp
et
s .c
om au
32
This study was sponsored by Virbac Animal Health.
et al
Use of an oral antiseptic bioadhesive tablet in dogs J Vet Dent
Quigley GA, Hein JW Comparative cleaning efficiency of manual and power brushing J
Am Dent Assoc 1962,65 26-29
.
Acknowledgements
Hamp SE, Emison CG Some effects of chlorhexidine on the plaque flora of the beagle dog
J Periodontal Res 1973; 12'.28-35
33
Turesky S, Gilmore ND, Glickman I Reduced plaque formation by the chloromethyl
analogue of victamine C J Penodontol 1970', 41. 41-43
34
Warrick J, Gorrel C A more sensitive method of scoring calculus Proc of I1th Annual
Veterinary Dental Forum Denver, USA, 1997.134-136
35
Gorrel C, Rawlings JM The role of toothbrushing and diet in the maintenance of periodontal
health in dogs J Vet Dent1996; 13: 139-143
36
Simone A, Jensen L, et
71-74
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