Dentistry - a concern over practice recommendation

RE: Dentistry - a concern over practice recommendation

Anthony Todd — Mon, 04 Sep 2017 22:06:55 GMT

Sorry only looked at one picture on their website.

Sorry again the logo is there in 2 out of three images; must have looked at the absent one.

And not on many bags if you search images of hills T/D...

RE: Dentistry - a concern over practice recommendation

Thomas Johnson — Mon, 04 Sep 2017 18:20:03 GMT

[quote user="Andrew Henfrey"]

[quote user="Anthony Todd"]Curiouser and curiouser, as neither Hills or Royal Canine seem to mention VOHC or show the VOHC logo??[/quote]

I've just looked and the VOHC logo is definitely on the bags of Hills canine t/d and Hills feline Science Plan Oral Care.

[/quote]

And the Hills, Royal Canin and Purina diets are listed here on the VOHC website:

http://www.vohc.org/VOHCAcceptedProductsTable_Cats.pdf

RE: Dentistry - a concern over practice recommendation

Andrew Henfrey — Mon, 04 Sep 2017 17:57:51 GMT

[quote user="Anthony Todd"]Curiouser and curiouser, as neither Hills or Royal Canine seem to mention VOHC or show the VOHC logo??[/quote]

I've just looked and the VOHC logo is definitely on the bags of Hills canine t/d and Hills feline Science Plan Oral Care.

RE: Dentistry - a concern over practice recommendation

Evelyn Barbour-Hill — Sun, 03 Sep 2017 16:07:25 GMT

[quote user="Anthony Todd"]Sorry, I do try, I really do, and I'm obviously pretty thick, as I always thought plaque and calculus caused periodontal disease which was the reason for teeth brushing and/or dental diets as Colgate seems to say in humans.[/quote]

Forget calculus. It is not pathogenic, it is only vaguely involved in periodontal disease, it is of course of considerable cosmetic importance.

Subgingival plaque is the cause of periodontal disease. One may hope that continual supragingival plaque disruption will prevent or reduce subgingival plaque accumulation, and that is the rationale behind those dental diets that disrupt plaque. Please note that I am explaining that that is the rationale, not suggesting either that it works or doesn't work.

A researcher can demonstrate that a diet will reduce supragingival plaque by such and such a percentage. The methodology is very well established, respectable and reliable.

However a 50% reduction in plaque does not imply a 50% reduction in periodontal disease. The relationship is not linear. It might produce no reduction in periodontal disease at all. My own feeling is that there is a threshold in plaque reduction that must be crossed before periodontal disease is reduced but I have no idea what that threshold might be.

Manufacturers either do not research the effects of their diets on periodontal disease, or they do research it but do not publish the results. To do so would, I understand, constitute making therapeutic claims and would bring them under medicines legislation; they do not desire this because it would be an expensive hassle (and, the cynic might feel, because they don't need to in order to flog their stuff).

[quote user="Anthony Todd"]I can now see why VOHC is not mentioned by the pet-food manufacturers if the evidence is secret but then I can't see the reason for VOHC at all.[/quote]

Quite sincerely, I have no idea what you are trying to say here.

[quote user="Anthony Todd"]Give me a link please 'cos I can't find it.[/quote]

No, I really can't be bothered to spend hours trawling through old journals and product announcements.

RE: Dentistry - a concern over practice recommendation

Anthony Todd — Sun, 03 Sep 2017 09:37:11 GMT

[quote user="Evelyn Barbour-Hill"]Jeez Anthony you really must read things more carefully.[/quote]

Sorry, I do try, I really do, and I'm obviously pretty thick, as I always thought plaque and calculus caused periodontal disease which was the reason for teeth brushing and/or dental diets as Colgate seems to say in humans.

I can now see why VOHC is not mentioned by the pet-food manufacturers if the evidence is secret but then I can't see the reason for VOHC at all.

[quote user="Evelyn Barbour-Hill"]They publish that evidence sometimes.[/quote]

Give me a link please 'cos I can't find it.

RE: Dentistry - a concern over practice recommendation

Evelyn Barbour-Hill — Sat, 02 Sep 2017 23:32:44 GMT

[quote user="Anthony Todd"]

The first time any manufacturer produces a "dental diet" and shows it works as well as brushing at treating or preventing periodontal disease, I shall be very enthusiastic. If I'm not dead or doolally by then.

As you said??? then you say the VOHC etc. ???

I'd say, in english, it doesn't follow???

[/quote]

Jeez Anthony you really must read things more carefully.

They produce evidence of reduction of calculus and/or plaque.

They publish that evidence sometimes. They often submit it to VOHC. VOHC are not above criticism but they are independent.

They do not produce any evidence of reduction of periodontal disease. Which is what matters.

See?

RE: Dentistry - a concern over practice recommendation

Anthony Todd — Sat, 02 Sep 2017 22:33:46 GMT

[quote user="Julian Earl"]Anthony please don't think that I was citing that as evidence.[/quote]

Of course I didn't think you were but, at the moment, all we have is that the evidence submitted to VOHC should be enough.

But this isn't mentioned by the manufacturers, nor shown anywhere so, as it stands, it seems to me as good as "my cat likes them"....

If the evidence was good I'm sure the devotees of EBVM would trumpet it as well as advising the feeding of the diets with this evidence backing and so would the manufacturers.

It isn't called Science Diet" for nothing, or that's what I assumed.

So where's this evidence??

RE: Dentistry - a concern over practice recommendation

Julian Earl — Sat, 02 Sep 2017 21:28:09 GMT

Anthony please don't think that I was citing that as evidence. Merely that they were recommended by the Webinarvet speaker as an effective means of reducing plaque. That my cat likes them was an off the cuff comment about that as a bonus. He doesn't like having his teeth brushed and he's a hefty Maine Coone so I take the easier option of the Dentabites! That's all.

RE: Dentistry - a concern over practice recommendation

Anthony Todd — Sat, 02 Sep 2017 18:01:50 GMT

[quote user="Julian Earl"]Certainly my cat loves them.[/quote]

Yeah well, hardly EBVM, even for me....

Still waiting for some evidence so at least you modvets have something to back recommendations on, y'know; EBVM!!!

I'm on your side. It's so easy to recommend something if there's some scientific evidence for it, as you all go on about.

Not so easy if you say some vet says "my cats like it"!!!

RE: Dentistry - a concern over practice recommendation

Julian Earl — Sat, 02 Sep 2017 17:34:33 GMT

I was told on a webinar in November 2014 that for cats, the Whiskas Dentabites are the most effective teeth cleaning option for cats. Certainly my cat loves them. On a par with brushing if I remember correctly!

RE: Dentistry - a concern over practice recommendation

Anthony Todd — Sat, 02 Sep 2017 12:36:22 GMT

[quote user="Anthony Todd"] then you say the VOHC etc.[/quote]

Curiouser and curiouser, as neither Hills or Royal Canine seem to mention VOHC or show the VOHC logo??

One just says the generic "clinically proven ..." and then "through Evidence-Based Clinical Nutrition™.

but the evidence is hard to find.

RE: Dentistry - a concern over practice recommendation

Anthony Todd — Sat, 02 Sep 2017 11:33:13 GMT

[quote user="Evelyn Barbour-Hill"]The reputable ones all have evidence that their diet will reduce calculus formation by so much, or reduce plaque accumulation supragingivally by so much, or both, and if they are really reputable those claims will have been validated by VOHC.[/quote]

All I, and I think others, are asking for is a reference or references, all very well for the manufacturers to say "we have evidence" but it must be available for scrutiny! I see "recommended products" of all sorts but not connected by evidence at all....

First I've heard of the VOHC, and there are quite a number of approved products but it would still be nice to see the evidence in the same way that it would be nice to see some decent evidence, under field, ie owner, conditions that brushing when recommended, ie compliance is the test, not recommendation, does actually works.

eg stopping smoking does help health but it's the stopping [which is the hard part] not the obvious recommendation.

As you said??? then you say the VOHC etc. ???

I'd say, in english, it doesn't follow???

These may help:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3058665/

http://www.vohc.org/

But the required trials are very short.....

RE: Dentistry - a concern over practice recommendation

Evelyn Barbour-Hill — Fri, 01 Sep 2017 23:12:16 GMT

[quote user="Anthony Todd"]I'd be very surprised if effective teeth brushing wasn't the best, even if it is not always done effectively, but I can't believe that reputable manufacturers have produced a " dental diet" with no evidence, at all, that it is of any benefit?[/quote]

Anthony, you really should read threads more carefully.

The reputable ones all have evidence that their diet will reduce calculus formation by so much, or reduce plaque accumulation supragingivally by so much, or both, and if they are really reputable those claims will have been validated by VOHC.

They leave us to judge whether these reductions will make any difference at all to periodontal disease – although naturally their advertising always suggests by tacit implication that they will.

Fortunately a few of us lot in practice are still capable of using our brains.

RE: Dentistry - a concern over practice recommendation

Anthony Todd — Fri, 01 Sep 2017 22:30:47 GMT

[quote user="Evelyn Barbour-Hill"]It has not been. The first time any manufacturer produces a "dental diet" and shows it works as well as brushing at treating or preventing periodontal disease, I shall be very enthusiastic. If I'm not dead or doolally by then.[/quote]

I'd be very surprised if effective teeth brushing wasn't the best, even if it is not always done effectively, but I can't believe that reputable manufacturers have produced a " dental diet" with no evidence, at all, that it is of any benefit?

Some vet must have asked for some evidence surely , we are in the age of EBVM , or you you lot in practice should be??

RE: Dentistry - a concern over practice recommendation

Evelyn Barbour-Hill — Fri, 01 Sep 2017 13:07:28 GMT

[quote user="Anthony Todd"]or it is shown that dental diets work as well as brushing?[/quote]

It has not been. The first time any manufacturer produces a "dental diet" and shows it works as well as brushing at treating or preventing periodontal disease, I shall be very enthusiastic. If I'm not dead or doolally by then.

RE: Dentistry - a concern over practice recommendation

Anthony Todd — Fri, 01 Sep 2017 10:53:48 GMT

[quote user="Sarah Keir"]it is my job is to recommend what is best for their pet/my patient[/quote]

What? Even if they can't brush [and an awful lot won't/can't I reckon] or it is shown that dental diets work as well as brushing?

No good passing the buck to the owner 'cos that doesn't help the pet and dental diet might.

Jeepers where's some TD EBVM!!

RE: Dentistry - a concern over practice recommendation

Sarah Keir — Fri, 01 Sep 2017 10:31:19 GMT

Diet change, chews etc will be part of my discussion with owners but my primary recommendation will remain brushing. I point out to clients (most, not the ones with awful unbrushed teeth themselves) that they brush their own teeth and the reasons behind this. If it is clear they will not go down this route then other options are discussed in more detail but it is my job is to recommend what is best for their pet/my patient and their job to decide how/if they want to do this.

RE: Dentistry - a concern over practice recommendation

Anthony Todd — Fri, 01 Sep 2017 09:47:41 GMT

The spin off, personally, is that now rather than painting a fence with my electric toothbrush I angle it to get into the sulcus and prevent tartar build up better.

Obvious really, but not to me.... [no comebacks please MA!]

RE: Dentistry - a concern over practice recommendation

Gillian Mostyn — Fri, 01 Sep 2017 07:24:29 GMT

Sorry but I'm with Anthony on this one. How realistic is it for people to brush their dog's teeth every day, even with knowing how important it is? (How many vets do? I don't.)

I do understand the OP's irritation at being told to give clients advice which is clearly not the current perceived wisdom. However, surely there is a compromise to be found rather than just getting resentful? (ie daily brushing is far and away the best way, but have you considered changing to a slightly more 'tooth friendly' food?)

RE: Dentistry - a concern over practice recommendation

Evelyn Barbour-Hill — Fri, 01 Sep 2017 01:39:27 GMT

[quote user="Anthony Todd"]Trouble is the chances of the client pursuing the "difficult" option is very low so something [provided there's some EBVM!!!] is always better than nothing.[/quote]

Not necessarily. "Oh, how can he have bad teeth, he has one of them Dentastix every day". If the something does nothing, plainly it is not better than nothing.

If you (consciously or not) present something to the client as difficult, they are going to think it too difficult and will perceive a coded message from you that they should not bother.

RE: Dentistry - a concern over practice recommendation

Anthony Todd — Thu, 31 Aug 2017 22:56:36 GMT

[quote user="robloxley"]Do you think that if you give clients an easy-option, they are less likely to pursue another, maybe better, albeit more 'difficult' option.[/quote]

Trouble is the chances of the client pursuing the "difficult" option is very low so something [provided there's some EBVM!!!] is always better than nothing.

RE: Dentistry - a concern over practice recommendation

patrick murphy — Thu, 31 Aug 2017 17:49:52 GMT

No dentist, but was there not a 'controlled' thing on bbc truth about dogs/vets where they did all of this just recently at one of the vet schools?

RE: Dentistry - a concern over practice recommendation

Rob Loxley — Thu, 31 Aug 2017 14:34:15 GMT

[quote user="Nicola Lawlor"]It's also more likely to be used regularly by owners than brushing if we are all honest about client co-operation and given that situation it may therefore become the more effective recommendation that we give to clients when you look at how many clients do something (better than nothing) and stick with it. If you point out what is considered best but also discuss the t/d clients have the right info and can make an informed choice whilst hopefully your patients get better than no dental care at all in some form.[/quote]

Do you think that if you give clients an easy-option, they are less likely to pursue another, maybe better, albeit more 'difficult' option.

RE: Dentistry - a concern over practice recommendation

Evelyn Barbour-Hill — Thu, 31 Aug 2017 11:31:45 GMT

[quote user="robloxley"]That unless you brush almost daily you might as well not bother, [/quote]

Yes, exactly. That's what the paper says , and thank you to Karin for bringing it to our attention. You think that means that Karin is trying to sell you something else?

[quote user="robloxley"]That unless you brush almost daily you might as well not bother, and therefore should look for some other solution, be that 'dental food' or maybe 'dental sealant'?[/quote]

Non sequitur.

[quote user="Anthony Todd"]Haven't the dental diet people done any decent trials; shouldn't be too difficult?[/quote]

Yes, Anthony, loads. The reputable ones anyway. And gained the approval of VOHC, which is an independent assessor of claims. The thing is, they demonstrate x% reduction of plaque, or y% reduction of calculus; but they don't demonstrate reduction of periodontal disease; and I'm absolutely sure that there is not a linear relationship.

RE: Dentistry - a concern over practice recommendation

Nicola Lawlor — Thu, 31 Aug 2017 09:27:55 GMT

There is a reasonable comprimise here and I fully support your ethic that daily brushing is the best way forward. You can still however discuss t/d as it isn't completely useless and can be used alongside brushing to help support that good work. It's also more likely to be used regularly by owners than brushing if we are all honest about client co-operation and given that situation it may therefore become the more effective recommendation that we give to clients when you look at how many clients do something (better than nothing) and stick with it. If you point out what is considered best but also discuss the t/d clients have the right info and can make an informed choice whilst hopefully your patients get better than no dental care at all in some form.