April 24, 2014
Good oral hygiene in canines is important to prevent microscopic changes in the heart, liver, and kidneys, hence increasing the lifespan of the dog. Dental hygienists can play a role in the veterinary practice by helping pets maintain great oral health, which enhances the quality of life for both pet and owner.
Canine periodontium and chemistry
Although the canine oral cavity contains similar genus of bacteria as in humans, the species are different.(1) Unlike humans, animals rarely get cavities. This is because cavities are primarily caused by the high sugar content of the human diet. However, the inflammatory disease (periodontal disease) process in canines is not much different than it is in humans. Canines have 42 permanent teeth that, like human teeth, are comprised of enamel, dentin, cementum, and pulp. The canine periodontium is composed of free and attached gingiva, alveolar bone, periodontium, and junctional epithelium.(3) The periodontium functions to support the teeth. Porphyromonas species are the predominant genus in dogs. The most prevalent species associated with periodontal disease in dogs are Porphyromonas crevioricanis and Fusobacterium canifelinum.(1) These gram-negative bacteria are able to migrate to other parts of the body causing systemic disease such as chronic bronchitis, pulmonary fibrosis, endocarditis, interstitial nephritis, glomerulonephritis, and hepatitis.(4)
Perio prevention and more for pets
Periodontal disease affects up to 80 percent of canines by age four.(5)There are many signs and symptoms to look out for during this disease process. The most obvious sign is halitosis. Other clinical signs may include ptyalism (excessive flow of saliva), anorexia due to pain during eating, noticeable changes in behavior, gingivitis, periodontal and periapical abscesses, nasal discharge, sneezing, and osteomyelitis (inflammation of bone or bone marrow). Roots are also weakened and the animal may experience loose teeth and teeth that simply fall out. Full mouth radiographs must be taken in order to determine the extent of periodontal disease. Full mouth probing is advised as well.(5)
Periodontal disease can be treated when caught early; there are treatment options available to slow down the progression of the disease and make canines comfortable again. As in humans, non-surgical periodontal therapy is the first choice of treatment. This involves a combination of hand scaling, ultrasonic scaling, polishing and sulcular irrigation under general anesthesia. In cases of severe periodontitis, mucogingival surgery and open curettage are required. Antimicrobials such as clindamycin hydrochloride, amoxicillin/clavulanate and metronidazole are the top choice to use before periodontal treatment and postoperatively for seven to 10 days. There are topical antimicrobial gels on the market such as doxycycline gel, which can be applied to teeth after they have been thoroughly debrided. Long-term use of antimicrobals are not recommended due to side effects.
Dental hygiene therapies for canines
The practice of dental hygiene in veterinary dentistry has increased dramatically. Sue Humphrey is a registered dental hygienist who contributes her skills and knowledge to benefit the animals in the Animal Coalition of Tampa (ACT), an animal clinic in Tampa, Florida. “The equipment and procedures used to do cleanings on animals are the same as for humans but the tooth morphology is different. I scale using a cavitron and then polish using the same prophy paste used in dental offices.”(7) In addition to performing prophylaxis, Ms. Humphrey applies other knowledge and skills she learned through her dental hygiene training. “Aseptic technique is important. I clean examining tables and equipment between patients, scrub surgical instruments prior to placing them in the ultrasonic cleaner and autoclave, and I clean cages. I observe and monitor vital signs while the animals are under anesthesia and in the recovery area as they come out of the anesthesia.”
It is legal for a registered dental hygienist to practice in animal clinics all over the United States under supervision of a veterinarian. However, in order to legally provide this type of care to animals, one must successfully complete a veterinary technician specialty program. It is a two-year program that consists of 6,000 hours of technician training, case studies, and a certification exam.(7)Veterinary dentistry has been recognized as a clinical veterinary specialty in its own right for 20 years. In North America, designation as a specialist in veterinary dentistry is limited to diplomates of the American Veterinary Dental College (AVDC), who have completed a training program and passed a certification examination, which includes a practical examination. Veterinary dentists perform the same types of restorative treatments on their clients as dentists do, including prophylaxis. There is no veterinary equivalent of a dental hygienist, because, according to many veterinarians, animals must undergo the prophylaxis under general anesthesia. This is actually a falsehood and many animals do not need to be drugged in order to receive a dental prophylaxis.
Non-anesthetic dental cleanings are a great alternative for older pets, and for those pets with chronic liver, kidney, or heart disease that might not be good candidates for general anesthesia. The practitioner (or hygienist) sits at eye level with the dog and uses a variety of proprietary holds to maintain control while keeping him calm and comfortable. Additionally, this also works well for those animals that become anxious or upset during long visits at the vet clinic.
These types of dental cleanings are being done more and more by veterinary technicians with limited formal knowledge of dentistry. This is partly because there is no dental hygiene specialty in dentistry and, therefore, no formal programs of education. Dali Shafer, owner of Houndstooth Non-Anesthetic Veterinary Dental Services, is a well-known name in the area of non-anesthetic dental cleanings. She and the other technicians she employs work with a veterinarian in a collaborative practice arrangement to provide safe care to all their clients. Located in California, she travels to all parts of the United States. She is hoping to begin a training program based on her proven methods in Washington, D.C.
Dogs and cats have the same dental needs as human beings. Some of our patients have good homecare routines and present in our offices with healthy gingiva and teeth. A routine prophylaxis to remove mild calcareous deposits and plaque are often indicated. Some of our patients, due to poor homecare routines or access to care complications, need additional scale/root planing therapies. As an animal lover and rescuer, I would not advocate putting any animal in harm's way. If any animal has advanced periodontitis and needs treatment that requires anesthesia, that is what he should get. However, viable, proven therapies such as non-anesthetic dental cleanings mean that our beloved animals can get the care they need without having to be deeply sedated, subjecting their owners to exorbitant fees. As oral disease prevention specialists with an inherent compassion and empathy, dental hygienists are ideal candidates to provide care to these special patients.
REFERENCES:
1. Dahlen G, Charalampakis G. Abrahamsson I, Bengtsson L, Falsen E. Predominant bacterial species in subgingival plaque in dogs. Journal of periodontal research. 2012; 47: 354-364.
2. American Academy of Periodontology. Periodontal disease fact sheet. Available at:http://www.perio.org/newsroom/periodontal-disease-fact-sheet. Accessed on January 22, 2013.
3. Fábio Alessandro Pieri, Ana Paula Falci Daibert,Elisa Bourguignon and Maria Aparecida Scatamburlo Moreira (2012). Periodontal Disease in Dogs, A Bird's-Eye View of Veterinary Medicine, Dr. Carlos C. Perez-Marin (Ed.), ISBN: 978-953-51-0031-7, InTech, Available from: http://www.intechopen.com/books/a-bird-s-eye-viewof-veterinary-medicine/periodontal-disease-in-dogs.
4.Jennifer ER, ; Richard EG, Alexander MR, “et al”. Association of periodontal disease with systemic health indices in dogs and the systemic response to treatment of periodontal disease. AVMA. March 1, 2011;238:601-609.
5. Amy S, Jason WS, Marcio C.C, “et al”. Metagenomic analysis of the canine oral cavity as revealed by high-throughput pyrosequencing of the 16S rRNA gene. Veterinary Microbiology, March 2013;162;891-898.
6. Carlos A, Francisco M, João R, “et al”. Canine periodontitis: The dog as an important model for periodontal studies. The Veterinary Journal. March 2012;191;299–305.
7. Sue Humphrey. Pet volunteer. RDH. http://www.rdhmag.com/articles/print/volume-32/issue-1/features/pet-volunteer.html. Accessed on January 31, 2013.
8. Admin. Veterinary Technician Specialties – Dental Technicians. Vet Tech Guide. http://www.vettechguide.org/veterinary-technician-specialties-dental-technicians. Accessed on February 23, 2013.
9. AVDC. Information For Human Health Professionals Interested in Veterinary Dentistry. AVDC. http://www.avdc.org/Info_for_human_health_professionals.pdf. Accessed on February 23, 2013.
10. http://houndstoothpetdental.com/
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Kristina Krivileva is a dental hygiene student at New York University College of Dentistry. She will be graduating in May 2014. In addition to her passion for animals, Kristina is also interested in participating in events that promote oral health. Recently, she traveled to La Preciosita, Mexico as part an outreach coordinated by NYUCD. She lives in New York City.
