WFU

2025年11月23日 星期日

不洗牙也能守護牙齒? 居家口腔照護在未洗牙犬隻中的成效研究

 作者:蔡依津獸醫師  楊慈嫻獸醫師 恩亞動物醫院



文獻背景

2024年底,獸醫齒科領域終於迎來一項重要突破—首度針對「未洗牙犬隻(dirty tooth model)」進行系統性口腔健康研究。不同於以往多數口腔護理產品或相關實驗,皆使用乾淨牙齒犬隻(clean tooth model),也就是在研究開始時先進行專業麻醉洗牙才做實驗的犬貓,本篇文獻首度聚焦於未經洗牙的犬隻,評估多種口腔護理產品及居家照護方式的實際成效,特別針對那些因麻醉風險或其他健康因素而無法進行專業洗牙的個體。

維持良好的口腔健康是整體健康福祉的重要一環。研究指出,多數犬隻在一歲以前便會出現不同程度的牙周疾病(periodontal disease, PD)。然而,牙周病在臨床上往往被低估且治療不足。許多患有中度甚至重度牙周病的犬隻仍能正常進食,導致飼主直到出現口臭、牙痛或明顯臨床症狀時才意識到問題的嚴重性。

刷牙雖被視為犬隻口腔保健的「黃金標準」,但實際執行面卻困難重重。即使在獸醫的建議下,飼主的遵從率普遍偏低,而且犬隻可能出現不配合行為。因此,市面上出現了許多不需刷牙的口腔護理產品,例如透過機械性摩擦幫助清潔牙齒的潔牙飼料與潔牙咬片、在犬用飼料或零食中添加抗牙菌斑/抗牙結石的化學抑制劑、塗抹於牙齦的口腔凝膠或噴劑、以及添加於飲用水中的口腔護理水添加劑。

其中部分產品經過乾淨牙齒犬隻的臨床試驗驗證,確實能延緩牙菌斑與牙結石的形成,甚至獲得 VOHC(Veterinary Oral Health Council) 認證標章。然而,針對未洗牙犬隻,這類產品的實際功效研究卻相對稀少

本篇的目的即是要評估未經專業洗牙的狗狗,僅靠居家口腔護理是否能有效去除牙結石並維持或改善口腔健康


實驗對象與設計

實驗共招募125隻個性良好、有飼主飼養的犬隻,並無品種、年齡或性別的限制,但須具備八顆目標牙齒:103, 203, 104, 204, 107, 207, 108, 208。若出現嚴重牙周病(包含會晃動的牙齒、牙根分叉部露出、齒槽骨流失超過50%者)、系統性疾病、服用處方藥物者、懷孕中母犬、及無法刷牙、無法吃嚼片或拒喝口服添加劑水的犬隻將被排除此試驗。

整個實驗歷時16週,整個過程需維持相同的飼料。在第零天時紀錄體重,並由同一位專業獸醫牙科醫師,利用放大鏡與頭燈評估八顆目標牙齒的牙夠堆積情況和牙周健康,過程中無任何口內器械或X光介入

最初的八週為清除期wash-out period,此階段禁用任何形式的口腔護理產品(如潔牙玩具、潔牙零食等),也不進行任何口腔護理。清除期結束後,犬隻再次接受相同牙科評估,並依據口腔狀況隨機分配為七組。各組的平均體重亦被計算,使各組間體重無顯著差異。

接下來的八週為測試期,飼主會被隨機分配至以下任一口腔護理方案:


a. BR-CET group:每兩天刷牙一次並搭配經證實能對抗口腔細菌的牙膏,且飼主接受了依據VOHC指南的刷牙技巧訓練。

b. VF group:每天餵食一次獲VOHC認可的潔牙咬片。

c. AQ group:每天於飲用水中添加含有石榴萃取物,具備抗凝聚、抗氧化效果,並對犬隻口腔細菌具抑制作用之潔牙水添加劑。

d. BR + VF group:每週刷一次牙搭配每天餵食一次潔牙咬片。

e. BR + AQ group:每週刷一次牙搭配每天飲用潔牙水添加劑。

f. VF + AQ group:每天餵食一次潔牙咬片搭配每天飲用潔牙水添加劑。

g. 控制組。


試驗結束後,由未參與分組且採盲法的同一位獸醫牙科醫師再次進行評估。評估方式為比較第八週時最嚴重的目標牙齒評分,與第16週同一顆牙齒的評分變化。若犬隻在第八週有多顆牙齒被評分為最嚴重,則取這些牙齒在第16週的平均分數。各項評分標準如下:


a. 牙周病:

0分 完全無牙菌斑或牙結石

1分 影響到< 25%的頰側牙冠表面

2分 影響到25-50%的頰側牙冠表面

3分 影響到50-75%的頰側牙冠表面

4分 影響到>75%的頰側牙冠表面

b. 牙周健康:

0分 健康,無明顯牙齦炎

1分 僅有牙齦炎,無明顯齒槽骨流失

2分 早期牙周病,流失<25%的預估牙根高度

3分 中度牙周病,流失多達50%的預估牙根高度


研究結果

與對照組相比,所有組別之牙菌斑與牙結石覆蓋率均在第16週顯著減少,其中又以「兩天刷一次牙」、「每日給嚼片」、「每週刷一次牙+每日添加潔牙水劑」、「每週刷一次牙+每日嚼片」四組具有統計上顯著差異(P<0.05)。


至於牙周狀況,與對照組相比,所有組別的牙周狀況也均有改善,其中又以「每週刷一次牙+每日添加潔牙水劑」、「每日嚼片+每日添加潔牙水劑」兩組具有統計上顯著差異(P<0.05)。

整體而言,只要涉及到機械性清潔(BR-CET、VF group),能有效減少牙結石沉積並維持牙周健康狀況。而當單純討論牙周健康時,每日添加潔牙水劑則有較顯著的影響。然而,唯一能在未洗牙犬隻中同時改善牙周健康與部分減少牙結石堆積的方案是:每週刷牙一次 + 每日添加水劑。

 

討論與研究限制

針對無法進行麻醉的犬隻,如何制定適當的牙周護理策略,是臨床獸醫牙科的重要課題。這樣的決策需考量兩個關鍵因素:一是是否有可信且可操作的方法能準確評估牙周問題與嚴重程度,以判斷犬隻是否能僅依靠居家護理維持口腔健康,或必須接受麻醉下的專業洗牙;二是各類口腔護理產品的實際有效性。

過去曾有一項涵蓋 29,702隻波蘭犬隻 的大規模流行病學研究,發展出一個適用於清醒犬的口腔健康指數(OHI),當中記錄了受影響最嚴重的牙齒、牙菌斑/牙結石覆蓋狀況、牙周健康狀況、及淋巴結大小。

此篇研究改編並擴充OHI評分系統,將牙菌斑/牙結石及牙周健康的評分範圍,從0-2分調整為0-4分。除此之外,此篇文獻也刻意將牙菌斑/牙結石與牙周健康狀況分開分析。雖然本研究所測量的牙菌斑與牙結石沉積量及牙周健康指標彼此相關,作者在分析時仍將其分別處理,因為推測不同的居家護理方式可能對這兩者產生不同程度的影響。

作者推論,刷牙或潔牙咬片提供的機械性作用,主要影響牙齦以上(supragingival)的牙菌斑與牙結石,對牙齦下(subgingival)組織的作用則相對有限。相反地,潔牙水添加劑可能在牙齦溝內發揮化學性作用。本研究結果也顯示,儘管VF + AQ group對牙結石沉積的改善未達顯著差異,但卻可使牙周健康狀況出現顯著改善,顯示化學性作用或可在特定條件下發揮輔助效益。

整體而言,每週刷牙一次搭配每日潔牙水添加劑是唯一能同時部分減少牙結石沉積並改善牙周健康的家庭口腔護理方式。然而,此研究的分組方式使每組樣本數較少,進而增加了結果的變異性。此外,本研究並未探討更積極的口腔護理方式搭配,如「每兩天刷牙 + 每日潔牙咬片 + 每日水添加劑」及「每天刷牙 + 搭配潔牙咬片與/或水劑」等。未來研究應在關鍵組別中擴大樣本數以進一步驗證此研究的結果。

本研究替無法麻醉接受洗牙的犬隻,制定了一套合適的維護口腔健康方案,然而,此研究的目的絕不是在鼓勵,在不洗牙的狀況下治療牙周病。若犬隻的整體健康狀況允許,專業洗牙始終應是首選


我們的觀點

這篇研究的出現,對臨床獸醫師與飼主教育都具有重要意義。過去,我們在面對因麻醉風險、年齡或全身性疾病而無法接受專業洗牙的犬隻時,往往缺乏具實證支持的口腔照護建議。此研究首次以「未洗牙犬隻」為研究對象,真實反應了臨床中這類患者在口腔環境與身體條件間的拉扯,也為日常居家護理策略提供了可參考的依據。

這項研究的幾項重點在於,機械性清潔仍是維持口腔健康的關鍵;化學性添加劑雖無法單獨取代刷牙,但可作為重要輔助,對牙周健康有重要影響;以及居家護理並非治療牙周病的替代方案,而是維持與延緩惡化的手段。

需注意的是,該實驗的設計是以非每天刷牙與其他外援方式來評估牙周狀況,請勿解讀為「只要一週刷牙一次就好」。對於已出現明顯口腔併發症的犬隻而言,單靠居家護理效果有限,且犬隻往往難以配合刷牙或啃食潔牙咬片。

臨床上,我們不應因犬隻無法麻醉而停留於「不能洗牙就無計可施」的階段。相反地,應為飼主制定可行、持續且以實證為基礎的客製化口腔護理計畫,以延緩牙周炎惡化並提升動物生活品質。

在台灣,飼主多對麻醉有恐懼與擔憂,但恐懼不應成為無法麻醉的理由。臨床獸醫師應進行完整的麻醉風險評估並充分溝通潛在併發症,協助飼主理解麻醉的安全性與必要性。未經治療及未得到充分治療的口腔與牙齒疾病是需重視的動物福利問題。


期刊原文出處 

Gawor, J., Jank, M., Harvey, C. E., & Nicolas, C. S. (2024). Effectiveness of dental homecare protocols in unscaled dogs.  Journal of Veterinary Dentistry,  42(3),  176-181.


2025年2月2日 星期日

蔡依津獸醫師履歷英文版 CV update 2025 Yi-Chin(Izzie) Tsai

Curriculum Vitae

Yi-Chin (Izzie) Tsai, DVM, MVM

Director and Founder, In-Asia Animal Hospital, Taipei, Taiwan

Director of Veterinary Dentistry & Oral Surgery, TACS-Alliance Research Center, Taiwan

Email: propofoltiva@gmail.com


Education, Training, and Certification:

2004 Specialty in Small Animal Surgery certificated by residency program from Institute of Veterinary Medicine and Veterinary Hospital, National Taiwan University (Certificate No. SAS05)

2004 MVM, Veterinary Medicine, Small Animal surgery, Clinical divisions of veterinary graduate school, Department of Veterinary Medicine, National Taiwan University

2001 DVM, Veterinary Medicine, Department of Veterinary Medicine, National Taiwan University


Professional Appointments:

2022-present Director of Veterinary Dentistry & Oral Surgery, TACS-Alliance Research Center, Taiwan

2007-present Director and Founder, In-Asia Animal Hospital, Taipei, Taiwan

2012-2017 Dentistry and Oral Surgeon, Veterinary Teaching Hospital, National Taiwan University

2006-2007 Chief resident of Surgical Section and Gastrointestinal Surgeon, Veterinary Teaching Hospital, National Taiwan University

2004-2006 Veterinary Clinician (Small Animal Anesthesia & Surgery), Asia-Pacific Animal Surgical Center, Taipei

2003-2004 Veterinary Surgeon, Veterinary Teaching Hospital, National Taiwan University

2001-2003 Resident in Small Animal Surgery (Graduate studies combined with residency training), Veterinary Teaching Hospital, National Taiwan University


Publications and Research Participation:

1. Tsai YC*, Wu Y (2025): Acute Inability to Fully Close the Mouth Secondary to Palatoversion of the Upper Canine Tooth in Kittens. The European Veterinary Dental Forum 2025, Oslo (Norway), May, 2025. (Accepted on Nov 29th 2024.) (*corresponding)

2. Wu Y, Tsai YC* (2025): Acute Inability to Fully Close the Mouth Secondary to Palatoversion of the Upper Canine Tooth in Kittens. The European Veterinary Dental Forum 2025, Oslo (Norway), May, 2025. (Accepted on Nov 29th 2024.) (*corresponding)

3. Hung TF, Kuo PJ, Tsai YC* (2025): Computer-aided Designed Palatal Obturator in the Treatment of Feline Oronasal Fistula: A Case Report. The European Veterinary Dental Forum 2025, Oslo (Norway), May, 2025. (Accepted on Nov 29th 2024.) (*corresponding)

4. Lin CH*, Lo PY, Tsai HJ, Wang LC, Liaw BS, Hsieh OF, Chang YS, Tsai YC, Yu SC, Chueh LL (2017): Dirofilaria immitis-exposure status in client-owned cats with or without lower airway/lung associated signs: case-control study in a canine heartworm endemic area. J Feline Med Surg 19(2): 153–157.

5. Tsai YC, Wang LY, Yeh LS (2008): A clinical comparative study of propofol total intravenous anesthesia in dogs. J Vet Clin Sci 1 (2): 20-28.

6. Tsai YC, Jeng CR, Zhuo YX, Tsai YC, Liu CH, Pang VF (2007): Amyloid-producing odontogenic tumor and its immunohistochemical characterization in a Shih Tzu dog. Vet Pathol 44(2):233-236.

7. Tsai YC, Wang LY, Yeh LS (2007): Clinical comparison of recovery from total intravenous anesthesia with propofol and inhalation anesthesia with isoflurane in dogs. J Vet Med Sci 69(11):1179-82, 2007.

8. Chang YC, Chiou HY, Du SJ, Tsai YC, Liu CM, Liu CH (2006): Histopathological Characteristics of Canine Myxoid Liposarcoma: A Report of Three Cases. Taiwan V J 32(2): 146-150.

9. Tsai YC, Chang YS, Jeng CR, Yeh LS (2003): Refeeding syndrome in a cat. Taiwan Vet J 29(1):66-70.


Publications in progress:

Tsai YC, Cedric Tutt. Combination of active and passive orthodontic appliances for the treatment of linguoverted mandibular canine teeth in two Shiba Inu dogs. Journal of Veterinary Dentistry. Under revision.


Professional Memberships:

European Veterinary Dental Society

Taiwan College of Veterinary Surgeons

Taiwan Academy of Veterinary Internal Medicine

Taiwanese Society of Feline Medicine


Professional Service Activities:

Reviewer for Mandarin Veterinary Textbooks in Taiwan

2024 An Update on Feline Chronic Gingivostomatitis. Vet Clin Small Anim 50 (2020) 973–982. Margie Scherk

2022 Oral and Maxillofacial Surgery in Dogs and Cats. Frank J. M. Verstraete, Milinda J. Lommer, Boaz Arzi

2021 Textbook of Veterinary Diagnostic Radiology 7th edition. Donald E. Thrall

2020 WSAVA Global Dental Guidelines

2019 Veterinary Dentistry: A Team Approach. Steven E. Holmstrom.

BSAVA Manual of Canine and Feline Dentistry and Oral Surgery. 4th Edition. Alexander M. Reiter, Margherita Gracis

2015 Veterinary Surgery: Small Animal. Tobias, Karen M and Johnston, Spencer A


Volunteering Service

2022-present Supporting dental care for various animals at the Taipei Zoo, including hyena, gibbons, giant pandas, sun bears, and beavers, etc

2024 Volunteering to perform root canal treatments on gibbons at the Dao Tien Endangered Primate Species Centre in Vietnam

2023-2024 Support for wildlife rescue and veterinary care - Volunteering to perform root canal treatments for Formosan black bears


Clinical Lecturer, Teaching Participation:

2012-2018 Lectures to veterinary students in Small Animal Dentistry, Small Animal Surgery, Veterinary Anesthesia, Small Animal Soft Tissue Surgery and Anesthesia, Small Animal Orthopedic Surgery. (National Taiwan University Veterinary Hospital)


Consecutive Interpreting for Foreign Speakers in Taiwan

2024 Anthony Caiafa

Extraoral Surgery and Guided Tissue Generation Surgery. Lecture and Wet Lab.

2023 Cedric Tutt

Feline Dentistry (Basic). Lecture and Wet Lab.

2022 Anthony Caiafa

Root Canal Treatment & Vital Pulp Therapy. Lecture and Wet Lab.

2019 Cedric Tutt

No X-ray, No Dentistry. Lecture and Wet Lab.

2019 James Anthony

What’s New- Canine and Feline Oral Disease

2019 Cedric Tutt

Common Oral Disease and Treatment

2018 Cedric Tutt

Feline Chronic Gingivostomatitis and Periodontitis.


Public Service and Pet Owner Education

2024-present Board member in Taipei Veterinary Medical Association

2017-present Sharing dental clinical cases and oral health information for veterinary practitioners and pet owners

Facebook – https://www.facebook.com/drtsaiyichin


2012-2015

Board member in Taipei Veterinary Medical Association


2007-present

Promoting small animal dental knowledge for veterinary practitioners and pet owner education

Blog – https://yi-chintsai.blogspot.com/


Veterinary Continuing Education Lectures

2024 VetShow, Singapore

Topic: Common Occlusal Problems (in English)


2023 Taipei (Taiwan)

Topic: Common Occlusal Problems

2022 New Taipei City (Taiwan)

Topic: Demystifying Occlusal Problems in Dogs and Cats 


2022 Webinar, Taichung (Taiwan)

Topic: Common Occlusal Problems


2022 Webinar, Singapore, Macau, Hong Kong, Malaysia, Taiwan

Topic: Common Occlusal Problems. (in English)


2022 Taipei (Taiwan)

Topic: Canine and Feline TMJ Disorders: Perspectives from Traditional Chinese Medicine and Modern Medicine


2020 Taipei, Taichung, Kaohsiung (Taiwan)

Topic: Dental Emergency in Dogs and Cats. 


2021 Kaohsiung (Taiwan)

Topic: Master Dental X-ray Techniques. Lecture and wet lab.


2019 Taichung (Taiwan)

Topic: Build Your Dental Practice.


2018 Tainan (Taiwan)

Topic: Small Animal Dentistry in Senior Patients


2017 Taipei (Taiwan)

Topic: Common Oral Disease in Dogs and Cats


2015 PingTong (Taiwan)

Topic: Small Animal Dentistry: Introduction


2013 Taipei (Taiwan)

Topic: A Blue Ocean Field: Small Animal Dentistry


Short Bio

Yi-Chin (Izzie) Tsai graduated from National Taiwan University in 2001, completed a residency in Small Animal Surgery, and earned a Master’s degree in this specialty. As the founder and head of In-Asia Animal Hospital, she specializes in small animal dentistry and oral surgery, managing referral cases across Taiwan with over 15 years of experience. Izzie has served as an interpreter for international veterinary dentistry experts, promoting small animal dental knowledge. She also shares clinical cases and oral health information via social media, writes educational articles, and conducts continuing education lectures.


Since 2022, Izzie has supported Taipei Zoo with dental care for various species and contributed to wildlife dentistry for Formosan black bears in Taiwan, gibbons in Vietnam. She is a reviewer for Mandarin veterinary textbooks and serves as a clinical scholar and director of veterinary dentistry at TACS-Alliance Research Center, advancing the field through education, mentorship, and innovation.