Tuesday, June 20, 2006

Shih Tzu - Switching To A New Dog Food And Oral Care

Here is what you need to do to ensure a smooth transition to a new dog food:

Day One: Start by mixing your old brand with the new brand in a ratio of 3/4 to 1/4 - the smaller amount representing the new brand. Do this for three days.

Day Four: After your dog has eaten the 3/4 to 1/4 mixture for three days, graduate to half and half for another three days.

Day Eight: For the last three days, go to a 3/4 to 1/4 mixture, only this time the smaller amount is the old brand of food.

By the end of the 12 days, your dog should be ready to eat the new food on its own.

If your dog is currently on a special diet, consult with your vet first before switching to a different brand of dog food.

One of the most important parts of keeping your dog healthy is to make sure his mouth and teeth are cared for. Proper oral hygiene is critical for dogs of all ages. And the older your dog gets, the more important it is to keep plaque and tartar off the teeth. In fact, not caring for your dog's teeth is a much bigger deal than just yellow teeth or bad breath. It can lead to serious health problems. A positive step toward this very important aspect of maintaining your dog's dental health is feeding healthy treats such as Gourment Dental Treats from HealthyPetNet.

Oral Problems

Plaque: Dogs usually don't get cavities. They are more prone to plaque and tartar build-up on the teeth.

Tartar: If plaque is not removed, tartar forms. Tartar irritates the gums and can lead to damage of the gums called gingivitis. Gingivitis manifests itself as reddening of the gums closest to the teeth.

Periodontitis: If tartar is not removed, it builds up under the gums. It separates the gums from the teeth to form pockets leading to more bacterial growth. If left untreated, this could lead to damage of the teeth called periodontitis. Veterinarians can slow or stop this process.

Home care for your dog's teeth:

Routinely examine your dog's mouth. Warning signs of tartar build-up are bad breath, red and swollen gums, a yellow-brown crust of tartar around the gum line, pain or bleeding when you touch the gums or brush the teeth.

Use chew toys specifically designed for dental health. Brush your dog's teeth according to your vet's instructions.

Proper diet: Feed your dog healthy food and treats. HealthyPetNet distributes some excellent products. They have a dental treat that contains Microdent, a patented plaque fighting ingredient used in human oral hygiene products that is clinically proven to reduce plaque and freshen breath. Microdent helps reduce plaque buildup by forming a coating in the mouth that helps make mouth surfaces to slick that plaque won't stick. This triple action formula also contains calcium for strong bones and teeth and parsley for fresh breath. The dental treats are made in a small bakery especially for HealthyPetNet.

Connie Limon publishes a FREE weekly newsletter. A professional newsletter with a focus upon health and wellness for you and your pets. Discounts on shih tzu puppies are offered to subscribers. Weekly updates of available puppies. Sign up at: http://www.stainglassshihtzus.com

Tuesday, October 04, 2005

Oral health care for patients with special needs


ABC of oral health

Oral health care for patients with special needs
Roger Davies, Raman Bedi, Crispian Scully.

People with special needs are those whose dental care is complicated by a physical, mental, or social disability. They have tended to receive less oral health care, or of lower quality, than the general population, yet they may have oral problems that can affect systemic health. Improving oral health for people with special needs is possible mainly through community based dental care systems. Education of patients and parents or carers with regard to prevention and treatment of oral disease must be planned from an early stage. This will minimise disease and operative intervention since extractions and surgical procedures in particular often produce major problems. Dental healthcare workers also often need to be educated about this subject.

Appalling oral hygiene and periodontitis in a patient awaiting cardiac valvular surgery. Dental procedures involving gingival laceration or periodontal disruption (such as extraction) can produce bacteraemia of oral microorganisms, which could lead to infective endocarditis

In this context various conditions can lead to people needing special care, not least patients with dental phobias. Many of these patients can be treated with behavioural modification techniques, though a minority will require sedation or general anaesthesia.

This article concentrates on those who are medically compromised, mentally challenged, mentally ill, or socially excluded.

Erythematous candidiasis, presenting as a median rhomboid glossitis, is common in patients with immune defects

Medically compromised patients
Medically compromised patients
Mentally challenged patients
Patients with mental illness
Socially excluded patients
The commonest problems are in patients with a bleeding tendency or cardiovascular disease, or who are immunocompromised.

Bleeding disorders
Dental extractions and surgical procedures, including local analgesic injections, can cause problems in patients treated with anticoagulant drugs and those with coagulation defects or severe thrombocytopenic states.

With patients treated with anticoagulant drugs, local analgesia and minor surgery (simple extractions of two or three teeth) may generally be carried out safely in general practice with no change in treatment if test results are within the normal therapeutic range (international normalised ratio <3). The same is true for patients with thrombocytopenia if the platelet count exceeds 50×109/l. Postoperatively, a 4.8% tranexamic acid mouthwash, 10 ml used four times daily for a week, may help.

In all but severe cases of haemophilia, non-surgical dental treatment can be carried out on haemophilic patients under antifibrinolytic cover (tranexamic acid), though care must be taken to maintain urinary flow to avoid urinary blood clot problems. Haematological advice must be sought before other procedures are undertaken. With mild haemophilia, minor oral surgery may be possible under desmopressin (DDAVP) cover. In other cases factor replacement is necessary.

In patients with bleeding disorders
Surgery can be hazardous in bleeding states
Haemophilic patients need factor replacement before most surgery
Patients treated with anticoagulant drugs can usually safely undergo minor procedures if the international normalised ratio < 3
Thrombocytopenic patients can usually safely undergo minor procedures if platelet count is over 50 × 109/l
Tranexamic mouthwashes used postoperatively may help haemostasis
Good oral care and hygiene are essential

Cardiovascular disease

Ischaemic heart disease
It is generally accepted that routine dentistry for most patients with ischaemic heart disease should be undertaken using short appointments and under local analgesia. More complex surgical procedures should be carried out in hospital with full cardiac monitoring. Elective dental care for patients who have recently had a myocardial infarct should be deferred for at least three months, and some recommend a delay of 12 months.

Cardiac pacemakers
The chief hazards from dental equipment to pacemakers are from electrosurgery and diathermy, but these are infrequently used and the risk from other equipment such as ultrasonic scalers or pulp testers is very small.

In patients with cardiac valvular defects
Good oral care and hygiene are essential
Oral healthcare screening and treatment should be completed before valvular surgery
Antimicrobial prophylaxis is indicated before invasive dental procedures

Cardiac valvular defects
Tooth extractions and dental procedures involving the periodontium can produce a bacteraemia of oral microorganisms, especially Streptococcus mutans and S sanguis, which can lead to infective endocarditis in patients at risk. However, dental treatment precedes only 10-15% of diagnosed cases, and in real terms the risks are thought to be fairly remote.

Oral health care (including maintaining high levels of oral hygiene) should be completed before valvular surgery. It is considered prudent to provide antibiotic cover for patients at risk who are about to have extractions, periodontal surgery, mucogingival flaps raised (oral surgery), scaling, tooth reimplantation, or other procedures where there is gingival laceration. However, there is no convincing evidence for the need for antibiotic prophylaxis for most local analgesic injections or for non-surgical, prosthetic, restorative, or orthodontic procedures other than banding or debanding.

WHO classification of oral lesions in HIV infection and AIDS
Group I. Lesions strongly associated with HIV infection

Candidiasis HIV-gingivitis
Erythematous Necrotising ulcerative gingivitis
Hyperplastic HIV-periodontitis.
Thrush (pseudomembranous) Kaposi's sarcoma
Hairy leucoplakia (Epstein-Barr virus) Non-Hodgkin's lymphoma

Group II. Lesions less commonly associated with HIV infection

Atypical ulceration (oropharyngeal) Viral infections (except Epstein-Barr virus)
Idiopathic thrombocytopenic purpura Cytomegalovirus
Salivary gland diseases Herpes simplex virus
Dry mouth Human papillomavirus (wart-like lesions)condyloma acuminatum, focal epithelial hyperplasia, verruca vulgaris
Unilateral or bilateral swelling of major salivary glands Varicella-zoster virusherpes zoster and varicella

Group III. Lesions possibly associated with HIV infection.

Miscellany of rare diseases

The current basic recommendations are to use a chlorhexidine mouthwash and, one hour before the dental procedure, a single oral dose of 3 g of amoxicillin (or 600 mg clindamycin for patients allergic to penicillin). Patients with a history of infective endocarditis require intravenous antibiotic prophylaxis.

Immunocompromised patients
Oral diseases in immunocompromised people tend to be more common with poor oral hygiene, malnutrition, and tobacco use. The commonest lesions are candidiasis and herpes viral infections, but others include ulcers, periodontal disease, and malignant neoplasms. Purpura and spontaneous gingival bleeding also are seen in patients with leukaemia. Drugs such as ciclosporin can cause gingival swelling.

Angular cheilitis caused by candidiasis

Oral lesions in patients with HIV infection or AIDS are most likely to appear when the CD4 cell count is low and are often controlled, at least temporarily, by antiretroviral treatment. Anti-HIV drugs can cause oral problems such as ulcers, xerostomia, and salivary gland swelling. Oral features are now classified as strongly, less commonly, or possibly associated with HIV infection.

Thrush and erythematous candidiasis are common in patients with immune defects and are often an early manifestation of the immunodeficiency. There is an increase, especially in those with HIV infection or AIDS, in antifungal resistance of Candida albicans and in non-albicans species such as C krusei and new species such as C dubliniensis and C inconspicua. Fluconazole in high doses, however, is often still effective.

Hairy leucoplakia may be seen in immunocompromised patients

Viral infections
Herpesviruses, especially herpes simplex virus, may cause herpes labialis, or oral or perioral ulcers. Hairy leucoplakia, a common corrugated (or "hairy") white lesion, is usually seen in HIV infection or AIDS but may be seen in any immunocompromising state.

Mouth ulcers
Ulcers in immunocompromised persons may be related to aphthous type ulcers, infections (herpesviruses, mycoses (especially histoplasmosis or cryptococcosis), mycobacteria or syphilis, or protozoa such as leishmaniasis), malignant neoplasms (see below), or drugs (such as cytotoxic or antiretroviral agents).

Diagnosis can be difficult, and biopsy with microbial studies may be needed to exclude infections such as cytomegalovirus or deep mycoses. Specific treatments are often indicated. Chlorhexidine and topical analgesics can be helpful local treatments. Granulocyte colony stimulating factor or thalidomide can be helpful in HIV related aphthous-like ulceration.

In immunocompromised patients
Oral candidiasis is common, and antifungal drugs are indicated
Oral hairy leucoplakia is common in patients with AIDS; Epstein-Barr virus is implicated, but treatment is rarely indicated
Mouth ulcers are common, and a wide range of aetiologies is possible
Kaposi's sarcoma, lymphomas, and carcinomas may be seen

Gingival and periodontal disease
Necrotising ulcerative gingivitis and periodontitis occur disproportionately often in immunocompromised patients for the level of oral hygiene. They can be painful and cause rapid loss of alveolar bone. Improved oral hygiene, debridement, chlorhexidine, and sometimes metronidazole are needed.

Malignant neoplasms
Immunocompromising conditions predispose patients to oral leucoplakia and carcinoma (see earlier articles), Kaposi's sarcoma, and lymphomas.

Kaposi's sarcomas in typical sites in the palate

Kaposi's sarcoma typically occurs on the palate or maxillary gingivae and presents as red, blue, or purple macules that progress to papules, nodules, or ulcers. It is associated with human herpesvirus 8. It can respond badly to irradiation but responds transiently to chemotherapy. Oral lesions are often managed with intralesional vinblastine or systemic chemotherapy if there are extraoral lesions.

Lymphomas are typically non-Hodgkin's lymphomas in the maxillary gingivae or fauces. They are part of widespread disease and are usually associated with Epstein-Barr virus. They are resistant to treatment, and chemotherapy is required.

Immunosuppressed patients and those with indwelling peritoneal catheters
Dental procedures are rarely followed by infection of such patients, and any infections rarely involve oral microorganisms. Thus, patients do not require antimicrobial prophylaxis before routine dental procedures unless they have a severe immune defect, there is some other indication, or surgery is to be performed.

Patients with artificial joints
Joint prostheses are only rarely infected because of dental procedures or oral microorganisms. Thus, patients with artificial joints do not require antimicrobial prophylaxis before most dental procedures unless there is some other indication, although antimicrobial use may be prudent for the first two years after arthroplasty and in patients with inflammatory arthropathies or who are immunocompromised.

In immunocompromised patients or those with prosthetic joints
Good oral care and hygiene are essential
Antimicrobial prophylaxis is not usually necessary before dental procedures

Poor oral condition in a mentally challenged person

Mentally challenged patients
Medically compromised patients
Mentally challenged patients
Patients with mental illness
Socially excluded patients
Mentally challenged people often have poor oral health (missing or discoloured teeth, periodontal disease, and oral malodour), which worsens their struggle for social acceptance. Barriers to dental treatment include fear (aggravated by inability to comprehend the need for treatment), the need to be accompanied, difficult access to healthcare facilities, and often a negative attitude or lack of training of the professional.

Patients with a mild to moderate disability can often be treated in general dental practice with help and encouragement from relatives and carers. Recent guidelines issued by the General Dental Council on minimum standards for general anaesthesia will probably lead to a decline in the availability of this in general practice. Those who require additional resources are often treated in the community dental service. For the most severely affected patients, dental care may have to be performed under general anaesthesia or intravenous sedation, often only available in the community dental service or hospital.

In mentally challenged patients
Good oral care and hygiene are essental
Access to care is often limited
Preoperative sedation may be needed

Patients with mental illness
Medically compromised patients
Mentally challenged patients
Patients with mental illness
Socially excluded patients
People with mental illness often avoid dental care, and their oral hygiene may be impaired, with consequential periodontal disease and caries. Their medication may produce adverse oral effects, especially xerostomia (with increased risk of caries) and dyskinesias. Dental management commonly involves ensuring good oral health care (which may involve the support of a carer), delaying treatment until there is relative psychiatric equilibrium, keeping appointments short, and oral or intravenous sedation as required.

Uncleaned denture in a person with psychiatric illness

Socially excluded patients
Medically compromised patients
Mentally challenged patients
Patients with mental illness
Socially excluded patients
Overall, oral health in UK children has been improving, and these benefits should soon be reflected among adults. However, the inequalities in oral health and in the use of services have increased between affluent and deprived groups, especially socially excluded groups (institutionalised elderly people, homeless people, refugees and asylum seekers, those engaged in substance misuse, etc).

In socially excluded people
Oral health is often poor
Access to oral health care is impeded
Good oral care and hygiene are essential

Institutionalised elderly people are more likely to have fewer teeth but more gross caries and root caries than other elderly groups.

Further reading

Aartman IH, de Jongh A, Makkes PC, Hoogstraten J. Treatment modalities in a dental fear clinic and the relation with general psychopathology and oral health variables. Br Dent J 1999;186: 467-71
Academy of Dentistry for Persons with Disabilities. A position paper from the Academy of Dentistry for Persons with Disabilities: preservation of quality oral health care services for people with developmental disabilities. Spec Care Dentist 1998;18:180-2
Bedi R, Uppal RDK. The oral health of minority ethnic communities in the United Kingdom. Br Dent J 1995;179:421-5
Carter EF. Dental implications of narcotic addiction. Aust Dent J 1978;23:308-10
Hakeberg M, Dernevik L, Gatzinsky P, Eklof C, Kennergren C, Jontell M. The significance of oral health and dental treatment for the postoperative outcome of heart valve surgery. Scand Cardiovasc J 1999;33:5-8
Porter SR, Scully C, eds. Oral healthcare for those with HIV and other special needs. Northwood: Science Reviews, 1995.
Scully C, Flint S, Porter SR. Oral diseases. London: Martin Dunitz, 1996
Yilmaz S, Ozlu Y, Ekuklu G. The effect of dental training on the reactions of mentally handicapped children's behavior in the dental office. ASDC J Dent Child 1999;66:154-5, 188-9

Homeless people often are not registered for dental care, make little use of dental services, miss dental appointments, have poor oral health, and are at increased risk of oral cancer.

Refugees and asylum seekers often find access to dental services difficult.

People who engage in substance misuse often have poor oral hygiene; tend to prefer sweet foods and sugar (especially methadone users), leading to caries; have damaged or lost teeth because of convulsions; and make little use of dental services, about which they have high anxiety.


Crispian Scully is grateful for the advice of Dr Rosemary Toy, general practitioner, Rickmansworth, Hertfordshire.


Roger Davies is consultant in special needs dentistry, Raman Bedi is professor of transcultural oral health, and Crispian Scully is professor of special needs dentistry at the Eastman Dental Institute for Oral Health Care Sciences, University College London, University of London (www.eastman.ucl.ac.uk).

The ABC of oral health is edited by Crispian Scully and will be published as a book in autumn 2000.



While innovation remains key, oral care future has bright spots


While innovation remains key, oral care future has bright spots
Drug Store News, March 21, 2005 by Antoinette Alexander

Save a personal copy of this article and quickly find it again with Furl.net. It's free! Save it.
Oral care, for the most part, is a mature market, but manufacturers have been able to tear down walls by creating unique products and positioning oral care as not just a hygiene product, but also a cosmetic benefit. Enter teeth whiteners.

Fueled in large part by baby boomers' desire to remain youthful and attractive, teeth whiteners continue to be a white-hot segment in oral care.

In fact, the dental preparation category--which includes tooth cleaners, whiteners and denture products, but is driven largely by whiteners--is expected to climb 15.9 percent to about $3.4 billion in 2008 from $2.9 billion in 2004, according to Packaged Facts' most recent "U.S. Market for Oral Care Products" report.

"Whitening is truly an incremental business. It has added a lot of growth to the total market, said Christophe Coudray, Gillette's business director for chemical products.

"Inherently, consumers are always on a quest seeking new beauty products, and I think, in the case of whitening, the satisfaction generally has not been as high, so they are looking for the next big idea to help them achieve what they want to achieve," said David Fox, vice president of marketing for oral care at Church & Dwight, whose brands include Mentadent, Arm & Hammer and Close-Up.

Church & Dwight, which has been working to revive the Mentadent brand it acquired from Unilever in 2003, this year is launching Mentadent Replenishing White toothpaste with Liquid Calcium, which promises to strengthen tooth enamel and prevent future stains from forming.

Continue article

Leveraging the Rembrandt teeth-whitening brand it recently acquired, Gillette rolled out in August the Oral-B Rembrandt Whitening Pen and Whitening Strips, followed up by the new Oral-B Rembrandt Plus Whitening Toothpaste.

With the help of Procter & Gamble's Crest Whitestrips Premium, P&G's share of the teeth-whitening segment now stands at about 70 percent. Sarah Irizarry, Crest brand manager for P&G, would not comment on new products in the pipeline, but did say, We believe that this is a profitable and now more mainstream segment, and we will continue to build on our current product offerings."

Meanwhile, P&G is shipping its new alcohol-free Crest Pro-Health Rinse, the first Crest mouthwash. With $100 million in marketing campaign support, it is considered Crest's biggest initiative of the year.

Behind the scenes, the industry is waiting to see what will happen with the Gillette and P&G oral care businesses as they await approval of the $57 billion deal in which P&G will acquire Gillette. Industry sources have speculated that divestiture decisions await the companies, especially in whitening products, toothbrushes and dental floss where there is some overlap. Both companies have declined to comment on the matter.

So how can retailers drive growth in an already mature oral care market? Irizarry has several tips:

* Set up shelf layouts emphasizing high-impulse items like whitening kits to disrupt a shopper's routine grab-and-go mentality.

* Create incremental opportunities for unplanned purchases of oral care items through relevant, high-traffic secondary locations outside the oral care aisle.

* Offer simple consumer education messages and claims at-shelf and in circulars to encourage the trade-up that comes with better understanding of key new items and product technology.

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