New oral healthcare products

As a small-animal practitioner, you spend a good portion of your day diagnosing and treating periodontal disease. Unfortunately, due to differences in salivary pH, our patients accumulate plaque and develop calculus five times faster than people. Research shows that 80% of dogs and 70% of cats show signs of gingival disease by the age of 3 according to the American Veterinary Dental Society. Periodontal disease can cause halitosis and pain and may be related to kidney and heart disease.

Jan Bellows

In the office, veterinarians and technicians perform small animal dental care and encourage owners to brush their pets' teeth daily to decrease plaque accumulation. Although daily brushing is a noble idea, it's rarely attempted or properly accomplished by the average pet owner at home. While two-thirds of clients understand the importance of pet dental care, only 20% attempt to brush their pets' teeth and only 2% brush with enough frequency to maintain proper oral health, according to a 2001 Gallup survey. The roadblocks to brushing include the pet's reluctance to have a brush placed in its mouth, the pet owner's frustration with brush and finger positioning, and the lack of a sanitary way to store the brush when finished.

Fortunately, the veterinary industry has responded by introducing several innovative oral hygiene options to help veterinarians and pet owners control plaque-the initiator of periodontal disease. I will describe a few of those new products here.

OraVet™ (Merial) is a unique oral hygiene product that helps prevent plaque accumulation in cats and dogs. The OraVet gel provides a protective coating on the pet's teeth that decreases plaque accumulation at the gingival margin1 and doesn't disappear after tooth brushing or eating hard food (G. Pitts: Unpublished data). The gel is odorless, tasteless, and invisible once applied. OraVet can be used in every professional teeth-cleaning procedure in dogs and cats beginning with their first oral hygiene visit and throughout the pet's life.

Figure 1. Professional application of OraVet while the patient was anesthetized.

The veterinarian or technician applies the professional-grade product along the marginal gingiva of clean, dry teeth while the animal is anesthetized (Figure 1). According to the manufacturer, the gel electrostatically adheres to the tooth's enamel and cementum (teeth are inherently negatively charged, while the gel is positively charged). To maintain the protective coating, pet owners apply a small amount of the home-care product to the maxillary teeth and gingiva once a week using their fingers or the provided applicator (Figure 2). Once applied, the gel creates an invisible barrier to reduce the formation of plaque and calculus. In two independent studies conducted by board-certified veterinary dentists, plaque decreased 22% to 46% over an eight-week period compared with controls (client-owned patients, as well as laboratory subjects).2 Tooth brushing is still encouraged for maximum plaque prevention.

Figure 2. Client applying OraVet gel at home.

OraVet's plaque prevention system allows veterinarians and pet owners to work together to improve pets' oral health. "In my experience, this technology substantially reduces plaque and calculus. We've found good client compliance with the home-care version of the dental sealant because pet owners are increasingly placing value on good oral health. Another advantage to using a product like this is that our clients are getting their pets' mouths open for examination on a weekly basis. This keeps my clients interested in plaque-control programs of all kinds," says Tom Klein, DVM, adjunct clinical professor of dentistry at The Ohio State University School of Veterinary Medicine in Columbus.

C.E.T.® HEXtra™ Premium Chews (Virbac) combine the mechanical plaque-removal action of rawhide with chlorhexidine in a palatable chew for dogs (Figure 3). Chlorhexidine induces bacteriostatic and bactericidal effects against bacteria, fungi, and some viruses, and is the most effective plaque-inhibiting substance for people.3 Once applied and bonded to the tooth surface, it continues to be effective for up to 24 hours.3

Figure 3. A bulldog chewing a C.E.T. HEXtra chlorhexidine-sprayed beefhide chew.

The amount of contact time is critical to allow chlorhexidine to bind to the teeth and gingival sulcus. For the maximum benefit in people, chlorhexidine is swished in the mouth for one minute twice daily. Because one-minute oral rinsing is difficult for pets to accomplish, the manufacturer created a way to keep chlorhexidine in contact with the gingiva in dogs for the required length of time. Each HEXtra Premium Chew is coated with 10% chlorhexidine solution. As long as the dog chews the product for more than one minute, chlorhexidine binds to the teeth and gingiva, providing sustained plaque control. As with all dental chews, advise your clients to supervise their dogs while chewing.

Greenies® (S&M NuTec) chew treats received the Veterinary Oral Health Council (VOHC) seal of acceptance in 2004 as an effective product to help control plaque and calculus in dogs of all sizes (Figure 4). Greenies are highly palatable, edible dental chew treats. They clean teeth by mechanically removing plaque and tartar from the tooth surface as the dog chews on the treat. The patent-pending process results in a texture that is firm enough to wipe away debris on the teeth, yet soft enough to allow the teeth to penetrate the product without fracturing teeth. According to Colin Harvey, BVSc, FRCVS, DACVS, DAVDC, the executive director of the VOHC, "Greenies was the first product to receive VOHC acceptance for all sizes of chews for all dog weights." Now Greenies has efficacy certification, which means independent research findings have demonstrated the product works. (To learn more about the Veterinary Oral Health Council see "VOHC certification")

Figure 4. An array of Greenies dental chews and treats (Lil Bits™ have not yet achieved the VOHC seal of approval).

MAXI/GUARD® OraZn™ (Addison Labs) is a neutralized and complexed zinc product in an oral, hydrogel preparation (Figure 5). Zinc is an essential trace element that helps heal gingiva, repair connective tissue, decrease inflammation, and increase cell proliferation during the repair process.4,5 Complexed zinc is temporarily bound by basic amino acids, thus reducing zinc precipitation and enhancing permeation into cells. According to the manufacturer, OraZn's dental benefits include:

Figure 5. MAXI/GUARD OraZn gel.

1. Stimulated epithelial regeneration (i.e., oral tissue healing).

2. Reduced plaque due to higher absorption of neutralized zinc ion and oxidation of anaerobic bacteria.

3. Reduced halitosis due to sulfur amino acid (taurine) chelation of sulfur compounds and reduced secretion of proteolytic enzymes following oxidation of anaerobic bacteria.

4. Increased pet acceptance, especially in cats, due to neutral pH, tastelessness, and efficacy without brushing.

5. Product's natural ingredients are safe for long-term use.

In small dogs and cats, a pea-sized amount of OraZn gel can be applied daily with the fingers or a gauze pad to the buccal surface of the distal maxillary molars. In medium- to large-breed dogs, OraZn can be applied directly to the pet's teeth from the bottle's built-in applicator tip. The oral cavity's bathing action helps to distribute OraZn to remote areas of the mouth.

Figure 6. DenTees Stars.

DenTees™ Stars and Chews (DermaPet) are palatable, digestible dental treats that contain sodium hexametaphosphate, acetic acid, grapefruit seed extract, and clove (Figure 6). Both sodium hexametaphosphate and acetic acid are sequestering agents, which bind minerals and, as a result, inhibit dental plaque transformation into calculus.6 Sodium hexametaphosphate coats teeth and decreases plaque and calculus build-up.6 DenTees treats are manufactured with limited antigens (no beef or beef by-products), which makes them appealing to owners of pets with food allergies.

DentAcetic™ Wipes (DermaPet) are dental swabs that contain ingredients similar to Dentees to help reduce plaque. The wipes use sodium hexametaphosphate and mechanical action to remove the accumulated plaque from the buccal tooth surfaces daily (Figure 7). The flavoring agents of cinnamon and clove, which are tolerated by most pets, help deodorize pets' breath. The addition of clove also helps relieve pain. The manufacturer sells a gel product, DentAcetic Tooth Gel, with the same ingredients. Both products are designed so clients can administer them at home.

Figure 7. DentAcetic Wipes.

Time will tell which of these products will work best to control plaque in pets, and which will gain favor with clients. When your practice increases client awareness of complete dental care and the veterinary products available to help reduce plaque and calculus, you'll be well on your way to diagnosing and treating fewer patients with advanced periodontal disease.

VOHC certification

References

1. Gengler, W.: A Study to assess efficacy of a prophylactic dental product in dogs (presentation).

18th Annu. Vet. Dent. Forum

, Ft. Worth, Texas, 2004.

2. Merial: OraVet barrier sealant and OraVet plaque prevention gel effectively prevent dental plaque formation in dogs. http://www.oravet.com/extras/TSB-4-0005-FTB.pdf Nov. 2004.

3. Bellows, J. Small Animal Dental Equipment, Materials, and Techniques: A Primer. Blackwell Publishing, Malden, Mass., 2004; p 165.

4. Polenik. P.: Zinc in etiology of periodontal disease. Med. Hypotheses 40 (3):182-185; 1993.

5. Agren, M: Zinc in wound repair. Arch. Dermatol 135 (10):1273-1274; 1999.

6. Stookey, G.K. et al.: Effect of sodium hexametaphosphate on dental calculus formation in dogs. AJVR 56 (7):913-918; 1995.

Dr. Jan Bellows graduated from the school of veterinary medicine at Auburn University in 1975. In 1986, Dr. Bellows became certified as a Diplomate of the American Board of Veterinary Practitioners-canine and feline-and was recertified in 1996. In 1988, he became a Fellow of the Academy of Veterinary Dentistry, and a Diplomate of the American Veterinary Dental College in 1990. Dr. Bellows has lectured extensively in the United States as well as Europe. He has written many articles on veterinary dentistry as well as two books, The Practice of Veterinary Dentistry: A Team Effort (1999), and Small Animal Dental Equipment, Materials, and Techniques: A Primer (2004). Dr. Bellows practices veterinary medicine and dentistry at Hometown Animal Hospital and Dental Clinic in Weston, Fla.