Friday, October 28, 2016

Chocolate Is Not the Only Toxin to Worry About This Season

Most of my clients are aware of the danger that chocolate can pose for their dogs and wit Halloween literally right around the corner, this is a concern.  However, I don't want you all to concentrate on the goodie bag on the counter and ignore some of the other hazards that lurk in our homes for our pets.

Now, the good thing for our pets is that the bulk of the candy that we bring home next week is not mostly chocolate.  While a few mini 3 Musketeer bars is likely to cause diarrhea, the delicious filling is not chocolate.  Pure chocolate bars like a Hershey's bar or even kisses are more likely to get to toxic levels.  In fact, a 15 pound dog that eats just two 1.55 oz bars in is the zone of potential side effects.  Dogs that get this amount of chocolate can become hyperexcitable, have muscle tremors, and with increasing doses of chocolate can have seizures and even die.  We had one dog get into a lethal amount of chocolate this past summer.  By the time he came into the hospital, he was in such an advanced stage of toxicity, there was nothing that we could do to save him.

Chocolate cakes and brownies (we just had a dog come in for boarding that had a breakfast at home of 2 dozen brownies) is likely to cause stomach upset, but unless you are using a dark fudge icing that is more dark fudge than icing, explosive diarrhea is probably the worst of the damage.  Fortunately for this owner, the mess will be ours to deal with while the cake bandit is staying with us and not hers.

While chocolate is on our minds this week, year round we see more pets that get into trouble taking their owner's medications.  Last week we had a dog eat a kids ADHA medication.  These medications fall into two distinct groups.  The more serious problems are usually seen with the stimulant drugs such as Adderall.  The dog we saw had gotten into an alpha antagonist medication and this drug is reversible with an injection that we have on hand.  He got to stay with us for the day on IV fluids but was able to go home that evening to sleep it off.

Another big problem is with ibuprofen.  Especially the name brand Advil is sugar coated and it seems that dogs can't resist.  Time and time again I have had owners tell me that the pill bounced on the floor once and the dog had it swallowed before the owner could do anything at all.Generics are not any safer and although not sugar coated, are extremely toxic to the kidneys and stomach lining.

And then there are cats.  While less likely to ingest pills off of the floor (way to discriminating for that), they are often poisoned by well meaning owners that give them human medicine.  Remember, a single extra strength tylenol will kill your cat.  Ibuprofen is right up there as well.  Children's cold medicines are dangerous for cats.  Do not medicate your cat without consulting with your veterinarian.

If you think your pet has gotten too much chocolate or any amount of your family's medications.  Call your veterinarian.  Or, call poison control at 1 888 426-4435.  This hot line is run by the ASPCA and they will get you the information that you need. You will have to tell them what your pet ate, how much and how long ago to get any useful help.  Time is off the essence in the case of a suspected poisoning.  Do not delay.

So, even though it is Halloween, I didn't intend to scare you, just give you some information.  Go out with your goblins and enjoy the American tradition of begging for candy while dressed up as your favorite ghoul.

Monday, October 24, 2016

Fleas

FLEAS!

I started my morning appointments today with an itchy Bulldog.  Not remarkable, most Bulldogs are itchy.  The thing that was interesting about this gal was that she was the fifth dog this week that was infested with fleas.  Crawling with them and this owner had bites on his ankles and legs.  Yet, he was still surprised when we showed him the little critters jumping all over his pet.  He was shocked because the dog never left the yard except to go on an occasional walk, and being a bulldog, and the weather being what it has been the past few weeks, those walks have been short and few.  So, how could this dog have fleas?  Here’s the deal, they are out there.  They are everywhere.  The mild winter and hot humid summer has been a bonanza for the fleas.  We are seeing fleas every day, and there is no reason for our pets to suffer.
Now, I’ve been in this business for a long time.  I spent many vacations in the seventies bathing and dipping dogs with the nastiest bunch of toxic chemicals in an effort to keep pets flea free.  We bathed, dipped, sprayed and powdered our pets with pyrethrins, organophosphates, and all sorts of nasty chemicals.  When that failed, we bombed our house with chemical foggers, spread powders in the rugs, or called in professionals every couple of weeks to try to eradicate those little blood suckers from our homes.  Flea prevention was unlikely to be very successful.  Flea treatment was the norm.
Fortunately, that is not the case anymore.  Starting with the topical products containing Fipronil (Frontline and Frontline Plus) in the 90’s, we now had a group of relatively safe and effective options to prevent flea and tick infestations in dogs and cats.  From that point on,simple, regular applications of a  product made it possible to keep our pets flea free and prevent the nasty home infestations that required chemical warfare in our living environment.  As consumers demanded better, less obtrusive products, and as fleas and ticks started to develop resistance to the older chemicals, newer collars and oral products have come to market.
Now, there is no need to worry about our pets becoming flea infested.  I put a Seresto collar  on my Bella in March when ticks first became active in our area and she has not had a single flea or tick all season long.  I replaced it in September and neither of us will need to worry about nasty bugs all year long.
That’s what makes my second appointment of the morning so frustrating.  The patient was a less than friendly Sheba Inu.  Now, if you know the breed, then you know that being unfriendly is actually normal.  You probably also know that their coats are really dense.  You couldn't find a flea on a Sheba if your life depended on it.  Due to this dog’s temperament, the owner told me that it spends a large part of its day out in the yard.  I could not believe how hard it was for me to convince him to pick up a single dose of Bravecto, an oral flea and tick medication,which would protect his dog from these parasites and keep his home safe for three months as well.  He went back and forth hemming and hawing about how the dog never leaves the yard. (Sounds like the Bulldog, no?).  Finally, when he thought about needing to get an exterminator in if the dog became flea infested, he took the product.  Wise move, don’t you think?
So, here’s the low down. There are several very good options for flea prevention in dogs and cats.  If any of your pets go outside,all of the pets in the home should be on some sort of flea control this time of year.
  1.   Seresto collar: I already stated that this is my preference.  Life is hectic, fleas are fast.  One collar will give up to 8 months (I trust it for 6) of protection against fleas and ticks on dogs or cats.
  2. Comfortis: The best-selling flea product in the United States.  This once a month pill will start killing fleas in 30 minutes.  It can be used in dogs and cats.  In fact, my clients that feed outdoor cats put the pill in some food to help keep the flea population down in their colonies.  Remember, if the outdoor cats that you are feeding are flea infested, your yard will be flea infested.
  3.  Simperica: Zoetis animal health’s newest addition to the oral flea and tick control market.  This drug is the same class as Bravecto and Nexgard but more effective.  One chew a month will prevent fleas and ticks on dogs.
Combine one of these products with an effective monthly parasite control product and your pets and home will be safe all year round.  Now isn’t that easier than getting an exterminator in to rid your house of the bugs?

Tuesday, October 11, 2016

Puppy and Kitten Vaccine Schedules


So, if you have been following, you'll see that I am back on schedule, even though this required two posts in one week.  There was a lot of information in the last post, but not all of it useful for the average pet owner.  I know, I can be a science wonk sometimes.  Here is a summary of our vaccine recommendations for puppies and kittens.  The first thing that you'll notice is that some shots are repeated.  We will discuss which vaccines your particular pet needs for their life style and risk factors.  We'll also tell you that your new pet (especially your puppy) can't go outdoors where other dogs go until they are finished with their pediatric vaccines. 
 

Why can't my puppy go outside until it's had all of it's shots?  

I get this question all of the time.  It is really a simple answer, although hard for most owners to swallow.  Most puppies and kittens are born with some immunity from their parents.  this is transferred across the placenta and via milk when nursing.  The maternal immunity will decrease over time, disappearing in most pets around the age of 16 weeks.  While this immunity will protect your pet while it is very young, they will become vulnerable to infection as the levels drop.  In addition, this maternal immunity will interfere with the vaccines that we are giving.  So, since we do not know when a particular individual's maternal immunity is low enough to allow the vaccines to work most effectively and we do not know when the vaccine induced immunity is high enough to be completely effective, we make a vaccine schedule that is designed to offer protection in what has proven over time to be a statistically effective way.  That is, we vaccinate periodically until 16 weeks of age so that maternal immunity is gone and vaccine immunity is present.  If your pet goes outside before this time and is exposed to one of the infectious agents that we are vaccinating for before it is completely immune, it is at risk of catching a very serious disease.
 
Now this isn't magic and the diseases are spread by infectious agents, viruses, bacteria, and mycoplasmas.  If you can take your dog outside where no other dogs go, then these agents willnot be present and your dog will not be at risk.  This is why we say that you can take your dog outside in the yard for training if you have a spot where no other dogs go.  No dogs, no viruses, no risk.  This means your yard, no puppy classes, no trips to the pet shop, no walks to the bus stop.  I'm not being mean, I'm just trying to recommend the best practices for your pet.  I went through the frustrations when Bella was a puppy and I do understand, but she didn't get a walk to the local fire hydrant until her vaccines were complete.
 

 

Puppy Vaccine Schedule

We recommend vaccinating all Puppies for DHPPV (see previous post for vaccine descriptions) every 3 - 4 weeks from 6 weeks of age until they are 16 weeks of age.  In our area, most puppies also get two leptospirosis vaccines incorporated with two of these injections.  Bordetella is given once, intranasally, usually around 12 weeks of age and Rabies vaccine is given at 16 weeks (18 weeks in small puppies to minimize reactions by giving too many antigens at once)
 
Dogs that will be at risk of Lyme disease are vaccinated twice as an initial series, usually in the two weeks between the DHPPV vaccines.  K9 Flu can also be given at that time (twice, between DHPPV vaccines for dogs that will be boarding.  The adult vaccination program is reviewed with the owners at this point and most vaccines will be boosted one year later.

Kitten Vaccine Schedule

Kittens can often complete their core vaccines by 12 - 14 weeks of age.  They need an FVRPC every 3 - 4 weeks form 6 weeks until they are 14 weeks old.  New recommendations are for all kittens to receive Feline Leukemia Vaccines, even if that is not continued as an adult.  This vaccine can be given with the FVRPC.  Rabies can be given after 3 months of age.  Initial boosters are one year later and the adult vaccine protocol will be discussed at this time.
 
While we try to explain the vaccine programs in advance to owners, they are usually overwhelmed with having a new pet.  Usually we just tell them when to come in next and when they do, we explain what we will be giving.  However, we have found those little health records helpful in cases where owners want the entire schedule laid out for them in advance, so we can accommodate you either way.  
 
 
I can't answer specific health questions, but you can ask questions of a general nature on twitter.  My account there is @KNVet.  Follow me and drop me a line.

Vaccine Science for Pets

So it only took 5 posts for me to fall behind on my schedule to post every week.  However, I do believe that my excuse is both timely and topical.  I usually try to complete my posts on Fridays, but last week, at the urging of my wife and the recommendations of the CDC, I went to get my Flu Shot.  Yes, I believe that what is good for the goose is good for the gander (your pet being the goose and I'm the gander in this post).  So, while I should have been teaching everyone about the importance of vaccines, I was off getting vaccinated.  Now, along with a very aggressive hand washing policy, I have done everything that I can to protect myself against Flu this season. I chose to get immunized because I am at risk for infection, research shows that the Flue vaccine is relatively effective in preventing infection vs not vaccinating, and vaccines in this country are generally safe so that the risk and expense is far outweighed by the benefit.
 

What are vaccines?

Vaccines are biological products that are designed to stimulate the immune system to generate a response to protect the patient from future infections.  Wow, reading that back I realize that it was quite the mouthful.  Let's look at it another way.  Our pets' immune systems are designed to ward off dangerous infectious agents.  When their body is invaded by a bacteria or virus, the body responds in a variety of ways, the most vigorous of which is to produce antibodies and special killer cells to destroy the infection and restore the body to a state of health.  In addition, the immune system tries to establish some memory, so that if the same infection comes along again, it will be primed to have a quicker response, possibly killing off the infection before the host becomes sick.  The duration of this immunity varies, depending on the type of infection and the health of the host. 
 
Vaccines are designed to stimulate the immune system, just like a dangerous infection, but without the risk. The body produces circulating antibodies and memory cells to keep us healthy in the face of potentially serious infections.  
 
There are several types of vaccines and modifications of each type but here is a summary.
  • Modified Live  Virus Vaccines. (MLV).  These vaccines contain living bacteria and viruses (OK sometimes mycoplasmas as well but why confuse the issue).  These infectious agents are attenuated, that is weakened so that while they can trigger an immune response, they don't cause disease.  The advantage to MLV products is that since the virus is alive, it will reproduce in the host, allowing a smaller number of virus particles to be injected.  This minimizes vaccine reactions while maximizing immune stimulation.  The potential downside is that attenuated vaccines are best for viral diseases (with the exception of that nasty nose drop Bordetella vaccine) and there is a small chance that the virus can revert to the wild state and cause illness.
  • Killed vaccines use dead viruses or bacteria (killed bacterin).  There is no chance for reverting back to the wild strain, however, since the antigen (bacteria or virus) are not reproducing in the host, a larger number must be injected.  In addition, these vaccines often contain adjuvents, which are chemicals to stimulate the immune system to give a better response.
  • Vectored vaccines.  In these vaccines, the antigen is incorporated into a harmless virus, such as canary pox.  The virus and the antigen are injected into the pet and the vector reproduces in the patient.  Since it is harmless for that patient, there is no risk of disease.  Since the antigen load increases in the host, there is no need for an adjuvent
  • Sub unit vaccines.  In these vaccines, only portions of the infectious agent are used to stimulate the immune system.  Some of these are adjuvented, some are not.  Most only give shorter term immunity, usually around a year.

Which Vaccines Does My Dog or Cat Need?

There are many different vaccinations available in all sorts of combinations.  Not all pets need all vaccines for all diseases.  You should have a conversation with your veterinarian to decide which diseases your pet is at risk of catching and then picking the appropriate vaccines to keep him/her healthy.  We recommend an annual life style assessment for all of our patients to help us to determine the best vaccination program for each individual.  We follow the American Hospital Association and American Association of Feline Practitioner Guidelines and divide our vaccines into core and non core.
 
  • Canine Core Vaccines (Vaccines every dog should have in our area), We include Distemper/adenovirus/Hepatitis/Parainfluenza/Parvo/ (5 in 1, or      DH2PPV), Leptospirosis (most dogs), Bordetella, and Rabies.
  • Canine non Core Vaccines include Lyme and Influenza.  Leptospirosis for certain toy breeds.
  • Feline Core Vaccines include Feline Viral Rhinotrachietis/Calicivirus/Panleukopenia (3 in 1 or distemper), Rabies and Feline Leukemia for kittens.
  • Feline Non Core Vaccines include Feline Leukemia for adult cats not at risk, chlamydia, and FIP.
We have been using an extended vaccine protocol for both dogs and cats for years and recommend that you speak to your veterinarian about how long each vaccine will provide protection for your pet.  Some vaccines need to be given every year, others not as often.  In general, the frequency of rabies vaccination is governed by state law.
 
The bottom line is that all of our pets are at risk for infectious disease.  I have seen puppies and kittens suffer horribly and die of preventable illnesses.  I have witnessed the chronic debilitation of pets that were infected with disease causing agents that could easily have been eliminated from their bodies before causing disease.  Prudent vaccination is definitely a cornerstone of an effective preventive health program for all of our pets.

Monday, October 10, 2016

Feline Urinary Tract Disease

 

This wasn't going to be the topic for the day.  Honestly, I didn't have a topic for today but then I had two cats come in for urinary tract problems and I thought that it must be some sort of sign, so let's talk about cat urination.
 
One of the major attractions of cats as pets is that they don't need to be walked because they use a litter box for elimination.  When all goes well, they truck off to the little sand box in some out of the way place and all we have to do as owners is clean the box out periodically. Truth be told, we should do it every day, but we're all guilty of a little slip up now and then, just ask our cats.  I'm going to gloss over the behavioral problems that may cause cats to go to the bathroom out of the box, since that is a book's worth of information, and try to address the signs, symptoms, and possible causes of Feline Lower Urinary Tract Disease.(FLUTD).
 

Definition

Feline Lower Urinary Tract Disease is technically any disease process that affects the bladder and urethra.  This excludes the kidneys and ureters.  Originally characterized as an infection, we now know that there are a variety of diseases, some related, some not, but most causing similar signs in cats.
 

Signs and Symptoms

The clinical presentation of a cat with FLUTD is similar for most of the different causes of this disease, a fact that makes diagnosis a bit challenging.  Affected cats will have an increased frequency of urination, often going in and out of the box multiple times an hour but only urinating a small volume.  The decreased urine volume may have a stronger odor than normal and may have blood in it.  One emergency associated with this disease complex is urinary obstruction, much more common in male cats than females.  In obstructed, or blocked cats, the urethra is plugged with mucous, crystals, clots or small stones making it impossible for urine to pass.  This is a medical emergency and will be fatal if not treated. promptly. If your cat is in the box straining and little to no urine is coming out you must contact your veterinarian immediately.  Like now, not in the morning, not after work.

The tubes in the picture come from two cats that I saw in the office today.  The one on the right is concentrated so it is a little darker in color than one might expect.  The tube on the left is obviously bloody.  The cat that passed the bloody urine was actually passing clots as well.
 

Causes of FLUTD

When I graduated from Veterinary School, we were taught that all cats that were showing lower urinary tract signs had an infection and that the underlying cause was too much ash in the diet.  Diets were re formulated to change the mineral content (ash).  Then we were taught that it was an alkaline pH that caused the infections, so diets were re formulated to lower the pH.  Then we saw different problems emerging as the diets swung from one extreme to the other and the profession started to realize that most cases of FLUTD were not even infections.  In fact, in our practice, male cats that present with clinical signs of FLUTD rarely have an uncomplicated urinary tract infection.  So, what's the deal with FLUTD?  The following syndromes can cause the signs associated with FLUTD
 
  • Infection, or  infectious cysitis,  (the letters itis on the end of a word mean inflammation).  Usually caused by bacteria, this condition is more common in females than males.
  • Urinary Stones.  As the it would suggest, these cats have mineralized concretions in the bladder or urethra.  These stones irritate the bladder wall and cause the signs that we see.
  • Sterile cystitis.  Remember your lesson above, this is inflammation of the bladder without infection.
  • Urinary tract tumors.
  • Behavior.  I said I was going to skip this but I just put it here for completeness.

Diagnosis

 
You veterinarian should take a careful history and then do an examination.  He or she may recommend diagnostic testing such as a urinalysis, a urine culture, radiographs or and ultrasound. Each test gives different information and helps to pin down the exact reason that your cat is having signs of FLUTD.
 

Treatment

 
The treatment will depend on the cause of the clinical signs.  Infections are treated with antibiotics.  Stones may need to be removed surgically.  Sterile cystitis is managed with diet changes, stress management, and medication to control pain and inflammation.  It is particularly important to make sure that your cat continues to urinate while the diagnosis and treatment is on going.  If there is a problem passing urine, call your vet immediately.  Once a diagnosis is made, your veterinarian will work with you to set up a long term strategy to prevent re occurrence of this painful problem.
 

Prevention

So, what can you do to help your cat avoid the painful FLUTD?  Across all studies, the most important thing seems to be to increase fluid intake.  Many of my colleagues in feline only practices recommend feeding only canned food due to the increased moisture content.  They feel that they see less FLUTD on cats that eat moist diets.  There is an increased risk of dental disease in cats eating only canned so some dry is probably a good idea.  Make sure that there is ample fresh water available.  Cats are notoriously poor drinkers so make the water as appealing as possible.  Drinking fountains, multiple clean bowls, dripping faucets, whatever it takes to encourage drinking.  And finally, stress reduction seems to help decrease the incidence of FLUTD.  So, alter your cat's environment to keep it interesting and stress free.  The Ohio State University, Indoor Pet Initiative is an excellent resource.
 
To paraphrase Fellinini, "To be fit as a fiddle, a man (cat) has to piddle."  "Something's amiss if a cat doesn't piss"
 

Sunday, October 9, 2016

These Posts May Seem Out of Order ...

It took me a while, but I think I may finally have things set up so that I can get all of my information streaming through a single location on the web.  Our web page technicians have set up a page on the practice web site that will pull these posts and publish them.  Of course, if you are already on the practice web site, then you know this and clicking on the link above will not really do much for you.

I have started to pull some of the older posts from the practice site and move them here, trying to consolidate everything and prevent redundancy.  That's why the previous post is about November being Pet Cancer Awareness month.  It appears to be dated last week, when in actuality, it was written last year and moved to the blog site last week. Make sense?  Well, it doesn't really matter, all content will be available through the Crawford Dog and Cat Hospital Webpage by the end of the week and then all new content will be posted here, published here and there, and referenced on Facebook and Twitter as it becomes available.  There is no way to hide, I'll get it to you.

Now that I've sort of explained the interruption in the space time continuum and annoyed you with a slew of links to a variety of web locations, I'm going to let you rest.  All of the posts, formerly on the web site will me migrated to this site, interspersed with new posts and we should be caught up by next week.

Saturday, October 8, 2016

NOVEMBER IS PET CANCER AWARENESS MONTH

 
Who knew?  I mean who would think that we should only be aware of pet cancer one month a year.  Fortunately, my twitter feed, the ever present, non resting source of all things important and not, let me know.  Now I'm letting you know.  November is Pet Cancer Awareness Month.
 
Now that we are all aware, I guess we should do something about it.  Dogs and cats can get cancer just as their owners can.  Sometimes it is obvious when a pet has cancer, sometimes it's not so obvious.  What are some of the signs you should look for?
 
  • Weight loss or changes in appetite
  • Lethargy
  • Vomiting (not once or twice but chronic vomiting)
  • Diarrhea (see above)
  • Lumps and bumps in the skin or under the skin
  • Coughing
  • Changes in urinary habits
  • Changes in drinking habits
  • Pale gums
  • Distended abdomen
  • Lameness or swollen limbs
There, I've mentioned something that most pets do at least once in a while, enough to make us all crazy.  So what should we do?  Well, first of all a regular physical examination for every pet is a must.  Discuss any concerns with your veterinarian.  Many cancers (along with other health problems) can be picked up with a good history and physical exam and some very minor and inexpensive testing.  Once there is a diagnosis, then a treatment plan can be formulated.  
 
Rather than go through a list of tests and diseases that will put most of us to sleep, I thought I would just share some cases with you that have come through our hospital in the past few months.
 
 
Let's start with lumps and bumps.  Here are two different cases.  From looking at them can you tell which is cancer and which is not?  
 
 
 The first is a mammary mass on a cat.  This could be potentially bad news as the majority of these masses are malignant and that is certainly what we though going into surgery.  Fortunately for this little kitty, that was not the case, it was benign and surgery cured the cat.  This little mass on the inside of a dog's let looks innocuous.  However, a fine needle aspirate showed abnormal cells and granules, suggestive of a mast cell carcinoma.  We removed it and sent it for a confirmation biopsy. Fortunately we got it early and removed the whole thing.  To date, no further treatment was needed.  Here is a picture of the slide that we made of the aspirate.  It's what we are looking at when we run to the back to use the microscope.
 
The big purple spots are cancerous mast cells.  The little purple spots are mast cell granules.  This is why we aspirate all masses, we don't want to miss something like this while it is still treatable.
 

PET DENTAL BASICS

Or, What You Should Know About Your Pet's Teeth.

 
A quick look into our pet dog or cat's mouth will illustrate just how different their teeth are from each other as well as from us.  Dogs have 28 primary or baby teeth and 42 adult or permanent teeth.  Cats have 26 primary teeth and 30 adult teeth.  In both cases, these teeth are specialized to accommodate the preferred diets of these species.  While herbivores have heavy, rough flat teeth for grinding plant based diets, the teeth of our domestic pets are designed to cut and tear the primarily meat based diets that they prefer.  Dogs do have flat surfaces on their molars for grinding and crushing, since we do know that they will eat some non meat foods and love to crunch on a big bone now and again.  Cat's however, have mostly sharp slicing dentition, adapted for a carnivorous diet in the wild.
Both species have adapted well to commercial diets and seem to have no trouble chewing processed foods.
 
Primary teeth start to erupt in both puppies and kittens when they are a few weeks old and are pretty much complete by the time of weaning at 6 weeks.  These will be replaced starting around 4 months of age, starting with the incisors in the front and ending with the large canines at around 6 - 7 months of age.  Extra teeth or missing teeth at this age are abnormal.  While spaces in  your pet's smile are normal, missing teeth need to be investigated.  Dental x rays should be taken to make sure that missing teeth are really not there, rather than simply hiding.  Un - erupted teeth can cause serious pathology later in life.  Dentigerous cysts can form causing pain while eating and even jaw fractures if left untreated.  Retained deciduous teeth should be extracted to prevent malocclusion and increased risk from periodontal disease and infection.  
 
Once your pet is through the adjustment period of early childhood and training, say at around 3 - 4 months of age, it is time to start a program of home dental care.  Regular brushing with a soft tooth brush and a pet tooth past is the best way to insure dental health.  Your veterinarian can help you pick a home dental care program that will suit your pet's needs and temperament as well as your schedule.
 
Dental examinations should be part of your pet's annual wellness visit.  Your veterinarian will let you know when it is time for a professional cleaning.  Remember, most dogs and cats will need to have their teeth cleaned, with anesthesia, periodically.  The interval will depend on several things, including how much home care you are able to do, your pet's diet, genetics, and anatomy.  Cleaning teeth before there is a problem, a true "prophy" cleaning, similar to what we have done in our mouths, is the best way to prevent serious dental problems in the future.