HealthyMouth Water Additive: Does It Help Prevent Dental Disease?

I am often asked by clients or readers about specific products, and while I certainly can  only investigate a small proportion of all the stuff marketed to pet owners, I try to look at as many of these things as I can. Some of my colleagues have begun using a product called HealthyMouth , a water additive reported to reduce accumulation of plaque and retard the development of dental disease. This product has received a seal of acceptance from the Veterinary Oral health Council (VOHC) and  an endorsement from Dr. Fraser Hale, a dental specialist and someone who generally takes a skeptical, evidence-based approach to dental therapies. Dr. Fraser has gone from being skeptical of the product to actively recommending and distributing it. These are sources I believe are trustworthy, so I thought I ought to take a closer look at the product. In keeping with my general approach, I will review the product in terms of the following general issue: 

1. Basic plausibility for proposed effect/mechanism of action
2. Pre-clinical, non-target species research
3. Clinical trials
4. Marketing claims 

Individual Ingredients
The product ingredients list is extensive, though specific quantities/concentrations are not provided. Only two are described as “active” ingredients, papain and zinc gluconate, but I will discuss several others that appear to be included for some specific effect. Theoretical rationales are provided for some ingredients but not others. Many ingredients are described as “organic,” which I suspect has little relevance. The dog and cat products appear from the ingredient list to be identical except for the addition of the amino acid taurine to the feline product.

1. Pomegranate- No specific claim is made about this ingredient.
There are a few in vitro trials that suggest anti-bacterial effects from pomegranate juice. There are also a number of human clinical trials suggesting anti-plaque and anti-bacterial effects for oral rinses containing this ingredient (1,2). There appear to be no clinical trials in dogs other than the two unpublished studies conducted by HealthyMouth, and no trials at all in cats. Clinical trials in humans and lab animal studies show little risk, though allergic reactions in humans have been reported, and there are some concerns about possible interference with the metabolism of other supplements or drugs.

2. Yucca- I was not able to find any in vitro research suggesting a benefit for yucca extract in preventing or treating dental disease. There have been a couple clinical trials of one yucca extract in dogs (3) and one in cats (4) reporting some decrease in the odor of flatulence, and no significant adverse effects were reported. There are reports of yucca extracts causing gastrointestinal symptoms. I was not able to find any clinical trials of yucca extract as a preventative or therapeutic for dental disease in humans or in dogs or cats.

3. Zinc gluconate- The claim made for this ingredient is that ” zinc gluconate operates as an antibacterial agent.” There are clinical trials of zinc gluconate containing rinses and toothpastes in humans which appear to show decreased plaque and gingivitis, but the compound is almost always combined with triclosan or other antibacterials, so it is unclear what role the zinc itself has in any effect seen. There are no clinical trials investigating the use of this agent in preventing or treating dental disease in dogs or cats. Excessive zinc ingestion can cause serious and even life-threatening complications.

4. Blueberry- I found one study suggesting a particular blueberry extract might have a weak effect reducing the aggregation of bacteria found in the human mouth (5). There appears to be no lab animal, or clinical trial evidence in humans or other animals that blueberry is useful in the prevention or treatment of dental disease. Blueberry’s are reported to contain substances which have anti-oxidant properties, but the clinical significance of this is unclear, and no apparent connection exists to prevention of dental disease.

5. Papain- A combination of proteolytic enzymes found in papaya, papain does not appear to have been studied extensively as an agent for prevention and treatment of dental disease, though it is occasionally found in toothpastes. I was not able to find any clinical trials in humans, or in dogs or cats regarding dental disease. There are some safety concerns as large amounts have been reported to cause perforation of the esophagus in humans, allergic reactions are possible, and there is some potential risk of reducing blood clotting function, especially in combination with some other herbal ingredients including cloves which is one of the flavoring agents in HealthyMouth.

6. Vitamins B2 and C- These appear to be included as “anti-oxidants” and to “increase the immune response.” The notion of boosting the immune system is a meaningless marketing device and while there is some preliminary suggestion that preventing oxidative damage can sometimes be a good thing, oxidation is also one of the ways the body suppresses cancer and fights infection, so it is not appropriate to assume that reducing it, even if these substances actually do that in a living animal, is a good thing.

7. Clove and cinnamon- These are apparently added as flavoring agents, and I found no research to suggest benefit or risk associated with them in dogs and cats. I wouldn’t expect them to be especially appealing to cats, but the company claims they love it.

Clinical Trials
As I mentioned, HealthyMouth has been awarded the Veterinary Oral Health Council (VOHC) seal of acceptance. VOHC is an independent organization that reviews the evidence for products claimed to have value for prevention and treatment of dental disease in animals. The organization requires clinical trial evidence to support product claims, and they have pretty specific protocols to ensure these claims are adequately demonstrated. However, I still have some concerns about the trials HealthyMouth uses to support its product claims.

As I often point out, all of us have biases about the ideas and beliefs we hold. We naturally believe our hypotheses to be true, and this can lead us to see what we want or expect to see, to focus on confirming information and ignore or minimize contrary information (e.g. confirmation bias and cognitive dissonance). And non-ideological motives, such as financial incentives, can also influence our interpretation of what we see even if our intentions are quite honest. It is well established in human medicine that trials funded by industry, for example, tend to have findings favorable to the products of the funder. The purpose of formal clinical trials is to help us test our ideas in a way that hopefully prevents these biases from inappropriately influences our findings.

It is important to be aware of the potential biases involved in a clinical study, not because this information allows us to automatically dismiss the findings but because it helps us spot weaknesses in the methods and evaluate the results in context.

In the case of HealthyMouth, the two clinical studies in dogs were both funded by the company that manufactures the product. And thought the chief investigator, Dr. Jean Dodds, is a well-respected veterinarian who has done much fine work for the veterinary  profession and animal welfare, she is also a prominent advocate of “holistic” veterinary medicine, having even received the Holistic Veterinarian of the Year award from the American Holistic Veterinary Medical Association, an organization I’ve discussed frequently before. These facts are relevant because they indicate the high potential for a bias favorable to the product in these trials, and so we must look carefully at the methodology of the trials to see if there are adequate controls.

It is difficult to evaluate all the details of the methodology since the trials have not, as far as I can tell, been through peer review or been published in the scientific literature. The information I evaluated about them comes from the HealthyMouth web site. It appears that two trials, with 40 different dogs in each study and a duration of 28 days (requirements of the VOHC protocol) were conducted by Dr. Dodds in a greyhound dog rescue center and blood bank she founded and manages. The advantage to this, apart from logistics, is that the husbandry of the dogs was likely pretty uniform, which reduces sources of variation between groups. The disadvantage is that the dogs were all of one breed (and one in which dental disease is a particular problem), and the conditions were likely very different from those experienced by typical pet dogs.

The VOHC standards recommends randomization of subjects, but it does not appear that procedure was used in this study. Subjects were allocated to groups based on kennel housing so that the access to treated or untreated drinking water could be more easily controlled. This introduces some small potential source of difference between groups other than the treatment itself.

The dogs had a full dental cleaning under anesthesia at the start of the trials, and their plaque scores measured at intervals, as recommended in the VPHC protocol. A big concern about the study, however, is that there was apparently no blinding. The treated and untreated water were easily distinguished, and the staff managing the dogs and evaluating their oral health were apparently aware of which group they were in. This always introduces a strong potential for bias, and it is especially a concern in a trial like this where there is a strong presumption of safety and efficacy in advance on the part of the organizers of the trial (the company making the product) and possibly among the investigator and her staff. In any case, the evidentiary  value of a clinical trial is substantially lower if it is not properly and effectively blinded, and such trials almost always find a positive treatment effect.

In any case, the trials both showed a strong positive effect on plaque scores. No trials have yet been made public in cats, and no independent evaluation of HealthyMouth appears to have been done.

Marketing Materials
As is probably inevitable, the marketing of this product involves a lot of “satisfied customer” testimonials. Stories of dogs and cats who apparently experienced great benefits are told, and of course no stories from pet owners who do not believe their pets befitted are told. This creates the impression of a safe and effective product, but of course it is a form of advertising, not a reliable source of information about whether the product actually works.

Dr. Hale gives the company founder credit, appropriately in my opinion, for marketing HealthyMouth as an adjunct to appropriate home and professional dental care, not a magic cure-all or substitute for other, established preventative and treatment methods. This is a point in the company’s favor.

Not so encouraging is the frequent use of words like “natural” and “artificial” to imply that the product must be safe. The advertising even goes so far as to claim there are “no chemicals” in the product, which is nonsense since water, blueberry juice, and every other ingredient is a “chemical.”

As I have often pointed out, botulism and uranium are “natural” and polio vaccine and penicillin are “artificial,” so these words don’t really mean what they are implied to mean. In any case, several of the ingredients have recognized health risks in humans, and most have not apparently been tested for safety in dogs or cats. And it is impossible to tell from the web site how much of the various ingredients are in the product, so no definitive statements about safety can be made.  I would be surprised if there are any significant risks from the product since it would require an awful lot of most of the ingredients to be dangerous as far as I can tell, so I’m not especially worried about the safety issue. But the claims of safety are really assumptions based on the naturalistic fallacy, and supposedly safe herbal and homeopathic remedies have turned out to be harmful in the past (e.g. cinnamon bark and homeopathic belladonna), so at least a little caution is appropriate.

Summary
There are some very limited in vitro and human clinical data to suggest it is plausible that the ingredients in this product might have some benefit in preventing dental disease. The only research actually testing the product in a veterinary species (dogs) showed benefits, but some caution is warranted in interpreting these results because they are unpublished, industry-funded trials with a lack of robust methodological controls for bias and other non-treatment effects. There is no significant evidence of any real risk from the product, though it doesn’t appear that most of the ingredients, alone or in combination, have been tested for safety in cats and dogs. The company generally markets the product in a responsible way, though it does make use of some misleading advertising strategies such as promotion through testimonials and invocation of the naturalistic fallacy.

Overall, I am inclined neither to recommend the product nor to recommend against it. I applaud the company for taking the first steps in conducting the research necessary to obtain VOHC approval, and I hope additional research, ideally independent and better designed, is eventually carried out to further clarify whether this product has real safety and meaningful efficacy. I agree wholeheartedly with the company that dental disease is a serious condition and that most pets do not receive adequate preventative care or treatment, so I hope additional research does eventually show this product to be a useful adjunct to other oral care practices, but I think it the case has not yet been effectively made.

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37 Responses to HealthyMouth Water Additive: Does It Help Prevent Dental Disease?

  1. Crest pro health tooth paste contains stannous fluoride that has been shown to work for treating gingivitis and tarter at the gum line in humans. A lot of the pet toothpaste sold has no fluoride or detergents because they were taken out for reasons that are debatable but may have been economically not medically conceived just to sell pet toothpaste.

    The healthymouth study reminds me of the Hills J/d study where blinding was broken because you could easily tell the difference between J/D and purina dog chow which was used as Hills control in their “evidence based” J/D promoted study.

    art malernee dvm
    fla lic 1820

  2. ellen says:

    testimonial only: my dog’s dentist recommended healthymouth water additive. i’ve been using it for over a year as part of a home dental care regimen, which includes brushing. it really seems to soften the plaque on my dog’s teeth, making it less adherent. when i’ve run out of the product, i find it harder to remove the plaque with the tooth brush. i’ve gotten much better results with healthymouth than with leba III (http://www.lebalab.com/) and petzlife oral care products (http://www.petzlife.com/), both of which I’ve also tried. of course, nothing takes the place of daily brushing and regular dental checkups. :)

  3. nothing takes the place of daily brushing>>>>

    I have read pet tooth brushing compliance is 3% and 5% among vets. Deep dental cleanings have about a 50% compliance rate in my practice. So we need something else to treat gingivitis. I am a fence sitter on this product but would sell it if a better blinded study showing efficacy could be published.
    art malernee dvm
    fla lic 1890

  4. Fraser Hale says:

    There is a link to paper on my website at the top of this blog (click the word endorsement). If you are a veterinarian, I can also invite you to send me an email for more information, but I am not allowed to promote a product to the public in an open access forum such as this.

    I have immense respect for Dr. Colin Harvey (boarded surgeon, boarded veterinary dentist with both the American and European Veterinary Dental Colleges…..one of the grandfathers of veterinary dentistry….), the founder and head of theVOHC. I have a paper on this organization available at http://www.toothvet.ca/PDFfiles/VOHC_SEAL.pdf. A product with the VOHC seal of acceptance for plaque control should be given very serious consideration regardless of trivial concerns about any “meaningless marketing device” found on the printed material.

    Why is the research/data not published? When the company was introducing the product to the profession, veterinarians demanded (quite rightly) to see the numbers. So, the studies were posted on the company website for all to view. Therefore, the Journal of Veterinary Dentistry (and likely other publications) will not accept the paper for consideration as it has already been published on the internet. Damned if you do, damned if you don’t. While there is no ‘peer-reviewed’ publication of the research as we usually understand the concept, the research was not only designed by but has also been scrutinized by the VOHC.

    Of course the research was paid for by the company. Any company wanting VOHC acceptance is going to have to pay for the research themselves as there is no incentive and no money for an independant or academic researcher to do this for them. While the research was paid for by HealthyMouth LLC, it was not done by HealthyMouth LLC. The VOHC guidelines for submission ensure that the research is done by an arms-length facility for this very reason.

    I could go on, but will wrap up by pointing out that HealthyMouth LLC is the only company with this type of product to invest the very considerable amount of time, energy and money to obtain the VOHC seal. Karen, the company founder is also very committed to evidence based medicine and continues to fund research to demonstrate the value of her products. I know of no other water or food additive that comes close to having this level of evidence or commitment to research. No, this product does NOT treat established dental disease, it does NOT replace brushing, it does NOT replace professional veterinary dental care and HealthyMouth LLC takes pains to inform its users of this. It is intended and should be used as part of a comprehensive oral care program that includes daily home plaque control and regular professional dental assessments and treatments.

    So please, compare healthymouth(tm) to any other food/water additive, not only in the ingredient panel (no alcohol, no xylitol, dyes or sweeteners…) but also the level of research so far (more to come). Then make an informed decision.

  5. skeptvet says:

    Dr. Hale,

    I appreciate your taking the time to contribute. As I mentioned in the original post, I have found your analysis of dental therapies very useful in the past, so the fact that you not only endorse the product but have become involved as a distributor in your area says a lot about your confidence in it.

    I tend to agree that the company deserves credit for doing the research and seeking the VOHC seal. I did not mean to imply that being a company funded study automatically made the results unreliable. I hope I was fairly clear that the relevance was simply that the risk of bias was greater, so there need to be appropriate controls in place to account for this. I am a bit surprised, given the effort that HealthyMouth went to to generate these data, that the company did not include randomization and blinding in their protocol. Or perhaps they did and this is simply not mentioned on the web site? I would be inclined to give the results greater weight if these controls were in place, so I think this is more than a minor methodological issue.

    In any case, while I’m maintaining a wait-and-see attitude towards the product at this point, I look forward the additional research you indicate is under way. Thanks again for your input.

  6. Karen Albert says:

    To address your issues regarding randomization and blinding, the brief trial overview on the website is intended for pet owners. Traditionally, veterinarians have contacted me directly for more detailed trial study guidelines. Although our submission to VOHC is confidential, if you visit the VOHC website (www.vohc.org) and review the protocol, you’ll see that randomization and blindness are two protocol requirements. our trials would have had to meet ALL protocol requirements in order to receive the seal.

    I always make myself available to veterinarians to address questions and to provide all non-confidential information. I certainly extend this same invitation to you.

    Kind Regards,

    Karen Albert
    Founder/CEO
    HealthyMouth L.L.C.

  7. skeptvet says:

    Ms. Albert,

    Thanks for your reply. As I said above, I’d certainly find the results of the trials you conducted more persuasive if they were effectively blinded, so I am encouraged to hear that apparently that was the case. If you are able and willing to send me more detailed information about these trials, I would appreciate the chance to review it and revise my assessment. Any other information you could provide, such as the rationale behind the choice of particular ingredients (i.e. any preclinical or human trials involving them) and the amount of the active ingredients pressent would also be very helpful.

    As Dr. Hale said, I think you deserve a lot of credit for making so much effort to produce solid evidence to back up your product claims, and I really appreciate your making the effort to develop and market your product in a responsible way. Thanks for your comment!

  8. v.t. says:

    Part of the problem as I see it, is that whenever the marketing employs “natural ingredients”, safety and so-called evidence (when there may be no singular evidence without including other mechanisms like brushing, chewing, regular veterinary dental care etc), pet owners are already suckered in, they don’t bother with validating the evidence. A seal of approval by some accepted body only seals their confidence. Didn’t greenies also get the seal of approval? Oh the problems that greenies have!

    It appears the VOHC kind of skirts the issue of evidence vs safety. In their docs, it states as long as the study/trial criteria are met and the ingredients are also deemed safe by the FDA, then it seems they are likely to be approved. However, FDA has no database on safety on many herbs etc for use in pets.

    Another part of the problem is cost to pet owners for veterinary dental care. Prices have skyrocketed in the last couple years, it costs more for a yearly dental with a potential extraction for one pet than it does for yourself with your own dentist. For you, you have the option of insurance, even if minimal. For the pet owner, most do not have pet insurance.

    So, these “water additives” are highly attractive to pet owners for various reasons. Convenience, lack of funds for regular veterinary care or prescription diets, laziness or inability to brush their pets’ teeth etc. Much like all CAM, promises, promises….

    If extended research proves promising, great. If not, it would be truly sad to see the VOHC fall into the CAM trap.

  9. Traditionally, veterinarians have contacted me directly for more detailed trial study guidelines. Although our submission to VOHC is confidential>>>>>>

    Karen, If you have a good “detailed” randomized study that proves the medicine you sell works please post it here or email it to me so i can post it myself . I need to show it to my clients, especially the clients that work in the human dental and medical field. If the study is posted we could then ask you questions about the study and peer review it..That can legally be done by doctors for educational purposes. The intellectual property laws have exception for providing copyright studies for educational purposes but I am not sure what deal you have signed with VOHC. The double blind RCT study you seem to say in your post exist, locked in some VOHC drawer somewhere, does not do me any good if what i want to do is provide evidence based medicine to my clients. My computer automatically prints out a hyperlink webpage to RCT studys right on my label directions when i sell medication. If you have been reading this blog you can see that those who control veterinary groups such as the American Animal Hospital Association cannot be trusted. The AVMA has promoted annual revaccination into our profession as the standard of care, resulting in a lot of harm to my practice and the credibility of the whole profession to do whats right for patients rather than what right short term for our check book. Science based studies show expert opinion cannot be trusted. Its the way our human mind works not because vets are bad people as a group. A VOHC approval or your, I am not allowed to show you the evidence, promotion is not the evidence I need. I “believe” a good blinded study that we could peer review would be worth more in dollars to your business than a VOHC approval. I believe if published a good blinded RCT would also get others to repeat the study independently to verify and see if we should be adding the stuff you sell to our own drinking water.

    Art Malernee dvm
    fla lic 1820

  10. Dea says:

    I recently purchased and have been using Healthymouth. Very glad I came across this discussion.

    I have a couple of tiny dogs that refuse to have their teeth brushed, so I am looking for an effective water additive.

    I was drawn to Healthymouth because it does not contain alcohol or xylitol, but it only has two ingredients that *might* be effective? I was not aware of this!

    I’m not sold on this solution. What else would you recommend?

  11. skeptvet says:

    The reality is that there is very limited evidence for any preventative measure other than brusing. Like Healtymouth, there are a number of other products that have met the approval standards of the Veterinary Oral Health council (VOHC). This isn’t perfect, since the supporting research is limited to a single study, funded and conducted by the manufacturer, and not published in a peer-reviewed source, so it has to be viewed as only weak evidence. But it is certainly better than the complete absence of evidence for products that haven’t met the VOHC standards. So I would look at products at http://www.vohc.org that are rated fro plaque prevention (calculus is far less important), and see if something there might work for your pets.

    Good luck!

  12. Catherine says:

    I love your website. It really tackles all the issues that pet owners like me are concerned about in a no nonsense, “just the facts m’am,” kind of way. I brush my dog’s teeth every morning (sometimes even before I brush my own!) I’ve been doing this since the second day I got him (he was 13 weeks old.) He is now 4 years old. I do have a question though. I’ve heard that it’s only necessary to brush the outsides of the teeth and that the dog’s tongue will naturally clean the insides of the teeth. Is this true? I’ve been brushing both insides and outsides because I don’t know how that could be true. (I use C.E.T. enzymatic vanilla mint toothpaste by Virbac.) What do you think? What does the research suggest? Thank you.

  13. skeptvet says:

    I was also taught that it is only necessary to brush the outside surfaces of the teeth, and I am not aware of any controlled research on the subject. The majority of the disease I see when I treat dental disease is on the outer surfaces, but sometimes there is also disease on the inside. I suspect a big reason for the recommendation is that it is often much easier to get a dog to tolerate brushing when you don’t try to open his mouth and reach the inner surfaces of the teeth, so it’s just easier for most people to brush only the outside. If your dog allows you to brush more thoroughly, I suspect it’s more effective to do so. In any case, it sounds like you’re doing a great job!

  14. Amy Mentes says:

    Greetings!
    Firstly, thanks for your website and the above discussion.
    I have a ten years old Basenji with a long history of dental/gums issues. He goes for regular dental cleanings. Also, I try to brush his teeth frequently, however it’s always difficult to reach his back teeth, where he really has plaque build up. A couple of weeks ago he had surgery (removal of a growth on his neck/chest area), so I decided to have his teeth cleaned, as he was going under anesthesia anyway. His Vet took x-rays of his teeth and one tooth definitely needed removal (add insult to injury ;) I just started him on HealthyMouth today, although I am skeptical I am also hopeful. I can keep you posted on the HealthyMouth results.
    Thanks again for the taking the time to blog,
    Amy Mentes

  15. skeptvet says:

    I certainly hope you have better luck with your dog’s dental disease in the future. There is no question brushing is the most effective preventative practice known, so definately keep it up! As for the HealthyMouth, it is unfortunately not possible to draw very useful general conclusions form the experience of individual patients. I’ve had clients who felt it was very helpful, slightly helpful, and totally useless, and without some organized, controlled experimental evidence, these observations don’t help me predict whetehr or not it will be useful for most of my patients. The limited evidence available now is encouraging, but I have to stress it is still limited, so while it’s reasonable to try it, I hope the company, or even better independant investigators, will make the effort to conduct more extensive research so we can have better information in the future.

    Thanks for your comment!

  16. Jan says:

    I am a nurse, and my husband is a research immunologist. We adopted an FeLV+ cat end of 2010 (between 2 and 3 years of age) and are trying to provide appropriate preventive care in addition to allowing her to live and be just a cat. To address her gingivitis and dental health (which is very good and has been basically stable for 2+ years) our initial vet determined she should be seen once a week for massaging of gums and cleaning of teeth by vet with finger and gauze pad, exam of teeth and gums for changes/need for more advanced intervention, and application of OraVet to teeth. We moved, and our current vet kept the same regimen but decreased visits to every two weeks. Our cat is growing progressively irritable at each visit, and we and the vet highly suspect she’s had about enough of visiting the vet every 2 weeks of her life. This vet has suggested our researching HealthyMouth as a replacement for all previous measures (ie, use HealthyMouth only, without any other dental health measures except periodic vet visit/exam) and possibly decreasing vet visits related to dental health to every 1 month or 6 weeks (with appropriate intervention should the dental health worsen in nature as detected at those visits or earlier by us at home). The HealthyMouth standard product information packet that our vet provided to us to read is extensive, but not conclusive. Our main concerns center around whether this product would be appropriate for an FeLV+ cat, whether it would be a good replacement for the current regimen (which all of us believe needs an alternative for her quality of life but to still maintain preventive measures to keep her as healthy as possible from a dental perspective and dental risks in the FeLV+ picture), and whether it would be safe for her, given she also has well-documented food (gluten/grain) allergies and has been fed only EVO grain-free diet (or gluten-free turkey deli slices for treats) since diagnosis. Ingestion vs. topical administration raises questions as well. The product information does not address use in FeLV+ cats. I could find only one statement regarding food allergies: “If your pet suffers from any food allergies, then please consult your veterinarian first,” but I’m not sure a vet would know (Do you?). A few comments in your review lend to my caution and being unsure as to whether we should use this product, particularly with reference to allergic reactions in humans (given no data in cats to date) found with several of the ingredients and the inappropriateness of interfering with oxidation (antioxidants vitamins B2 and C are two ingredients you addressed on this topic) as it relates to prevention of infection (“oxidation is also one of the ways the body suppresses cancer and fights infection, so it is not appropriate to assume that reducing it, even if these substances actually do that in a living animal, is a good thing”) (of course, we need all the infection-fighting we can muster with the feline leukemia virus). I would appreciate your responding as to whether you concur with my caution [my “gut” feeling is that this product would not be appropriate in the face of FeLV and known food allergy (and possibly unknown ones as well, given ingredients such as pomegranate (you indicate there have been “allergic reactions in humans … reported”) and who knows if our cat has ever ingested this and is OK from an allergy standpoint]. I would also welcome guidance on alternative therapies and where we could research those therapies. I find it relatively easy to research human medicine but that my door to veterinary medicine is usually closed. Our cat is doing so well on the current regimen, but the stress of frequent visits has been mounting and stress is an FeLV+ cat’s enemy as well. Thank you.

  17. skeptvet says:

    Thanks for your question. My first reaction is that I cannot imagine why rubbing the gums with a gauze pad weekly, much less every other week, would have any effect on gingivitis at all. It is generally considered ineffective to brush teeth less than every couple of days, though I’m sure the regime you are using hasn’t been evaluated specifically. One of the hardest problems in clinical medicine is knowing whether the patient is doing well (or not) because of or in spite of the therapy.

    The Oravet has only been evaluated in one industry-sponsored clinical trial, and this did show some benefit, so it may be helping. However, it certainly sounds like the stress of the procedure is likely greater than the benefits at this point.

    Unfortunately, I can’t really give you much guidance on whether or not to use HealthyMouth. Apart from the limited evidence I discuss in this article, my own experience has included pets whose teeth seem to stay healthy since the owners started using the product and also pets whose dental disease progressed rapidly while using it, so it certainly doesn’t work for every patient or replace more aggressive dental care (home care as well as thorough cleaning under anesthesia). Of course, in your situation the inflammatory reaction you’re treating may be more a function of the FeLV than normal gingival or periodontal disease, and there is simply no way to know if this product will be helpful, harmful, or neutral in that situation. I don’t think the risks are very high, but I also don’t have a lot of confidence that it will help. The uncertainty is great enough that any choice you make (or that we make as vets) amounts to little more than a guess.

    Sorry I couldn’t give you more clear guidance. Good luck to you and you kitty.

  18. Catrina says:

    A study on zinc use in cats (posted by a company selling a zinc-based product).
    http://www.addisonlabs.com/documents/ClarkeDentalStudy-Final.pdf
    Looks good, doesn’t it? But…
    I found this article indicating toxic levels of zinc in pet food, “Cat fanciers may be legally and unwittingly feeding toxic doses of zinc to their cats.”
    http://www.dailyfinance.com/2009/06/18/questions-arise-over-possibly-toxic-pet-foods/
    I’d like to try Nature’s Dentist, but it has zinc.
    http://www.trinatural.com/supplements-mcintosh-dentist.php
    If one finds a product without zinc, it usually has seaweed (high iodine).

  19. Sandra says:

    I’ve been brushing my dogs teeth nightly for years & getting regular cleanings. I also used a gel oral product as well as a kelp based food additive. All of these products did not keep my Cairns teeth clean. I switched to C.E.T. toothpaste and Healthy Mouth water additive. These products work!! Dogs teeth are extremely clean. Small dogs are prone to dental problems due to all of the teeth that are crammed into such a small jaw and my dogs were not exempt from this issue.

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  21. Kathryn says:

    I have read all the previous posts with great interest, since my Vet has just suggested HealthyMouth for my 11 year old mini Poodle. Since all the dogs, Border Collies and Poodles, share the same water bowl, I would like to know if it you consider to be a worthwhile additive.
    Have there been any further studies reported since the original and, if so, what do you think of the product now?

  22. skeptvet says:

    There have been no additional published studies. We offer it our practice, so I have seen a lot of dogs using it. Subjectively, I have seen dogs using it reguarly who do subsequently develop significant dental disease, and dogs who do not, so I really don’t have any clear way to know if it is beneficial or not. I have not seen any significant side effects, though a few dogs will not drink the water it is added to (and a larger proportion of cats will not). So overall, I tell my clients it might help but I am not certain, and it is unlikley to be harmful, so it is reasonable to try but not something I would rely on as a substitute for brushing and other proven dental care. And I do not use it with my own dogs (I brush daily).

  23. Kathryn says:

    Thank you very much for your quick reply. With 5 dogs, I have been very lazy about brushing. If I had, the dogs would be better off and I would be wealthier!

  24. I have been using this product on my Maine Coons(all ages) for about a year. I can say
    that all their bad breath disappeared almost instantly. My vet checked the ingredients and said that nothing was harmful…Only time will tell if this supplement works long term to prevent gingivitis, etc.

  25. Dr. Michael G. Scott PhD says:

    Your research raised several “red flags” about the effectiveness of this product…research funded by companyitself and lack of published results. Study limited to one breed (greyhounds) is a deep concern. The bottom line appears to be …. maybe it works and maybe it doesn’t. Not reassuring!!!! No mention was made concerning cost: In Canada, we purchased an 8 ounce container at $75.00 I can’t help but wonder what the wholesale cost is, as well as the suggested retail cost … and if this is an incentive for vets and others to “push” the product?

  26. Gail Dolly says:

    We just brought our Yorkie (5 years) home from his dental procedure at the Vet’s. Since he was a very sick puppy (liver shunt, etc.) we more or less neglected his teeth. However, the procedure today, which included the removal of a small tooth, seems to have been the beginning of a new “healthy mouth” program at our house. His sister will also have the same procedures starting around July. We had just started putting “Dental Fresh” in their water and they seem to love it, but the vet recommended “Healthy Mouth” so my husband just ordered a supply.

    Thank all of you people for the work you do with our beloved pets. We are so lucky to live in an era where a dog born with a fatal genetic flaw is now living a happy, carefree life with two adoring parents. Since he was a “rescue” we are also blessed that he came to us because where we live people don’t do much with pets except “use” them.

    Kudos for all the people in both animal and human medicine who are increasing both the quantity and quality of life for us. We appreciate you very much!

  27. Teresa Doyle says:

    My cat Oliver was diagnosed just over 2 years ago with Stomatitis. For those of you that not familiar with it, it is a painful chronic oral disease. The cats immune system is unable to fight off the bacteria that causes plaque, producing swelling in the gums an throat. There is no cure for this disease and we were told the best chance our cat had was to remove all his teeth which we did. They had also advised us that he would likely be on medication for the rest of his life as the disease could still attack his gums and throat. Long story short, our dental surgeon recommended Healty Mouth after the surgery and we immediately starting putting it in his water. All I can tell you is that since using this product, we were able to gradually take him off all medication and he is happily living with no teeth and extrememly health gums for over 2 years. I will continue to use Healthy Mouth and truly believe this is why my cat is medication free.

  28. Art Malernee Dvm says:

    This thread was started January 2011. Has both the owner of the product and the seal of approval company both been ask why a peer reviewed study cannot be published? Is the situation the studies cannot be published in peer reviewed journals for legal or political reasons?

  29. Art Malernee Dvm says:

    Just saw a tv Milk Bone dog commercial where milkbone dental chews are promoted as effective at removing tarter as brushing teeth 2x week. The dental milkbones are promoted by the same boarded vet who designed the anesthetic free dental study that concluded dental cleanings can be anesthetic free. I think its time the FDA steps in and regulates the claims on these dental products so we can tell if they work.

  30. VFin says:

    I’ve used “HealthyMouth” on my 3 Labrador Retrievers for YEARS, with one of my older Labs who “had” Odontic Fibrosarcoma (cancer of the mouth *gums* for those of you who are lay persons), and irrespective of “Skeptical Vets” and doubting consumers within this page, “IT WORKS PERFECTLY” as described, with clearly noted improvements within 1 month of commencing daily use.

    All the other so called “Great Dental Solutions” I’ve tried over the years are ALL “PooPee” as far as I’m concerned, so either buy the product, or lose out on HealthyMouth’s fabulous benefits. The choice is yours. Nuff said. End of story.

    Submitted on behalf of my dogs–> BlackJack, Zoey-Girl & Chloey-Babe & their sparkling pearly-white teeth and healthy gums!

  31. skeptvet says:

    I assume you’re not suggesting HealthyMouth does anything for oral fibrosarcoma? That would be far beyond any claim made by the manufacturer.

    As usual, I’ll just point out that anecdotes don’t prove anything. Why should anyone believe your experience and not those of “doubting consumers” who haven’t seen such results, or of a “skeptical vet” whose seen dozens of dogs given the treatment and certainly not seen the kind of dramatic effects you claim to have. What makes your personal experience so much more reliable than anyone else’s?

    Ultimately, if it were as simple to decide which therapies worked as just trying them out personally, we wouldn’t need science and research at all. It’s not that simple. End of story.

  32. Art Malernee Dvm says:

    I keep reminding myself that the first positive study showing a medicine is effective usually is false. That’s why the FDA usually wants two independent studies before approval. Nothing worse then telling a client who is calling for a refill that the follow up studies, on the drug they have been buying from me, shows the stuff I have been selling for years does not work so I no longer sell it.

  33. Catherine says:

    I have a question if anyone would care to tackle it. I’ve been daily brushing my dog’s teeth now for 6 years (since puppyhood) and I’ve always used a pet toothbrush and Virbac’s CET vanilla mint toothpaste. No problems, however, a thought occurred to me which gave rise to this question: Is the toothpaste really necessary or could the same results be gotten by using the toothbrush alone? Just wondering.

  34. Art says:

    Boarded dental vets promote “It is the brush that does the good, not the dentifrice. ”
    Many suggest using Disclosing solution weekly to make sure that brushing is effective. While Fl is known for it’s anticaries, it is anti-plaque as well. People worry about toxicity in the cat I have never seen it.

    zylitol solutions that are mixed with water are so dilute they are harmless would be another alternative. But yet there are some that are very fearful about this .

  35. skeptvet says:

    I’m not aware of any controlled studies comparing brushing with or without dentifrice, but it dental specialists do routinely say that the brushing itself is what matters. Pet toothpastes do not contain fluoride, partly because caries are much less of a risk than in humans and mostly because they will not rinse and spit, so they would likely swallow the fluoride, and as with young children there is a concern about toxicity over time.

    I use toothpaste with my dogs because they seem to like it and are eager to have their teeth brushed (the treat afterwards doesn’t hurt either, of course). This site will tell you about some of the limited data we have on some toothpastes and other oral care products.

  36. Annie Harding says:

    I would like your opinion on the cost? My vet just added this product to my bill for my senior terrier’s dental work, and upon checking out, it was just assumed I would buy it and start using it. I took a look at the ingredients, thought “snake oil”, and said no thanks. I think so many of these unproven, “healthy”, “medicine” marketed products are ripping off the pet owning consumer. $50+ for a water additive is outrageous highway robbery. I guess I’m a skeptic preaching to the church.

  37. skeptvet says:

    The cost is likely to vary quite a bit from one practice to another, based on market, volume sold and all that stuff. I’ve seen quite a bit more than that charged for the HealthyMouth. SO as far as whether your vet is charging more than others, I suspect not.

    Deciding whether the cost of a medical therapy is worth paying is a complex business of evaluating the risks, benefits, and the urgency of intervening. WHile I think preventative dental care is very important to pet health, I think the evidence for the efficacy of HealthyMouth is limited. One encouraging clinical study paid for by the manufacturer is often all we get in vet med, sadly, but it’s not nearly enough to draw a strong conclusion. And my uncontrolled anecdotal experience hasn’t been nearly as positive as suggested by the testimonials used to promote the product. So maybe it reduces the development of clinical disease slightly or maybe it doesn’t, I don’t think it’s very clear.

    If a more strongly supported approach, such as regular brushing, is possible, certainly that would be the best choice. Even the promoters of HealthMouth encourage such care and acknowledge the product is not intended as a substitute. But for those people who simply can’t accomplish effective brushing, I do include this product and the others on the VOHC web site as options to consider. Unfortunately, I can’t really answer for anyone else whether or not these products are worth their cost.

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