Dentistry A to Z: "I" is for innovation

You might expect innovation and disruption to be prominent in veterinary dentistry, considering that periodontal disease has been a prevalent health issue in dogs and cats for as long as we can remember. Fortunately, a shift has occurred: We now embrace inflammation as the primary trigger for periodontal disease instead of bacteria, leading to new strategies for prevention and treatment.

Hyaluronic acid (HA) was initially recognized for its applications in human orthopedics, ophthalmology, and wound healing. It is poised to become an advancement in veterinary dentistry for treating periodontal disease and improving oral surgical site recovery in pets.

Evidence-based, peer-reviewed studies have shown that a single dose of HA after a procedure accelerates tissue healing, enhances bone formation, and reduces probing pocket depth in various dental settings. The use of HA in veterinary dentistry is significant because of the following:

• HA targets the underlying inflammation responsible for periodontal disease.¹
• HA may slow the progression to more advanced periodontal² disease and extractions.
  

This shift toward using HA represents a more holistic and less invasive approach to managing pet periodontal disease. It also aligns with the increasing understanding of inflammation’s role in the condition and moves away from antibiotic-based interventions.

Understanding the challenge: Periodontal disease in companion animals

Periodontal disease remains one of the most prevalent health issues in veterinary practice, affecting approximately 80% of dogs and 70% of cats by 3 years of age.³ If left untreated, it can lead to progressive tissue destruction, chronic pain, systemic inflammation, and organ damage. Although traditional methods such as mechanical debridement, adjunctive therapies, and, ultimately, extractions continue to be the standard treatments, the increasing demand for more biocompatible solutions calls for innovative interventions.⁴

What is HA, and why is it relevant in veterinary dentistry?

HA is a naturally occurring glycosaminoglycan found in extracellular matrices, synovial fluid, and soft tissues.⁵ Its hydrophilic properties enable it to retain moisture and encourage cellular migration, making it a component in tissue regeneration and repair. HA has been successfully integrated into treatment protocols for periodontitis, postextraction healing, and implantology in human dentistry.^6-9 Its potential for veterinary applications is being explored through previously published studies showing significant benefits in managing periodontal disease in dogs and cats.

The primary advantages of HA in veterinary dentistry include the following:

• Enhancing angiogenesis and tissue regeneration¹⁰
• Modulating inflammatory responses¹¹
• Exhibiting antimicrobial properties¹²
• Providing analgesic effects¹³

By incorporating HA-based therapies into routine dental care, veterinarians can provide a multimodal approach to managing periodontal disease, ultimately enhancing clinical outcomes and patient comfort.

Angiogenic benefits of HA in oral wound healing

One of HA’s contributions to veterinary dentistry is its ability to stimulate angiogenesis, which encourages tissue repair and accelerates postsurgical healing. HA’s proangiogenic effects are advantageous because impaired blood vessels lead to the progression of periodontal disease.

HA supports angiogenesis by¹⁰:

• promoting endothelial cell migration and proliferation, enhancing capillary formation in damaged periodontal tissues;
• improving oxygen and nutrient delivery, ensuring adequate support for regenerative processes; and
• accelerating healing after surgery, especially at extraction sites, gingival flaps, and during grafting procedures.

The studies on dogs indicate that applying HA-based gels topically after dental procedures shortens healing time and enhances mucosal integrity. Additionally, HA emerged as a valuable adjunctive treatment for chronic periodontal issues and recovery after extractions. The 5 canine studies referenced in this article include histologic confirmation of the positive effects of HA on periodontal disease of varying severity, including gingival recession,¹⁴ class II furcations,¹⁵ class III furcations,¹⁶ 2-wall intrabony defects,¹⁷ and infected extraction sockets.¹⁸ Each of these studies reported statistically significant improvements in several end points, such as the regeneration of bone, periodontal ligament, and cementum.

Anti-inflammatory properties of HA in periodontal therapy

Inflammation is a key factor in the pathology of periodontal disease, as bacterial biofilms often provoke an extreme immune response that results in gingival destruction and alveolar bone loss.¹⁵ HA alleviates inflammatory damage through several mechanisms, including the following:

• Regulation of cytokine activity: HA modulates the release of key inflammatory mediators, such as tumor necrosis factor-α, IL-1β, and IL-6, reducing excessive immune activation.¹
• Inhibition of matrix metalloproteinases (MMPs)1: HA inhibits the activity of MMPs, which break down extracellular matrix components and contribute to the degradation of the periodontal ligament.
• Enhancing tissue hydration and lubrication: HA maintains mucosal hydration by binding to water molecules, reducing tissue irritation, and promoting healing.¹⁹

Antimicrobial properties: HA’s role in controlling oral pathogens

Another aspect of HA use in veterinary dentistry is its intrinsic antimicrobial activity. The oral cavity harbors a diverse microbiome, and dysbiosis plays a key role in developing periodontal disease. HA exhibits antimicrobial effects through multiple mechanisms, including the following:

• Direct bacteriostatic action: HA disrupts bacterial cell membranes, particularly in periodontal pathogens such as Porphyromonas gingivalis and Fusobacterium nucleatum.²⁰
• Biofilm disruption: HA hinders bacterial adhesion and biofilm formation, decreasing plaque buildup and gum inflammation.¹²
• Synergy with other antimicrobial agents: HA enhances the efficacy of antiseptics such as chlorhexidine and essential oils, making it a valuable adjunct in plaque-control strategies.^9,21

With increasing concerns regarding antibiotic resistance, HA presents a nonantibiotic antimicrobial aid for managing periodontal infections, reducing bacterial load, and supporting a healthier oral environment.

Analgesic effects of HA in veterinary dental procedures

Pain management is a vital aspect of veterinary dentistry, as ignoring oral pain can severely affect an animal’s quality of life. HA possesses intrinsic analgesic properties, making it especially effective for decreasing pain related to periodontal disease and oral surgery. The following includes the ways in which HA provides pain relief:

• Modulating pain receptors: HA interacts with nerve endings, reducing nociceptive signaling and discomfort.^13,22
• Promoting soft tissue healing: Quicker tissue repair leads to less inflammation and extended pain relief after surgery.¹²
• Demonstrating localized analgesic effects: Clinical studies in human dentistry showcase HA’s effectiveness in alleviating postprocedural pain, a benefit that is now being used in veterinary applications.⁴

Clinical applications of HA in veterinary dentistry

Figures courtesy of Jan Bellows, DVM, DAVDC, DABVP (Canine, Feline), FAVD

Figure 1. HA gel injected into a cleaned 5-mm

Figure 2a. Generalized inflammation of the attached gingiva caused by blood pressure medication.

Figure 2b. Application of HA to the inflamed gingiva.

HA is available in various veterinary formulations, including oral gels, mouth rinses, and injectable solutions. I am currently using the gel formulation for the following:

• Periodontal disease management: HA gels applied to gingival pockets after scaling and root planing help reduce inflammation and promote tissue regeneration. (Figure 1, Figures 2a-2b)
• Postextraction care: HA minimizes the risk of alveolar osteitis (dry socket in humans) and accelerates healing. (Figures 3a-3c)
• Wound healing after oral surgery: HA-based formulations enhance mucosal recovery following gingival flap surgery and tumor excision.

Figure 3a. Complicated crown-root fracture of the left maxillary fourth premolar.

Photo 3b. Extracted site.

Photo 3c. HA application.

Integrating HA into veterinary dental protocols

Despite its promising benefits, HA’s use in veterinary dentistry remains underutilized because of limited awareness and product availability. However, innovative formulations, such as the HA-based gel formulated for veterinary use, offer veterinarians a practical tool for incorporating HA into standard dental care protocols.

As more clinical trials validate the efficacy of HA in veterinary dentistry, we anticipate a broader adoption of HA-based therapies. Future research should concentrate on the following:

• Optimizing application protocols for periodontal treatments
• Assessing the long-term impacts of HA on periodontal health
• Developing combination therapies with existing dental treatments

HA is an advanced treatment for periodontal disease in dogs and cats. Its angiogenic, anti-inflammatory, antimicrobial, and analgesic properties make it a valuable tool for veterinarians committed to enhancing patient outcomes. As veterinary dentistry progresses, incorporating HA-based products into practice presents a promising opportunity to improve oral health and overall patient well-being.

Jan Bellows, DVM, DAVDC, DABVP (Canine, Feline), FAVD, received his doctorate in veterinary medicine from Auburn University in Alabama. After completing an internship at the Animal Medical Center in New York, New York, he moved to Florida, where he practices companion animal medicine surgery and dentistry at All Pets Dental in Weston.

REFERENCES

1. Waddell DD, Kolomytkin OV, Dunn S, Marino AA. Hyaluronan suppresses IL-1beta-induced metalloproteinase activity from synovial tissue. Clin Orthop Relat Res. 2007;465:241-248. doi:10.1097/BLO.0b013e31815873f9
2. Enlund KB, Brunius C, Hanson J, et al. Dental home care in dogs - a questionnaire study among Swedish dog owners, veterinarians and veterinary nurses. BMC Vet Res. 2020;16(1):90. doi:10.1186/s12917-020-02281-y
3. Kirkwood J, Newman S, Whittemore M. Dental disease and oral health in dogs. J Vet Dent. 2010;27(1):25-30. doi:10.1053/j. jdsci.2010.01.002
4. Caton J. Biological and measurement issues critical to design of gingivitis trials. J Periodontal Res. 1992;27(4 Pt 2):364-374. doi:10.1111/j.1600-0765.1992.tb01697.x
5. Miglani A, Vishnani R, Reche A, Buldeo J, Wadher B. Hyaluronic acid: exploring its versatile applications in dentistry. Cureus. 2023;15(10):e46349. doi:10.7759/cureus.46349
6. Eliezer M, Imber JC, Sculean A, Pandis N, Teich S. Hyaluronic acid as adjunctive to non-surgical and surgical periodontal therapy: a systematic review and meta-analysis. Clin Oral Investig. 2019;23(9):3423-3435. doi:10.1007/ s00784-019-03012-w
7. Ostos-Aguilar BI, Pinheiro Furquim C, Muniz FWMG, Faveri M, Meza-Mauricio J. Clinical efficacy of hyaluronic acid in the treatment of periodontal intrabony defect: a systematic review and meta-analysis. Clin Oral Investig. 2023;27(5):1923-1935. doi:10.1007/s00784-022-04855-6
8. Gegout PY, Stutz C, Huck O. Gels as adjuvant to non-surgical periodontal therapy: a systematic review and meta-analysis. Heliyon. 2023;9(7):e17789. doi:10.1016/j.heliyon.2023.e17789
9. Dababseh D, Altell R, Kang J, et al. Adjunctive use of hyaluronic acid in non-surgical periodontal therapy: a systematic review and meta-analysis. J Dent. 2025;155:105613. doi:10.1016/j. jdent.2025.105613
10. Kawano Y, Patrulea V, Sublet E, et al. Wound healing promotion by hyaluronic acid: effect of molecular weight on gene expression and in vivo wound closure. Pharmaceuticals (Basel). 2021;14(4):301. doi:10.3390/ph14040301
11. Lajeunesse D, Delalandre A, Martel-Pelletier J, Pelletier JP. Hyaluronic acid reverses the abnormal synthetic activity of human osteoarthritic subchondral bone osteoblasts. Bone. 2003;33(4):703-710. doi:10.1016/S8756-3282(03)00206-0
12. Ibrahim Almusi BJ, Al-Kamali RK. Effect of platelet-rich fibrin combined with hyaluronic acid on bone formation in dental implant sockets: an in vivo study in sheep. Cureus. 2024;16(7):e64651. doi:10.7759/cureus.64651
13. de la Peña E, Sala S, Rovira JC, Schmidt RF, Belmonte C. Elastoviscous substances with analgesic effects on joint pain reduce stretch-activated ion channel activity in vitro. Pain. 2002;99(3):501-508. doi:10.1016/S0304-3959(02)00260-9
14. Shirakata Y, Nakamura T, Kawakami Y, et al. Healing of buccal gingival recessions following treatment with coronally advanced flap alone or combined with a cross-linked hyaluronic acid gel: an experimental study in dogs. J Clin Periodontol. 2021;48(4):570-580. doi:10.1111/jcpe.13433
15. Tella EA, Aldahlawi SA, Azab ET, Yaghmoor WE, Fansa HA. Evaluation of hyaluronic acid gel with or without acellular dermal matrix allograft in the treatment of class II furcation defects in dogs: a histologic and histomorphometric study. Saudi Dent J. 2023;35(7):845-853. doi:10.1016/j. sdentj.2023.07.007
16. Shirakata Y, Imafuji T, Nakamura T, et al. Cross-linked hyaluronic acid gel with or without a collagen matrix in the treatment of class III furcation defects: a histologic and histomorphometric study in dogs. J Clin Periodontol. 2022;49(10):1079-1089. doi:10.1111/jcpe.13694
17. Shirakata Y, Imafuji T, Nakamura T, et al. Periodontal wound healing/regeneration of two-wall intrabony defects following reconstructive surgery with cross-linked hyaluronic acid-gel with or without a collagen matrix: a preclinical study in dogs. Quintessence Int. 2021;52(4):308-316. doi:10.3290/j. qi.b937003
18. Kim JJ, Song HY, Ben Amara H, Kyung-Rim K, Koo KT. Hyaluronic acid improves bone formation in extraction sockets with chronic pathology: a pilot study in dogs. J Periodontol. 2016;87(7):790-795. doi:10.1902/jop.2016.150707
19. Jegasothy SM, Zabolotniaia V, Bielfeldt S. Efficacy of a new topical nano-hyaluronic acid in humans. J Clin Aesthet Dermatol. 2014;7(3):27-29.
20. Romanò CL, De Vecchi E, Bortolin M, Morelli I, Drago L. Hyaluronic acid and its composites as a local antimicrobial/ antiadhesive barrier. J Bone Joint Infect. 2017;2(1):63-72. doi:10.7150/jbji.17705
21. 25. Harrer D, Sanchez Armengol E, Friedl JD, et al. Is hyaluronic acid the perfect excipient for the pharmaceutical need? Int J Pharm. 2021;603:120589. doi:10.1016/j.ijpharm.2021.120589
22. Gotoh S, Onaya J, Abe M, et al. Effects of the molecular weight of hyaluronic acid and its action mechanisms on experimental joint pain in rats. Ann Rheum Dis. 1993;52(11):817-822. doi:10.1136/ard.52.11.817