Medical and Nutritional Management of Dental Disease
World Small Animal Veterinary Association World Congress Proceedings, 2014
Loïc Legendre, DVM, DAVDC, DEVDC
Northwest Veterinary Dental Services Ltd., North Vancouver, BC, Canada

Introduction

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

 HealthiDent

 Bright Bites

 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.

Antibiotics

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

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.

Others

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.

  

Speaker Information
(click the speaker's name to view other papers and abstracts submitted by this speaker)

Nick Cave, BVSc, MVSc, PhD, DACVN
Massey University
Palmerston North, New Zealand

Loïc Legendre, DVM, DAVDC, DEVDC
Northwest Veterinary Dental Services Ltd.
North Vancouver, BC, Canada


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