CVC highlight: A 4-tiered approach to considering the efficacies of dental home care techniques
Individualize the home care regimen for dental care for each patient, says Christopher Snyder, DVM, DAVDC. He spoke of what he likes to think of as a tiered system of home dental care on Thursday, May 8, during the CVC in Washington, D.C.
Tier 1: Tooth brushing
So which pets should be conditioned to a toothbrush? Dr. Snyder says the short answer is the safe ones. An unpredictable pet, a fear biter, or an animal that has a history of biting should not have their teeth brushed. 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, says Dr. Snyder. 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: Dental diets
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; 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
Dr. Snyder says the Veterinary Oral Health Council website (www.VOHC.org) is a great source for clients and veterinarians to find reliable information about which oral health products work. 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
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.