Tuesday, July 28, 2009

Pearly White Profits From Teeth Cleaning

This is how a Jack Russell Terrier smiles.

The cover of the February issue of Veterinary Economics features an article entitled Pearly White Profits in which veterinarians are advised that canine and feline dentistry are great profit centers.

Tips are given on how to get the receptionist to bill pad suggest new services such as teeth cleaning, and the article says every veterinary practice should have associates "devote two to five minutes of every 15- to 20-minute office visit to talking about dental care."

The article says everyone in the practice should "make a list of the top 10 things you can do to increase the number of dental procedures your practice performs."


But you know what this article never says or even suggests? That there is any scientific evidence to support the notion that there is any medical benefit to annual teeth cleaning.

Absolute silence there!

And you know why? Because no such evidence exists.

And, here's the kicker: that's not just true for dogs, it's true for humans too. As the Journal of Evidence-based Dentistry notes, there is "insufficient evidence to understand the effect of routine scaling and polishing".

And that's for humans. For dogs?

Well, do you really need to know which way the wind blows?

Think it through for a minute. What's the main difference between the teeth of a human and the teeth of dog?

That's right! The human can be expected to live 80 years with adult teeth, while the dog will generally be dead after 12 or 13 years.

But there's more.

You see, human teeth cleaning can be done with the human wide awake and sitting up in a chair, while canine dentistry has to be done with the dog completely knocked out under general anesthesia.

That's a big difference!

And the reason that's a big difference is that anesthesia is risky for both humans and dogs.

In fact, complete general anesthesia is so unsafe that today, when a human heart stent is put in, the patient is almost never put completely under. The sames is true for laser eye surgery, most small tumor removal, and carpal tunnel surgery.

In fact, veterinary anesthesia is so dangerous your vet will insist on doing a full run-up of blood tests before it is done, and even then anesthesia complications and fatalities are fairly common.

And yet, your vet cannot show you a single scientific study that shows that dental scaling and polishing on a dog or cat has the slightest medical benefit.

Not one.

Bottom line: Annual teeth cleaning is not about canine health care, it's about veterinary wealth care.

The entire field was invented, approximately 20 years ago as a way of bringing more money into veterinary practices to replace money disappearing because of changing vaccine protocols for dogs and cats.

Go ahead and brush your dog's teeth. Home-based prevention is good medicine. But when it comes to an annual dental cleaning at the vets, just say NO.

Does that mean there is no place for canine dentistry?  No, not at all.  I recommend taking in a dog when it's about five years old for a teeth cleaning, and then again when it's about 10.  The cost is high, and the benefits are not clear, but a good scaling of the teeth may make them look a little better and may reduce doggy breath a bit (but do not count on much change on either score).  



Anonymous said...

Tooth brushing, not cleaning, is what a responsible vet clinic should be pushing IMO.

Another pet peeve of mine is that most vets advise against giving dogs raw bones like beef femurs to chew on. 'Cause of course dogs didn't evolve with the ability to chew and digest raw meat. [sigh] Mine get their teeth brushed and I give them raw bones regularly. I've never had any of my dogs' teeth cleaned and the only tooth-related problem we've had is when one dog's malformed tooth fell out.

Pai said...

Coincidence that a lot of the food vets push is the kind of cheap crap that probably contributes to tooth decay in dogs? I think not.

Don't feed your dog complete garbage food and their teeth (and coat) will be healthy. My mother cooked for our family dogs (stuff like liver with rice/peas or cheap meat) and they never had doggy odor and never needed their teeth cleaned. That showed me firsthand that a good diet does matter -- the same goes for us humans, as well. =P

PBurns said...

While food plays some role in canine dental problems, the role is actually the opposite of what you suggest Pai -- soft foods tend to result in more dental problems than hard kibble, as a general rule. That is why raw bones and chicken wings tend to help teeth -- they abraid the teeth in a natural fashion. Human foods, on the other hand, are too easily digested by dogs, and sometimes contain sugars that can speed dental decay.

Of course, the main factor in dental issues (other than age, whether a dog owner occassionally brushes the dog's teeth, and whether the dog has a tendency to chew on rocks) is the dog's SIZE.

Bigger breeds tend to have fewer dental problems, while small dogs tend to have quite a few (often because their teeth are too crowded in their mouth).


Viatecio said...

Smartdogs, our vet said the same thing about the raw bones. I actually looked it up, and apparently there are some cases where the dog eats too much bone or the sharp shards from long bones don't digest very well, but every single person I've talked to who feeds raw or gives raw bones tells me they've had no problems. I actually have a consultation appointment set up with the vet to discuss this. My dog can choke on her kibble just as easily, chewing rawhide actually can cause blockages if she swallows a huge chunk, and she has no interest in Nylabones. She LOVED the one raw bone I gave her before my parents found my stash and threw them away because they don't want her to have them because the vet said so because the vet knows ALL because...do your eyes hurt yet?

We had our old dog's teeth professionally cleaned maybe twice or three times at $200 a pop before we said 'The heck with that' and started just brushing his teeth nightly.

I was also told that with both humans and dogs (probably pertains to cats too) that if some scaled bacteria gets into the bloodstream through the gums, it can cause heart problems.

PBurns said...

The trick with bones is to make sure they are large RAW bones. Not bones from a roast, not boiled bones, not baked bones. RAW. Uncooked. Bones.

Knuckes are great as they give the dog something to chew on, but RAW chiken wings are pretty great too as they are a combination of flesh, fiber, fats and canine entertainment. Again, these are RAW chickens wings that come in big bags. I give them to my dogs frozen, as they seem to last a little longer.


Gina said...

I'm sensing some serious frustration over your work trying to get health-care reform, and subsequent redirected aggression. How very Terrier of you!


PBurns said...

Health care reform is going swimingly, actually. I am not actually on the inner workings of that this times (which may explain why it is going so well), but I have never seen anything move faster and with more core agreement on some big things. Helth care reform WILL happen, and in the last 17 years, I have never said that before.

I mostly work on massive health care fraud issues, which is why it is so easy to see the same thing going on in the area of veterinary care, where fraud is a core business practice. Billing for medically unnecessary care? Kickbacks from companies? Price gouging? Kickbacks for referrals to other vets? This is the bread and butter of veterinary care, same as it is as the car dealership, and the ethics of the people in charge are about the same (no better or worse). You know these people, same as me Gina. They are not bad people. But they sure have rationalized price-gouging, selling medically unnecessary goods and services, upcoding, and kickbacks, haven't they? With Medicare and Medicaid those actions lead to massive fines and jail time. Not in veterinaruy care, where there is not legal recourse and the only answer is to EDUCATE. But you know what? That education never happens, because the people asked by the magazines and TV shows to educate are veterinarians, and they do not want to break their own rice bowl or the rice bowl of their friends. Has a veterinarian EVER gone on TV or written about veterinary scams like annual booster shots, annual teeth cleaning, and dosing with Heartguard in Minnesota in the winter? I don't think so. How sad is that!


Sara said...

Unneccessary vaccines - YES! If a vet is concerned about the risks of not "boostering," a blood titer test can set their mind at rest. The only vaccination my pets receive is that required by law for Rabies. I continue to hope that the Rabies Challenge Fund is able to complete the research and change legal requirements for rabies vaccination (www.rabieschallengefund.org)

Unneccessary poisons - YES! My dogs DO go running through tall grass and heavy brush on a regular basis, and I do not use monthly flea and tick preventative. I typically dose with Frontline twice a year, in the spring and fall when the ticks are heaviest. I comb my dogs thoroughly after they have been running to remove any ticks. I dose with heartworm preventative every 45 days during the warm season.

Unneccessary dental cleanings... erm...? I'm sorry, but I have to respectfully disagree with you on this one.

I'm a CVT and a professional groomer, and I see the insides of dogs' mouths on a daily basis. I see more dogs who DO need dentals and do not receive them than I see dogs who are getting unneccessary dentals.

Gum disease hurts. It can lead to heart, liver, and kidney problems. The majority of pet owners do NOT brush their dog's teeth on a regular basis, much less provide raw bones to chew. I all-too-often see dogs with fire-engine-red gums that bleed constantly, teeth with the roots or nerve pulp exposed, and breath that can knock you down from 10 paces. These dogs live in constant pain every single day, and their lives are most likely shortened by their severe gingival decay. These dogs often need not just a dental cleaning, but multiple tooth extractions and antibiotics to clear up severe gum infections. Think of how much it hurts when you have a little toothache. Dogs may process pain differently than we do (autistic scientist Temple Grandin suggests that for most animals, fear is more aversive than pain), but it is clear that dogs do feel and are affected by pain.

Certainly there are vets out there who recommend unneccessary dentals to pad their wallets. I occasionally have dogs come into my grooming practice who have had their first dental at less than 2 years of age - ridiculous! However, I think in this case education needs to be done not just on preventative care, but the necessity of proper medical care when owners fail to keep up on brushing.

Not treating a dog's painfully infected mouth is every bit as abusive as starving or beating that dog, IMO.

PBurns said...


Read what I wrote again Sara.

I did NOT say to ignore the mouth, or that dental work was never needed.

What I said was that ANNUAL dental cleaning is a scam. And it is. There is not one shred of evidence to suggest it has any benefit except to a veterinarian's bottom line. And yet the vet trade now pressures EVERY patient to have an annual cleaning. That is BAD medicine, not just economically but in terms of anesthesia risk too.

And, just to recap a point I made earlier in the comments: dental problems are MOST related to size of dog (very small dogs have more dental problems), the age of the dog, whether the owner brushed the dog's teeth, type of food (hard food is best), and and whether the dog has a tendency to chew on rocks. If you have a large dog, you brush the dog's teeth, and feed it hard kibble, you will probably never have to have a dog's teeth cleaned.


Viatecio said...

Patrick, I think the question now is how often is appropriate? Obviously annual cleanings are unnecessary. But at what point should someone, especially someone with a small dog, throw in the towel and get the teeth cleaned? Obviously waiting until the gums are bleeding and the dog can't chew the kibble is too long, but should they spend the whole dollar amount for just a small amount of tartar? A little buildup is OK in my book, but if most of the tooth is discolored, that's very concerning.

Ironic thing is that everyone complains about "dog breath" and when I ask them "Well, do you do anything with his teeth?" I get the 'Are you crazy?!' response. They either just don't think about it or they think it's too snobby to brush the dog's teeth. People just don't put two and two together, and when they do, they want the easy way out: breath bones/Greenies, "YipYaps" mints, that stuff you put in the water dish that doesn't do much at all...they don't want to actually DO anything. They want something to do it for them. (And we all know that this is the case for many things, not just pet dental care!)

PBurns said...

I do not take dogs to vets for "well dog" visits, but I do think that a cleaning at age 7 for a dog that might live to 15 is not crazy. Before then, provided the dog is not a toy dog, decent food has been given (not canned food but kibble!) and a few chews and the occassional brushing has gone on, there should be no real dental problems. If there is, take the dog in. If not, not. "Doggy breath" is not a problem I have ever had with any of my dogs, but then I feed my dogs kibble, give them chews, and have found a use for my old toothbrushes. I use Crest on the dogs by the way. None of that "doggie toothpaste" stuff.


The Dog House said...

My puppers eat grain free, high protein kibble as a supplement basically. The remainder of their diet is home cooked, canned and ground raw.

Twelve years, no dentals, no icky teeth.

I have to respectfully disagree with the canned vs. kibble argument. Crappy, high carb/high sugar FOOD will raise the pH of the saliva and increase tooth decay and plaque buildup. High protein, acidifying foods will decrease the chances of tooth decay and plaque buildup.

I think that the original kibble vs. canned argument arose when canned food was sugared to the point of disgust. Newer, meat based canned foods do not have the same result.

I deal with a few hundred dogs a year through rescue, and several thousand through my work. I have found ZERO correlation between feeding good quality canned or homecooked and poor teeth.

I have, however, found some dogs, like people, who do require regular (even annual) scaling - although these are a TINY minority.

PBurns said...

Feed what you want Dog House, but the research on teeth has been done, and what you are saying is not supported.

Check out this simple one pager on diet and teeth from the American Dentistry Association >> http://www.ada.org/prof/resources/pubs/jada/patient/patient_13.pdf

They note that acids damage teeth, the OPPOSITE of what you are saying.

As for kibble, how about looking at the side of a bag? Dog food is not loaded with sugar, and NO research has ever been show that corn in kibble is bad for dogs. Not one iota of research. Zero. And it's not like there is not a LOT of money to made by doing that research. The problem is that the facts don't support it. Corn is fine in dog food. See links at previous posts on this blog. In fact, a dog food without corn or some form of grain in it is probably BAD for your dog as it is not likely to be fully balanced.

As for hard dog food, here too the research has been done: A diet of hard dog food is less likely to result in teeth problems than soft dog food. The bigger the pieces of hard food the better, as a general rule, which is why UNCOOKED bones and frozen chicken wings help teeth, as do pieces of rawhide and other chews. Hard kibble helps. Soft dog food, on the other hand, simply packs down in the small places along the gums. This kind of basic canine information is not hard to find. Use the Google, or just start here >> http://www.canismajor.com/dog/teeth.html


The Dog House said...

Patrick, the link provided is in regards to acidic foods and human teeth. Let's talk apples to apples here, ok? What I am talking about are foods that naturally lower the overall acidity level of saliva and stomach contents. NOT the feeding of acidic foods to human beings.

As for your previous articles on corn in dog food, I've read them, and I have no wish to read them again. While we agree on many things and I have a great respect for you, like many of your other readers I simply think you're incorrect on this one.

Corn is not a natural food for ANY being. Cows are not even capable of processing corn. Dogs are meant to eat meat. Not corn, not wheat, not soy...

I recently had a discussion with a veterinary nutritionist regarding grain in dog food and why I was such a strong proponent of grain free foods. I explained the results we have had with protein losing disorders, diabetes, allergies, coat issues, dental decay, obesity, joint degeneration, etc, when switching to a grain free, high protein, quality diet.

His response was that certainly these foods help these issues, but healthy dogs are "just fine" with grain inclusive. My response was why not use higher quality diets to prevent the issues in the first place.

As for your suggestion that food requires corn to be balanced... I don't think I've ever known you to make such an unsubstantiated claim.

And we haven't even discussed the fact that up to 90% of corn is GMO, leading to... well, who knows, because no one's ever done any long term testing. Sorry, but my dogs and I are not about to be the guinea pigs for frankenfood. I'm not judging, what works for one may not work for the other... but frankly you couldn't pay me to feed my dogs (or my rescues, or my clients' dogs) over processed bags of grain.

In addition, we do not vaccinate any more than ABSOLUTELY necessary... so who knows, perhaps that plays into things as well.

Incidentally, the amount of mucous the body of a grain free dog produces should be indicative about what a grain based diet does to the digestive tract...

PBurns said...

Dog House, you are typing a lot but not saying too much, and you are saying nothing that is supported.

Even your typing needs a little work.

In your original post, you wrote: "High protein, acidifying foods will decrease the chances of tooth decay and plaque buildup."

I take it you meant NON-acidifying foods? That would have the opposite meaning from what you wrote.

As for internal construction of dog teeth, they are made exactly the same as human teeth. You know that, right?

As for corn, here's the deal: there is NOT ONE live dog feed study showing that corn is bad for dogs. NOT ONE.

Stop typing and TRY RESEARCH. Try science instead of conjecture. Prove me wrong about corn, for example, and prove me wrong by finding a real live-dog double-blind feed trial. Dog food is a very competitive, multi-billion dollar a year industy, and I have actually done the research. My challenge to you, and anyone else as far as corn is concerned, can be found here >>

Knock yourself out. Prove me wrong. But recognize that I will not be posting more unsupported nonsense on this. I want science and research. Post that and I will be ecstatic.


Viatecio said...

With all due respect, at least one popular dog kibble does contain sugar AND a sugar substitute listed in the ingredients, which do have the same effect on teeth as the real thing. I looked at the ingredients of a few other types of kibble put out by that company and didn't see it, but still the fact that the one (the lowest quality kibble out of the company's whole lineup) has it is concerning. It's a popular feeding option because the commercials are so misleading and make it sound like the best thing for your dog, even better than (what I consider to be) their higher quality lines.

I looked at a few other brands and didn't see sugars listed per se, but I did see one or two that had corn syrup in them, which counts in my book!

So they're out there and people DO feed them, especially when there is not the money or even the variety of foods available to feed raw/organic/premium foods we see around these days. I know we eat sugars too, but humans are more conditioned to brush our teeth than we are to take care of the dog's. We shouldn't really be eating it either, if you think about it, especially in the quantities that we chow it down these days!

PBurns said...

Viatecio, , as you have seen from looking at kibbled dog food labels, kibbled dog food is NOT loaded with sugar. And guess what? There's a reason for that. Sugar is expensive and it is not what dogs are seeking when they look for food. Dogs seek FATS, which is why most calories in dog food come from fats, and complex carbohydrates are second.

In any case, sugar is not a poison. In fact, we humans eat a lot of it, and seem to generally be doing fine. In fact, however, there is very little simple sugar in dog food. If it is present in any amount at all, it is generally not in hard kibble dog food (i.e. hard dog food), but the semi-moist stuff.

When in doubt, go to the experts. What do they say? Consumer Reports asked them and they said: "There's no scientific evidence that any food is better than the next." Read the whole thing here >> http://www.consumerreports.org/health/healthy-living/health-safety/pet-food/overview/pet-food-ov.htm

Half the vets consulted, however, said they had seen dogs and cats becomes ill from home-made dog food.


Viatecio said...

I didn't mean to make it sound like all dog foods had sugar in it, I was just looking at some that did. It's not prevalent, thankfully. I was just trying to make the point that none is best (both humans and dogs can get carbs through the proper grains), some is OK, too much is bad. And since most people don't brush their dog's teeth (or give them appropriate chews) like they do theirs, even 'some' sugar might be pushing the 'OK' point since it just keeps building up.

Homemade diets have to be done very carefully to get the right balance of nutrients and whatnot. This is why we do not do this with our dog. It's also very expensive. Just like eating right for people involves fruits and veggies and whole grains, which aren't cheap on a budget. Most people on assistance programs buy what they can afford, which is the processed meal-in-a-box.

I know to go to the experts as well with a lot of things, but even the Applied Animal Behavior Science journal has more dog behavior studies advocating the use of clicker training in it's purity than any balanced method of training. I guess our experiences can differ in some ways and like others, I agree to disagree on some points. My dog is none the worse for wear being fed a sugar-free (and corn/wheat/soy-free) diet, even if our wallets aren't. Even our vet noticed a difference in her dogs when she switched them off a corn-based food to the one she recommended to us.

By the way, my consultation with the vet regarding her restrictions on raw bones and other chews is tomorrow. I'm just hoping I'll get at least a partial lift on the ban.

Anonymous said...

there is a lot of info here, thanks for sharing.

SLD said...

Thank you for a reasonable description of what is needed for canine dental care. My vet has been telling me that my dog needs a dental cleaning, and I was about to give in. It costs $180 and includes ultrasonic cleaning, polishing, and a fluoride treatment. That is twice the cost of MY dentist, and he says fluoride treatments aren't really necessary (I assume that is true for dogs, too). My wallet, my (non-working, may-or-may-not-be-a-terrier mutt) dog, and I thank you.
Sarah Linn Downing

Miki said...

My 5(?)-year-old rescue miniature poodle had a dental last Wednesday - at my home, by a licensed/insured/experienced/professional vet - cost me $55. My regular vet's office quoted me $750 plus $75 per extraction, which they were sure he would need. After 30 years using that practice, I'd finally had enough. To be sure, my new vet gears her practice toward poor people and shut-ins (but also sees people like me) - and I paid her double her usual charge, which she promptly applied to an elderly woman whose cat she treated later that day. But she recognized a need for animals to get affordable, necessary treatment, so that's what she does. I'll still use my old vet for things Dr. Marie can't do (x-rays, 24-hour care, minor surgeries), but that's it. Enough is enough.

Rich said...

This is an older thread but, I thought I would chime in. I'm a veterinarian. I can't speak for the whole profession obviously. I generally agree with much of your site and enjoy reading your take on issues affecting dogs. I love working dogs. I feel for dogs, which I see everyday in my line of work, who will never get to live up to their potential. The American Veterinary Medical Association (AVMA) and American Animal Hospital Association (AAHA) and other national groups have to "paint with wide brush strokes" when making recommendations. While the recommendations are not going to apply in every case, they will apply in most cases, or bring the greatest good to the greatest number of pets.
More and more veterinary practices are corporate owned, top down managed, and disinterested in quality medicine and customer service. Fortunately, I am a partner at a private practice with no plans of going corporate. I can still do things the way I see best and focus my attention on the needs of my individual patients.
Dogs don't HAVE to be vaccinated every single year or every 3 years even. A titer should be done to determine if a dog needs to be vaccinated. Unfortunately that costs around $150, the vaccine is only $22. In an effort to save cost, most people like to stick with the recommendations made by manufacturers and the state guidelines in regards to how often the dog should be vaccinated. I routinely offer to do an antibody titer, some of my clients prefer it.
In regards to dental cleaning, if your vet tells you "every dog needs an annual cleaning" and there is no room for discussion, go somewhere else. If he/she looks in your dogs mouth and can show you the periodontal disease, root exposure, broken teeth, abscesses, swelling/pain, etc...your dog needs its teeth cleaned. The amount of time between cleaning varies based on dog breed, diet, etc. As mentioned by PBurns, if every dog were larger, young, had regular brushing, and was eating quality kibble, we WOULD see less dental problems. In my experience, most dogs who come through my door are small, old, have NEVER had any brushing, they eat poor quality food, and (more increasingly) are now afraid of general anesthesia. Recipe for failure in my mind. I see poor dogs whose teeth have all rotten, the dog cries in pain when his face is approached.
I routinely stress with my clients, if you are not brushing their teeth, they will need regular dental cleanings, under anesthesia. "Anesthesia -free" dentals are a waste of time. My clients who do not want to risk anesthesia are not criticized or belittled, simply educated on the things they will need to do, how they can be proactive in preventing dental problems.
Just my opinion, based on my daily interaction with dogs.