PERIODONTAL DISEASE P6
2013
The next best thing is aquahexine mouthwash, and I think this is actually a superb product that Virbac have got. I think it’s horribly underutilized in practice. Chlorhexidine is a very unstable molecule, but it’s got a really good property, which means it will actually bind to the tooth surface, on to the tongue, and it can last up to 12 hours in the mouth and have an antibacterial effect. So, it is a good product.
I think we should be using it, following all dental treatments in animals that are teething, following extractions, for example. A lot of people reach for antibiotics rather than something like aquahexine mouthwash which is all you would need. I use it preoperatively and before I start getting into polishing to reduce my bacterial aerosol. I use it postoperatively so once I finish scaling and polishing, I just flush out the mouth. I use it in things where I’m going to be doing oral surgery. You can’t always prep the area like you could if you were doing abdominal surgery, so I use chlorhexidine to get the mouth as clean as possible after jaw fractures or during lump removals or gingiva and things.
I think it’s absolutely invaluable in cases of chronic gingivostomatitis or in these really young cats where they get a juvenile gingivitis or an eruption gingivitis. Often, you can get it well under control if the client’s using a good quality chlorhexidine product from an early age.
There are a whole range of products out there with dental claims, and I think you should be really, really careful with what you recommend. Some of these on the screen, I do recommend. I do recommend dental diets. I think they are good, but I think the client has to be aware of the limitations. As I said, when a tooth sinks into the kibble, the whole crown is going to be effectively cleaned, but the gingival margin is where your disease process is occurring. The plaque there is not going to be affected.
So, when you’re reading any published studies that are related to any of these products, always look at what do you change at the gingival margin, and dental trials should separate out the gingival margin and the coronal margin. The coronal margin is the tip of the tooth. I’m not that bothered if there was calculus reduction or plaque reduction on the tip of the tooth. What I’m really worried about is was there a change at the gingival margin because that’s where it’s going to have an impact on the animal’s health.
I would strongly encourage you, if you get drug reps coming around or if you get somebody recommending a dental product, that you actually ask what the claims are and look at the published studies because, at the end of the day, a lot of these products are costly. Clients think they’re doing the right thing by adding an additive to the diet where perhaps there’s not a lot of science to support the product.
I think I’ve probably discussed this, and I’ve said it myself. Once again, when you’re looking at these trials, what do the results mean? What I’d just like to mention here is the Veterinary Oral Health Council. When you look the claims, for example [01:01:04] has got the VOHC seal of approval. Immediately you think, well that’s good because that’s going to have a health benefit, but all that indicates is that there is a claim that it’s going to reduce plaque accumulation. It’s going to reduce calculus accumulation. The VOHC doesn’t say that this is going to be of a health benefit to your pet. So, when you are looking at these trials, really do look at it. What does this mean for my pet? Is it a product worth using?
So, when is plaque control adequate. Basically, it is adequate when there is no gingivitis. You know, a dog like this, I would start tooth brushing and see how you get on.
The last thing I’m just going to finish with are just the management of two cases. The first is a five year old pug. It’s in for a routing dental treatment. There is no home care. I’ve put routine dental because that’s one thing that absolutely drives me mad. Routine dental, we use it all the time or a lot of vets use it all the time. What does dental mean? It means nothing to the client. They don’t come in for cardiacs. They don’t come in for dermals. So, why are they coming in for dentals? We should always be using the phrase, “They come in for dental treatment,” because immediately, the client starts thinking along a different line.
So, there’s no homecare, but the clients are willing to try postoperatiely. So, this is what we find under and anesthetic. This is the lower molar. You can see that there’s an overlap between the fourth premolar and the first molar. We’ve got a probing depth in that area. We’ve also got a probing depth on the lower canine, and you can see a very heavy calculus accumulation.
So, if we go back to important teeth, functional teeth, what is the owner going to be able to do? Immediately, following scaling and polishing and radiographs, I would be considering extracting this tooth, purely because you’re going to be getting an area of plaque stagnation where the client is going to find it very difficult to brush in between those teeth and to keep it clean. On this tooth, on the lower canine, there is a 5 millimeter periodontal probing depth. Now, in a pug, 5 millimeters is probably borderline whether I would extract it or not.
On the other side, which you can’t see, is we had a deep probing depth between the incisor and the canine. So, I would always extract the incisor because you don’t want an area of plaque accumulation. I would clean that thoroughly, but then you can actually discuss with the client why you’ve kept the tooth in (the lower canine is such an important functional tooth), why they need to toothbrush, and how they can toothbrush.
The next case is a seven year old Maltese terrier. The owners do meticulous home care. They brush twice daily, and they do use a chlorhexidine mouthwash. He also uses little teepee brushes to clean between the furcation. So, this is what we’ve got with this little dog. X-rays show that we’ve got some bone loss between the molar and the fourth premolar.
Once again, I would be tempted to extract this tooth. We do have the 3 millimeter dental probing depth here, but because the client is brushing and because he’s got a good boney attachment, the rest of the tooth, which I can see radiographically, I wouldn’t consider extracting that lower molar.
On the top, you can see the third premolar. We’ve got an area of bone loss over here. We’ve got an area of bone loss over here, but given how well the client is tooth brushing, I would opt to keep those in for now purely because he is tooth brushing so well. The last molar, unfortunately, you can see a [01:05:00] where you get bone destruction around the root of that tooth. So, my radiographs are showing me that this is affected. It really has got almost the equivalent of a peri-apical abscess. So, that tooth would need to be extracted, but it’s showing you how a combination of radiographs, periodontal probing, and knowing what your client is going to be able to do postoperatively. It’s going to help you with your decision making.
So, I think that’s all I’ve got to say. It’s just, hopefully, a different way of think about periodontal disease and just remembering that it’s not just about smelly breath. It’s not a cosmetic procedure that you’re doing. You’re actually doing something to try and help these animals.
Thanks, Lisa. Buh bye.