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Periodontal disease is not simply bad teeth. It is a bacterial infection that begins at the gumline and, if unchecked, destroys the soft tissue, ligaments, and eventually the bone that anchor each tooth in the jaw. It progresses in stages — from reversible gingivitis (gum inflammation) to irreversible periodontitis (bone loss) — and in its advanced form, it is painful, permanent, and directly linked to systemic disease affecting the kidneys, heart, and liver. [1]
The disease starts with plaque — a soft bacterial film that forms on tooth surfaces within hours of eating. Left undisturbed, plaque mineralises into calculus (tartar) within days. Calculus creates rougher surfaces where more bacteria accumulate. The immune system responds to the bacterial load with inflammation. That inflammation, sustained over months and years, is what destroys tissue and bone.
The only thing that disrupts this cycle before it becomes calculus is mechanical removal. Brushing. Nothing else, including diet, fully substitutes for it. This is the honest starting point of this entire conversation — and every claim that follows is built around that truth.
The largest study on Shih Tzu health to date is the RVC VetCompass study (Dale et al., 2024), published in Canine Medicine and Genetics. It analysed anonymised veterinary records from 11,082 Shih Tzus across the UK. The findings were unambiguous. [2]
At the grouped disorder level, dental conditions were the second most prevalent category in Shih Tzus at 13.3%, behind only skin conditions at 16.6%. The study authors specifically concluded that periodontal disease should be a priority for preventive healthcare in this breed, and that increased toothbrushing could improve welfare — especially if implemented early in life. [2]
A separate large-scale study using over three million US veterinary records confirmed that extra-small breeds — the weight category Shih Tzus fall into at 6–8 kg — were up to five times more likely to be diagnosed with periodontal disease than giant breeds. Additional risk factors in that study included age, being overweight, and time since the last professional dental cleaning. [3]
Two structural facts about the breed create compounding risk that no other intervention fully compensates for.
Brachycephalic skull, full set of teeth. Shih Tzus have a compressed facial structure but carry the same 42 adult teeth as a larger dog. Those teeth are crowded into a jaw that does not have room for them to sit cleanly. Crowded, rotated, and misaligned teeth create pockets and surfaces where plaque and food debris accumulate faster and are harder to dislodge. Toy breeds, small dogs, and dogs with short muzzles are specifically prone to overcrowding and rotation of teeth, which encourages the accumulation of food and debris leading to periodontal disease. [4]
Small body size alone is a risk factor. The relationship between body size and periodontal disease in dogs is well-established across multiple studies. The biological reason is not fully settled, but contributing factors include proportionally larger teeth relative to jaw size, less natural abrasive chewing activity in toy breeds, and differences in saliva flow and oral microbiome composition. [3]
Neither of these is changeable. They are anatomical facts of the breed. This is why management — not cure, not prevention through diet alone — is the realistic goal.
Tooth brushing for pet dogs is essentially a non-practice in Indian middle-class households. This is not a criticism — it is an accurate description of where the culture currently sits. Dog grooming was in the same position twenty years ago. It is now normal in urban India. Dental hygiene is roughly one generation behind.
The feeding culture makes it worse. The typical Indian Shih Tzu is eating soft rice, roti, dal, or commercial wet food — sometimes all four in rotation. These are high-starch, soft-textured foods that leave residue on tooth surfaces, provide no mechanical abrasion during chewing, and give oral bacteria a ready supply of fermentable carbohydrates to metabolise into plaque-forming acids.
As VOSD — one of India's most established veterinary welfare organisations — has noted: in Indian households, absent tooth brushing is still an uncommon habit for most dog owners, which contributes to early-onset dental disease in many pets. [5]
The result, predictably, is that Shih Tzus in Indian homes are likely experiencing periodontal disease earlier and more severely than the already-high rates recorded in Western clinical studies. There is no India-specific epidemiological study to cite for that specific claim — but each contributing factor is independently established.
Most pet nutrition content in India either ignores dental health entirely or mentions brushing as a throwaway line that nobody acts on. The more useful thing to do is say: we know you are not brushing — here is why that matters, and here is the smallest possible habit that will actually make a difference. — Anamitra Dasgupta, Founder, KMCho Canine
This needs to be said plainly: no food prevents periodontal disease. Diet cannot remove plaque that has already formed. It cannot replace the mechanical disruption of brushing. Any claim to the contrary is not supported by the clinical evidence and should be treated with scepticism.
What diet can do, specifically and honestly, is influence the rate at which the problem builds. Two things are factually defensible.
The oral bacteria that initiate the plaque cycle metabolise fermentable carbohydrates — starches and sugars — to produce the acids and biofilm that form plaque. A diet structurally lower in refined starch gives those bacteria less to work with. This does not eliminate plaque formation; it modulates the rate.
KMCho's menu — chicken, fish, mutton, bone broth, vegetables — contains no refined starch, no maida, no added sugars, and no carbohydrate binders. It is structurally different from commercial kibble (which is carbohydrate-dense by manufacturing necessity) and significantly different from the roti, rice, and table scraps that most Indian Shih Tzus are actually eating. This is a meaningful distinction. It is not a cure. It is a contributing factor that reduces the rate of accumulation.
For context: studies on food texture and periodontal disease confirm that compared to soft and mixed diets, firmer-textured dry food had a positive influence on oral health, decreasing dental deposits and development of periodontal disease. [6] Fresh food from KMCho is softer than kibble but far cleaner in composition than soft commercial wet food or table scraps.
Bone broth provides collagen, glycine, and proline — structural proteins that support the integrity of gum tissue. Healthy gum tissue, with an intact epithelial barrier, is more resistant to bacterial invasion. This is a supporting role at the tissue level, not a dental treatment. The claim is defensible; it cannot be stated as dental disease prevention in isolation.
What diet cannot do: remove calculus that has already formed, reverse existing periodontitis, or substitute for professional dental scaling. These require a veterinarian. Anyone selling a food product on the claim that it prevents or treats periodontal disease is not being accurate.
Here is the thing about brushing that nobody says clearly enough: the clinical evidence does not require a toothbrush, a special paste, or a willing dog.
It requires mechanical disruption of the plaque film before it hardens. That is it.
A piece of cotton cloth — the kind already in every Indian home — wrapped around a finger and wiped along the outer surfaces of the teeth three to four times a week achieves this. The 2019 AAHA Dental Care Guidelines confirm that a finger wrapped in gauze or surgical cloth is a clinically acceptable alternative to a toothbrush, particularly for dogs that resist brushing. [7]
The outer surfaces are what matter most. Plaque accumulates fastest on the outer (buccal) surfaces of the upper teeth — the side facing the cheek. You do not need to reach the inner surfaces or the back teeth to make a meaningful difference. Most of the relevant surface area is accessible in under a minute.
Forty seconds. Three or four times a week. A piece of cloth. That is the entire protocol.
The reason this feels impractical is framing. Nobody tells Indian pet parents that it takes forty seconds. Nobody shows them that it does not require a compliant dog — just a cloth, one hand, and a dog that can sit still for less time than it takes to send a WhatsApp message. When the ask is framed correctly, it is not impractical at all.
Everything below is achievable without specialist equipment, without imported supplements, and without a dog that has been trained since puppyhood. This is the complete picture — diet and habit together, ordered by evidence and practicality.
| Item | Frequency | Approximate Monthly Cost |
|---|---|---|
| Cotton cloth for wiping (reusable) | 3–4x per week | ₹0 (existing cloth) |
| Raw carrot chew | 1–2x per week | ₹20–40 |
| Bone broth (KMCho subscription, bundled free / or homemade) | 3–4x per week | ₹0 (if subscribed) / ₹150–250 (homemade) |
| Dog-specific toothpaste (optional) | One tube lasts 2–3 months | ₹80–120 amortised |
| Annual vet dental check | Once yearly | ₹125–333 per month amortised |
| Total (approximate) | ₹225–750 per month |
For comparison: treating advanced periodontitis with multiple extractions under anaesthesia typically costs ₹8,000–20,000 in Indian cities, depending on severity. The preventive protocol above costs less in a year than one late-stage dental procedure.
Slow-simmered from whole meats and vegetables. Collagen-rich, preservative-free, and available daily from our Chandkheda kitchen. Subscribers get it bundled in at no extra cost — add it to your Shih Tzu's bowl three to four times a week, it is the easiest part of this protocol.
Order on WhatsApp View Full MenuMild breath odour is common in dogs. Persistent, strong, or foul-smelling breath — particularly if it smells like rot rather than simply like food — is a reliable early indicator of active periodontal disease. It reflects bacterial activity at or below the gumline. Have your vet examine the mouth. Do not normalise it.
Chewing toys provides some mechanical abrasion and is better than nothing. It does not replicate the targeted disruption of a cloth or brush along the gumline. The gumline is where the disease begins. Toys help; they do not substitute.
Coconut oil has mild antimicrobial properties in laboratory conditions. There is no clinical trial evidence demonstrating that coconut oil prevents periodontal disease in dogs. It is not harmful, and if it makes your dog more cooperative with the wiping routine, use it. Do not rely on it as the active ingredient — the cloth doing the wiping is what matters.
Start by simply touching the muzzle and lips daily without attempting to wipe anything. Offer a small food reward after each session. After a week, lift the lip briefly and reward. After another week, introduce the cloth for one second and reward. Most dogs will tolerate a brief wipe within two to three weeks of this gradual approach. The younger the dog when you start, the faster the acceptance.
Some studies show that firmer-textured dry food provides more mechanical abrasion than soft food during chewing. However, most kibble is also high in refined starch, which contributes to the bacterial environment that drives plaque formation. Specially engineered dental kibble with larger kibble size or added polyphosphates performs better than standard kibble, but none of it replaces brushing. Fresh food with a wipe routine is a better combination than kibble alone without any home care.
Start the wiping routine as soon as adult teeth come in — around 6 months of age. The earlier the habit is established, the more cooperative the dog will be, and the less ground you will need to make up. Annual vet dental checks from age 3 onwards are a reasonable baseline. For Shih Tzus with no home care at all, earlier screening is advisable.