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Periodontal Disease and Home Care
Copyright 2020 by Elite Science, LLC, All right reserved

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Dr. James Anthony, DVM, BSc (Agr.), MRCVS, FAVD, DAVDC, DEVDC, PAg
- 40 years of veterinary experience
- Western College of Veterinary Medicine, University of Saskatchewan and received his DVM degree in 1983
- 30 years of clinical veterinary practice in USA & Canada
- 1986 Fellow of the Academy of Veterinary Dentistry
- 1989 first group of veterinarians to become a Diplomate of the AVDC.
- One of the founding members of the EVDC and is a Diplomate of the EVDC.
Veterinary Dentistry Professor:
- University of Guelph
- University of Montreal
- University of Prince Edward Island.
- Tenured Professor at the University of Saskatchewan (Western College of Veterinary Medicine) as the Head of Veterinary Oral Surgery and Dentistry.
Author & Speaker:
- Written 40+ articles and book chapters
- Lectured globally at veterinary meetings.
One of the most respected veterinary dental specialists in the world. He has also been a veterinary dental consultant for many zoos and aquariums
throughout North America and Asia and has mentored numerous individuals to become Diplomates in the AVDC.
Dr. Anthony has just retired from practicing advanced dental procedures at Red Bank Veterinary Hospital in Tinton Falls, New Jersey. He is currently teaching advanced veterinary dentistry throughout the world. He mainly teaches in Asia and South America trying to avoid the Canadian winter.
On a side note h e has a vineyard at his farm in Princeton, British Columbia.

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Dental Evolution
Change happens whether you want it or not, veterinary dentistry is changing almost daily
Dr. James Anthony
Veterinary Dentist

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Periodontal Disease
- It is the most common disease in dogs and cats of all ages
- Benefits of prevention include:
- This is a better focus than treatment
- Improvement in attitude and quality of life
- Halitosis, this primarily benefits the owner
- Prevention of more serious disease

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You cannot ignore this

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Veterinary Dentistry 101
Components of periodontium
- Cementum covers the dentin of the tooth root.
- Periodontal ligament surrounds the root and anchors the root to the alveolar bone
- Consists of collagen bundles, nervous and vascular tissue.
- Alveolar bone provides seating for the tooth roots.
- Three layers of bone: in order tooth, cribriform plate, trabecular bone and then compact bone.
- Gingiva
- Attached gingiva: mucogingival margin and extends to the crest of the alveolus and is closely attached to the alveolar bone. Keratinized.
- Free gingiva: the enfolding towards the tooth and attaches at the cemento-enamel junction as the junctional epithelium.
- the gingival sulcus, which is not keratinized.

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Veterinary Dentistry 101
- Periodontitis is simply active inflammation of any of the parts of the periodontium.
- Periodontal disease:
- Resulting loss of the periodontium as a result of periodontitis.
- Once a n animal has attachment loss, it has periodontal disease, even without active inflammation.

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Veterinary Dentistry 101
Periodontal disease
What grade?
Bone loss furcation area

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Veterinary Dentistry 101
Severe Periodontal disease
15 extractions later and oral hygiene

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Steps of oral hygiene procedure
Preliminary examination and initial treatment planning
1. Dental radiographs, charting and oral rinse
2. Removal of calculus, plaque and stains subgingivally
3. Removal of calculus and plaque subgingivally, with gingival curettage.
4. Polishing of the tooth surfaces above and beneath the gingiva.
5. Flushing the gingival sulcus, and oral cavity.
6. Fluoride application
7. A post-prophylactic examination
8. Recheck in 12days

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Plaque!
What periodontal disease starts with
1. Pellicle = salivary mucoproteins
2. Plaque = pellicle with attached bacteria within 24 hrs. Initially Gram + aerobic spps. Such as Staph and actinomyces. Also, have food debris and extracellular glycoproteins.
3. Plaque starts supragingivally and progresses into the gingival sulcus -> gingivitis

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Plaque! (continued)
4. In the sulcus, predominantly Gram – anaerobic such as Bacteroides
- Bacterial by-products = tissue and bone destruction
- More important: host defense response response causes even more inflammation with tissue and bone damage.

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Periodontal Disease of Yesterday vs. Today
Yesterday
- Researchers believed that gingival loss in periodontal disease was caused by bacteria
Today
- Researchers have determined that the gingival loss in periodontal disease is caused by the inflammatory response to the bacteria

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Pathogenesis of Periodontal Disease
Oral Bacteria / Pathogens
Dental Plaque / Tartar
Host Defense
Inflammatory and Immune Response
Chronic / Pathological Levels of
Inflammatory Mediators
Tissue Destruction / Bone Resorption
Yucel-Lindberg, T. and T. Bage (2013). Inflammatory mediators in the pathogenesis of periodontitis. Expert Rev Mol Med 15: e7.

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What Is Inflammation?
Inflammation is the bodies first response to an injury
- Acute inflammation includes redness, swelling, heat, and altered function as well as being self-perpetuating.
- There are several biological markers of inflammation in blood, including C-reactive proteins.
- Inflammation appears to be a common link between several common diseases of aging.

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Inflammation’s Objective
Inflammation tries to contain the injury to the local site
• The body’s reaction is immediate (innate response)
• Its ultimate purpose is to protect the body from further damage

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Inflammation is Damaging When Uncontrolled
Though inflammation can be helpful under certain conditions, uncontrolled inflammation, also called chronic inflammation, is harmful and causes tissue loss.
Chronic inflammation occurs when there is a sustained infection, like periodontitis.
Chronic inflammation involves more inflammatory mediators than the immediate innate response.
Chronic inflammation can negatively affect all organs and tissues of the body.
Chronic diseases of aging are connected through common chronic inflammatory mechanisms.

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Why Encourage Homecare?

- Maintain oral health
- Increased quality of life
- Oral problems detected earlier (treated earlier)
- Oral hygiene procedures are easier
- Increased time between oral hygiene procedures
- Increased bond between owner patient
- Increased bond between owner-hospital
- Decreased oral infection
- Relieves oral pain
- Improved mastication
- Decreased bacteremia
- Increased life span

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Homecare in Practice

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UNDERSTANDING Clients Expectations and Perceptions
Moments of truth with you in the practice
Good communication principles (listen)

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Home Care vs. No Home Care

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Lack of Time is Not an Excuse

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Methods of Plaque Prevention
- Antibiotics
- Irrigation
- Chemical (suppress oral flora, inhibit bacterial colonization, inhibit plaque forming factors, dissolution of plaque, prevention of plaque mineralization)
- Mechanical
- Chew toys
- Treats
- Diets
- Brushing
- Natural Products
- Combinations

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Todays’ Periodontal Home Care
Detect active inflammation
Reduction of tissue inflammation
Reducing one type of inflammation may reduce another

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How To Reduce Inflammation
- Reduce direct sources of inflammation (chronic infections)
- Oral examination and hygiene when needed
- Homecare program
- Control bacteria (plaque)
- Activate inflammation resolution systems
- Anti-inflammatories
- Omega - 3 fatty acid to diet
- 1-TetraDecanol Complex
- Other

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Factors in Home Care Success
- Adequate client education in product use
- Cooperative patient
- Adequate education of normal
- Owner compliance
- Reasonable goals for the owners
- Provide home care products that are acceptable
- Regular follow up and monitoring:
- 10-14 days (exam)
- 21 days (phone)
- 3-6 months (exam)

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VOHC

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Gold Standard of Home Care
Daily brushing
- Sulcular method, horizontal plane
- 45 angle towards the tooth
- Soft bristle human toothbrush - not veterinary brushes
- Adult - large and medium dog
- Child - small dog
- Proxabrush - cat
- Replace once a month
- Buccal/ labial aspect
- Veterinary toothpaste

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Gold Standard of Home Care
Drinking water additive
- Xylitol is a hydrogenated carbohydrate that has a n antibacterial effect resulting in plaque reduction in humans and animals
- Xylitol taken u p by bacteria -> metabolized to xylitol-5-phosphate
- Xylitol-5-phosphate inhibits the uptake of glucose by bacteria -> bacterial growth
- Toxicity???
- Healthy mouth

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Gold Standard of Home Care
Oral hygiene rinse
- Antimicrobial- dilute chlorhexidine
- Reduces bacterial load in the oral cavity plaque accumulation
- Binds to the salivary pellicle and is released over a prolonged period

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Gold Standard of Home Care
Oral hygiene gel
- Muco-adhesive gel contains zinc ascorbate and taurine
- Zinc ascorbate heals gingiva by stimulating collagen production & bond strength between collagen fibers, slight antibacterial action
- Taurine is a sulfur amino acid, chelates with malodorous sulfur compounds produced by bacteria in the mouth providing a rapid reduction of halitosis

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Gold Standard of Home Care
Dental diets
- VOHC
- Use as treats
- 1kibble per 5 lbs. (2kg) body weight
- If more, reduce regular diet
- Mechanical and/or chemical plaque removal
- Squeegee effect
- Use appropriate-sized kibble
- If used as a treat recommend the largest size
- Don’t use as a substitute for an oral hygiene

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How To Reduce Inflammation
1-TetraDecanol Complex
- To decrease and prevent gingival inflammation
- To help promote gingival reattachment
- To help promote bone regrowth
- To decrease resorptive lesions?
- To enhance the healing of the gingiva post surgery

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Conclusion
- Dental health is a very important aspect of the animal’s quality of life, don’t let your clients ignore it!
- Many options for the owner.
- Can mix different methods but brushing optimal!
- Client-Veterinarian / AHT / Receptionist communication is critical
- Customize the home care to meet the owners and patients needs
- Remember to control inflammation
- Bi-annual veterinary oral exam

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Thank You