What to do if periodontal treatment or surgery is not available or allowed. More control can be achieved using medications, diets or other compounds. Several products are now available to us to help slow down the progress of periodontal disease.
Simplest to use are diets. Many have claims of being "dental diets." Best is to recommend diets from companies whose reputation is not in question or diets that carry the V.O.H.C. seal. V.O.H.C. stands for Veterinary Oral Health Council. It is an organization that verifies companies' dental claims regarding control of plaque and/or calculus to ascertain that they are accurate and true.
V.O.H.C.-accepted diets are:
Prescription Diet® canine T/D
Prescription Diet® feline T/D
New and improved Prescription Diet® feline T/D
Friskies® feline dental diet
Science Diet® oral care diet for cats
Science Diet® oral care diet for dogs
Eukanuba adult maintenance diet for dogs
Purina Veterinary Diets® DH Brand canine formula
Purina Veterinary Diets® DH Brand small bites canine formula
Purina Veterinary Diets® DH Brand feline formula
Iams chunk dental defense diet for dogs
Royal Canin feline diet dental formula
Chews (edible treats) can also be used to control periodontal disease progression. V.O.H.C. has recognised:
Del Monte Tartar Check® dog biscuit
Friskies® Cheweez® beef hide treats
Greenies® edible dog treats
Hartz® favor-infused oral chews
Milk-Bone brushing chews for dogs
Canine Greenies hip and joint care chews, all sizes
Virbac CET VeggieDent chews for dogs, all sizes
Purina Veterinary Diets® dental chews canine treats
Feline Greenies feline dental treats
Canine Greenies senior, all sizes
Tartar Shield soft rawhide chews for dogs
Next are mouthwashes. The most efficient and well recognized are the solutions with 0.12% Chlorhexidine gluconate as the active ingredient. In that category are CHX®, Novaldent®, Hexarinse®, Peridex®, CHX Guard®. MaxiGuard® contains zinc ascorbate and cysteine. The potentiated zinc kills bacteria by rupturing their cell membranes. Zinc also helps to revitalize the collagen in the gingival tissues and to break down the volatile fatty acids causing bad breath. Oxyfresh contains the oxidant chlorine dioxide. Its efficacy is promoted by its marketers, but scientific studies backing those claims are lacking. Biotene is another product whose scientific background is nebulous, etc.
Amoxicillin plus Metronidazole, amoxicillin with clavulanic acid, and clindamycin, are the most common dental antibiotics used. They all offer broad-spectrum coverage. Clindamycin has one further advantage; it concentrates in the crevicular fluids and seems to offer the best results. They are recommended for short-term treatment but not for long-term control or in pulse treatment.
Perioceutics are antibiotics placed directly in periodontal pockets. The products act locally without becoming systemic. The high concentrations achieved locally inhibit bacterial growth and allow the sulcular epithelium to heal properly. Doxirobe® and Atridox® share the same formulation. The former is directed to the veterinary market, whereas the latter is directed to the human market. The active ingredient is doxicycline HCl. It is mixed in a plastic carrier that is supposed to stay in the gingival sulcus for several days. Actisite® is a fiber impregnated with tetracycline placed in the sulci and left 10 days. Periochip® is an actual 4 mm x 5 mm x 350 um chip that is slid into a periodontal pocket and releases chlorhexidine gluconate. Elyzol® is a metronidazole gel that is placed into the gingival sulcus. Arestin® is a solution of microbeads of minocycline also introduced in the sulci with a fine syringe. Not all are available in any one area, so your choice may be restricted. Not one has been shown to be vastly superior to the others. Their advantages are to reach much higher concentrations where needed without all the side effects associated with systemic administration.
Periowave® is a broad spectrum antiinfective. A topical photosensitized dye is placed into periodontal pockets. The dye selectively binds to bacterial cell wall components: liposaccharides and cytoplasmic membrane. Laser excites the dye and causes reactive oxygen species (ROS) production. ROS cause lethal disruption of cell wall as well as inactivate bacterial toxins (liposaccharides). The disinfection targets fungi, bacteria, parasites and viruses. It is a cold laser, so there is no metabolic involvement. The treatment is completed in a single visit lasting 60 seconds per site. So far, it has been used to treat various forms of periodontitis, oral infections, extraction sites, surgical sites, endodontic infections. No resistance and very safe, this may be the way of the future.
A few other products have recently appeared in the arsenal of products to control periodontal disease. The following products all have received the VOHC seal: Healthy Mouth antiplaque water additive for dogs and cats, Healthy Mouth antiplaque gel for dogs and cats, Healthy mouth antiplaque spray for dogs and cats, Petsmile toothpaste, and Sanos dental sealant.