Research in Veterinary Science 154 (2023) 8–14

Contents lists available at ScienceDirect

Research in Veterinary Science

journal homepage: www.elsevier.com/locate/rvsc

Strategies to improve the home care of periodontal disease in dogs: A

systematic review
E. Barbosa a, P.G.S. Pires b, L. Hauptli c, P. Moraes b, c, *
a
Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Medicina Veterinária Convencional e Integrativa Rod, Ulysses Gaboardi, Km 3, 89520-000
Curitibanos, SC, Brazil
b
Advanced Poultry Gut Science, Florianópolis, SC, Brazil
c
Centro de Ciências Agrárias-CCA, Universidade Federal de Santa Catarina, Rod. Admar Gonzaga, 1346 – Itacorubi, 88034-000 Florianopolis, SC, Brazil

A R T I C L E I N F O A B S T R A C T

Keywords: The expected contribution of this study is to have a complete view of the available products used in the pre­
Canine vention of periodontal disease in dogs. The related studies in databases including Web of Science, Science Direct,
Dental products and Scopus, from 1992 to 2021, were retrieved, and 36 studies were used in the systematic review. Among the
Disease
continents researched, North America proved to have the most developed research relating to the subject. The
Periodontal
Oral health
active ingredients researched, isolated, or compared to each other, were polyphosphates > phytogenics >
chlorhexidine > enzymes > vitamin C > xylitol = adelmidrol = and probiotics. The form of use of active products
was chewable > solution via water = via food > biscuits > paste and gels > mucoadhesive. Gingivitis index was
the most studied parameter used to assess oral health. According to the evidence recovered in the systematic
review was possible to conclude that products with different active agents and forms of use demonstrated
positive effects in the prevention of periodontal diseases. The results of this study summarize the most frequently
used active ingredients and application forms for cleaning dogs' teeth and provide a roadmap for future research
on the maintenance of oral health in dogs.

1. Introduction veterinarian under a general anesthesia examination e.g. periodontal

pockets.
Domestic dogs are dependent on their owners and their health and Treatment for dental calculus is invasive, requiring anesthesia and
welfare depend on some basic care. However, some care may not be teeth scaling, making it an expensive procedure for the owner. One way
contemplated, such as canine oral hygiene (Wiggs and Lobprise, 1997). to prevent the accumulation of bacterial plaque is to brush daily.
Periodontal disease is the most representative oral health problem, However, for the success of this procedure, there is a need to condition
affecting up to 80% of dogs over two years of age, and is one of the most the animals to this practice from a young age, in addition to requiring
frequent diseases in the veterinary clinical routine (Riggio et al., 2011). time and dedication from the owner. For these reasons, most owners
Bacterial plaque is the main etiological factor of periodontal disease and choose alternatives to brushing, which have preventive effects against
is formed by an organic matrix of aggregates of bacteria and their by- periodontal diseases and can be performed at home (Paiva et al., 2007).
products, salivary glycoproteins, food particles, inorganic substances, Some products stand out in the market, such as toothpaste, dental
and epithelial and inflammatory cells (Adepu et al., 2018). When plaque chew, sprays, biscuits, liquid solutions, and mucus adhesives. Studies
removal does not occur, mineralization and dental calculus formation relating the use of these products to their efficacy are scarce and carried
occur (Marx et al., 2016). Bad breath is often the first sign of a problem out with different methodologies. In order to map the scientific evidence
observed by the owner, although it is not always present, this may be on the different products used in homecare to prevent oral disease in
followed by: tooth mobility, severe gingivitis, gingival recession, root dogs, this systematic review aims to present the active agents and
exposure, mild and moderate gingival hemorrhage, nasal secretion, and products used and their benefits for the oral health of dogs.
oro-nasal fistulas (dos Santos et al., 2012), signs that are behavioral
(pawing at the face, reduced appetite) and those observed by a

* Corresponding author at: Advanced Poultry Gut Science, Florianópolis, SC, Brazil.
E-mail address: [email protected] (P. Moraes).

https://doi.org/10.1016/j.rvsc.2022.10.025
Received 9 August 2022; Received in revised form 1 October 2022; Accepted 25 October 2022
Available online 3 November 2022
0034-5288/© 2022 Elsevier Ltd. All rights reserved.
E. Barbosa et al. Research in Veterinary Science 154 (2023) 8–14

2. Material and methods

2.1. Literary research

This systematic review was conducted in accordance with the

Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) statement guidelines (Moher et al., 2009). The searches
were performed in Web of Science, Scopus, and Science Direct and the
terms used were as follows: (dogs OR canine) AND (extract OR “me­
dicinal herb” OR phytogenic OR “phytotherapic medicine” OR herbal
OR “extract herbs”) AND (“dental calculus” OR “bacterial plaque” OR
“periodontal disease”) AND (bones OR chews OR enzyme OR adjuvant
OR “oral hygiene” OR “oral health” OR polyphosphates OR “sodium
hexametaphosphate” OR biscuit OR food OR additive OR biofilm OR
mucoadhesive). The search was performed on May 8, 2021, with a new
search after 180 days to check for new publications on the topic studied.
The searches were based on the title, abstract, and keywords, and the
languages included were Portuguese, Spanish, and English. No re­
strictions or filters were imposed in terms of study design, the origin of
the study, and publication year. An additional search of the proceedings
of the British Veterinary Association, Wiley Online Library, ASM Jour­
nals, Europe PMC, and Sage Journals was performed, in order to retrieve
more publications on the topic.

2.2. Inclusion and exclusion criteria

During the screening process, the following criteria were considered

for inclusion of articles in the review: studies published in peer-reviewed
scientific journals; studies on the effects of additives and/or chewables
to prevent periodontal disease in dogs; use of additives in order to
reduce the accumulation of calculus, plaque, gingivitis and bad breath in
dogs.
The selection and assessment of study eligibility for systematic re­
view were performed by two reviewers individually. When there was no
consensus, a face-to-face meeting was held among the researchers to
discuss and define the inclusion or exclusion of the papers. The eligi­
bility criteria were previously defined for selection by title, abstract, and
full text. In the title selection phase, reviewers are required to select
articles that contain words like “dogs” and “oral health”. In the phase of
selection by abstracts, articles that presented data on oral health in dogs
were selected. In the final selection phase, it was required that the full
texts of the articles be published as scientific articles and contain results
about the topic. In the abstract and full-text phases, the publications that
were letters to the editor, editorials, review articles, conference ab­
stracts, notes, papers presented in congresses, books, thesis, and Fig. 1. Flow chart for searching process.
incomplete articles were excluded.
The search returned 10,990 publications, with the following origin: retrieved, while this number increases to 13 papers between 2001 and
45.27% Scopus; 43.33% Science Direct; 10.68% Web of Science, and 2011 and 15 papers between 2012 and 2021 (Fig. 2). The number of
0.72% from other sources. After 7000 duplicates were removed, a sub­ publications about periodontal disease has become more evident over
total of 3990 papers remained. A total of 1975 papers were removed the last 10 years, due to several factors. Among them, the proximity of
during the title or abstract evaluation, resulting in a subtotal of 2015 intimate contact in the dog's home with their owners stands out, who
papers, of which 1740 did not meet the inclusion criteria. This meant end up being bothered by the animals' bad breath, which is the first sign
275 papers remained for the full-text evaluation stage. Efforts to retrieve observed in oral health problems.
all studies were carried out exhaustively, including sending an email to The studies were developed in North America (36.11%), Europe
the corresponding author. At the end of the screening process, 36 papers (30.55%), South America (13.88%), Asia (13.88%), and Oceania
were selected for the systematic review. The summary of the search and (5.58%), with the largest number of publications from the United States
screening procedure is shown in Fig. 1. The identification and descrip­ of America (11 papers, 30.55%), followed by Brazil (6 papers, 16.67%),
tion of the 36 papers are shown in Table 1. France (4 papers, 11.11%), England (3 papers, 8.33%), Australia, Can­
Quantitative analyses are limited by the small number of studies ada, and Spain with two papers (5.56) each, and India, Italy, Iran, Israel,
comparing similar substances. Japan and South Korea with only one publication (2.77%) each. Most
articles were published in the Journal of Veterinary Dentistry (19 papers
3. Results and discussion - 52.77%), followed by the American Journal of Veterinary Research (3
papers - 8.33%), Brazilian Archive of Veterinary Medicine and Animal
3.1. Overview of studies included in the systematic review Science (3 papers - 8.33%). Other journals such as PLoS ONE, Ars Vet­
erinária, Scientifica, Canadian Veterinary Journal, Journal of Dental
In this review, only eight studies published up to the year 2000 were Research, Animal Feed Science and Technology, Journal of the

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E. Barbosa et al. Research in Veterinary Science 154 (2023) 8–14

Table 1
Characteristics of the studies included in the systematic review about oral health in dogs (in alphabetic order).
Reference Country Dogs Product Active ingredient Dental and oral Outcomes
analyzed analysis

Allan et al. United Multiple dental chew, feed, enzyme dental calculus, Daily brushing was more effective in controlling
(2019) Kingdom breeds toothpaste dental plaque plaque build up compared to dental chew or diet.
n 22
Bonello and Italy Multiple sealant aldemidrol gingivitis The combined use of mucoadhesive gel ↓ gingival
Squarzoni breeds inflammation.
(2008) n 20
Brown and Australia Multiple dental chew chlorhexidine gingivitis, dental No significant difference between mastication,
McGenity breeds plaque control treatment, and chlorhexidine.
(2005) n 12
Carciofi et al. Brazil Multiple biscuits polyphosphate dental calculus The biscuit was effective in ↓ dental calculus.
(2008) breeds
n 28
Clarke et al. Australia Toy breed dental chew – gingivitis, dental The daily use of vegetable blend ↓ the
(2011) n 16 plaque, accumulation of plaque, calculus, gingivitis, and
halitosis.
Do et al. (2019)- South Beagle solution via water probiotic dental calculus, Daily brushing was more effective in controlling
Korea n 18 breath, dental plaque plaque build up compared to dental chew or diet.
Garanayak et al. India Multiple feed chlorhexidine, gingivitis, dental Chlorhexidine + dental chew ↓ reduced plaque
(2019) breeds enzyme, phytogenic plaque deposition.
n 16
Gorrel (1996) US Multiple dental chew, feed – dental calculus, The use of dental chew daily ↓ to halitosis,
breeds breath, dental plaque, plaque, and calculus.
n 24 gingivitis
Hennet (2001) France Beagle leather – dental plaque The use of raw bovine hides ↓ plaque
n 22 accumulation when offered BID.
Hennet (2002) France Beagle toothpaste chlorhexidine, dental plaque Application of chlorhexidine as a component of a
n 22 polyphosphate dental gel ↓ dental plaque.
Hennet et al. France Multiple dental chew phytogenic dental plaque Feed + dental chew ↓ plaque deposition and
(2006) breeds calculus build up.
n 18
Hennet et al. France Beagle feed polyphosphate dental calculus, dental Sodium tripolyphosphate was shown to be an
(2007) n 40 plaque effective anti-calculus agent compared to
hexametaphosphate.
Isogai et al. Japan Multiple feed phytogenic gingivitis, breath Japanese green tea extracts ↓ bad odor and
(1995) breeds gingivitis.
n 10
Jeusette et al. Spain Multiple dental chew vitamin c breath ↓ bacterial growth for 12 h and bad odor for 24 h.
(2016) breeds
n 10
Kozlovsky et al. Israel Beagle mucoadhesive chlorhexidine dental calculus, dental Chlorhexidine ↓ plaque build up and gingivitis.
(1992) n 30 plaque, gingivitis
Lage et al. (1990) US Beagle biscuits polifosfato dental calculus Biscuit was no more effective than rawhide in ↓
n 67 the calculation.
Lindinger (2016) Canada Multiple solution via water enzyme, phytogenic dental plaque The product showed good palatability and ↓
breeds plaque formation in the first two weeks.
n 87
Logan et al. US Multiple feed – gingivitis The feed ↓ plaque and gingivitis.
(2002) breeds
n 40
Low et al. (2014) US Multiple toothpaste phytogenic dental calculus, There was ↓ halitosis when using daily
breeds breath, dental plaque antimicrobial gel with antioxidants.
n 27
Lowe and Canada Multiple solution via water xylitol dental calculus, dental Xylitol ↓ the accumulation of plaque and calculus.
Anthony breeds plaque, gingivitis
(2020) n 15
Mateo et al. Spain Toy bread dental chew vitamin c dental calculus, dental Daily use of dental chew ↓ plaque build up,
(2020) n 17 plaque calculus, gingivitis, and halitosis.
Milella et al. US Multiple tooth gel phytogenic gingivitis, dental Gel + brushing ↓ plaque build up and gingivitis.
(2014) breeds plaque
n 15
Paiva et al. Brazil American biscuits polyphosphate dental calculus, dental Oral adjuvants with polyphosphate had an
(2007) Foxhound plaque effective ↓ action on the formation of dental
n16 calculus.
Pieri et al. (2010) Brazil Multiple solution via water copaíba oil dental plaque Copaiba oil is a candidate to replace
breeds chlorhexidine in oral antimicrobial therapy.
n 18
Pinto et al. Brazil American feed polyphosphate dental calculus Phosphates ↓ the calculus deposit on the dogs
(2008) Foxhound teeth.
n 25
Pinto et al. Brazil Beagle bone – dental calculus Bone supplementation was effective in removing
(2020) n 12 supragingival calculus.
Quest, Bradley W US dental chew, feed polyphosphate dental calculus, There was ↓ plaque and calculus accumulation in
(2013) dental plaque, breath the test group.
(continued on next page)

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Table 1 (continued )
Reference Country Dogs Product Active ingredient Dental and oral Outcomes
analyzed analysis

Multiple
breeds
n 60
Rawlings et al. England Multiple dental chew, feed polyphosphate dental calculus, There was a difference in stone formation with a
(1997) breeds breath, dental plaque specific oral health diet compared to the standard
n 15 diet.
Rawlings et al. England Multiple dental chew chlorhexidine gingivitis Chlorhexidine ↓ the accumulation of bacterial
(1998) breeds plaque.
n 11
Santos et al. Brazil Multiple biscuits polyphosphate, dental calculus Biscuits with pomegranate extract ↓ the area
(2021) breeds phytogenic covered by dental calculus in dogs.
n 40
Sitzman (2013) US Beagle sealant enzyme dental calculus, There was no significance in the gingival score
n 15 gingivitis, dental but there was ↓ in the plaque index.
plaque
Smith and US Multiple toothpaste enzyme dental calculus, dental In gingivitis and plaque accumulation there was
Smithson breeds plaque, gingivitis no difference, and the calculation score was
(2014) n 20 reduced.
Stookey et al. US Beagle biscuits polyphosphate dental calculus Sodium hematophosphate ↓ the formation of
(1995) n 29 dental calculus.
Stookey et al. US Beagle biscuits polyphosphate dental calculus There was ↓ dental calculus with the use of
(1996) n 24 sodium hematophosphate.
Stookey (2009) US Beagle leather polyphosphate dental calculus, dental There was ↓ the formation of plaque with the use
n 16 plaque, gingivitis of leather with sodium triphosphate.
Torkan (2015) Iran Uninformed spray solution chlorhexidine, dental plaque Herbal spray ↓ gingivitis, bad breath, and oral
n 20 phytogenic bacteria.

have proportionally larger teeth than larger dogs, when compared to

mandible size (Gioso et al., 2001; Harvey, 1998) reducing the efficiency
of natural processes that support oral health, such as chewing that
removes plaque deposits by abrasion (Harvey, 1998).
A great variation was observed in the studies regarding the sample
size, age group of dogs, collection period, and duration of the research.
In the papers that presented this information (80.55%), the dogs had an
age range from 1 to 15 years and a weight range from 2 to 40 kg. Despite
the variation between the studies, there was a similarity in body weight
and age in each study, which is recommended by the Veterinary Oral
Health Council (VOHC) for consistency in statistical analyses. The VOHC
organization has developed a seal of approval for products specifically
designed to support the oral health of dogs and cats, they can endorse
products for their efficacy based on an evaluation of the data generated
during scientific in vivo studies conducted following their described
protocols.
Fig. 2. Number of publications by decades.

American Veterinary Medical Association, Journal of Small Animal 3.3. Analyzes used to assess the oral health of dogs
Practice, Biosciences Biotechnology Research Asia, Microbial Ecology in
Health and Disease published only one article (1 paper - 2.77%) each. The indicators used to assess oral health were (presented in order of
highest occurrence in the articles): gingivitis index (41.66%), plaque
index (33.33%), dental calculus index (27.77%), plaque coverage
3.2. Characteristics of animals (27.77%), halitosis index (22.22%), microbiota assessment (16.66%),
calculus coverage (16.66%), calculus reduction (13.88%), plaque
The studies showed variations in the dog breeds used. Beagle dogs reduction (8.33%), gingivitis reduction (2.77%), plaque thickness
accounted for 41.66% of the studies, however, 52.77% of the studies did (2.77%). These are based on indices previously used in humans and
not use a single breed of dog. The greater frequency of the Beagle breed laboratory studies in Beagles dogs (Ericsson et al., 1992).
was expected, because the breed is known to be widely used in scientific The gingivitis index was the most used in the evaluations, as it re­
research due to its medium size and good genetic patterning (Gorrel, cords the gingival condition and severity of the lesion. According to the
1996). Regarding housing conditions, most animals belonged to protocol established by the VOHC, the gingivitis index needs to be
research centers (72.22%) while the rest of the dogs were evaluated at described and referenced, however, if a new gingivitis index is used,
the owners' homes (27.78%). Studies without breed standardization there must be a detailed statement justifying the evaluation method. In
were carried out with animals that lived with owners. Small and this review, 20 papers evaluated gingivitis with the following indices:
medium-sized dogs were used more frequently (63.63%). A total of Silness-Loe indices (70%), own method (10%), Logan-Boyce (15%),
27.70% of the studies used dogs of different breeds and sizes in the same Lobene (5%).
study. The standardization of the breed used is important for better The plaque index requires detection and recording on the surface of
homogeneity between treatments, as dogs of different breeds, and even each tooth, revealed by the application of fuchsin solution that identifies
within the same breed, may respond differently to the presence of pla­ the affected area and estimates the plaque thickness based on the in­
que on the dental surface (Ruparell et al., 2020). In addition, small dogs tensity of staining. The main methods used in the studies were: Logan-

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E. Barbosa et al. Research in Veterinary Science 154 (2023) 8–14

Boyce (34.61%), Tureskey (23.07%), and Silness-Loe (19.23%) of diets containing chlorhexidine and phosphates. Currently, research is
According to VOHC recommendations, teeth must be scaled and interested in evaluating the effects of using phytogenics, in spray form or
polished on day zero for the test to start with zero scores for plaque and included in dog diets. The focus of the discussion is the three most used
calculus. Most studies met this recommendation (83.33%). The recom­ active agents.
mended minimum trial period is 7 days for plaque and 21 days for Polyphosphates, such as hexametaphosphate and tripolyphosphates,
calculus. The studies found in this review remained within the recom­ function as salivary calcium chelators, preventing plaque mineralization
mended range, where 17 studies (47.22%) presented an average expe­ (Paiva et al., 2007). A total of 30.95% of the studies evaluated poly­
rience time of 21 to 35 days, while 13 studies (36.11%) presented 45 to phosphates, found in the form of sodium hexametaphosphate (60%) or
120 days and 6 studies (16.66%) presented from 7 to 14 days. tripolyphosphate (26.4%) or pyrophosphate (13.3%), included via food
Following the VOHC, the teeth of the upper jaw - I3, C, P3, P4, M1, (food or treat). These additives were effective in reducing dental cal­
and the lower jaw - C, P3, P4, M1 must be present and intact, with culus formation, halitosis, and gingivitis. Published studies with
normal occlusion and scores must be made on the oral surfaces of the different products containing polyphosphates show beneficial effects in
teeth on both sides of the mouth. The affected tooth varies according to reducing plaque accumulation, calculus, and salivary flow stimulation
the size of the animal, in general, the articles evaluated the third incisor (Mateo et al., 2020; Stookey, 2009).
(I3); canine (C); second premolar (P2), third premolar (P3), fourth Phytogenics are secondary metabolites of plants and have several
premolar (P4), and first molar (M1), both in the mandible and maxilla actions, such as: antioxidant, anti-inflammatory, antibacterial, antiviral,
(Table 2). and antifungal activities (Low et al., 2014). In the present review
21.43% of studies evaluated the effects of phytogenics on the oral health
of dogs. The main phytogenics used alone or in the association were:
3.4. Strategies to improve oral health in home care green tea (3 articles); thymol and menthol; pomegranate (2 articles);
parsley: blueberry; papaya; eucalyptus; Echinacea. Of the nine studies
Dog oral health care needs daily maintenance. This systematic re­ that used phytogenics, three were in the form of dental chews, two were
view highlights two important factors in this maintenance: the active in the form of paste and/or gels, three were in the form of a liquid so­
agents and the way of using the products evaluated in the studies. lution (spray, via water), and one was included in the diet. The appli­
cation of phytogenics via dog food is an effective method for the
3.4.1. Active agent prevention of periodontal diseases (Hennet et al., 2006; Torkan, 2015),
The active ingredients researched, isolated or compared with each due to its antimicrobial, antioxidant, antiseptic, and anti-inflammatory
other, as a preventive focus for oral diseases in dogs were (presented in action. Water delivery of 0.8% green tea extract showed an average
order of highest occurrence in the articles): polyphosphates (30.95%), 37% reduction in plaque formation in the first two weeks of evaluation
phytogenics (21.43%), chlorhexidine (14.29%), enzymes (9.52%), and a reduction in plaque index and coverage at 28 days of evaluation
vitamin C (4.76%), xylitol (2.38%), adelmidrol (2.38%) and probiotics ((Lindinger, 2016). The supply of phytogenics via treats and biscuits also
(2.38%). Perhaps the use of other similar search terms (e.g. bioactive) shows promise. Santos et al. (2021) developed baked biscuits with
during the search and selection phase of papers could modify the result different phytogenics under evaluation and concluded that pomegranate
found. Previously, studies were aimed at verifying the effects of the use extract (0.9%) reduced the area covered by dental calculus in dogs,
having a similar effect to the use of sodium hexametaphosphate.
Table 2 Chlorhexidine is a chemically synthesized antiseptic with a broad
Relationship between the size of dogs and the tooth evaluated in the study. spectrum of action. Their acts by increasing the permeability of the
Reference Breeds size Teeth Assessed bacterial cell membrane, precipitating macromolecules in the cyto­
plasm, causing bacterial cell lysis and subsequent death (Serra et al.,
Lindinger, Small: 7 Medium: I3, C, P3, P4 e M1
2016 10 Large: 1 2018; Severiano et al., 2010). The articles evaluating chlorhexidine
Milella et al., Small: 20 Medium: Maxillary sets: (16.67%) evaluated the bacteriostatic action in the prevention and
2014 8 Large: 13 All six incisor; left side Canine/Premolar + treatment of diseases related to plaque formation, and the different
P1–3, P4 + M1, M2; right side Canine/
routes of application: liquid solution, in the form of mouthwashes and
Premolar + P1–3, P4 + M1, M2
Mandibular sets:
gels, sprays, and mucoadhesive or dental chews. The lowest chlorhexi­
All six incisors + both canines, left side dine level evaluated was 0.12% (Jeusette et al., 2016) and the highest
P1–4, Left side molars 1–3 was 20% (Kozlovsky et al., 1992). The absorption of chlorhexidine is
Logan et al., Small: 2 Maxillary sets: minimal, and it has low toxicity. Some studies conducted with radio­
2002 I3, C, 3-4P, 1 M.
actively labeled chlorhexidine mouthwash have indicated that pene­
Mandibular sets:
C, 2–4P, 1 M tration into the mucosa and gingiva is low, with little gastrointestinal
Bonello et al., Small: 4 Medium: Maxillary sets: I3, C, 2–4P, 1 M absorption (Case, 1977).
2008 3 Large: 5 Mandibular sets:
C, 2–4P, 1 M 3.4.2. Form of use/application of the active ingredient
Rawlings et al., Small: 5 Maxillary sets: I3, C, 2–4P, 1 M
1998 Mandibular sets:
The forms of application of the active agents used in the studies
C, 2–4P, 1 M found in this review were chewable (38.89%), solution via water
Paiva et al., Large: 1 Maxillary sets: C, P2–4, M (16.67%), via food (13.89%), via biscuits (13.89%), paste or gel
2007 (11.11%), mucoadhesive or sealant (5.56%).
Rawlings et al., Small: 2 Maxillary sets: I3, C, 2–4P, 1 M
Compared to main meal feed, the calorie level in chewable products
1997 Mandibular sets:
C, 2–4P, 1 M like dental chews or leathers is negligible. There are several products
Pinto CFD Large: 1 Maxillary and Mandibular sets: C, 2–4P available on the market, developed as a form of enjoyment to stimulate
et al., 2008 chewing. Due to their mechanical abrasion, they help to reduce the
Allan et al., Small: 8 Medium: Maxillary sets: I3, C, 2–4P, 1 M accumulation of dental substrate, they may or may not contain active
2019 6 Large: 5
Do et al., 2019 Small: 1 Maxillary sets: I3
agents (Logan et al., 2002). This review points out chewable as the main
Mandibular sets: C, 2–4P, 1 M format of research on the oral health of dogs. Active agents inserted in
Sitzman, 2013 Small: 1 Maxillary sets: I3, C, 3-4P, 1 M Mandibular dental chews can have an effective and significant action in reducing the
sets: formation of dental calculus. Some components help prevent bad breath.
C, 3-4 PM, 1 M
The addition of functional ingredients such as phytogenics, prebiotics,

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and special fibers, also promote health and well-being in the dog beyond inflammation for a period of 45 days. The other study with
oral health. (Silva et al., 2020; Stookey et al., 1996, 1995). chlorhexidine-based mucoadhesive utilized a slow-release technology
Bovine skin and bones can be included in the daily routine of dogs to for the active ingredient (Kozlovsky et al., 1992), after eight weeks 88%
promote oral health. Some dogs accept leather straps well and friction of the vestibular surfaces and 52% of the lingual surfaces of the dogs
during chewing helps remove plaque. Bones can promote a reduction of teeth had no plaque. Regarding sealants, these are composed of poly­
up to 57.7% of dental calculus (Pinto et al., 2020). However, some mers (poly-L-lactic acid, polyglycolic acid), and are used to prevent the
studies have associated bone consumption with visceral perforation accumulation of plaque in dogs. They exhibit good bioadhesion poten­
problems and esophageal and intestinal concretion formation (Gianella tial in the oral mucosa, making it possible to add an active ingredient,
et al., 2009). In this review, no research reported these adverse effects. which is released in the region in small amounts (Labib and Aldawsari,
The consumption of raw bones is effective due to the friction caused by 2015). In addition, sealants act as a hydrophobic barrier binding to tooth
the bone in contact with the bacterial plaque on the teeth (Davies et al., enamel, repelling the attachment of bacterial plaque. Sitzman (2013)
2019), but the fact that they are raw can cause contamination by Sal­ used a sealant on the teeth of dogs and found a 30% reduction in plaque
monella sp., Escherichia coli, Clostridium species, Listeria monocytogenes, compared to dogs that did not receive the treatment.
Yersinia and Campylobacter species. Cooked bones are not recommended
because cooking alters the collagen structure, making them more lethal 4. Conclusion
than raw bones in terms of dangers of digestive tract perforations (Marx
et al., 2016). In addition, the use of hard bones can cause fractures in The results of 36 papers showed that a wide variety of active in­
dogs' teeth. A study using the fourth premolar tooth from dog cadavers gredients have received attention for their benefits to the oral health of
performed by Soltero-Rivera et al. (2019) observed that the mean dogs. Among the active ingredients used, polyphosphates were the most
maximum sustained force at the fracture point was 1281 N at a mean tested. Another important result of this study was that the gingivitis
impact angle of 59.7◦ . index is a common metric for evaluating the oral health of animals.
Solutions are formulated to clean and refresh the oral cavity. Among the countries researched, the United States was ranked as the
Although dental solutions do not replace daily brushing, they help fight first in establishing investigations. There has been increasing interest in
plaque, reduce tartar accumulation, and prevent gingival disease (Pieri canine oral health and periodontal disease over the last 10 years as
et al., 2010). Substances such as chlorhexidine, xylitol, enzymes, and measured by the number of scientific publications, probably the reason
phytogenics can help inhibit the release of sulfur compounds, reducing is the close relationship between dogs and owners and the impact of bad
bad breath (Lindinger, 2016). Phytogenic-based sprays have been breath, one of the early warning signs for poor oral health, has on their
studied to assess the potential for preventing plaque formation, gingi­ interaction. In addition, there is a tendency towards increased research
vitis, and periodontal diseases in dogs, with statistically significant re­ on this topic, mainly focusing on different herbal medicines.
sults in the antibacterial effect on the oral cavity (Lindinger, 2016).
Daily tooth brushing in dogs is the main way to maintain oral health. Availability of data and material
The plaque formed by the bacterial biofilm is soft enough to be removed
with brushing, however, after the formation of tartar, it becomes more The data that support the findings of this study are available from the
resistant. The use of active ingredients such as chlorhexidine, poly­ corresponding author.
phosphates and phytogens aids in the removal of dental plaque (Smith
and Smithson, 2014). Low et al. (2014) observed a reduction in plaque
Authors' contributions
and halitosis index with the use of a gel containing phytogenics, applied
twice a day for a period of 4 weeks. Hennet (2002) used chlorhexidine
All authors contributed to the study and reviewed the final manu­
dental gel with a standardized application technique, with 10 back-and-
script. Conceived study: Priscila de Oliveira Moraes. Performed
forth movements with the index finger, resulting in a 32.9% reduction in
research: Evelyn Louise Candida Machado Barbosa. Analyzed data:
the plaque index. Possibly, this reduction in the plaque index was only
Priscila de Oliveira Moraes. Wrote the paper: Evelyn Louise Candida
achieved due to the antimicrobial effect of phytogenics and
Machado Barbosa, Paula Gabriela da Silva Pires, Priscila de Oliveira
chlorhexidine.
Moraes, Lucélia Hauptli.
Some commercial pet foods have kibbles with an abrasive texture,
and periodic consumption can significantly reduce dental plaque build
up and gingival inflammation (Hennet et al., 2007; Rawlings et al., Declaration of Competing Interest
1997). Wet or homemade diets, with a softer texture, favor the accu­
mulation of dental plaque, which can result in periodontitis (Logan The authors declare that they have no competing interests.
et al., 2002). As dogs do not have the habit of chewing, the use of active
agents leads to greater efficiency of these rations in oral health. Hennet
Acknowledgment
et al. (2007) observed that the size of the kibble interferes with the
abrasive capacity to reduce plaque and tartar and that the addition of
We acknowledge support for a scholarship from Fundação de
sodium hexametaphosphate increased the effectiveness, reducing the
Amparo à Pesquisa e Inovação do Estado de Santas Catarina – FAPESC
accumulation of dental calculus in dogs. Sodium hexametaphosphate
for Evelyn Louise Candida Machado Barbosa.
applied in the food is an effective active ingredient in the oral health of
dogs and can be added as a coating on the granule or inside the kibble
mass (Pinto et al., 2020). References
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