"DentaTreat" is a cheese based sprinkle you add (sparingly) to your dogs food. In about 2-3 weeks you will begin to see results, and after a month you'll be amazed at the difference. I was.
I've used the RX (vet) paste for years with great success and this "DentaTreat" is the only thing that's come even close to the results of vet-level stuff.
I get my DentaTreat at my feed store, a local Mom & Pop shop that specializes in the really nice stuff that the big box stores don't stock. It's inexpensive and worth a try! I've only been using it a couple of months and I'm deeply impressed.
With the RX "OraVet" the oral health of my dogs has been such that I had their teeth professionally cleaned every 3 years, with three dogs this has allowed me to stagger their cleanings so I only pay for one dogs cleaning each year.
I'm with you, with a heart condition I'd not be able to forgive myself easily if my dog passed as a result of a vet tooth cleaning.
Hope that helps. Best wishes.
Dogs most certainly DO NOT need yearly vaccinations, that's an old line that some vets use to get you to do more than is needed.
Over vaccination has shown to trigger some immune diseases in dogs, it is not necessary to vaccinate your dog every year once he has had the basic puppy shots and booster.
Only vaccination mandated by law is rabies vaccination.
It has been shown for some time that vaccinations last a great deal longer than a year - some are lifetime.
Use some common sense, do some real research and don't blindly do what your vet wants if he is an old line vet who routinely vaccinates dogs every year - that's for his financial betterment, not the dog's health.
I'd go for the 3 year rabies vaccination, booster shots for what's prevalent in your area if your dog is under 6, after that I question ANY vaccination - except, of course, the rabies because it is required by law.
Make sure your dog is on heartworm preventative and flea/tick preventative - either Advantix or Frontline Plus works well.
Aside from that, decent food and exercise should keep your dog well.