Have you ever had a patient you wanted to “flip the lip” for a dental exam, but the patient was anxious about mouth handling? Raising the upper lip, also known as “Flip the lip” can be difficult for pets’ who are wary of handling around the head. These situations are challenging, and pose a bite risk to handlers and veterinarians. I try to think of ways to get an exam done while reducing stress and aggression. In one of her lectures, Dr. Sophia Yin demonstrated using pretzel sticks to give rewards to dogs that grabbed at food. If they bit the pretzel stick, no problem – they could swallow and digest it easily. Fingers and hands were safe and the dogs liked the baby food or cheese whiz on the pretzel stick. It’s a great way to keep a dog focused on something else during low stress exams. Since, then, I’ve added pretzel sticks to my treat shelf selection and kept them in mind for mouth exams.

I had my opportunity to try a pretzel stick dental exam last week with a new patient who was pretty easy to examine, but clearly nervous around the head. I am very aware of how big the teeth were on this beautiful German Shepherd, and how fast a Shepherd tends to react when they are stressed. Immediately, I thought of the pretzel stick as a means of “flipping the lip”. This dog was happy but would keep pulling her head away from me as I felt under her neck and approached the mouth. Time to try the pretzel trick. I dipped the end of the pretzel in peanut butter, and now the dog was focused on that.   With my tech holding lightly around the shoulder I allowed the dog to lick the pretzel with the peanut butter, then slid the end to “flip the lip”. Now that she had something fun to think about, the dog didn’t resist or pull away. She kept licking at the peanut butter as I would slide the lip up then allow her to lick the end of the stick then go to the front and other side always allowing a quick lick at the stick. She even opened her mouth trying to get more of the stick so I could see the roof of her mouth easily. The complete exam took just a few seconds and was done easily. Breaking off the slobbery end for her to eat afterwards was her reward for tolerating a mouth exam. I did not have to put my hands on the head – which helped ease any anxiety for this dog, plus she got a lot of rewards. For this dog, she’s learned a mouth exam is fun. That’s what I want her to remember and, in her record, I noted this technique for future exams.

How to do the Pretzel Stick Dental Exam:

Dogs

1. Have the long pretzel sticks handy and dip the end in peanut butter, baby food or squeeze cheese
     
2. Allow the dog to lick the end of the stick they like the stick when it approaches the mouth
     
3. Slide the end of the stick under the upper lip and gently push the upper lip to show the teeth
     
4. Continue to slide the stick along the molars pushing the upper lip to show the molar teeth
     
5. Put the end of the stick in between the molars or at the back of the mouth to have the dog open the mouth to see the roof of the mouth
     
6. Allow the dog to lick or bite the end of the pretzel as a reward for the exam
     

Dog Exam Tips – Avoid struggling! If the dog resists, stop! Allow them to lick the pretzel, be sure to keep your hands off the upper jaw and limit holding around the neck and head. Use the collar holds featured in the Handling, Moving and Restraining video series. 

Be quick when you look. Remember these dogs do not like having their mouth handled. They may be experiencing pain or had punishment techniques used that centered on the head and so, resist head exams. Note: foul odor, red gums or increased resistance around canine teeth or large upper molars are common signs for periodontal disease.

Mouth exams on cats can be a challenge. I’ve developed a Q-tip method to make “flipping the lip” fun. Dipping the Q-tip in a little baby food or tuna is the cat’s reward. A skinny pretzel stick also works. Lots of cats even like Cheese Whiz. Anything that keeps your hands out of their mouths will decrease bite risk. This pretzel stick technique decreases the need to hold the mouth open, or pull on the lower or upper jaw, which makes things more comfortable for a cat. Remember, anything that increases comfort and helps animals associate medical care with something positive is how they learn to co–operate for an exam and reduce aggression.

Cats

1. Put a towel or the bottom of the carrier on a table to help your cat stay in place
     
2. Use Q-Tip or thin cocktail pretzel – load with baby food, squeeze cheese or canned tuna juice
     
3. Allow the cat to sniff the end of the Q-tip and lick off food
     
4. Gently slip the end of the Q-tip under the upper lip and push the lip up slightly to see the canine teeth
     
5. Slide the Q-tip to the end of the lips to see the back molars and the roof of the mouth
     
6. Only put your hands behind the head at the base of the skull to hold – NO SCRUFFING!
     
7. When finished, give the cat more reward on the Q-tip or pretzel stick
     

Cat Exam Tips – If you see gingivitis (red gums) around the canine teeth of the cat, remember this may be very painful as you slide the Q-tip. If the cat resists – give pain meds, and schedule dental with sedation immediately.

Holding the upper jaw and opening the mouth wide can also stimulate pain in the temporal mandibular joint in cats – keep your hands off the upper jaw!

Pretzels are cheap, easy to find at most grocery stores and safe if a dog swallows one. Dogs digest them easily! Owners can use this technique at home also if they want to do a home dental check on their pet. If a pet has a wheat allergy, check your grocery aisle for gluten free pretzels as a substitute. Let’s keep our hands out of the mouths of pained or fearful pets and use pretzels to do a good job with oral exams.

To learn more about other methods of desensitization & counterconditioning, read the book, Low Stress Handling, Restraint and Behavior Modification of Dogs and Cats, by Dr. Sophia Yin or purchase the Desensitization and Counterconditioning DVD.