CVC highlight: A 4-tiered approach to considering the efficacies of dental home care techniques

CVC highlight: A 4-tiered approach to considering the efficacies of dental home care techniques

Take a look at these building blocks to create individualized home care regimens for each of your veterinary patients.
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Jul 01, 2014

Numerous studies with various levels of evidence have been published regarding the benefits of a variety of oral health products, techniques, and medications. But what is lacking is a compilation of all of these options into a logical approach to dental care at home.

I like to think of these different products or techniques as having positives and negatives and, along with that, different efficacies for preventing periodontal disease. When considering these materials’ functionality and efficacy as proven by the veterinary and human literature, you can use a general tiered system. The organization of these products represents my personal understanding of the human and veterinary literature and combines my own personal experience.

Tier 1: Tooth brushing
Daily tooth brushing remains the gold standard to prevent periodontal disease and maintain good oral health. I recommend brushing once a day before feeding. Owners should not use human toothpaste since the amount of fluoride contained in these products is not meant to be swallowed and may cause fluorosis of the kidneys. Veterinary studies have suggested that brushing with water versus veterinary toothpaste demonstrates no significant difference in the amount of plaque and tartar accumulation. The mechanical action of the bristles and brushing provides the greatest benefit.1 But veterinary toothpaste tastes good to dogs and cats and functions more as a reward than a primary cause for plaque reduction.

So which pets should be conditioned to a toothbrush? The short answer is the safe ones. Owners of an unpredictable pet, a fear biter, or an animal that has a history of biting should not be coached into tooth brushing. Putting a pet owner at risk is not worthwhile. In addition, since periodontal disease in the classic sense will not affect animals under 6 months of age, save tooth brushing recommendations for animals 6 months of age or older.

Also, do not encourage tooth brushing in animals more than 1 year of age without performing an anesthetized thorough oral examination. If unappreciated areas of disease are unknowingly contacted by the toothbrush, the pain may result in the client being bitten or the animal associating the toothbrush as something that causes pain.

Tier 2: Food
When it comes to feeding, in most situations dry food results in less plaque and tartar accumulation. It has also been shown that a 50% increase in kibble size results in a 42% decrease in calculus accumulation in dogs.2

In addition, veterinary therapeutic diets such as Prescription Diet t/d Dental Health (Hill’s Pet Nutrition) and Royal Canin Veterinary Diet Dental (Royal Canin) incorporate technology that causes the fiber within the food to orient in a manner that predictably affects the way the food breaks when chewed. Repeated chewing creates a mechanical disruption of plaque before it can mineralize into calculus.

Some pet food products (e.g. Iams Dental Defense—Iams; Royal Canin Veterinary Diet Dental) contain polyphosphates, which are responsible for chelating calcium found in saliva. When the salivary calcium is rendered unavailable to plaque, plaque mineralization and subsequent calculus formation slows.

Tier 3: Treats, toys, and sealants
Careful selection of appropriate treats and toys that are not so hard that they fracture teeth is important. A good rule of thumb for clients: If you can hit yourself in the knee with it and it hurts, it’s probably too hard for them to chew on. Chew treats and toys offer a limited mechanism of periodontal disease prevention. While mechanical disruption of plaque may be helpful, chew treats and toys do not reach below the gum line where periodontal disease-associated bacteria accumulate.

The Veterinary Oral Health Council website (VOHC.org) is a great source for clients and veterinarians to find reliable information about which oral health products have been proven with science to be effective. Many more products may be safe and efficacious than are presented on this list. These manufacturers have gone through great expense to perform high-quality scientific experiments to prove their products work.

Barrier sealants such as OraVet (Merial) have also been shown to reduce plaque and tartar buildup. While OraVet is not a replacement for brushing, it can be used in patients in which daily tooth brushing is taking place. Remind clients that when they are applying OraVet, they should brush the teeth first that day, and then apply the treatment. Twenty-four hours after OraVet is applied, it is thought to have repelled itself all around the exposed tooth surface.

Tier 4: Water additives, rinses, and antibiotics
Use water additives, oral rinses, and prescription antibiotics carefully and sparingly. The ultimate challenge with rinses and water additives, even when used properly, is that they require sufficient contact time to be effective and do not penetrate well into the targeted area where periodontal disease develops—subgingivally.

Antibiotics mostly act as a Band-Aid for the long-term management of periodontal disease. With extended use, selection for resistant bacteria is expected. The use of “pulse dosing” antibiotics can be helpful in cyclically reducing the load of subgingival bacteria colony-forming units. A commonly used pulse-dosing schedule involves medicating the patient for the first five to seven days of each month.

Drugs used for the treatment and management of periodontal disease include clindamycin, potentiated amoxicillin and clavulanic acid, metronidazole, and doxycycline. The concentrating ability of doxycycline in the gingival crevicular fluid as well as the anti-inflammatory effects make doxycycline a good choice for patients requiring long-term therapy. Doxycycline is best titrated to the lowest effective dose and consistently administered.

Summary
No simple equation exists for creating the perfect home care treatment plan for every patient. Having realistic expectations about what various dental home care products will provide is the first step in coaching clients to play a proactive role in maintaining their pets’ oral health.

Remember: “An ounce of prevention is better than a pound of cure.” Coach clients early and often to prevent the development of periodontal disease, and those yearly dental cleanings will become quicker and less costly and will involve fewer expensive and invasive treatments in the long run.

References
1. Roudebush P, Logan E, Hale FA. Evidence-based veterinary dentistry: a systemic review of homecare for prevention of periodontal disease in dogs and cats. J Vet Dent 2005;22(1):6-15.
2. Hennet P, Servet E, Soulard Y, et al. Effect of pellet food size and polyphosphates in preventing calculus accumulation in dogs. J Vet Dent 2007;24(4):236-239.