Influence of Chewing on Dental Health in Dogs
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1 1 Influence of Chewing on Dentl Helth in Dogs S Bjone 1, W Brown 2, J. Billinghm 3, A. Hrris 3 nd P M c Genity 3 1 School of Psychology, University of New Englnd, Armidle, NSW, 2351, Austrli 2 Animl Science, University of New Englnd, Armidle, NSW, 2351, Austrli 3 Msterfoods Complementry Petcre, UK Astrct Periodontl disese is common prolem in dogs. Previous studies hve shown tht dentl deposits in dogs cn e reduced y feeding dily dentl chew. This study compres the effectiveness of two chews of different toughness. Both chews significntly reduced plque (p=0.003) nd clculus (p=0.008). The tougher chew required significntly more time (p=0.001) nd numer of ites (p=0.001) to consume thn the stndrd chew. The incresed time nd chewing to consume the chew with greter toughness ws ssocited with directionl improvement in orl helth, lthough not sttisticlly significnt, s compred to the stndrd chew. Introduction Periodontl disese is the most common orl condition in dogs (Gorrel, 1998; Hennet, 1995), nd is possily the most common disese in smll niml prctice (Gorrel & Roinson, 1995) or for dogs specificlly (DuPont, 1998; Hrvey, 1998). A study of 31,484 dogs exmined t privte veterinry prctices in the United Sttes found dentl clculus nd gingivitis to e the most commonly reported disorders (Lund, Armstrong, Kirk, Kolr, & Klusner, 1999). A frnk definition of periodontl disese would e gingivitis tht hs een neglected (Colmery & Frost, 1986). The disese hs multi-stge development initited y cteril plque tht ccumultes on tooth surfces, resulting in gingivl inflmmtion (gingivitis). Gingivitis does not develop unless plque is present (DuPont, 1998). Plque tht ccumultes for extended periods clcifies nd ecomes clculus, which is difficult to remove without professionl tretment (Hrvey, 1998). Clculus, in itself, is not detrimentl, ut it does provide incresed surfce re upon which more plque cn ccumulte (Gorrel, 1998; Lindhe, 1989). The gingivitis which results from plque ccumultion cn led to periodontitis, which gives rise to tissue destruction nd possile tooth loss (Hrvey, 1998). Chewing mechniclly disrupts the ccumulting plque, nd is therefore self-clening ction (Hennet, 1995). Chewing lso stimultes flow of sliv, which contins nti-cteril gents tht help clen the mouth (Gorrel, 2001). Therefore, chewing s initil physicl rsions s well s the resulting sliv flow help keep the mouth clen. In humns, studies hve found no significnt enefit from vigorous chewing of rw crrot or pples on orl helth (Lindhe & Wicen, 1969; Wde, 1971); however, this my e due to the structure nd spcing of humn teeth (Lindhe, 1989). The scissor ite of the dog would e expected to imprt greter enefit from vigorous chewing thn the humn teeth occlusion. Previous studies hve shown tht dentl deposits in dogs cn e reduced y feeding dily dentl chew (Brown & M c Genity, 2005; Gorrel & Bierer, 1999; Gorrel & Rwlings, 1996; Gorrel, Wrrick, & Bierer, 1999). It ws theorised tht greter reduction in dentl deposits could e chieved y incresing the toughness of the dentl chew, due to incresed mstiction nd time for consumption. The present three-period crossover study investigted the effectiveness of two chews, which were formulted to hve significntly different toughness properties. Efficcy ws determined y mesuring the extent of gingivitis nd the
2 2 ccumultion of dentl plque nd clculus (clinicl signs of periodontl disese) in dogs fed the different dietry regimens. The numer of ites nd time to consume ech of the chews ws recorded. Mterils nd Methods Study Animls Twelve dogs (7 mles nd 5 femles) of mixed reeds were used in the current study. Dogs ges rnged from 1 to 12 yers nd ody weights rnged from 4 to 27 kg. All dogs were housed in kennels t the University of New Englnd, Armidle, NSW, for the durtion of the study. A qulified veterinrin exmined ll dogs efore eginning experimentl procedures, nd ny niml tht ws considered unsuitle on the sis of helth or temperment ws excluded from the study. Animl Ethics nd Welfre Authority to conduct this study ws grnted y the UNE Animl Ethics Committee, in ccordnce with Section 25 of the Animl Reserch Act (1985). Written permission ws otined from ll pet owners for the inclusion of their nimls in this study. Animls received the highest stndrd of cre throughout the study, in ccordnce with UNE Animl Ethics Committee guidelines. Diet Throughout the study, ll dogs were fed Reference Diet consisting of premium complete nd lnced commercil dry dog food in comintion with premium complete nd lnced commercil tinned food in rtio of 1:2 y weight. The Reference Diet ws fed in the morning nd ny refusls were weighed nd recorded. Dogs were fed mintennce energy requirements (MER) s determined y the formul MER (kcl) = 140 x BW(kg) 0.75 nd mounts were djusted s necessry to mintin idel ody weight. Fresh wter ws ville d liitum. Study Design The study ws designed s Ltin squre three-period crossover study. The following three dietry regimens were fed over the three periods: 1. Reference Diet + Chew A 2. Reference Diet + Chew B 3. Reference Diet + No Chew (Control) The products tested in this study were two vritions ( stndrd nd modified form) of dentl hygiene chew for dogs. These chews differed in their texture, y the inclusion of dditionl fire in the experimentl chew to increse toughness, ut were otherwise identicl. Chew A: Chew B: Stndrd - This is n extruded strch-sed dentl chew for dogs. Modified - This experimentl chew included dditionl fire to crete chew with incresed toughness. Chew A cn e descried s hving firm ut chewy texture with the flexiility of grden hose. Chew B, on the other hnd, is more rigid nd does not end esily. Pedigree Advnce Adult - Turkey nd Rice (MsterFoods ANZ, Rgln, NSW) Pedigree Advnce Energy - Chicken nd Rice (MsterFoods ANZ, Wodong, VIC)
3 3 Experimentl Procedures Ech period of the experiment consisted of two-week pre-test phse followed y fourweek test phse. Dentl scoring procedures were conducted under light generl nesthesi t the conclusion of ech test phse. Pre-Test Phse (14 Dys) On Dy 1, the dogs teeth were scled nd polished to provide clen tooth surfce. The dogs teeth were then rushed ech fternoon for the reminder of the 2-week pre-test phse using doule-ended toothrush c nd dentl pste d. The purpose of the pre-test phse ws to encourge cliniclly helthy gingive prior to commencing the test phse. All dogs were mintined on the Reference Diet throughout the pre-test phse ut no dentl chews were given. Test Phse (28 Dys) On Dy 1, seline gingivitis scores were recorded. Teeth were then scled nd polished to provide clen tooth surfce. During ech 4-week test phse, dogs were fed either Chew A or Chew B ech fternoon in ddition to the Reference Diet fed ech morning. The order of chew presenttion per dog ws determined y Ltin squre crossover design s outlined in Tle 1. Dogs received smll or lrge version of ech chew depending on their weight. Both versions hd the sme cross sectionl re nd profile, ut differed in length. Dogs tht weighed under 10kg received the smller chew (Dogs #1-4), while dogs over 10kg received the lrger chew (Dogs #5-12). Dogs in the control group were fed the Reference Diet in the morning nd received no chew in the fternoon. Gingivitis, plque, nd clculus scores were recorded on the finl dy of ech test phse. Teeth were then scled nd polished in preprtion for the next pre-test phse. Tle 1: Ltin squre three-period crossover design, showing the lloction of dogs to tretments (Chew A, Chew B, or no chew). Dog 1 st Period 2 nd Period 3 rd Period 1 A B - 2 A B - 3 B - A 4 B - A 5 - A B 6 - A B 7 - B A 8 - B A 9 A - B 10 A - B 11 B A - 12 B A - c Dentipet (Arnolds, Shrewsury, UK) d Dentipet Premier dentl pste (Arnolds, Shrewsury, UK)
4 4 Dentl Scoring An exminer tht ws trined in these procedures nd lind to designted tretment groups performed dentl scoring. The order of ssessment ws lwys gingivitis, plque, nd then clculus. Plque nd clculus ccumultion nd the severity of gingivitis were scored using humn techniques modified for veterinry use. The methods re summrized in Tles 2-4. For ech dog, 22 teeth were scored for gingivitis, plque, nd clculus: Left nd Right Mxill: I3, C, P2, P3, P4, M1 Left nd Right Mndile: C, P2, P3, P4, M1 (I=Incisor; C=Cnine; P=Pre-molr; M=Molr) Tle 2: Gingivitis A modified Löe nd Silness (1967) gingivl index ws used. The uccl gingiv for ech scored tooth ws divided into thirds (mesil, uccl, distl). Ech site ws evluted y the following criteri. Criteri 0 = No gingivitis 1 = Slight inflmmtion slight redness ut no leeding on proing 2 = Mild inflmmtion slight redness nd swelling, with delyed leeding on gentle proing of the gingivl sulcus 3 = Moderte inflmmtion the gingiv is red nd swollen nd leeds on gentle proing of the sulcus 4 = Severe inflmmtion the gingiv is red or reddish-lue, the gingivl mrgin is swollen, nd there is tendency to spontneous hemorrhge or profuse hemorrhge on proing nd/or ulcertions long the gingivl mrgin Clcultions A totl tooth score for ech tooth ws otined y dding together the scores from ech of the three sites. The tooth scores from ll teeth scored were then verged to otin men whole mouth score for ech dog. Tle 3: Plque Index A Quigley nd Hein index (1962) s modified y Turesky, Gilmore nd Glickmn (1970) ws used. Plque ws disclosed y pplying Red Cote dentl disclosing solution (1.5% D&C Red No. 28; John Butler Compny, Chicgo, IL, USA) to the uccl surfce of ech tooth nd immeditely rinsing with wter. The gingivl nd coronl hlves for ech tooth were scored for coverge nd intensity. Criteri Coverge Intensity 0 = No oservle plque 1 = Light pink to light red 1 = 1-24% coverge 2 = Moderte red 2 = 25-49% coverge 3 = Hevy drk red 3 = 50-74% coverge 4 = % coverge Clcultions The coverge ws multiplied y the intensity fctor to give gingivl nd occlusl score for ech tooth. The gingivl nd occlusl vlues for ech tooth were dded together to otin tooth totl. The score for ech dog ws the men score for ll teeth scored.
5 5 Tle 4: Clculus Index The Wrrick nd Gorrel (1997) method ws used. The disclosed plque ws removed with toothrush nd the teeth were rinsed nd ir-dried. Ech verticl third (mesil, uccl, distl) of the uccl surfce of ech tooth ws scored for coverge nd thickness. Criteri Coverge Thickness 0 = No oservle clculus 1 = Light <0.5mm 1 = 1-24% coverge 2 = Moderte mm 2 = 25-49% coverge 3 = Hevy >1.0mm 3 = 50-74% coverge 4 = % coverge Clcultions The coverge score ws multiplied y the thickness score for ech tooth surfce. The tooth score ws the sum of the scores for ech of the three tooth surfces. The sum of the teeth scores ws verged to otin whole mouth men clculus score for ech niml. Chewing Mesurements Dogs were filmed eting dentl chews three times per ech week during ech Test Phse. An electronic timer ws used to record the time it took ech dog to consume the whole chew, strting from the first ite until the chew ws finished. The numer of gnwing ites executed on the left nd right side of the mouth nd other ites were recorded using Lortory Counter (Cly Adms, Prsippny, NJ, USA) while reviewing the video recordings. Gnwing ites were identified s ites used to sever piece from the whole chew. Often, the chew ws plced to the ck of the mouth in the molr region for this gnwing motion. Other ites were ny ite tht ws not gnw ite. Totl ites were clculted y dding together gnws nd other ites. Texture Anlysis Texture nlysis ws crried out using n XHDi Texture Anlyser (Stle Micro Systems, Surrey, UK). A penetrtion test entiled pushing proe of 6mm dimeter into the product t speed of 1mm/sec, nd mesuring the force encountered. A frcture wedge test entiled pushing V-shped wedge into the product, gin t speed of 1mm/sec, nd mesuring the force encountered. Sttisticl Anlyses Repeted mesures nlysis of vrince ws used to determine significnt differences in the dentl scores for Chews A nd B nd the reference diet. Two-tiled pired t-tests were used to estimte significnt differences in chewing ehviours for Chew A nd Chew B. Person correltions determined significnt reltionships etween two vriles. All lph levels were set t α=0.05. Results Both chews were effective in significntly reducing the ccumultion of plque (p=0.003, pn 2 =0.42) nd clculus (p=0.008, pn 2 =0.35) s compred to the Reference Diet (Figure 1). Gingivitis did not significntly differ during the seline tooth rushing phses (p=0.668), nd there ws lso no significnt difference in gingivitis scores etween oth chews nd the reference diet (p=0.110). In ddition, there ws no significnt difference in gingivitis scores when compring the three pre-test tooth rushing phses nd the two Chews (p=0.286). Dogs
6 Numer of Gnws or Bites Dentl Score 6 hd less plque nd gingivitis when fed Chew B thn Chew A, ut this difference ws not significnt. 12 Chew A 10 Chew B Reference Diet Gingivitis Plque Clculus Mens within columns for ech dentl score not shring common superscript letter differ significntly (p<0.05). Figure 1: Gingivitis, plque, nd clculus scores for Chew A nd Chew B, nd the Reference Diet. Dt shown re group mens (±SEM) of whole mouth scores for ll dogs (n=12) Chew A Chew B Gnw Left Gnw Right Totl Gnws Other Bites Totl Bites Mens within columns for ech chewing mesure not shring common superscript letter differ significntly (p<0.05). Figure 2: Men numer of gnws nd ites required to consume Chew A nd Chew B. Totl gnws is the sum of left nd right gnws, while totl ites includes left gnws, right gnws, nd other ites. Dt shown re group mens (±SEM) for ll dogs (n=12).
7 7 Chew B took significntly more time to consume thn Chew A (p=0.001). Chew B lso required more gnws (p=0.001) s well s more other ites (p=0.001) nd totl ites (p=0.001) to consume compred to Chew A (Figure 2). The ite rte (ites/minutes) did not differ etween Chew A nd Chew B (p=0.627). Chew B required more gnws on the left (p=0.001) nd right side (p=0.001) to consume compred to Chew A. Overll, dogs did not show preference for gnwing on the left or right side for either chew s indicted y the left nd right gnws in Figure 2. However, some dogs did show n individul preference for one side. Tle 5 shows side preferences for ech dog for oth chews. A singulr indiction of side preference ws determined y sutrcting the numer of gnws on the right side from the numer of gnws on the left ll divided y totl gnws. Eleven dogs were consistent in their side preference for oth chews. One dog switched his side preference; Pogo gnwed more on the left side for Chew A nd the right side for Chew B. Figure 3 presents two dogs ech gnwing on different side of the mouth. Tle 5: Side preference s determined y the men percentge of gnws, left side minus the right side, for ech dog nd Chew. A positive vlue indictes dog tht gnws more on the left side wheres negtive vlue indictes dog tht gnws more on the right side. For instnce, Chrlie gnwed 38.7% more on his right side thn his left side for Chew A. Dog Chew A Chew B Preference 1 Jckie Left 2 Bndit Left 8 Toy Left 9 Blckey Left 12 Re Left 5 Pogo Left, Right 3 Snoop Right 4 Chrlie Right 6 Tim Right 7 Penny Right 10 Smudge Right 11 Perdy Right Despite the significnt increses in chewing etween Chew A nd Chew B, there were no significnt correltions etween totl gnws or totl ites nd ny dentl score (gingivitis, plque, clculus) for either Chew. There were lso no correltions found etween gnws on the left or right side nd ny of the dentl scores for the respective side.
8 8 Figure 3. Tim (on left) gnws with his right side while Pogo gnws with his left. The texture of the chews ws significntly different s confirmed y texture nlysis. Fifteen smples of ech chew were sujected to texture nlysis using the 6mm proe penetrtion nd the frcture wedge tests outlined in the Methods. Figure 4 shows typicl force/time plots for the two chews from the penetrtion test, while Figure 5 shows similr plots using the frcture wedge test. It cn e seen in oth cses tht the pek forces nd res under the curve re significntly lrger for the tougher chew B. Tle 6 displys men key texture prmeter vlues cross the fifteen smples of ech chew. Figure 4: Penetrtion test for Chew A nd Chew B.
9 9 Figure 5: Frction wedge test for Chew A nd Chew B. Tle 6: Men texture prmeter vlues for Chew A nd Chew B (n=15). Penetrtion Test Frcture Wedge Test Chew A Chew B Chew A Chew B Are Under Curve (kg mm) Pek Force (kg) Discussion Both dentl hygiene chews were effective in reducing plque ccumultion nd the severity of gingivitis s compred to the stndrd diet, concurring with previous reserch (Gorrel & Bierer, 1999; Gorrel & Rwlings, 1996; Gorrel et l., 1999; Rwlings et l., 1998). The effectiveness of oth Chews ws equl to the effect of tooth rushing on gingivitis. Therefore, for those non-complint owners tht do not rush their dogs teeth dily (Miller & Hrvey, 1994), dily provision of dentl chew would still mintin gingivl helth. Rwlings et l. (1998) noted tht the physicl rsiveness of their dentl chew, rther thn the chemicl ctivity of chlorhexidine, might hve hd the greter impct on orl helth in their study. The current study tested the physicl ttriute toughness, which ws hypothesized to increse chewing, thus improving orl helth. Although Chew B required significntly more ites nd time to consume s compred to Chew A, there ws no significnt difference in ny dentl mesure (gingivitis, plque, clculus) etween the two chews.
10 10 It hs een found tht soft chewing is etter thn no chewing (Egelerg, 1965) nd tht chewing hrd diet reduces plque ccumultion nd the severity of gingivitis more so thn chewing soft diet (Egelerg, 1965). It is surprising then tht the incresed chewing with Chew B did not significntly improve dentl helth. There my e correltion etween chewing nd dentl deposit removl; however, current dentl helth ssessment methods my not e dequtely sensitive to indicte significnt difference etween dentl chews. Both chews were identicl, except tht Chew B hd incresed fire content resulting in greter toughness. Possily, different ingredient tht increses toughness would hve greter impct on dentl helth. Or, it my e tht Chew B ws too tough requiring more prehensile qulity to grsp the teeth on the initil ite nd on retrction. The higher inclusion rte of the fire ingredient in Chew B resulted in different texture, indicted y the greter rigidity of Chew B s compred with the flexiility of Chew A. It is likely tht the rsive ction ginst the tooth surfce ws ltered y this chnge in texture. It ppers tht the softer Chew A ws in fct more effective t clensing the teeth on per ite sis, nd tht Chew B, y comprison, required mny more ites to hve n equivlent impct on dentl helth. Therefore, lrger Chew A, rther thn chew with greter toughness, should e tested to determine the effect of incresed chewing of the sme mteril on orl helth. Erlier studies hve found n improvement in orl helth with the dily ddition of orl hygiene chews to the diet, ut do not report the numer of ites necessry to consume the chews. However, one study did note the time required to consume the current study s Chew A. On verge, it took 2 minutes to consume Chew A with some dogs consuming the chew much fster (ie 44 seconds) (Brown, McGenity, & Servet, 2004). The time required to consume the chews in the present study rnged from 44 seconds (Chew A) to 4.5 minutes (Chew B). These short consumption times my led the oserver to elieve tht the chew ws not effective when the dog swllowed it so quickly. However, these short-lived chews do require numerous ites to consume: numer of ites rnged from 92 (Chew A) to 530 ites (Chew B). By comprison, the Reference Diet required, on verge, etween 269 nd 827 ites to consume. The current study is the first to document the numer of ites in ddition to the time required to consume dentl hygiene chew. While consumption times my e misleding in their revity, the numer of ites required to consume chew offers different perspective nd illumintes the physicl mechnism, chewing, y which these dentl hygiene chews work. References Brown, W. Y. & McGenity, P. (2005). Effective periodontl disese control using dentl hygiene chews. Journl of Veterinry Dentistry, 22(1), Brown, W. Y., McGenity, P., & Servet, E. (2004) Short nd long-term effects of feeding dily orl hygiene chew on cnine dentl deposits. Wlthm Veterinry Focus. April supplement. Colmery, B., III, & Frost, P. (1986). Periodontl disese: Etiology nd pthogenesis. The Veterinry Clinics of North Americ: Smll Animl Prctice, 16(5), DuPont, G. A. (1998). Prevention of periodontl disese. Veterinry Clinics of North Americ: Smll Animl Prctice, 28(5), Egelerg, J. (1965). Locl effects of diet on plque formtion nd development of gingivitis in dogs. I. Effects of hrd nd soft diets. Odontologisk Revy, 16,
11 Egelerg, J. (1965). Locl effects of diet on plque formtion nd gingivitis development in dogs. III. Effect of frequency of mels nd tue feeding. Odontologisk Revy, 16, Gorrel, C. (1998). Periodontl disese nd diet in domestic pets. Journl of Nutrition, 128, 2712S-2714S. Gorrel, C. (2001). The effects of diet on periodontl disese. Pper presented t the World Smll Animl Veterinry Assocition World Conference, Vncouver, Cnd. Gorrel, C., & Bierer, T. L. (1999). Long term effects of dentl hygiene chew on the periodontl helth of dogs. Journl of Veterinry Dentistry, 16(3), Gorrel, C., & Rwlings, J. M. (1996). The role of 'dentl hygiene chew' in mintining periodontl helth in dogs. Journl of Veterinry Dentistry, 13(1), Gorrel, C., & Roinson, J. (1995). Periodontl therpy nd extrction technique. In D. A. Crossley & S. Penmn (Eds.), Mnul of Smll Animl Dentistry (2nd ed., pp ). Cheltenhm, UK: British Smll Animl Veterinry Assocition. Gorrel, C., Wrrick, J., & Bierer, T. L. (1999). Effect of new dentl hygiene chew on periodontl helth in dogs. Journl of Veterinry Dentistry, 16(2), Hrvey, C. E. (1998). Periodontl disese in dogs: Etiopthogensis, prevlence, nd significnce. Veterinry Clinics of North Americ: Smll Animl Prctice, 28(5), Hennet, P. R. (1995). Periodontl disese nd orl microiology. In D. A. Crossley & S. Penmn (Eds.), Mnul of Smll Animl Dentistry (pp ). UK: British Smll Animl Veterinry Assocition. Lindhe, J. (1989). Dentl plque nd dentl clculus. In Textook of Clinicl Periodontology (2nd ed., pp ). Copenhgen: Munksgrd. Lindhe, J., Hmp, S.-E., & Löe, H. (1975). Plque induced periodontl disese in egle dogs. A 4-yer clinicl, roentgenogrphicl nd histometricl study. Journl of Periodontl Reserch, 10(5), Löe, H. (1967). The gingivl index, the plque index nd the retention index systems. Journl of Periodontology, 38(Supplement), Lund, E. M., Armstrong, P. J., Kirk, C. A., Kolr, L. M., & Klusner, J. S. (1999). Helth sttus nd popultion chrcteristics of dogs nd cts exmined t privte veterinry prctices in the United Sttes. Journl of the Americn Veterinry Medicl Assocition, 214(9), Miller, B. R., & Hrvey, C. E. (1994). Complince with orl hygiene recommendtions following periodontl tretment in client-owned dogs. Journl of Veterinry Dentistry, 11(1), Quigley, G. A., & Hein, J. W. (1962). Comprtive clensing efficiency of mnul nd power rushing. Journl of the Americn Dentl Assocition, 65, Rwlings, J. M., Gorrel, C., & Mrkwell, P. J. (1998). Effect on cnine orl helth of dding chlorhexidine to dentl hygiene chew. Journl of Veterinry Dentistry, 15(3), Turesky, S., Gilmore, N. D., & Glickmn, I. (1970). Reduced plque formtion y the chloromethyl nlogue of vitmin C. Journl of Periodontology, 41(1), Wde, A. B. (1971). Effect on dentl plque of chewing pples. Dentl Prctitioner, 21, Wrrick, J., & Gorrel, C. (1997). A more sensitive method of scoring clculus. Pper presented t the 11th Annul Veterinry Dentl Forum, Denver, CO, USA. 11
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