At-home care is crucial to combating periodontal disease

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February is National Pet Dental Health Month, the perfect time for pet owners to learn about the importance of getting their pets a much-needed visit to the clinic for a dental cleaning. However, pet dental care shouldn’t begin and end at the veterinary hospital. At-home care is vital for combating periodontal disease and keeping pets happy and healthy.

The complexity of periodontal disease

Not every dog suffers from this disease. Approximately 10% of dogs do not get periodontal disease, despite differences in diet, breed, and the significant variance in plaque and tartar burden.¹ However, those that do develop disease show signs rapidly, and as many as 90% of dogs already show signs at 2 years old.² Why do most dogs get it, and what is the cause? The field is still learning about the precise nature of all molecular and cellular disease drivers—the past 40 years of research show that it is very complicated. The things we do know include the following:

1. A combination of scaling and root planing (SRP), amoxicillin, and metronidazole was shown to be the most effective at reducing periodontal disease in 21 randomized clinical studies, but it is still not curative.³
2. SRP is not curative and shows no significant reduction in plaque or gingival index scores after 4 weeks.⁴
3. Plaque burden does not correlate with periodontal disease.⁵
4. Dysbiosis (having too many pathogenic microbes and insufficient beneficial microbes) predisposes dogs to periodontal disease.^6,7
5. More important than dysbiosis is the metabolic activity of the oral microbiome, rather than composition, as the most significant driver of disease.^8-12
6. Periodontal disease is triggered by a polymicrobial infection, which is why a single-pathogen vaccine approach does not work.^11,13
7. Periodontal disease is an autoimmune disease, initially dependent on dysbiosis and pathogenic microbial metabolic activity.^14-16

With such a complex set of factors that influence periodontal disease, the goal after an annual deep cleaning should be the maintenance of a healthy level of biofilm supragingivally and subgingivally. That’s why at-home care is so important. The question then becomes: What should the clinician recommend to pet parents to help maintain ideal oral health between visits?

At-home care

Toothbrushing is recommended, if done at least once a day. For small dogs, this is a must. Sadly, in 2 recent questionnaires answered by 505 dog owners, less than 3% brush their dog’s teeth on a regular basis.¹⁷ A great solution is to recommend the use of a cloth chew toy. Slow-motion movies of 10 dogs chewing cloth toys vs toothbrushing shows there is more penetration, subgingivally, with soft toys over brushing along the molars. Moreover, compliance is likely to be higher because of a lower “hands-on” threshold. Finally, replacing toothbrushes every 2 months is extremely important, as is washing chew toys in soap and hot water every week to limit oral biofilm growth on these items.

Another critical task is to wash water and food bowls daily with soap and water. The food dish and water dish have a thick biofilm coating both surfaces that harbors enteric and periodontal pathogens.¹⁷

With respect to food, moderation is key. A diet with diverse proteins and vegetable fibers is ideal to keep the oral and gut microbiomes diverse. Limit foods with grains, tubers (potatoes, sweet potatoes, etc), and fruit to fewer than 2 days a week.

Ongoing research

There are numerous at-home care products in the dental category. Dental chews are the most popular; toothpaste is the least popular. It is understandable that clinicians rely on the Veterinary Oral Health Council (VOHC) certification to guide choices on recommendations. Problematically, the VOHC certification does not take into consideration what is now known about periodontal disease: It’s about the kinds of microbes that live in the plaque and tartar and what they do, and based on the data, it is only modestly about the reduction of plaque and tartar.^8-12

Through this author’s laboratory, a thorough study examined all ingredients on online-only, veterinary-only, and diverse-channel products for at-home use. What was found may be surprising. This author has evaluated microbial biofilms for 22 years and we were not expecting how ineffective commonly used antiseptics are on a dental biofilm from an aged dog.

Here are the major takeaways from the aforementioned research. First, dental chews grow biofilms. Second, dental chews with antiseptics (cetylpyridinium, delmopinol, triclosan) select for resistant microbes, many of which are enteric pathogens. Additionally, water additives with alcohol or dioxide skewed the composition of the biofilm but did not significantly reduce dental pathogen burdens. Finally, water additives with sodium or potassium benzoates block the growth of good microbes at very high concentrations (that pose a risk to the dog’s mitochondria) and also do not affect biofilm production.

The complicated nature of the causes of periodontal disease, coupled with the often-surprising results at the frontier of treatment research, all point to 1 thing: There are no easy answers or simple solutions. Preventing periodontal disease requires diligence from the pet owner and an ongoing commitment to at-home care at the microbial level as well as the mechanical level.

References

1. Wallis C, Holcombe LJ. A review of the frequency and impact of periodontal disease in dogs. J Small Anim Pract. 2020;61(9):529-540. doi:10.1111/jsap.13218
2. Niemiec B, Gawor J, Nemec A, et al. World Small Animal Veterinary Association Global Dental Guidelines. J Small Animal Pract. 2020;61(7):E36-E161. doi:10.1111/jsap.13132
3. Sgolastra F, Petrucci A, Ciarrocchi I, Masci C, Spadaro A. Adjunctive systemic antimicrobials in the treatment of chronic periodontitis: a systematic review and network meta-analysis. J Periodontal Res. 2021;56(2):236-248. doi:10.1111/jre.12821
4. Penmetsa GS, Panda KD, Manthena AKR, Korukonda RR, Gadde P. Evaluating the efficacy of different magnification variables during root planing procedure under a surgical operating microscope in chronic periodontitis: a randomized clinical trial. J Indian Soc Periodontol. 2020;24(1):32-36. doi:10.4103/jisp.jisp_378_19
5. Theilade E, Theilade J. Role of plaque in the etiology of periodontal disease and caries. Oral Sci Rev. 1976;9:23-63.
6. Loesche WJ. Clinical and microbiological aspects of chemotherapeutic agents used according to the specific plaque hypothesis. J Dent Res. 1979;58(12):2404-2412. doi:10.1177/00220345790580120905
7. Theilade E. The non-specific theory in microbial etiology of inflammatory periodontal diseases. J Clin Periodontol. 1986;13(10):905-911. doi:10.1111/j.1600-051x.1986.tb01425.x
8. Takahashi N. Microbial ecosystem in the oral cavity: metabolic diversity in an ecological niche and its relationship with oral diseases. In: Watanabe M, Takahashi N, Takada H, eds. Interface Oral Health Science, International Congress Series No 1284. Elsevier; 2005;103-112.
9. Takahashi N, Nyvad B. Caries ecology revisited: microbial dynamics and the caries process. Caries Res. 2008;42(6):409-418. doi:10.1159/000159604
10. Takahashi N, Nyvad B. The role of bacteria in the caries process: ecological perspectives. J Dent Res. 2011;90(3):294-303. doi:10.1177/0022034510379602
11. Takahashi N. Oral microbiome metabolism: from “who are they?” to “what are they doing?” J Dent Res. 2015;94(12):1628-1637.
12. Folke C, Carpenter S, Walker B. Regime shifts, resilience, and biodiversity in ecosystem management. Annu Rev Ecol Evol Syst. 2004;35(1):557-581. doi:10.1146/annurev.ecolsys.35.021103.105711
13. Update: Pfizer discontinues periodontitis vaccine. Veterinary Practice News. April 29, 2011. Accessed January 12, 2022. https://www.veterinarypracticenews.com/update-pfizer-discontinues-periodontitis-vaccine/
14. Nair S, Faizuddin M, Dharmapalan J. Role of autoimmune responses in periodontal disease. Autoimmune Dis. 2014;2014:596824. doi:10.1155/2014/596824
15. Kaur G, Mohindra K, Singla S. Autoimmunity-basics and link with periodontal disease. Autoimmun Rev. 2017;16(1):64-71. doi:10.1016/j.autrev.2016.09.013
16. Wucherpfennig KW. Mechanisms for the induction of autoimmunity by infectious agents. J Clin Invest. 2001;108(8):1097-1104. doi:10.1172/JCI14235
17. Grunklee T, Obeidat B, Stein E. Comparison of Protektin42 against common antiseptic approaches for canine dental biofilm control [Unpublished manuscript].