Thanks, Anthony. If you have come back, for the, for the second instalment, thank you. I must have said something right on Monday.

So tonight's almost like a second date, which is quite exciting. If you didn't manage to catch Monday's webinar, then it is available to view online. And the two talks actually complement each other quite well.

So, it definitely would be worth listening to Monday nights. I qualified in 1997 from, from Edinburgh and I mentioned on Monday that I didn't really have much dentistry training to speak of and that's how I got into dentistry. And I would just like to qualify that statement to say that Edinburgh now have made big, big changes to the, the dentistry in their curriculum and, and I'd like to applaud them for that.

So things are changing gradually, thankfully. The other thing I wanted to just clarify was on Monday night, Anthony mentioned that I'd opened my own practise. Well, sadly, I haven't done that yet.

I do work out of two practises on the south coast. I work for Grove Lodge Veterinary Hospital in Worthing, and I also work primarily from Wilbury vets in Hove as well. And thank you, of course, to pedigree, without whom this probably wouldn't be possible.

So a big thank you to pedigree, . I'm very pleased, to work with Pedigree on this project because like me, they're committed to educating people, they're committed to educating the general public and they're also committed to, Educating vets. And for those of you that don't already have an educational flip chart, I would recommend you, you email Mary Louise, to get a copy of both the K9 and the feline one.

They're really nice resource to have in the consulting room, and I'll give you her email address at the end. I'm, I'm just going to do a shameless plug now for the BVDA, the British Veterinary Dental Association, because to be honest with you, without them, I probably wouldn't be where I am today. And they were the association that I initially approached when I wanted to do some CPD and I'm currently the course organiser for for our CPD programme and our undergraduate training programme.

So I would urge you, if you're interested in dentistry, to, to join, and you can get details online. You can follow us on Twitter, and we do run, quite a lot of CPD courses. We're also excited to be joining pedigree in their dental care programme, which will basically be an ongoing, oral care programme, but pretty much to, to replace their oral care month now will be an ongoing, venture.

We have got some CBD courses coming up, and there is the link if you want to, go on any, it's a modular courses, 6 courses, and we'll be covering all sorts of things like radiography, extractions, feline dentistry, and that's, in conjunction with the College of Animal Welfare. So dentistry is for life. The reason I wanted to, to do this, talk was that we're all used to the fact that the older animals get dental disease and periodontal disease obviously is the number one.

And disease really in small animal practise. But what I wanted to try and make you aware of is that that young animals, puppies, kittens, they get their fair share of dental problems as well. And it's it's really important as professionals that we detect these problems and treat them appropriately.

So we see puppies and kittens regularly when they're young. The vet checks them at vaccine times. So that's several times between the sort of ages of 18 and 16 weeks.

And many practises now hold puppy parties, and nurses often get involved in, in poppy and kitten checks as well. So we've got multiple opportunities to check these patients. The first thing I want to talk about is occlusion, and occlusion really means how teeth fit together.

And this is obviously an adult dog. If you look at the top photograph, this is the incisor occlusion. So this is what we would call a scissor bite, and the upper.

Incisors sit just rostral to the lower incisors and the lower incisors actually bite on what's called the singular, which is like a little bite plate on the back of the upper incisors. And then the lower canine teeth basically flare out so that they sit on the outside of the gingiva there at the top. And then if we look from the side again, you can see the the incisor occlusion, the upper incisors just sit rostral to the lower incisors.

And then if we look at the canine teeth, and the canines have what we call an interlock. So the the mandibular canine should sit midway between the lateral incisor and the maxillary incisor. And then again, it sits just lateral to that gingiva there.

If we look at the premolars, the mandibular first premolar should be just in front of the maxillary first premolar. And those premolars kind of form a pinking shear effect. So they're the sort of shearing teeth, if you like.

And then the maxillary 4th premolar, the carnassal, sits lateral or buckle to the lower first mole of the other carnassal. So that's what we would call normal occlusion, and it's the same in the puppy. So if we look at some puppy teeth, again, the lower canine tooth should sit midway between the upper canine tooth and the lateral incisor.

And if you can see in both of the top pictures, it's just lateral to that gingiva. And if we look from the front, I'm sorry, the picture's a little bit blurry, but those lower canine teeth should just flare out and just sit on that lateral surface of the gingiva. So sometimes that goes wrong.

And if we look at these puppies, hopefully what you can see in all of the images is that either the canine teeth and all the incisors are in the wrong place. And in the top two photos, you can see quite clearly that lower canine tooth is is occluding or touching gingival tissue as the mouth closes. And in some cases, the incisors will also touch the roof of the mouth.

You can see that in the bottom two cases. This is painful, and you can see here the pits that are being created in the roof of the mouth by those poppy teeth hitting the roof of the mouth every time the poor puppy closes its mouth. So these are painful.

If you've ever felt poppy teeth, you know that they are really sharp. So every time the poppy closes its mouth, it, it's really hurting itself. And the other important thing is that this will actually restrict the jaw growth.

Dogs and cats jaws basically grow in 4 quarters. We have the two halves of the maxilla, and we have a left and right mandible. And each of those grow independently.

And the problem with this situation is that when the puppy is asleep and doing most of its growth, the mandible becomes locked because of the tooth that's jammed into the roof of the mouth. So it means that the mandible can't potentially attain the length that it would reach, and that means that we're more likely to have this type of maleclusion when the adult teeth up. So very often what we need to do is extract these teeth, partly to relieve the pain, but also to try and help the, the jaw grow to its normal size and hope that the maleclusion won't happen in the adult tooth as well.

But remember that poppy teeth are not easy teeth to extract. The the roots are incredibly long, and the ratio of the crown to the roots is much different in the poppy tooth than it is in the adult tooth. And if you look on that left hand photograph, you can see we've extracted both deciduous canines and the 6 and sizes, and you can see the two middle ones have broken.

We did retrieve the, the root tips, but they're very, very fragile teeth. So often it's a good idea to approach this as an open or surgical extraction. And we talked about that in in Monday night's webinar.

So if we get a little bit older now, by the time we're reaching sort of 5 months of age, we should start to be seeing, most of our our permanent teeth erupting. They will start coming through at about the age of 3 months. And if we're getting to 6 months old and we've still got permanent teeth and deciduous teeth, then we have a problem.

We should either have a deciduous tooth or we should have a permanent tooth. We don't want to see two of the same kind of tooth in the mouth at the same time. So if you look at the dog on the left hand side, this was a chihuahua, and you can see it's almost like a shark.

It's got two rows of teeth. It's also got persistent canine teeth and, and the top right photograph, that's its lower jaw, you can see we've got extra incisors and we've got retained or sorry, persistent, Canines as well. Cats are not exempt.

This was, of course, a vet's cat, the diet that I looked at, and this cat had a number of problems. It damaged its mandible by falling off a shelf so that the mandibles didn't grow properly. It's got persistent canine teeth.

It's got supernumerary teeth, so of course that would be a vet's animal. So cats do get that as well. Why do we need to think about deciduous teeth that are persistent?

Well, persistence leads to overcrowding, and, and we talked about that a little bit on Monday night. Wherever we get teeth that are overcrowded, we're going to get plaque accumulation, and if we get plaque accumulation, we're more likely to get periodontal disease. We also tend to get displacement of the permanent tooth.

So in the mandible, the deciduous tooth is lateral or buckle to the permanent tooth, and in the maxilla, the deciduous tooth always sits just caudal to it, and it tends to displace those canine teeth. So in mandible, the permanent tooth tends to be displaced into a more upright position. And the maxillary canine tends to be displaced into a more rostral or medial position there, and then that in itself can cause problems.

So traditionally, certainly when I first graduated, we used to think of of extracting deciduous teeth as a pretty easy job. We used to say, well, let's just wait till the the dog, is, is castrated or spayed. It'll be a quick job.

It'll only cost you about 20 pounds. Well, we need to start rethinking that, opinion really. And we need to think about if there is a tooth that's persistent and has not been shed properly, then why has that happened?

And to understand that we need to understand how deciduous teeth are normally exfoliated or normally shed. And if you look at the bottom right hand X-ray, we can see that there are permanent teeth waiting to erupt. And then we also have a permanent tooth that has already erupted.

So the big tooth on the left hand side is the molar. There are no deciduous molars, so that doesn't have a precursor. The other two premolar teeth are permanent, and above them, the green stars are the deciduous teeth.

And what happens is the permanent tooth basically grows, if you like, and and starts to move towards the deciduous tooth. And as it does that, it puts pressure on the roots of the deciduous tooth, and it creates resorption. And we're all familiar with osteoblasts and osteoclasts remodelling bone.

Well, odontoblasts will build teeth by laying down dentin, and the odontoclast will actually remove tooth substances. So we're all familiar with feline odontoclastic lesions. So the odontoclast basically resorb the root, and once the root is resorbed, there really is nothing left holding the tooth in the mouth, and it will be shed naturally.

Now if that doesn't happen for whatever reason, then very often the whole root of the deciduous tooth will remain there. And that may be because the permanent tooth bud is not in the right place to actually put pressure on the root, or there may be some other genetic factor that we're not aware of, but The point is that these persistent deciduous teeth can have complete roots on them. And remember we talked about extracting deciduous teeth on Monday night.

These are not easy extractions, very often I would do them as a surgical approach. And we've also got a very, very delicate permanent tooth just next to it that we want to make sure we don't damage. In this example, you can see in the X-ray, there's absolutely no absorption of that deciduous tooth.

So I raised a surgical flap, and I use very fine, sharp instruments, very gently luxated, removed the entire route and then sutured my flat back into position. I think this case was actually done when the, the dog was castrated, and, and I can tell you it's It took longer than the actual castration procedure. So don't be afraid to charge properly for this.

And one of the best pieces of advice I can give you is the next time you do extract a deciduous tooth, keep it in a pot and then show it to the client, and you can show them how long the route is and how delicate the surgery is, and then they, they will be much happier about you charging them what you want to charge them. And this just shows you how long that deciduous tooth root is. If the crown is 5 millimetres, the root is easily 20 millimetres.

So once we get to 6 months of age, again, often we'll do puppy checks and kitten checks at this age that might be with a nurse, it might be with the vet. And but what we should be thinking about introducing at that age is the concept of toothbrushing, but also getting the clients to get the pet used to having their, their mouth and teeth handled. And I normally advise people to try and start brushing once the permanent teeth have erupted.

Very often clients will say to me, you know, when the dog comes in at age 1011, 1213, we, we perhaps do some extractions. They can, they ask me what we can do to, to try and maintain your health and I go through home care. And they say, well, I wish I would have known.

I wished I could have started this when my pet was 6 months old. Why did nobody ever tell me? And I think we're, we're letting our clients down and we're certainly letting our pets down if we don't give clients, adequate, education.

So we need to give clients the opportunity to do the best for their pet. If we can get clients interested and motivated to to perform some home care, then we may have a chance to try and prevent periodontal disease. And that's particularly important for small breed dogs.

We know that small breed dogs are more likely to get periodontal disease than large breed dogs. So, If you get your Maltese, your Chihuahuas, your your Lhasa, so your shih-tzus, your Daxis walking through the door, I would make a particular effort to get those clients motivated and committed from an early age. If you take nothing else from this lecture, what I'd really like to sort of try and drum home is the fact that we should be being more proactive about dentistry.

We should be more preventative. What we're doing at the moment. It is a very reactive approach.

What we do is we we perhaps tell Mrs. Jones year on year out that there's some gum disease there that we really need to have fluffy in for for a dental. Mrs.

Jones doesn't listen to us and then when Fluffy gets to 10 years old, we have fluffy in and, you know, we extract 20 teeth and then think that sending her home with with a bag of dental food is going to make a difference. Well, To be honest, it's, it's too late at that point. We need to be more proactive.

We're used to being proactive in preventing diseases that we can vaccinate for. We we're used to worming. We're used to preventing fleas, but, dentistry sadly has sort of missed the boat there, and I would urge you all to think about being a lot more preventative.

So again, at 6 months of age, we should really have got all of the adult teeth through, and it's a good time to check that they're all there. We need to start counting teeth, because if there are missing teeth, what could have caused that? Well, they may have been extracted, but you would probably doubt that at 6 months of age.

It may be that the crown is missing, but there is a root there. It may be that the tooth has not erupted properly, so it could be trapped underneath the gum or in the bone, or it may be that it was truly missing and it never actually formed. And some breeds of dogs that generally suffer from an epidermal dysfunction, so that the Chinese crested, they typically get.

Dental problems as well. So their teeth don't form properly. The, the, enamel doesn't form properly because that's an epidermal, origin.

And we can see in this the photograph, this dog has got multiple missing teeth. I X-rayed this dog and and then they were, they were so genuinely missing. But sometimes, however, we can get missing teeth that actually cause big problems.

And if we have a tooth that hasn't erupted properly into the mouth, they can form what we call denigous cysts, and these are expansile cysts that essentially grow within the the bone of the jaw and destroy the bone and teeth as it goes. And these can be undetected, but they can get so large that they actually cause pathological jaw fractures. The most important thing is that these are often incidental findings.

So the boxer in the photograph this came in for, I think it came in for a biopsy of surprise, surprise a lump, and, I was a general practitioner at the time and doing what I always do was was count teeth, . When I intubated it and it had a missing first pre-molar and you can't see the first molar very well, but that's number 9. If we count forwards from that, we have 8, we have 7, we have 6.

But then there's a gap where tooth number 5 should be, and then we've got the canine. And when I took an X-ray, hopefully you can see in the X-ray we have a radio dense structure just behind the canine. That's actually an uncorrupted first premolar, and the radiolucent shadow around it and going back to the the third premolar there is a dented your cyst.

So that needed surgical. Debridement, curettage of the lining, removal of the cyst lining, and histopathology because these can actually become, the cyst lining can become malignant. So brachycephalics are most common to get this.

So your boxers, your Boston terriers, your French Bulldogs, Bulldogs. It's always worthwhile having a look in these mouths, no matter what you're doing. And if you, if you see a sort of fluidy swelling, it will be worthwhile taking a dental X-ray if you can, or referring to somebody that can take a dental X-ray.

And as I say, these are often incidental findings. So the moral of the story is to always count teeth and I can't even go on holiday without, thinking about teeth. This was, at the Scripps aquarium in San Diego.

When the permanent teeth are coming through, we also need to check that the permanent teeth are not malecluded. And these are so common. If you start looking, you will be amazed at how many dogs have a maleclusion.

Some of them are breed related, so boxers, clearly they have a maoclusion, but that's normal for the breed. But other dogs, have a maleclusion and it can cause quite serious problems for them. Types of problems that can be caused obviously are pain.

In both of these cases here, we can see the lower canine tooth is not in the right position. Remember, it should be in that gap between the canine, the upper canine, and the lateral incisor. And instead, it's, it's too far caudal, too far medial, and it's, it's hitting the roof of the mouth when the dog closes its mouth.

So clearly we get palatal trauma and long term, we certainly run the risk of of getting an or nasal fistula. And we also run the risk of getting periodontitis in that area on the pal aspect of the upper canine tooth. And one thing I forgot to mention when we talked about this in poppies is that poppies with this problem are very, very often head shy.

So when you go to try and examine them, they really wriggle. They don't like being looked at. And why is that?

Well, If you think you're going to get hurt, then what do you do? You tense up, and if you tense up, then your jaw muscles clench, your mouth closes, and of course, the puppy's tooth is going to go right into the roof of its mouth. So every time they get touched, they, they associate that with, with pain, basically.

So do touch these dogs and cats very, very gently around the face. So what do you need to do? You need to detect these problems when the permanent teeth have erupted.

So by 6 months of age, you should be able to detect these problems, and you either need to treat them or you need to refer them. What we shouldn't be seeing is these dogs coming to us for treatment when they're aged 789, 1011 years old because they've lived with this problem for all those years, and I think that's a disservice to them. The treatment options, I'm not going to talk about in detail, but basically, for this type of maleclusion, there are lots of maleclusions, but for this type of maleclusion, we need to extract the tooth that's causing the problem.

Now, nobody likes extracting a healthy mandibular canine, so that would really be the the last option. We can shorten the tooth, and because we shorten it, we're going to expose the pulp. So then we need to perform what's called vital pulp therapy to essentially put a dressing on the pulp and keep it alive so that the tooth can continue to develop.

We can also use orthodontics to to move teeth into the correct position. And that sounds crazy, but it's, it's not quite as crazy as it it perhaps sounds. So this Scotty on the left, we, applied a brace to it.

It's called an inclined plane, so that when the lower tooth, when the mouth closes and the lower tooth hits that bite plane, the tooth is effectively, deflected into the correct position. In the German Shepherd on the right, we chose to perform a crown shortening, and if you're wondering what that funny thing is over the tooth, this is a dentist's attempt at a sterile field. It's a sterile latex glove because we want this surgery to be as sterile as possible.

And that's the postoperative image of both of those cases. So really good outcome for the Scotty and time will tell with the German Shepherd. I need to follow that one up and with X-rays in the autumn.

But it's certainly both of them are much more comfortable now. So moving now on to adults, I'm going to ask you what the most common disease we see in adult dogs and cats is, and hopefully, because it's a dentistry webinar. Well, actually, even if it was a different type of webinar, you would all be able to tell me that the most common disease is, of course, periodontal disease.

You all know the statistic that 70 to 80% of dogs and cats are going to have some form of periodontal disease by the time they're 2 to 3, and it really is, is common. We talked It's about periodontal disease on Monday. I am going to talk a little bit more in detail about it now, but I, I'll try not to bore you.

What about this dog? This is a Labrador. This is about a 4 year old Labrador, and you, you might initially look at that mouth and think, wow, that's a really healthy mouth.

There's there's no tartar, and that mouth looks really healthy. But, but look closely, look how inflamed the gingiva is on that canine tooth, on the second premolar on the carnassal. That's gingivitis.

That is a disease that needs treatment. Now, treatment at the moment may only be instituting some kind of home care programme, but we shouldn't be ignoring that problem. So what is periodontal disease?

It's caused by a plaque. It's an inflammation of the support structures of the teeth. And we have these two sort of syndromes, if you like.

We have gingivitis, where we have inflammation of the gingiva, and we have periodontitis when we actually start to get attachment loss for the tooth, and ultimately, we will lose the tooth from the mouth. So gingivitis essentially is inflammation of the gingiva. And this is an illustration that was kindly loaned to me by David Crossley.

And he's very elegantly drawn a cross section, of the tooth there, showing the gingiva as it attaches to the tooth, and then also showing the socket, the alveolus, and the periodontal ligament. Which is of course detached to the cementum on the tooth roots. So with gingivitis, the gingiva becomes inflamed, but we have no attachment loss of the bone or the periodontal ligament.

How do we recognise gingivitis? Well, we see an inflamed, reddened, potentially edematous gingival margin, and we would typically get bleeding when we use our periodontal probe. The most important thing is that this stage is potentially reversible.

When they were doing human research in the 1960s, and they got a load of dental students, and he said vet students and dental students to enrol in a study which looked at gingivitis, and they got the students to stop brushing their teeth for a week. Now you can probably imagine what their mouths were like at the end of that week. Pretty stinky, pretty horrible, lots of, of bleeding when they, they did start brushing their teeth again.

But when they started brushing their teeth again, the gums went back to normal clinical health. So we know potentially at this stage, we can get the gums back to normal clinical health. So what is the cause of gingivitis?

Well, it's plaque and as I, I talked about on Monday night, plaque is a biofilm, and a biofilm is basically a community of bacteria that that live together. Instead of being free living planktonic bacteria, they've, Over millions of years of evolution have found a way of forming a community where they can stick to a surface but also stick to each other, so they can attract further bacteria to join that biofilm. And literally hundreds of species have been identified in dogs and cats' mouths.

And if you wear contact lenses, biofilms are, are an issue, and that's why you need to not only soak your contact lenses, but you need to physically clean them as well. Biofilms are best removed, best removed physically. Plaque isn't really visible unless it's very, very thick.

And we can use plaque disclosing solutions to actually highlight it. And, and those are nice tools again to have in the consulting room or in your dental room so that when you've done your scaling and polishing, you can apply the solution and just see if you've missed any areas. Or if you've got a client that is performing toothbrushing, you can get them in on a regular basis, perhaps at a nurse's clinic, and apply some .

A disclosing solution and see how effective their efforts are. So let's think about a bit of microbiology now. The bacteria that initially form a plaque are Gram-posit aerobes, and those are, as in the grand scheme of things relatively benign bacteria.

But because they're aerobs, they use up oxygen. And if you use up oxygen, in that environment, so in that gingival sulcus area, then that allows anaerobes to proliferate as the level of oxygen is, is dropping. And these tend to be gram-negative organisms, and these bacteria are much more aggressive, much more nasty bacteria.

They have lots of virulence factors, and they produce toxins, exotoxins, endotoxins, and they produce volatile sulphur compounds. Now, volatile sulphur compounds not only contribute to bad breath, so halitosis, but also contribute to actual tissue damage as well. So many dog and cat owners think that their, their smelly dog and cat breath is normal.

Well, well, actually, it's the first warning sign that there's periodontal disease there. Tartar, and remember, is the same thing as calculus, it's one and the same thing. Essentially, it's mineralized plaque.

If plaque is not removed, then it will absorb calcium phosphate, calcium carbonate from the saliva from food. And it will harden into this very sort of cement-like structure on the tooth surface. It isn't in itself pathogenic, but it creates a very rough surface that more plaque bacteria will stick to.

So we do need to remove calculus when we're treating periodontal disease, but it's not the key thing. Plaque is the key thing we're trying to control. If we move on to periodontitis, again, I did talk about this on Monday night, so I won't labour the point, but essentially, we have destruction of the attachment apparatus.

So what that means is what is holding the tooth in the jaw. It's the periodontal ligament, the alveolar bone, the the cementum, and the gingiva. All of these things get destroyed not only by the bacteria and their toxins, but the way in which the host's immune response and approaches that infection.

So many cytokines will get switched on. Those cytokines can switch on osteoclasts, so we, we start to get bone loss. We have colagenase enzymes that are released, that will break down the the periodontal ligament, and so we get this ongoing chronic problem.

And the important thing is that gingivitis may progress to periodontitis. It may not necessarily, but there's, there's a chance that it will. You know the prevalence, I've already mentioned that there's been quite a few studies over the years that have looked at it, and I do have a list of references, at the end.

And if you want a list of references from both of my talks, please do email me and I'll send you the whole, whole list. So what if it's, you know, the most common disease we see in in in small animal practise . When I was doing general practise, I can honestly say that this was the most common thing that I saw multiple times a day, if not every patient that walked through the door.

It's important because it is so common, and it's also important because of the consequences and there's local and systemic consequences, and potentially we have a chance to prevent this disease. So what are some of the local consequences? Well, pain, discomfort, abscesses either around the periodontal tissue in the gingiva or around the root, and those are certainly painful, or a nasal fistulas, bone infection, osteomyelitis, fractures of the mandible pathological fractures, and, and the end stage obviously is, is strategic tooth loss.

So here's an example of a peripal abscess around that, . Second molar tooth in the mandible. We've also got occasional bone loss there, so we've got horizontal bone loss, and we've got that, that nice circular, perapical lucency which would be consistent with an abscess or a granuloma, and those are painful.

Here's an or nasal fistula. And when we talked about vertical bone loss on Monday night, and one of the common places to see that is on the palatal aspect of the canine tooth, the maxillary canine tooth. So we get bone loss there and potentially that bone loss will erode so much bone that we end up with a communication between the mouth and the nose, and that's obviously an all nasal fistula.

In actual fact, that bone plate in health is very, very thin anyway. So if we get periodontitis there and bone loss, it doesn't take that long for us to have a communication into the nose. And what happened with this Daxi was that the, the canine tooth was mobile.

So the vet that extracted it just, I think, used a pair of forceps, pulled the tooth out, tried to close the gap, and, not surprisingly, the, the extraction site didn't heal, and within a short space of time, we had an obvious or nasal fistula there. Now, this requires a surgical approach to to repair it. And this was a bilateral problem.

One of the ways to tell that there is a preexisting or nasal fistula when you probe on that palatal aspect of the canine tooth, if you get blood coming down the nostril, you know you've got an or nasal fistula there. So you need to, to use a surgical approach and make sure you remove all of that, epithelial tissue that's kind of growing from the mouth into the nose. Otherwise, that your, your flap that you've made, will break down.

And here's the situation that nobody wants to see. This is a pathological fracture of the mandible, and that's because so much bone in that mandibular area underneath the two roots that the cortex has just not got enough strength in it to hold the jaw, and this little dog was probably just happily eating its breakfast when it broke its jaw. So these are all very, very serious consequences.

We also have pretty serious systemic consequences, sorry, consequences as well. There's research to show that these animals have a chronic bacteremia, and they have increased levels of certain cytokines and inflammatory mediators like C-reactive protein. And we also know There's evidence of histological changes in the heart, the kidney and the liver, and that was found in dogs.

Now, I don't say heart, kidney and liver disease. I do sort of temper that with the fact that it's histological changes. We don't know at the moment whether that equates to disease in those organs.

We do know, however, that there is an association between the severity of periodontitis and the level of azotemia. So the more severe your periodontitis, the more likely your, your azotemia is to be much higher. We also know that periodontal disease will have an effect on other diseases as well.

So, diabetes mellitus can be affected by periodontal disease. I always like to throw in a picture of human teeth because I think we're so used to seeing gory animal photos. We never actually see gory human pictures and I think this one's in there just to wake you all up.

And there's obviously lots of research in in human periodontal disease and there are proven. Links or associations with diabetes, cardiovascular disease, pneumonia, chronic kidney disease, cancer, and women premature birth and low birth weights. And ultimately, if you have bad periodontal health, you're more likely to die younger than if you don't.

So I would imagine everyone tonight is going to be brushing their teeth, particularly effectively. So here's a quick question for you all, after dental treatment, so after our scaling and polishing, how long does it take for plaque to start reforming? So how long does your good work last for?

I've just put that poll up, Rachel, so we're just giving it a chance for for people to vote. Most people have voted, we have 57% who are saying that it's minutes. At 37% say it's 48 hours.

5% say 1 week and 1% say 1 month. OK, that's interesting and and the majority of you have got it right, . Basically, what we call a pellicle forms within minutes.

Now that is a layer of salivary glycoprotein which sticks to the enamel surface. That is then colonised by bacteria. So the bacteria, basically stick to that.

They, they text their mates, get their mates to come and join in the party. This builds up to a kind of a critical mass, and within 48 hours, we have what we call pathogenic plaque. So really, your, your efforts, your scaling and polishing are really only going to last 2 days.

OK, so if we want to prevent the recurrence, if we do nothing, then obviously the periodontal disease will, just continue from where, where, where it left off. If we want to do anything about controlling periodontal disease, then we need a home care programme. And that must revolve around daily plaque control.

That's why we brush our teeth twice a day. It's why we floss, it's why we use mouth mouth rinses. Now plant control can either be mechanical or it can be chemical, and we'll talk about those two things shortly.

But what we need to do is to tailor each plan based not only on the animal, but also on the client's commitment and ability. And if you're looking at home care and options, there's there's so many products and and options out there that it can get quite confusing. What I would urge you to do is, is look at the evidence and hopefully you're all familiar with the concept of, of evidence-based veterinary medicine.

Essentially, anytime we choose any treatment for one of our patients, we should be bearing in mind the, the latest, and best, evidence that we can. So please try and do that when you're making home care recommendations as well. And if you're not familiar with this, this is what we call the the pyramid of evidence, and essentially at the top we have the best level of evidence, and at the bottom, it's the the worst or the weakest level of evidence.

So at the top we have the, the randomised controlled clinical trials, the double blinded studies. If you take a whole load of those and Check that they were indeed randomised and blinded and if they fit your criteria, then you can add them all up and you have a systematic review and then if you perform. Statistical analysis on those reviews, you have what's called a meta-analysis, and that really is the highest form of evidence because you're looking at huge numbers.

So when you're evaluating the evidence, what you need to decide is, is there actually any evidence at all or is it all marketing hype? Has the evidence been published or is it just on, a, a PowerPoint presentation? Has it actually been published in a recognised journal?

Was the evidence and produced in vitro or in vivo? Because if we look back at this, then the best quality evidence is going to come from clinical trials in your target species rather than in in vitro. And so again, is there a clinical trial available in the target species?

And if you've not read this book, then I would recommend you download it or buy it. Bad Science by Ben Goldacre. I think it should be on the curriculum of all veterinary, dental and medical curriculums because It's a very, very good book and it will tell you how to sift through a scientific paper and actually decide whether it's, it's worth, you reading it and taking something from it or whether it should be filed in the the bin.

The VOHC seal is another thing that you can look at. The Veterinary Oral Health Council was set up in 1997, basically because there were so many products out there claiming to reduce plaque and tartar. And what the VOHC does is it it evaluates that evidence.

And if they're satisfied with the research, then they will give it the VOHC seal. So that's something that you can look for as well. So home care, ideally what we would want to have coming through our consulting room door is either this dog or or this cat.

These are your compliant animals that that you can do most things with. What you don't want to have walking through your door is is these two creatures. Now, clearly I'm never going to say to the clients of these two that, they need to start brushing their teeth because I think they would just laugh at me.

The best form, the gold standard of mechanical plaque control is toothbrushing, and that's why we brush our teeth. But you need to introduce it gradually. So start the client with some kind of facial handling.

And the ideal time to do that, as I said earlier, is when you've got your 6 month old puppy or kitten. Try and get into a routine so you get the client to have the, the same routine, and then the dog or cat will get into that routine as well, and concentrate on praise and reward. The animal must associate the experience with something positive, otherwise it's never going to be sustainable.

What we need to aim for is once a day. If the mouth is clinically healthy, then we can maintain it like that by doing it 3 times a week. But I would always urge you to tell clients to try and aim for once a day.

Unfortunately, once a week is as good as doing nothing, so you might as well save some energy and do nothing because you'll get the same outcome. If clients are coming in to me and saying, well, I'm brushing teeth, but I'm only doing it once a week, of course, what I will say to him is, that is fantastic, brilliant. Keep going, but let's just see if we can get it a little bit more frequently than that.

So do always motivate your clients at the same time. So we want an animal toothpaste. We don't want a human toothpaste because of course that contains fluoride, and we know to spit that out, but, but animals don't.

Generally, animals don't like mint flavour. We do like mint. And the other reason to use an animal toothpaste is that it won't froth.

We apparently like frothy toothpaste, but animals don't tend to like that. So do warn the client that their pet toothpaste is not going to be a frothy one. And then use a soft or medium bristle brush, you can get the the silent electric ones and and some people that don't cope very well with toothbrushing might be able to cope with an electric toothbrush.

And make sure you get the client to replace it. Sometimes clients will come in with the toothbrush that they're using. It looks like one that they've kept from 1974 that has been used to clean the car and all sorts of things.

So do get them to replace it as often as they would replace their own toothbrush. Then we're gonna angle it at 45 degrees to the gum line, so we're aiming the bristles up into that gingival sulcus, and we're gonna brush in a, in a circular motion. And I tell clients to start at the back and work forwards.

The incisive area. Is quite sensitive, so I always leave the incisor area to the very end. And what I find quite helpful in dogs is to just gently hold the mouth closed, because if their mouth is open, the dog can kind of chew on the brush and then the brush gets trapped and the client gets a little bit disheartened because they don't feel like they're doing a very good job.

So I tend to hold the mouth closed, and just gently introduce the brush underneath the lips and then work on those, those outer surfaces. And for cats, I use a slightly different technique. I sort of put my hand, my non-dominant hand over at the top of the cat's head, as if I were going to, to pill it and then try and brush the teeth in that position.

Toothbrushing with finger brushes, they're not that effective, I'm afraid. They are OK as a training tool, but the bristles on them are really not that effective. If they were effective, we'd all have a finger brush sitting in our bathroom cabinet, but we don't.

We have a lo nylon bristle toothbrush, and that's what we should be using in our pets. I also don't like telling clients to put their fingers in their pet's mouth because I'm sure they're going to get bitten quite horribly, inadvertently at some point, and that wouldn't be very good. You can get these double-sided toothbrushes.

I've never really found them to be that useful, but, but they are available if you feel that your clients would get on better with it. So that was my cat, Eric. What you could see was that he, he quite enjoyed the experience.

He, he liked licking the toothpaste at the start. He didn't mind having his teeth brushed and then at the end, he didn't kind of scar her and run away scared. He was still sitting there and and and looking for more toothpaste.

So he's the kind of one end of the spectrum. And then my other cat, Elliott is the other end of the spectrum. So Elliott, the eight-legged octopus doesn't like having his teeth brushed.

And what you could see the difference between the two cats is that Elliot didn't even like the toothpaste at the start. He, he didn't even make any effort to look at it. He certainly didn't like being handled, didn't like having his tooth, teeth brushed.

I got about a millisecond of brushing in there and then he he ran off afterwards. So clearly with a cat like that, I'm not going to ask the client to brush their teeth because I think it just disrupts that bond that the client has with their pet. And I think that's that's something that we need to preserve.

However, we mustn't assume that everybody has a cat like Elliot because they may have, a cat like Eric, and you may have a committed client that wants to do the best for their pets. So why not teach them how to do that if they're keen. The problem with toothbrushing is that we all know clients are not very compliant, and there was a great study that Colin Harvey did at Penn University, and they looked at highly motivated pet owners that were brushing their pet's teeth, and then sadly, after 6 months only, well, less than 50% were still brushing.

So the long term compliance rates are likely to be much less. And I think it's important to warn clients of the consequences. What it means is if they're not doing the gold standard, then they sadly are going to have to come into you more frequently.

And it also means that perhaps other things like chews and dental diets are going to play a bigger role for these patients and particularly cats that are notoriously difficult at being able to brush their teeth. So what else do we have up our sleeve as a sort of an adjunctive method? Well, dental diets, it needs to be a specific dental diet, so not any old dry food.

So something like Royal Canon Dental, which I do give my cats. These diets have enhanced textual characteristics. The the kibble is slightly bigger in size, so it's promoting chewing activity.

But they also have sneaky little things in there that are going to help combat the, the the periodontal bacterial burden. So zinc salts are added in there because they have an antibacterial effect, but they also help to mop up those volatile sulphur compounds that we talked about. So the zinc salts in them are going to help control halitosis, which will certainly please the client.

They also have polyphosphates in them, and what these do is they bind calcium, and this will decrease the accumulation of calculus. If we get decreased calculus accumulation, we've got less potential surface area for plaque bacteria to accumulate. And the other thing that they have added, and I think this is possibly the most exciting area, and this is the addition of of polyphenols which act as antioxidants.

And I think in the future this will be the area that there will be a lot of research on, and particularly in the human field, there's a lot of research, on that at the moment. And the point is if we can modify the way the body reacts to these bacteria, then we may not get such a dramatic, changes with periodontitis. So the point is if we can modify.

The host immune response to the plaque bacteria, we might be able to modify the disease outcome. So I think what watch the space with polyphenols cause I think that will be a big thing for the future. There's good research out there.

The research has shown that these diets will reduce plaque and calculus accumulation, but what we don't know is if there is already periodontitis there, are they going to make a big difference? And that's what we don't know. So again, it's all about starting pets on these diets earlier rather than later, not waiting till you've extracted 10 teeth and then sending the pet home with a bag of dental food and expecting it to make a big difference.

What about chewy things? Well, I couldn't really do this talk without mentioning chews and there's a good reason for them to be in there because there's a lot of research behind, pedigree dent sticks, . Anything that promotes chewing is going to be good.

Saliva has very natural defence mechanism anyway. So if we can get the dog or cat to produce more saliva, and that's going to be good. Again, pedigree dentist sticks have the zinc salts added.

So it's going to have an antibacterial effect and it's also going to help control the halitosis by mopping up those volatile sulphur compounds. And that again is hopefully going to be very pleasing to the, to the client. Again, they have polyphosphates added, so binding the calcium is going to help decrease the calculus or tartar accumulation.

One of the pieces of evidence was published in 2005 in the Journal of Veterinary Dentistry. And essentially this was, a clinical trial, in dogs where they looked at the effect of the chew, against a standard dog food alone, and they measured plaque, calculus and gingivitis. And to summarise really the study and the results, the study showed that using the pedigree dentist sticks made a marked and statistically significant difference or reduction in the levels of not only gingivitis, but plaque and calculus as well.

And they also took, a pedigree dentist sticks and added an antimicrobial agent to it. But it wasn't that that made the difference. It was the textual characteristic of the pedigree dentist sticks.

So we know there's there's good research out there to to back that they work, and they're designed to be fed once a day. And contrary to popular myth, they're not a fatty treat. They're very low fat.

They're less than 2% fat. And again, they have these specific textual characteristics and these added ingredients. So Sometimes when clients come in and say, oh, I feed my dog pedigree well, sorry, I feed my dog dentist sticks, just qualify that it's pedigree dentist sticks because if they go and get the supermarket own brand, dog chew and inadvertently call it dentist sticks.

It's not going to have the same benefit. So again, I'm coming back, I'm hopefully getting the point across, we need to be more preventative. These chews are far better to be used preventatively than waiting till we've got established periodontitis.

And again, if we can reduce gingivitis by reducing plaque, by reducing tartar, then we're certainly going to reduce the risk of periodontitis. If we think about chemical plaque control, then the gold standard agent is chlorhexidine. It comes in a gel form, it comes in a liquid rinse form.

And it's a good antimicrobial. It's broad spectrum. The bacteria can't become resistant to it because of its mode of action, and it has what we call substantivity.

So that means once you apply it to the tissues, it carries on working for several hours. That's why it's often used as a scrub preoperatively on skin tissue because it has an antimicrobial effect for several hours. And you can use this postoperatively if you've done some extractions and you don't want the client to start brushing immediately, then by all means send them home with some, hexa rinse as a, as a rinse to to use for the first week.

Zinc, as I mentioned, is, is a good antimicrobial, and it does come in a gel form. It has been shown, and there's a good study that David Clark did, that it will reduce plaque and gingivitis and certain pathogens in cats. So that's another option for your cats.

And there's obviously lots more things out there, just to sort of quickly mention a few of the, the, the ones that you will see on your shelves. The water additives, these, use xylitol. And the theory is that the bacteria will try and use the xylitol for energy, but they're not able to use it and they, they are killed.

And there was one study, again in the Journal of Veterinary Dentistry, which showed a beneficial effect in cats, but it was only over a short term period. And there have been, no studies published in dogs that I'm aware of at the moment. And of course, we are all aware that xylitol is, is toxic, to dogs.

So we need to be aware of that if we're considering using it over the long term. The seaweed and food additives, again, no evidence published. So if, if a product doesn't have any evidence published, you need to sort of question why, why that is.

And then, the, the, the active ingredient, if you like, this RF2 factor is a derivative from a plant, which is known as Chinese rhubarb. There is some research that's been published, This was in vitro. And the biofilm that was grown was a single species biofilm, and it was based on, a bacteria called strep mutans.

And strep mutans is primarily involved in causing caries or dental decay in, humans. So That that's the research that's published and I'm, I'm going to leave you to make your own minds up about how, how useful that evidence is for you. Raw diets, lots of times I get questions about raw diets.

There was a study that looked at the difference in the teeth of feral cats to the teeth of domesticated cats that were fed dry and canned foods. And interestingly, what this study showed was that there was reduced calculus in the feral cats, but there was no statistical difference in the level of periodontal disease. So what that means is both wild cats and domestic cats get periodontal disease, but the wild cats have much cleaner teeth.

And I think that's the trap that many people fall into when they they think that raw diets will prevent periodontal disease, because the teeth look clean, they assume or they equate that with periodontal health, and that's certainly not the case. Again, people often ask about the difference between dry and wet food. Wet food doesn't promote periodontal disease, .

Dry food, there's a lot of conflicting evidence out there. Some studies say that dry food is protective, and, and other studies say that it makes no difference. What we do know is that a diet with these enhanced textual characteristics is beneficial.

Do follow these cases up. What I tend to do is have a postoperative check at 3 days. Introduce the concept of toothbrushing and then get the client back after 3 weeks.

And we can then use our plaque disclosing solution and see how well they're coping. Now, at that point, if the client can't brush or won't brush or isn't brushing, then they're far more likely to invest in chews or diets or whatever because they feel like they've perhaps let their pet down, but they still want to do something. If you send the patient home with a bag of food or some chews, then they're probably more likely think, well, I'll just do that and I won't bother toothbrushing.

So always try toothbrushing first and if it's not working, then, then sort of go for your other methods at that point and do get these clients back. And this is where your nurses can really make a big difference. Clients, I think, are much more likely to be absolutely honest with the nurse rather than the vet.

They want to please the vets, so I think they're probably more likely to come in and say to the nurse, you know what, I'm I'm just not managing this toothbrushing. So nurses can really play a good role in, in home care. Do warn the client know that even if they do brush their teeth, the pet may still need to come in and have occasional cleanings.

If you think about yourself, you know, we brush our teeth twice a day, we floss, we use mouth rinse, and yet we may still need to go and visit the hygienist, you know, every 6 to 12 months. So do tell the client that that doesn't mean they're never going to come in again for, for dental treatment. I'm getting there.

I'm I'm conscious of time and I promise not to keep you for too much longer, but I'm moving into the sort of the geriatric period now. And one of the common things that I hear both clients and unfortunately vets say is that the pet is too old for dental. You know, I've seen this written in clinical notes numerous times, and I'd like to challenge that really.

We know, hopefully you've all heard the phrase that age is not a disease. Well, age isn't a disease. What do we know about getting older?

Well, we know that periodontal disease is likely to get worse. The older you get, and the incidence also increases with age. We know that the level of azotemia is associated with the severity of periodontal disease, and we know that many dental diseases can be associated with significant pain and certainly chronic bacteremia as well.

And remember I mentioned these histological changes in the kidney, liver, and heart. The problem with age is that as you get older, you're more likely to have other diseases which may affect your general anaesthetic. What you need to do with these patients is manage the anaesthetic properly and again, charge properly for what you're doing and, and try and think about balanced anaesthesia.

So that means using perhaps more types of drugs so that overall you're using less drugs, if that makes sense. So If you're doing a lot of dentistry, I would strongly recommend you, invest in one of these gadgets, a bear hugger or a cocoon. They are absolutely worth their weight in gold for dentistry.

And they really do help to keep the patient lovely and warm, and hypothermia is, is a big problem, particularly in geriatrics, particularly, for prolonged anaesthesia. So think about keeping your patient warm. Think about monitoring them.

And if you don't have a multi-parameter monitor, then perhaps you have a Doppler blood pressure machine floating around in a cupboard somewhere. Get it out, put the probe on, you can even have it going all the way through the op so you can hear the heartbeat, or get the nurse periodically just to check what the systolic blood pressure is and try and keep that over 90. Think about local anaesthetics.

I personally use blivicaine in pretty much all of my patients where I'm going to be doing something painful. It really does help to stabilise your anaesthetic. You can turn down the level of your volatile anaesthetic, and that will in turn help your, your vital parameters.

The nurses are much more happy when I've, I've done my nerve blocks than when I haven't. And if I've not managed to get my nerve block in the right place, then the nurse will tell me, oh, you didn't get that in the right place because all the parameters will start going all over the place. So if you don't know how to do nerve blocks, and then, then either read a book or come on one of our courses and learn because they are really useful.

There are risks associated with with doing nerve blocks, so you need to be aware of those risks before you embark on them. And sadly, I don't have time to go through that in this talk. Intravenous fluids, to be honest with you, most of my patients get intravenous fluids, generally because my procedures are, are quite lengthy.

So you don't have to put just the geriatric patients on fluids. If you've got a 2 year old dog that's going to have an, you know, over half an hour procedure, 1 hour, 2 hours, then make sure it has fluid support. Pre-oxygenate, I love pre-oxygenating my geriatrics.

It doesn't really cost you anything and it only takes a moment or two, but it really does help these elderly patients if you pre-oxygenate them. They don't have much compliance in their chest. They don't have a big sort of reserve capacity.

So give them the best start with an aesthetic by pre-oxygenating them. And intravenous antibiotics, if we're talking about prophylactic antibiotics, then the kind of patients that I, I would consider using prophylactic antibiotics on are geriatrics, those with, systemic disease, so my, my renal cats, my hyperthyroid cats, those with, heart issues, heart disease, or immuno compromised patients. If I'm just doing one extraction in a young dog, then I certainly don't need intravenous antibiotics.

But it's worth thinking about using them in, in your geriatrics. And if you're using them intravenously, then please do give them slowly IV. So that means over 5 to 10 minutes.

It doesn't mean a great big bolus because you will probably enjoy its blood pressure through its boots. So do give it very, very slowly. This is Zia.

She was a 17 year old Asiatic tigers, I was very fortunate to be asked by Lisa Milla to go and help treat her and I gladly went along. This was at the Isle of Wight Zoo. Now tigers in captivity live roughly the same length of time as domestic cats.

So 17 for a tiger in captivity. Is certainly geriatric and she had a 3.5 hour anaesthetic, and had multiple work done on multiple teeth and made a really good recovery.

And that was thanks to, you know, a team approach, a good anaesthetic, keeping her warm, keeping her fluids up, monitoring her blood pressure. This was a slightly smaller cat. This was Rocky.

He was a domestic short hair that I saw, and he had lots of problems. He had hyperthyroidism, which had contributed to his heart murmur. He had renal insufficiency, and the vet that referred him to me was obviously concerned about the anaesthetic, but the client knew that that Rocky was really painful with his mouth, and she basically said to me, I understand the risks, but we have to do something.

So we did all the things that I've just, just mentioned. And these are his X-rays. These were awful teeth.

I haven't seen many mouths that are this bad, and I extracted all of these teeth, and they just look so painful, these teeth. And the anaesthetic went well, he made a nice smooth recovery. And when I saw the client for the postoperative check, I asked her how Rocky was getting on, and she told me that he'd caught two mice one week after extracting all the teeth and promptly handed me a bottle of champagne, which was Actually lovely because it was 2 weeks before my 40th birthday, so it was very nicely received.

But that was a really nice outcome. I really am near the end now. You'll be pleased to, to hear.

And just a last word about diabetics. Remember, I, I mentioned that there is an association with periodontal disease, and diabetes. In humans, if you've got one, you're more likely to have the other.

So if you're diabetic, you're more likely to have, bad periodontal, health, and if you've got bad teeth, you're more likely to get diabetes. Periodontal disease can affect the stabilisation of these pets with diabetes. So basically what it can contribute to is insulin resistance.

And so you need to warn the client that they may need to come in for an annual cleaning to try and help keep them stable. Sometimes if the mouth is really bad and you've got them on a certain dose of insulin, it may be worth preempting a slight reduction in that dose, because they're not going to need as much insulin once they've got a clean mouth. So something to think about, and I think we are pretty much there.

So again, a big thank you to the webinar vet for hosting this event. It's been wonderful to be a part of it, and of course, thank you to Pedigree for making it all possible. And for those of you that are Twitter inclined, the, the tweets, then there are some Twitter addresses there if you'd like to follow any of us.

My email address is there. I'm quite happy for you to email me questions or or comments. And if you are interested in getting one of the, the flip charts, then Mary Louise is your, your pedigree contact.

And what I forgot to mention in the first webinar was that I've got a big long list of, references, I don't want you to think that I'm kind of making this all up as I go along. It is based on, on evidence. So if anyone wants the list of references, which is quite long, then do email me and I will, I'll email you a PDF.

So I think I'm, I'm done talking and I apologise for going over again. It's because I like dentistry so much. I quite like talking about it.

Thank you so much, Rachel. We will let you off because it was just so good. I'm just quickly launching the dental X-ray machine pole because I think that'll be interesting while people are getting questions together.

Couple of little announcements, again, very windy night. You wouldn't have wanted to travel an hour to get this talk. So again, it's just another reason to do webinars, but there you go.

. We have a Royal College question time coming up next Wednesday at 8 o'clock. The officers from Royal College often go around the country doing question times where people can ask, you know, questions about practise standards or whatever, pertaining to the Royal College, and we're doing our first ever virtual, question time. I am asking if you do come to that, don't wear any garish shirts.

I'm pretending to be David Dimbleby for the night. And I don't, I, I'm just feeling I'm missing out on that possibility saying the lady with the poorly placed mascara and things, but I won't be able to do that because it's a virtual conference, so never mind. Tomorrow we have a talk by Neil Palmer, who's a vet at Abbey House where I do some dermatology in Leeds.

He's giving a talk on chemotherapy and We are making that a reduced amount from 35 pounds plus VAT to 20 pounds plus VAT. If you go to the webinar vet upcoming webinars page, if you put in the word pedigree, it will reduce the cost from 35 to 20, so it's a 15 pounds discount. So thank you to Pedigree for for helping out with that and .

Survey is coming up at the end of the webinar, so when you quit out of the the webinar, you will see there's a few survey questions. So if you could answer those, that would be splendid. Love the videos, .

As well, Rachel, it's, it's good to know you've got, you've got a kitten and a hunter, Eric and E. So a fine old pair there by the sound of things. So who's who boss is the other one?

Eric is the boss. Eric, now, isn't that interesting, Eric bosses. That's probably why Elliot gets so napped off when you're trying to do something I get bullied enough that you trying to.

Yeah, maybe that's what it is. Love the orthodontic stuff as well. I mean, Lisa did a little series for us and it was fascinating just some of the stuff you can do with orthodontics now, isn't it?

Well, people think of orthodontics and then think of of doggy braces and just have a bit of a laugh, but it really is the point of orthodontics. Well, no, the point of orthodontics in in dogs and cats is to give them a comfortable bite and a functional bite. That's that's really what it's about.

We have some, I, I think you're going to be a little bit cross now after all this happiness. There is 22% who are using X-ray machines and 78 who aren't, so obviously that's an area that we can improve on. But I mean, you know, fantastic X-rays, and I think it just shows the importance.

I noticed on the last one with the hyperthyroidism, there was, some roots showing in one of those. The tooth was obviously had disappeared. Put the roots you'll never take them out, will you?

I've kind of used radiography in in these talks, all the way along because that's that's how I work. You can't do dentistry properly without radiography and I don't want to sort of just sort of make that point. But if you are in a practise that is doing dentistry on a regular basis and you are one of the decision makers, then the best piece of advice I can give you to improve the dentistry would be to invest in, radiography.

Not only will it benefit your patient, the client will benefit as well because they can see the disease, they can see why you've done what you've done, and they will feel much happier about parting with their hard earned cash, and you will financially profit as well. So it's a win win win situation. And if anyone needs any tips or pointers on radiography, then please do email me and I can point you in the right direction.

But, you know, if you're doing dentistry more than once a week, you will, you will start making money within several months. And it was interesting with some of those deciduous teeth. It again really helps you to decide, oh gosh, that, you know, deciduous canine is actually quite a bit longer than I thought and I need to do it surgically rather than a good old yan.

Yeah, absolutely. Sorry, that was the dermatologist coming out. So 23% say yes, 77% say no.

So maybe that was I'm on at some point. If we'd have asked people 5 years ago, we wouldn't have had 22%. So I'm, I'm encouraged by that and undoubtedly within 10 to 15 years, the number is going to be more like 95%.

So do keep up with the times and and invest in radiography if you can afford it. Just one last thing, I know people are always very interested in the certificate. We did say to people, you know, the certificates that are there now, it's on the webinar vet.com/ pedigree, dentistics webinar.

I think Wendy can perhaps put that in the chat box for people. And obviously the only recording up so far is from Monday. If you want to have your certificate personalised, then you need to become a silver member, which is a free membership that we offer at Webinarett.

You get 6 hours of webinars, but one of the benefits is it personalises your certificates. So, just go to the homepage and you can sign up for that. And then as long as you're signed in, when you go to our website, you will get a personalised certificate.

I think that's everything we need to talk about. We have got Mary Louise on the phone who's who's made it all possible on the webinar today. So I'm going to On mute her just to to just thank you so much, Mary Louise for for making it possible.

I think there've been two splendid webinars and I've certainly learned some new stuff. I'm sure everybody else has as well. So, so thank you so much.

Oh, you're very welcome and and thanks everybody for joining and I'm seeing lots of requests coming in for the training guides, which is brilliant. Please do email me for them and I'm getting them out to you as quickly as I can. That's great.

So we'll move on to questions, . Mary Louise, if there's a few more technical questions, are you OK to answer those? As long as it's technical about product, I think you'll have a go, right, OK, good.

Let me just get this open just a little bit more so I can see them a bit better. If any of you are wondering that that photograph is actually Zia the tiger's foot, and every time I look at it, I still can't believe just how big this creature was. She was amazing.

Mhm. Great. Sandra is saying, does the root of the deciduous tooth resolve before they are shed?

I've seen a few after they've fallen out and they haven't had such long roots. So if they, if they shed naturally, then, then you should get really just a crown that comes out with a sort of a jaggedy root because that's the normal exfoliation process. The root should resolve if the deciduous tooth comes out normally.

If it's one of these persistent ones, then sometimes it might be partially resolved. So you may have some of the root left, but as, as Anthony just suggested, the only way you're going to know is by taking an X-ray. Do, obviously you may not know this, this answer, but I'll ask you anyway.

Do insurance companies pay for the sort of, congenital type treatments, you know, when you were changing bites and things, would insurance companies pay for that? It really depends on the insurance company and the, the, the policy wording, the, the Scotty that I showed you, this was an interesting case. We tried to get pre-authorization on that and initially, I think I can't remember, it might have been John Lewis.

Initially they said no because it's teeth and the client very elegantly managed to argue that it actually wasn't a tooth problem per se. It was a jaw length discrepancy. It was a jaw problem.

And because of that argument, they reversed their decision and they they agreed to pay out. So I think it really depends, depends on the insurance company. Yeah.

Emma has asked the question, which I think has been answered, which was this suggestion that a raw meaty diet reduces the chance of gingivitis and periodontitis. Your reckoning was less calculus about but . But not not less plaque obviously and gingivitis.

Well, less less calculus, possibly less plaque, but not necessarily less periodontitis, and I think the trap that that people fall into is they look at the mouth, they don't see very much calculus, and they equate that with a healthy mouth. So. These animals are never going to be anaesthetized for probing and radiography, and that's the way we diagnose periodontitis.

But if we did if we did anaesthetize these, these patients, then I'm sure we would still find periodontitis as as the study showed in the wildcats. Christiane is asking, I, she thought that the mouth has a normal endogenous flora. So would this, contribute to the stain in showing up with the plaque test?

If that's the case. That's a good question, and I'm afraid I can't answer that. But the problem is endogenous law because in theory, we shouldn't have any bacteria in our mouths at all, but we have that sort of we have plaque in our mouth.

The reason we get disease or not is how our body responds to those plaque bacteria. But you're right, the levels of plaque bacteria will vary from person to person. I think we don't quite know why the the level and volume of plaque will vary from one, person or dog or cat to another.

But if there is a, is a biofilm of plaque there, then it will show up with, with your disclosing solutions. But the question is, can you decide whether that's a pathogenic layer of of plaque or not, then no, you can't. Sandra is saying, is it worth clients brushing teeth with heavy calculus when they are reluctant to allow their dog to have a GA?

Yes, that's going to have some benefit, because if you're brushing, you're still removing plaque, and remember plaque is the etiological agent. But I think it it often it's the client that is reluctant to have the genders and anaesthetic, and I think it's our job to educate them then that, OK, there is a small risk associated with with an anaesthetic. But potentially the the benefit to the patient of anaesthetizing it and treating the periodontal disease is going to outweigh that that risk.

Because until you've got the patient anaesthetized, you can't really tell, you know, all the teeth with abscesses, you know, the big periodontal pockets. We can't tell any of that we have them under the anaesthetic. Janice is saying, why not make all dry diets, dental diets with the addition of these useful elements.

Do you think that would be a good idea? I would imagine, well, I might let Mary Louise answer that, but my initial thought would be that it would just make them, make the whole process too too cost prohibitive. Yeah, that's, that's basically right.

So, often having a particular kibble shape or texture, it it becomes a more difficult kibble to make and to produce and therefore slows down production, which it obviously becomes more expensive now with a particular dental diet, you can factor that into the whole price structure around the diet and and that works very well. . But it's kind of the same with the active ingredients really.

We tend to reserve them for the sort of higher end products, whether the dry diets or or or chews. Tina and Emma, while you're on, Mary Louise are asking, are there dentist sticks available for cats? Yeah, so, we have a product on the market at the moment called Whiskers Dent to bits.

So it's under the Whiskers brand, which helps. It, it's a fairly low level claim, . It's it's mildly abrasive.

We are currently working our socks off to make something really good for cats and we'll have some new news quite soon on that. It's a very, very difficult area though, because as I'm sure you all know, cats just don't want to chew. And every time we produce something that's quite chewy for them, that really does clean the teeth incredibly well, we find that after 3 or 4 days, they're not interested in it anymore because it's just too much like hard work.

So, it's a really good research challenge and and one that we're very actively working on at the moment. Cats are just fussy, aren't they really? It's the same with food trialling cats for for food allergy, you know, they, they eat the food for a few days and then they, they go off and it can be quite difficult.

Yeah. Nina is asking Rachel, what's your view on ball therapy to help with maleclusion of canine teeth? OK, that's, that's a great question.

And for those of you that are not familiar with ball therapy, what it is designed for is in the, the dogs that have the, the lower canines that are in the wrong position that are too upright and and going into the roof of the mouth. By using ball therapy, what you're, you're Doing is you're getting the dog to hold on to a rubber ball that's just wider than the canine teeth for about 15 minutes, 3 times a day, and the pressure of the dog holding the ball and will act like an orthodontic device. So it acts to move the canine teeth into the correct position.

However, there has to be space for the lower canine teeth to move into. So literally, they just need to be in the right space, but just too upright. And then ball therapy is quite good to get those teeth just to flare out and move, move laterally.

If the lower tooth is, is just right on the palatal aspect of the upper tooth, then it's going to be trapped and ball therapy won't work. So, I've had two cases recently that have worked really well with ball therapy, but it was all about, well, two things, case selection and having a committed, committed owner and of course a dog that will actually play with the ball. But yeah, it works if you, if you choose the case correctly.

Great, OK. Just for those people who are just wondering where to go for their certificates, if you look in the chat box, Wendy very kindly has put the URL in there, and also from Monday's webinar is also up as well for those of you who missed it and would like to see it. .

Couple of questions just on chlorhexidine here. David's saying, how would you suggest applying chlorhexidine or oral hygiene gel to a cat that won't allow toothbrushing, and Nicole is asking or has stated that she's been told that chlorhexine rinses turn the teeth orange. Is this right?

So the first question was how, how to apply it to, to cats. The hexarinse liquid, is useful and you can use that in, a syringe for a cat about 2.5 mLs.

The problem with it is it tastes awful and most cats will let you do it once and then they're never going to let you do it again. So what I find more useful is to use one of the gels and just apply it with a cotton bud. You just gently lift the lip and then gently apply it with with a cotton bud.

I try not to use the corsoil because that tends to have a sort of a minty flavour. So the one that I showed was, was the pet dent gel. The second question, you're absolutely right, with long term use, chlorhexidine, stains teeth, it's not a permanent stain, and it can be removed, by scaling and polishing.

So it's perhaps worthwhile just warning the client. If they are going to be using it long term, that potentially it's gonna stain the teeth, but that's not not a big deal. Javier has said excellent lecture again.

Thank you, Rachel, and Javier is speaking from Spain. Suzanne is being a little bit of a smoothie here. She said, brilliant lecture.

You can run over as long as you want to. Any, any comparisons between dental diets and dentist sticks, owner may prefer dentist sticks for cost. That's probably that's a difficult one, isn't it?

But I think what she's saying is how do you feel about You know, would you go more dental diet or dentist sticks or is it a mix or how would you go? I think you've got to have a conversation with the client and see where they're coming from. You know, if the patient has got any particular food requirements, or any allergies, then you've obviously got to to bear that in mind.

But the thing I like about dentist sticks is it creates a bonding experience. You know, clients like to please their their dogs and being able to give the dog a treat every day. I think clients love that.

So, you know, for some clients then then pet dentist is going to be, you know, really, really good for them. OK, if I can just add that as well, Anthony, just briefly, what we also have to bear in mind is that neither dental diets nor dentist sticks completely clean the teeth. Neither of them can achieve 100% cleaning on their own.

So I think using these products in conjunction with each other will hopefully have a cumulative effect and the work. Slightly different ways because the textures are a little bit different and often the active ingredients are a little bit different. So I think, you know, if you've got, you're lucky enough to have a client that might want to do both, then there's no reason why they shouldn't do that.

And hopefully have as I said in a cumulative effect anyhow. And toothbrushing as well. Yeah, I think that that's a really good point to make, Mary Louise, because sometimes clients will say to me, well, I'm not managing to brush every day, or is there something that I can do on the days when I can't brush and then, you know, something like that the dental eye or or the, you know, dentist sticks is is a great thing for them to use as an as an adjunct to their their toothbrushing.

Yeah. Tamsin moving off that point is, is asking you what you feel about 5 days of anti-road before a dental, or should I say clindamycin, where multiple extractions are expected. Oh, that's, that's a common question that that frequently gets asked.

Now. If we're thinking about prophylactic antibiotic use, so we are expecting a bacteremia when we perform extractions and scaling and polishing, and we want to prevent those bacteria from seeding in other parts of the body, then we're using the the antibiotic prophylactically. So if we're doing that, then in theory, we just need a one-off dose IV 30 minutes before we start, rather than 5 days of anti-ro before we before we actually start the procedure.

If the tissues are really, really horrible and friable, and I think, wow, this is going to be really difficult to extract these teeth because the tissues are so friable, then I may use 5 to 7 days of antibiotics and a non-steroidal if it's safe to do so, just to make the inflammation go down so that my surgery is, is easier for me. It's easier to do the extractions if the tissues are not quite as friable. But if you're just doing it as a prophylactic measure, then then IV at the at the time of surgery is is IV?

So, augmenting or Zenoceph, so your cefuroxime or your, your, potentiated amoxicillin. So, I mean, I always felt, you know, you've got the the cat or the dog, the Yorkie that's come in, you know, that's come in, it's probably too late for you to do much about dental prophylaxis, you, you're taking 2025 teeth out. You know, that I would always have given that, you know, 5 to 7 days of antibiotics.

That's a different, that's a different thing. If, if we're, if we're treating disease, then, then antibiotics can be an adjunct to our treatment. Now the treatment is your extractions, your scaling, you know, those kind of things and antibiotics have been shown to be of benefit as an adjunct, but they're never the sole therapy.

But you're right, if we're doing a lot of extractions, particularly if I'm doing a lot of surgical extractions, then I think antibiotics are are appropriate. OK, that's great. .

Are you OK? We've still got quite a few people still on the line. You know, obviously the, the advantages with the webinar, you can slink out whenever you want and nobody will know that you've left.

So please feel free if you do want to leave, you don't have to stay here. Rachel is obviously keen on dentistry, but it could go on till 12 o'clock. I might sink out at midnight.

That that's when that's when the The, the, the pumpkin that that it all gets change, it's the Cinderella effect, isn't it? And Tiago is saying, I sometimes wonder why it is that most insurance companies don't cover treatment for periodontal disease. Any thoughts, Rachel?

Possibly because they feel that it it is one of the things that is, that is, preventable. I don't know. The whole insurance thing is, is a minefield and I do get quite irritated about it because If, if they don't cover dentistry, then often it's in tiny small print that the client has never read and then they come to do a claim and it and it that you know won't cover anything to do with with teeth or gums, which is, which is terrible because they don't make blanket, exclusions on any other parts of the body, but .

I, I think I, it's Mary Louise again, I've got a little bit of an opinion on this one. I might be wrong, but I suspect it's when you're managing risk levels and you know that 80% of the people of the animals you're insuring are likely to get dental disease. You're gonna have to pay out on it.

So I think it's, it's easier just to say we don't cover it because they know that the vast majority of their their their clients will make a claim. Mm that's a good point. With Pep plan, you know, we did a lot with Pep plan when we were open, when, when I had to practise and their thing was, You know, obviously, If somebody like myself said, oh, look, you know, you're starting to build up some plaque there, you've got gingivitis, you really need to do something about it, and they obviously hadn't done and 12 months elapsed and then of course the teeth were in a mess, and they'd say, well, you haven't followed your vet's instructions, so I can see the kind of.

You know, the sense in that, that, as, as Mary Louise has said, if it's such a big problem, then people have got to follow our advice and often we don't push it enough, but also not necessarily everybody is compliant with what we suggest anyway, are they? As as clients, that's my take on that. If I can just make a comment to follow that up, I think you're right, but there's there's a different way of making a recommendation, and I see this quite a lot in the clinical notes and it will be something like, lots of plaque tarta recommend dental, we'll need dental in 6 months.

Now, what I don't understand is if we're, if we're recognising. Disease, if we're recognising gingivitis, then why aren't we saying your pet needs treatment now. And I think that's one of the problems is that we probably come across a little bit like this to the client.

We say, well, yeah, you know, Fluffy's got a little bit of plaque and tart there. And we probably need to do some dental work, but, you know, let's think about doing it in the next 6 months. Now what does that say to the client?

It says, I don't need to bother. Yeah. No, compare that to saying, You know, Fluffy's got significant signs of of periodontal disease.

We need to do something about that now before it gets much worse. You know, there's a very different way of saying it, and I think we need to reflect on, on how we're making these recommendations. And really most of the time then if it if it's got to that stage, it's a 5 year old dog, it's going to need a scale and polish to kind of get you back to square one and then start talking about.

You know, toothbrushing and use of you know, dental sticks and diet and things is the best place to start from is, is a clean, a clean mouth, and that's what a lot of these research studies, they, they use the clean mouth model. Interestingly, little sort of snippet, they've done some research in in human periodontal disease and Some amazing scientists has worked out the surface area of of your sort of typical mouth that's got periodontitis. What is the surface area of all those areas of pockets, periodontal pockets, all that inflammation, and they've worked out that it's the size of the palm of your hand.

Now, where else in the body would we ignore? You know, that kind of surface area of information. If it was a hotspot, you know, the client would be weeping on the phone that they, you know, that there was had to be seen instantly, you know, we would treat it instantly, but because we don't see the level of information in the mouth, we're much more, it's much more easy to ignore it and and and not not treat it properly.

I'm amazed by how many people you know would bring in a dog that you haven't seen for a couple of years, and this is a diagnosis sometimes you make. You know, 100 metres away because the smell is so bad, and yet they haven't, they're genuinely surprised when you lift up the lid and teeth start dropping out in front of you. So it's, it's fascinating.

It it is, but then why would the client have any motive to look in their pet's mouth? If the halitosis is built up gradually, they, they think that that's normal, you know, it, it really is our job to, to educate the client. We we must assume that they have no background knowledge at all.

Yeah. Samantha is saying thank you very much. Emma, thank you very much, very interesting.

Becky, thank you very much. This has been really useful. Bert, thank you, Rachel, fantastic webinar.

Bert from Italy. So lots of, positive comments again, let me just see a couple of more questions, . Richard said great series of webinars, thanks, exploded a few myths about food, choose, etc.

A big thank you to Rachel and the organising team from Kelvin. Great talk, loads of new things learned. Thank you, Luciano.

Samantha is saying, are you able to suggest a basic first dental radiography unit for a practise starting to do dental radiographs? Are human units suitable? Yeah, I mean, it's worth approaching local dentists because they, they often sell old dental X-ray machines.

Many of the, X-ray companies will also be able to sell you regenerated units. And of course there's plenty of companies that, that sell new dental X-ray machines as well. So crews, veterinary concepts or no they they sell new machines, but they're definitely worth doing.

You can take dental X-rays with your standard X-ray machine. But the problem with that is it's, it's a real pain in the neck. The dental, sorry, the standard X-ray machine is never in the same room that you're doing dentistry.

And of course, the head is pretty much fixed to within a few degrees. So that means you have to manipulate your patient and it's, it's, it's a real pain. So try and try and look if you're starting out for a reconditioned unit or an old, human dental machine.

What, what's the sort of budget, how much is your dental X-ray unit in your two practises? In one practise, we got a reconditioned X-ray machine and I'm using film there. So the, the reconditioned unit was 650 pounds.

And then, the dental films like 20% each. So really, you know, not an ongoing costs. In the other practise, we have a digital system, and the setup for the for the actual machine and the sensor is about sort of 6, 6000.

You know, I think there's options in between as well, so. You can spend as much you can spend 1213, 14 1000 if if you want, but you can certainly get started with film. But if you're, if you're committed, then I would say go digital because it's so much easier.

Mm. You know, many people have, sorry, go on. No, no, go on you.

Well, I was going to say many practises have an endoscope in the cupboard that they very, very rarely use or an ultrasound machine that they very, very rarely use. But, you know, for the same amount of money or or less, you know, you can get a dental X-ray machine and you'd probably be using it on a daily basis. Yes, absolutely.

No, I think it makes sense, doesn't it? Do you consider raw high hoes useful as dental aids? Yes, I do actually.

That again, there is some actually decent research to back rawhide shoes, so I I'm happy to, to say yes to those. I think from my perspective we just some of the work I've been doing with some of the other vet dentists as well, am I right in thinking, Rachel, that if the raw hide gets very big and there's sort of big knotted hard ra raw hides, it can be a bit of a risk in terms of fractures. I think so and I think the sort of the flatter chews are probably better than the the the massive ones, particularly in terms of swallowing them them whole as well.

Sure. Ian's got a, a great question here. It's quite a long one, but I'll, I'll read it out to you if you don't mind.

Rachel, are you perhaps lucky that you are seeing referral clients and the clients are generally the converters and are willing to pay? I regularly see dogs and cats with marked periodontal disease which desperately need dental treatment, and clients decline treatment because the animal is still eating well and doesn't appear in discomfort to the client. Clients are also put off.

By the cost of a couple of 100 pounds, how do we get around the resistance, as it is very frustrating and often demoralising when these clients refuse treatment. And that's a really good point. And, a lot of the patients I see are not referral, they are first opinion cases, but you're right, they're coming to me knowing that I have a special interest in dentistry.

So you're right, they are kind of they they want to do something to help their pet. When I was a general practitioner, my, the main problem I had was a lack of time. And I think that is, is one of your your drawbacks is that you've got 10 minutes.

The client probably didn't come in for a dental problem. They came in for an ear infection or fleas or whatever, and you've got to deal with that problem and then try and talk about periodontal disease, and why they need treatment in about 2 minutes and it's just not possible. So one thing you could say is, you know, that there are signs of significant dental disease here.

What I'd really like you to do is to come back. See me for another appointment. It will be a reduced cost.

We can really talk about what what the problem is. And for me, I spend, you know, 20 minutes with clients explaining periodontal disease, and I use a variety of visual aids. So I draw pictures for people, I use pedigree, flip charts, and I really try and explain to clients what's going on, and you have to explain to clients that the pet is not going to stop eating.

You know, and it's very subtle changes that that they're not going to detect. So I, I, I do understand that it is hard, but trying to give yourself more time if you can or you know, maybe getting the client to come back, or, or maybe, making a handout, a dental handout, and that can go through, you know, what's going to happen is we don't carry out treatment and what are the long term consequences. Give them something to go home and read.

Yeah, I mean, I often found, obviously some people don't want to spend the money and that's always going to be the case, but again mentioning the fact that it's not just The mouth, it's also, as you said, the problems with, you know, the, the heart and lungs, the the kidneys where the infection can potentially go to, you know, it's, it's something to consider. I did learn today actually because I wasn't aware of this link with diabetes as well, which was interesting to hear because that's something that I just wasn't aware of. So, I always think if you learn one or two new things in the webinar, it's, it's great and that's certainly been one of my take homes for, for today anyway.

11 final comment. Oh sorry, can I just make a comment about the sort of the clients not being able to afford things and and and the whole insurance thing. I think one of the traps we fall into as a vet is we ask the client if they have insurance, and as soon as they say no, we then make an automatic assumption that they're not prepared to pay any money for their pet.

And I think we need to try and get over that because just because the client is not insured, it doesn't mean that they're not prepared to to to pay out for their pet for whatever treatment. So I'm saying that because I've, I've had to learn that over the last few years. Never make assumptions about what people are prepared to spend.

Oh, absolutely, yeah. Mirrella is asking, should you risk And leave behind a root that fractured while extracting a cat tooth. How likely is it that it will be resolved.

You don't know until you've taken a radiograph. This is a whole entire another lecture, so feline adontoplastic resorptive lesions or, or it's now being called tooth resorption. It's a massive problem in cat teeth and and unfortunately, unless you take a dental X-ray, you, you just, you just can't know.

So there's two types of, of resorption in cat teeth. So this is the pathological disease. If it's a type 2, then the, the treatment of choice is a crown amputation where you literally are removing the crown and then suturing the gum and assuming that the the root will continue to be reabsorbed.

But if it's a type 1 lesion, you need to extract that whole route. So it's not going to be, be reabsorbed if it's a, if it's a type one lesion, you need to go in and take the whole root out. Equally, if there is some kind of abscess on that root tip, then leaving that root tip behind is going to be, problematic.

It becomes almost like a foreign body within as well. So again, if you're doing any amount of feline dentistry, then you you you really must have Radiography because of the the incidence of of tooth absorption. Caroline is saying a lot of our clients seem to give Hill's TD biscuits as treats rather than as the bulk of the diet.

How much benefit does this have? So I suppose they're buying them and then giving a bit of it, but not the whole diet. Yeah, I mean, if you, if you speak to, to either the raw cannon people or the hills people, they're going to tell you that it will have a negligible effect.

It really needs to be a substantial portion of the of the pet's diet. . Mary Louise, you want to make a comment on that?

Yeah, I mean, it's absolutely true that the trials and so on are always done on 100% daily feeding of the diet and and nothing else when it's a dry main meal diet and that's what gives you the the figures that that you see for reduction. So. Reducing the levels that the animal takes will just reduce the effect.

Essentially. Doreen is asking, I don't have the chat box. Could you send me a dress certificates?

It will be on the bottom of your box that's on the right, Doreen, but it, we will be sending out an email to all those who've attended and all those who haven't. Letting them know exactly where they can find the recordings, but it's, it's basically the webinar vet.com/pedigree dentists webinars, but you will be getting that sent in the in the next day or two.

And Ian is asking, does denisecept gel work? And Caroline is saying any benefits of the Maxiguard with vitamin C. The dentist gel has chlorhexidine in, so yes, that's that that's definitely going to have some benefit.

And the maxiguard gel, with the zinc is, is, is certainly going to help. There was a study in cats that showed that that helped. And I'm not quite sure why they had the vitamin C.

I think it's again to improve the, the overall, health of the Sorry, the bacterial population, but I don't know if the vitamin C makes a huge amount of difference over the over the zinc. OK, great. Aing is saying any textbooks guide you would recommend to a recent graduate who wants to get better at dentistry.

Probably the best one to think about, well, there's two actually. There's the BSAVA manual, which is, which is a great place to start. I, I've certainly got a copy of that.

And then Cecilia Grell, has produced dentistry for the general practitioner, which is also a really nice, textbook. And if you want a radiography textbook, the best one that I can recommend is, an Atlas of Dental radiography by Greg DuPont and Linda debs. Grace.

We also, we did a a a nice dentistry expertise series with Lisa Mella, which was fantastic. So if anybody still on the line is is interested in knowing more about that, just email Catherine at office at the webinar vet.com and she can give you some details.

That was about 6 hours of Of webinars to a small group of vets. I think we're coming nearly to the end we we seem, I fear, Phil says I fear cat dentals, crowns undermined and roots welded. How best to extract roots with a drill.

Question mark. That's opening up another whole kind of worms, unfortunately, again, with that. I'm happy to do another one.

Again, without radiography, you you you really can't tell what's going on. But perhaps I think what what the the person is alluding to is that the whole kind of drilling out of roots and and that is a big no no. We should only be using the dental drill when we're either sectioning a tooth or removing buckle bone if we're doing an open extraction.

So trying to remove a tooth root by using the drill and drilling it into the socket is an absolute, no, no. You risk so many problems, you risk bone necrosis, you risk damaging the, the maxillary, sorry, the, the infraorbital, neurovascular bundle, the, the mandibular neurovascular bundle, and at the end of the day, you will not remove the whole tooth roots. So no more drilling out of cat roots if you break them.

OK. There's just 1 or 2 more that I just want to Go back to Lisa says, how long should a dog take to eat a dentist stick? My dog devours them very quickly, so I haven't been as impressed and use flat or high chews.

How do they compare, and I think that's probably a question for for Mary Louise. Yeah, OK, so they, they do eat them quickly, quickly. A lot of dogs eat them quickly.

We know that they really enjoy them. But our studies are all done on regular dogs that eat them quickly or some eat them slowly. So you do have a variable lasting time, but the interesting thing is we've we've actually studied this and looked at dogs that eat them really, really quickly and then we filmed them to quantify how many chews they take to eat the chew.

And we found interestingly, no correlation between the lasting time and how well the teeth are cleaned. So even in the dogs eating them extremely quickly, they're still cleaning the teeth. We have an example in one of our trials where a dog took 40 seconds to eat the the dentist sticks, and that particular dog was the quickest dog on the trial, and it actually had the highest plaque reduction of 65% and it took 92 chews to consume the products.

So it chewed the product 92 times in that 40 seconds. And I think this is what people don't necessarily see. So they'll often say.

I hear it a lot. My dog bites in half and swallows it whole. And actually, in reality, that's, that's not happening.

The dogs are doing a lot of chews. We have another dog. The next one up was 54 seconds, and that one did 129 chews in that time.

So, whoever was looking at that, that's a researcher who loves his job, doesn't he? Look at the detail to the minutiae, isn't it? Yeah, absolutely.

Fantastic. We've got Samantha, and I'm going to make this the last question because it's nearly 10 o'clock, and, and I really don't want you to change into the the rags, Rachel. Can you tell how much roughly you would charge for a single dental X-ray radiograph as this is one of my concerns when trying to convince a client to pay for the dental even without the cost of a radiograph.

Most practises charge somewhere in the region of 10 to 15 pounds for the initial X-ray and then a sort of a reduced fee for subsequent ones, so maybe, I don't know, 7 to 10 pounds for follow-up x-rays. So they don't have to be prohibitively expensive. OK, Caroline has said the vitamin C is sold as helping collagen repair, that's what the, the company is saying evidently.

Vanessa is saying great webinar, I really enjoyed it, but I have to go now at time for work in Australia. Thank you very much. So there you go.

You've had people from all over the globe listening to you, Rachel. I loved it. It's been great.

I've learned so much, which, unfortunately, I'm not taking any teeth out anymore, so I might not be able to immediately put it to practical use, but I know there's been a lot of people on the webinar. There's still a lot still on, have really enjoyed the webinar, you know, thank you so much. It's been great.

Thank you, Mary Louise, for making it possible. And looking forward to seeing you on another webinar very soon. Thanks, everyone.

Good night.