Preventive dentistry

Preventive dentistry

Introduction

Oral and dental conditions generally cause distress and many cause debilitating pain to the affected animal. Most owners do not routinely examine their pet’s mouth and diseases are generally not diagnosed until late in the disease process, when the animal is showing obvious signs of oral discomfort or pain.

Prevention is always preferable to treatment and many oral and dental conditions are readily amenable to preventive measures. Common conditions that can be prevented (totally or partially) include:

• Periodontal disease

• Excessive wear

• Tooth fracture

• Certain types of malocclusion.

Periodontal disease

The epidemiology, etiology, pathogenesis and treatment of periodontal disease are detailed in Chapter 9. This chapter will deal with preventive measures that should be encouraged for every dog and cat.

Prevention (and treatment) of periodontal disease have two components:

1. Maintenance of oral hygiene

2. Professional periodontal therapy.

Maintenance of oral hygiene is performed by the pet owner in the home of the animal. It is also called homecare. The goal of homecare is to remove, or at least reduce, the accumulation of dental plaque on the tooth surfaces, i.e. plaque control. The prevention and long-term control of periodontal disease requires adequate plaque control by means of homecare strategies.

Professional periodontal therapy is performed under general anesthesia and includes:

• Supra- and subgingival scaling

• Root planing

• Tooth polishing

• Subgingival lavage

• Extraction of unsalvageable teeth

• Periodontal surgery in specific situations.

The benefit of any professional periodontal therapy is short lived unless maintained by effective homecare. In fact, if no homecare is instituted after professional periodontal therapy, then plaque will rapidly reform and disease will progress. It has been shown that, if no homecare is instituted by 3 months after periodontal therapy, gingivitis scores are equivalent to those recorded prior to therapy (Gorrel and Bierer 1999).

Maintenance of oral hygiene

Client education

The cause (dental plaque) and effects (discomfort, pain, chronic focus of infection, loss of teeth, possibility of systemic complications) of periodontal disease must be thoroughly explained to the pet owner (Box 10.1). The owner must be made aware that homecare is the most essential component in both preventing and treating periodontal disease. The responsibility of maintaining oral hygiene, i.e. keeping plaque accumulation to a level compatible with periodontal health, rests with the owner of the pet. Once instituted, homecare regimens need continuous monitoring and reinforcement. The veterinary nurse can play a vital role in educating clients, checking compliance and reinforcing the need for homecare.

Box 10.1 Some practical suggestions to give to owners

• Start toothbrushing as early in life as possible as prevention of disease development is the goal. The primary teeth will be exfoliated and replaced by the permanent dentition. Consequently, the benefit of introducing toothbrushing at a young age will not benefit the primary teeth, but the procedure will be accepted at the time the permanent teeth erupt. Moreover, it is far easier to train puppies and kittens to accept dental toothbrushing than middle-aged or older animals.

• Make the animal comfortable and approach from the side rather than in front.

• Start with just a few teeth (premolars and molars rather than incisors since retracting the lips is usually readily accepted, while many animals do not like having their nose lifted) and gradually increase the number of teeth cleaned each time until the whole mouth can be cleaned in a single session.

• Initially, the mouth does not need to be opened. Concentrate on brushing the buccal surfaces of the teeth, especially at the gingival margin.

• When the animal is comfortable with having the buccal surfaces of all its teeth brushed, an attempt should be made to open the mouth and carefully brush the palatal and lingual surfaces of the teeth. If this is not accepted, there is every reason to continue with daily brushing of the buccal surfaces. However, gingivitis will occur on the palatal and lingual surfaces if these are not brushed (Ingham and Gorrel 2001) and periodontitis may occur at these sites.

• Offer a reward at the end of the procedure, e.g. a game or a walk.

• Include toothbrushing as part of the daily grooming routine. Homecare is more likely to be acceptable to an older pet if it is introduced as an extension of a pre-existing routine, e.g. evening meal, walk, grooming. The owner is also more likely to remember a consistent routine.

• Owners can sit small dogs and cats on their lap while brushing, at the same time cuddling them to reduce their apprehension; alternatively, one person cuddles and restrains while a second performs the toothbrushing. Some animals may better accept the use of a ‘grooming table’ type situation.

However, the owner must realize that, even with homecare, most animals will still need to have their teeth cleaned professionally at intervals. The intervals between professional cleaning need to be determined for each animal. With good homecare, the intervals between professional cleaning can be greatly extended. It is useful to draw an analogy to the situation in humans, i.e. most of us do brush our teeth daily but still require dental examinations and professional periodontal therapy (at a minimum scaling and polishing) at regular intervals.

Toothbrushing

Toothbrushing is known to be the single most effective means of removing plaque. Studies have shown that in dogs with both experimentally induced gingivitis (Tromp et al. 1986) and naturally occurring gingivitis (Gorrel and Rawlings 1996a) daily toothbrushing is effective in returning the gingivae to health. In a 4-year study using the Beagle dog (Lindhe et al. 1975), it was shown that with no oral hygiene plaque accumulated rapidly along the gingival margin, with gingivitis developing within a few weeks. Dogs that were fed an identical diet under identical conditions but that were subjected to daily toothbrushing developed no clinical signs of gingivitis. In the group which were not receiving daily toothbrushing, gingivitis progressed to periodontitis in most individuals.

Toothbrushing is the ‘gold standard’ for plaque control. Every effort should be made to get every pet owner to commit to brushing their pet’s teeth on a daily basis. The success of toothbrushing depends on pet cooperation and owner motivation and technical ability. Toothbrushing should be introduced gradually and as early in the animal’s life as possible. Adult cats are generally less amenable to the introduction of toothbrushing than adult dogs, but with patience and persistence many will accept some degree of homecare. In contrast, kittens often accept toothbrushing more readily than puppies.

Toothbrushes.: There are innumerable brush head and handle designs and sizes of human and veterinary toothbrushes available, but there is insufficient evidence to clearly recommend any particular one. The choice of brush should be based on the effectiveness of plaque control in the hands of each individual. In general, a soft to medium texture nylon filament brush of a suitable size for the intended pet seems to be the most comfortable.

A flannel cloth folded over a finger or a rubber ‘finger brush’ may be more comfortable for animals and owners, but is less effective (removes less plaque) than a nylon filament brush. The use of a finger brush or cloth during the training phase is useful, but every attempt should be made to get the animal to accept a proper toothbrush.

Toothpaste.: The use of non-foaming tasty pet toothpaste is recommended, but not critical. It is the mechanical action of brushing which removes the plaque. Therefore, brushing with a toothbrush moistened with water will still do the job. However, the use of pet toothpaste is recommended as it tastes nice and the pet will therefore usually allow the owner to brush for longer, thus removing more plaque. The paste should be pressed down into the bristles to maintain it on the brush or the animal will just lick it off.

The use of a human toothpaste is not recommended, mainly because of the high fluoride content, which may lead to acute, but more likely chronic, toxicity problems as our pets do not rinse and spit but will swallow the toothpaste (Gorrel 1994).

Frequency of toothbrushing.: In a study of experimental gingivitis in laboratory dogs, brushing once-daily was effective in returning the gingivae to health, while brushing three times or once a week was not effective (Tromp et al. 1986). Another study has shown that brushing every other day was not sufficient to maintain clinically healthy gingivae in dogs (Gorrel and Rawlings 1996a). Brushing twice-daily with a human’s hard nylon filament brush resulted in traumatic gingival lesions in the dog (Sangnes 1976).

In the only published toothbrushing study involving cats, teeth brushed either daily or twice-daily on one side of the mouth had 95% less calculus, and teeth brushed once-weekly had 76% less calculus, than unbrushed teeth at the end of an 18-week trial period (Richardson 1965). Unfortunately, gingivitis was not scored in this study.

Based on the above studies, the current clinical recommendation should be daily toothbrushing to establish and maintain clinically healthy gingivae for the whole life of the animal. With the increasing life expectancy of dogs and cats, preventive medicine becomes increasingly important.

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Tags: Veterinary Dentistry for the General Practitioner

Oct 9, 2016 | Posted by admin in GENERAL | Comments Off

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