As the veterinary profession celebrates more than 20 years of modern veterinary companion-animal dentistry, there is still reluctance in the general veterinary community to stress the importance of oral hygiene homecare programs. All of veterinary periodontology revolves around the combination of effective professional care in the dental operatory under general inhalation anesthesia and daily homecare-oral hygiene programs. The professional care has been referenced as Professional Periodontal Care and the homecare as Client Periodontal Maintenance. Each homecare program is based on an accurate professional diagnosis using testing modules that center on quality extra- and intra-oral exams, accurate measurement of probing depths, charting of periodontal indices and oral radiology diagnostics. Patient monitoring must be comprehensive and certified, registered and licensed technicians should be present. CPM begins immediately as PPC ends. The technician and veterinarian create a patient-specific CPM program based on the periodontal needs uncovered in the diagnostic process. It is important for the veterinarian-technician team to review CPM programs with clients in detail. It is best not to rely on a general periodontal homecare fact sheet that provides the same homecare for every patient treated. This is not only poor medicine but homecare will fail. There may be some overlaps in treatment programs but each program must maintain its own identity. Supportive Periodontal Care Most importantly, CPM progress must be monitored with re-visit, re-evaluation and re-check appointments. The periodicity of these appointments is directly proportional to the severity and staging of the patient's periodontal problem. Supportive Periodontal Care is not a "dental" or a "cleaning" but centers on detailed re-evaluation and periodontal treatment under general anesthesia based on prior and present testing module information comparison. The products I mention below are just some of the products used by The Connecticut and New York Specialty Centers for Oral Care for treating gingivitis. Toothpaste Options Dentifrices come in many forms. A dentifrice, or toothpaste, contains abrasive compounds that improve the mechanical cleansing of the tooth with some implement of delivery. Some common abrasive polishing agents are sodium phosphate, calcium phosphate, calcium carbonate, silica, alumina and aluminum hydroxide. Dentifrices may also contain anti-tartar compounds, fluoride, flavoring agents, binders and surfactants. One excellent veterinary dentifrice is CET by Virbac. Other products can be used to remove plaque with a toothbrush, finger brush or other brushing implement. Oxyfresh Gel (stabilized chlorine dioxide) and Maxiguard (zinc ascorbate) are both outstanding. Each has its own unique mechanism of action and work well to remove plaque and treat gingivitis. Clients should brush all surfaces of all teeth at the gum-tooth margins with a systematic twice-daily approach. Clients must understand that brushing the interdental areas and reaching the gingival sulci with the brushing program is essential to success. Human interdental brushes are available at most large pharmacies. The micro-heads work wonderfully in toy and small breeds. Waxed dental floss and dental tape is reasonable for medium and large breeds, once brushing is accepted. Repetition of motion and working for two minutes, at a minimum, in the oral cavity is essential when brushing. The client should be told to "take baby steps" when first starting a brushing program. In the beginning, perform oral hygiene only a few seconds each day and temper the treatment with a unique reward that the patient only receives at brushing time. This will encourage patient compliance at the next CPM visit. CPM Homecare Oral hygiene CPM in periodontitis is much more complex and the products used must be well understood. Using a product for the wrong indication will lead to program failure and patient discomfort. In the initial stage of advanced periodontitis, avoid brushing. If periodontal ulcers, severe gingival or mucosal inflammation, or another advanced oral pathology is present, brushing will only antagonize the patient and prohibit the acceptance of this form of periodontal care when the patient moves from acute treatment to convalescent care. Seek the advice of a dental specialist in your area for suggestions on CPM programs for advanced periodontal care patients. Here are some excellent products to consider in your CPM programs. Chlorhexidine Gluconate 0.12 to 0.2 percent is a topical agent that will lead to effective inhibition of plaque formation when used correctly. It is applied with saturated cotton balls or gauze squares with a gentle massaging action. It should never be used long term without re-evaluation. If flap surgery has been performed and bone is exposed, there can be delay in healing with this product. For safety, clients should avoid the surgical sites for the first few days. Chlorhexidine staining of the teeth enamel, root cementum and exposed dentin can occur. It is removable with cup or air polishing but unesthetic complaints by clients can occur if they are not forewarned. Never use this product above a concentration of 0.2 percent in the oral cavity. I use a 0.12 percent product. Oxyfresh Oral Products, available in an oral rinse and oral gel forms, decrease volatile sulfur compounds responsible for accelerating oral inflammation. When using the rinse in the pet's drinking water, change the water twice daily. It has been a personal observance that the rinse is accepted better in bottled water. Since fluoride is readily absorbed in the topical form, it is critical that the client use it sparingly in the pet's oral cavity to avoid potential flurotoxicosis. Even though no specific data on fluoride toxicity has been established in the companion animal population, it makes sense to caution clients and use it minimally. Fluoride is not a dentifrice and should not be used as such. It is applied with digital application on a gloved finger. In advanced periodontitis with enamel loss, cementum loss, furcation exposures or root exposure, fluoride may be beneficial in reducing patient sensitivity. The mechanism of action involves the formation of a fluroapatite bond after application. No food or water should be given for a minimum of 30 minutes after any fluoride treatment. The common homecare fluoride is 0.4 percent stannous fluoride. There is no information to point to the need of any topical fluoride products in the oral operatory after a routine non-complicated periodontal prophylaxis in the dog or cat. Desensitizers are administered under general anesthesia. Denclude is a desensitizing paste manufactured by Ortek Theraputics Inc. It is a combined arginine bicarbonate/calcium carbonate compound. It is applied to exposed root surface or dentin with a rubber polishing cup on a slow speed handpiece. Dr. DeForge is a fellow of the Academy of Veterinary Dentistry and adjunct instructor at Northwestern Connecticut Community College in oral radiology and periodontology. His website is www.vetdent.com. <HOME>
