Effectiveness of silver diamine fluoride 38% on reduction of gingivitis in dogs: a randomized clinical trial

Introduction

Periodontal disease is a ubiquitous disease in small animal veterinary medicine. Currently regular professional dental cleaning and daily tooth brushing are considered gold standards in the prevention of periodontal disease. Efforts to find a noninvasive, cost effective and easy to use preventative for periodontal disease are ongoing. The primary objective of this double-blind randomized clinical trial was to determine if a single application of silver diamine fluoride (SDF) 38% on the buccal surface of all teeth would reduce gingivitis within 3 months in dogs with stage two periodontal disease.

Methods

Twenty-nine client-owned dogs 3-12 years old, 6-35 pounds were randomized 1:1 into active and placebo-control groups. Both groups underwent a baseline treatment and a three-month follow-up under general anesthesia. Gingival Index (GI), Plaque Index (PI), and Calculus Index (CI) were assessed and recorded at each event.

Results

A single application of SDF 38% did not significantly lower GI relative to the control group. However, the GI score dropped significantly in both groups relative to baseline, with a 53% reduction in the average GI score for dogs that received SDF 38% treatment and a 44% reduction for dogs that received placebo treatment. There were no differences in PI or CI scores compared to control groups.

Conclusion

Further research is needed to determine if a more frequent application or a longer study duration would yield a different outcome.

Strategies to improve the home care of periodontal disease in dogs: A systematic review

The expected contribution of this study is to have a complete view of the available products used in the prevention of periodontal disease in dogs. The related studies in databases including Web of Science, Science Direct, and Scopus, from 1992 to 2021, were retrieved, and 36 studies were used in the systematic review. Among the continents researched, North America proved to have the most developed research relating to the subject. The active ingredients researched, isolated, or compared to each other, were polyphosphates > phytogenics > chlorhexidine > enzymes > vitamin C > xylitol = adelmidrol = and probiotics. The form of use of active products was chewable > solution via water = via food > biscuits > paste and gels > mucoadhesive. Gingivitis index was the most studied parameter used to assess oral health. According to the evidence recovered in the systematic review was possible to conclude that products with different active agents and forms of use demonstrated positive effects in the prevention of periodontal diseases. The results of this study summarize the most frequently used active ingredients and application forms for cleaning dogs' teeth and provide a roadmap for future research on the maintenance of oral health in dogs.

In Vivo Evaluation of the Efficacy of a Nisin-Biogel as a New Approach for Canine Periodontal Disease Control

Periodontal disease (PD) is a common oral disease in dogs. Recent in vitro research revealed that nisin−biogel is a promising compound for canine PD control. In this work, a clinical trial was developed to assess the in vivo efficacy of nisin−biogel in dogs by determining the dental plaque index (DPI), gingivitis index (GI), and periodontal pocket depth (PPD) after dental administration. The biogel’s influence on aerobic bacteria counts was also evaluated, as well as its acceptance/adverse effects in dogs. Twenty animals were allocated to one of two groups: a treatment group (TG) subjected to a dental topical application of nisin−biogel for 90 days and a control group (CG) with no treatment. Besides daily monitoring, on day 1 (T0) and at the end of the assay (T90), animals were subjected to blood analysis, periodontal evaluation, dental plaque sampling, scaling, and polishing. Statistical analysis with mixed models showed a significant reduction in mean PPD (estimate = −0.371, p-value < 0.001) and DPI (estimate = −0.146, p-value < 0.05) in the TG animals at T90. A reduction in the GI (estimate = −0.056, p-value > 0.05) was also observed but with no statistical significance. No influence on total bacterial counts was observed, and no adverse effects were detected. The nisin−biogel was revealed to be a promising compound for canine PD control.

Revisiting Periodontal Disease in Dogs: How to Manage This New Old Problem?

Periodontal disease (PD) is one of the most prevalent oral inflammatory diseases in dogs. PD onset begins with the formation of a polymicrobial biofilm (dental plaque) on the surface of the teeth, followed by a local host inflammatory response. To manage this disease, several procedures focusing on the prevention and control of dental plaque establishment, as well as on the prevention of local and systemic PD-related consequences, are essential. The removal of dental plaque and the inhibition of its formation can be achieved by a combination of dental hygiene homecare procedures including tooth brushing, the application of different oral products and the use of specific diet and chew toys, and regular professional periodontal procedures. Additionally, in some cases, periodontal surgery may be required to reduce PD progression. Associated with these measures, host modulation therapy, antimicrobial therapy, and other innovative therapeutic options may be useful in PD management. Moreover, PD high prevalence and its relation with potential local and systemic consequences reinforce the need for investment in the development of new preventive measures, treatments, and oral procedures to improve the control of this disease in dogs. Knowledge on the specific guidelines and diversity of the available products and procedures are fundamental to apply the most adequate treatment to each dog with PD.

World Small Animal Veterinary Association Global Dental Guidelines

Dental, oral, and maxillofacial diseases are some of the most common problems in small animal veterinary practice. These conditions create significant pain as well as localized and potentially systemic infection. As such, the World Small Animal Veterinary Association (WSAVA) believes that un- and under treated oral and dental diseases pose a significant animal welfare concern. Dentistry is an area of veterinary medicine which is still widely ignored and is subject to many myths and misconceptions. Effective teaching of veterinary dentistry in the veterinary school is the key to progression in this field of veterinary medicine, and to the improvement of welfare for all our patients globally. These guidelines were developed to provide veterinarians with the information required to understand best practices for dental therapy and create realistic minimum standards of care. Using the three-tiered continuing education system of WSAVA, the guidelines make global equipment and therapeutic recommendations and highlight the anaesthetic and welfare requirements for small animal patients. This document contains information on common oral and dental pathologies, diagnostic procedures (an easily implementable and repeatable scoring system for dental health, dental radiography and radiology) and treatments (periodontal therapy, extractions). Further, there are sections on anaesthesia and pain management for dental procedures, home dental care, nutritional information, and recommendations on the role of the universities in improving veterinary dentistry. A discussion of the deleterious effects of anaesthesia free dentistry (AFD) is included, as this procedure is ineffective at best and damaging at worst. Throughout the document the negative effects of undiagnosed and/or treated dental disease on the health and well-being of our patients, and how this equates to an animal welfare issue, is discussed.

2019 AAHA Dental Care Guidelines for Dogs and Cats*

The 2019 AAHA Dental Care Guidelines for Dogs and Cats outline a comprehensive approach to support companion animal practices in improving the oral health and often, the quality of life of their canine and feline patients. The guidelines are an update of the 2013 AAHA Dental Care Guidelines for Dogs and Cats. A photographically illustrated, 12-step protocol describes the essential steps in an oral health assessment, dental cleaning, and periodontal therapy. Recommendations are given for general anesthesia, pain management, facilities, and equipment necessary for safe and effective delivery of care. To promote the wellbeing of dogs and cats through decreasing the adverse effects and pain of periodontal disease, these guidelines emphasize the critical role of client education and effective, preventive oral healthcare.

Effects of Edible Treats Containing Ascophyllum nodosum on the Oral Health of Dogs: A Double-Blind, Randomized, Placebo-Controlled Single-Center Study

The objective of this placebo-controlled, double-blind, randomized study (designed according to evidence based medicine standards) was to determine the effect of 90-day administration of edible treats containing the brown algae, Ascophyllum nodosum, on plaque and dental calculus accumulation on the teeth of dogs, as well as on other parameters characterizing canine oral health status, including: plaque index (PI), calculus index (CI), oral health index (OHI), gingival bleeding index (GBI), and volatile sulfur compound (VSC) concentration. Sixty client-owned dogs, including Japanese chin, miniature Schnauzer, Chihuahua, Pomeranian, and West Highland White Terrier (WHWT) breeds, underwent professional dental cleaning and were randomly subdivided into two groups receiving daily edible treats containing the brown algae A. nodosum, or placebo, adjusted to their bodyweight. After a comprehensive oral health assessment, including a professional dental cleaning, which were both performed under general anesthesia, clinical assessments of PI, CI, OHI, GBI, and VSC concentration were performed under sedation after 30, 60, and 90 days of treatment. Oral administration of edible treats containing A. nodosum significantly improved PI, CI, and VSC concentration, compared with the placebo-treated group. The consumption of edible treats containing A. nodosum efficiently decreased plaque and calculus accumulation in the investigated dogs. Dogs treated with A. nodosum also exhibited significantly lower concentrations of VSC and better oral health status (e.g., OHI and GBI) than those in the placebo-control group.

Periodontal disease in cats: back to basics--with an eye on the future

PRACTICAL RELEVANCE

Periodontal disease is commonly encountered in feline practice. Gingivitis, followed by inflammation of the rest of the periodontal tissues, can lead to chronic oral infection, bacteraemia, pain and ultimately tooth loss. Given adequate plaque control and thorough, consistent dental home care, gingivitis is a reversible and controllable condition. Periodontitis, however, is an essentially irreversible and progressive condition. Treatment aims to control tissue inflammation, returning the gingiva to clinical health and preventing destruction of the periodontium in other parts of the mouth.

CLINICAL CHALLENGES

Diagnosis must be established using a combination of oral examination under anaesthesia and dental radiography. Periodontitis leads to tooth attachment loss, and given the short length of most cat teeth, probing depths of 1 mm or more should alert the clinician to the presence of periodontitis. The decision of whether to extract or preserve affected teeth needs careful consideration. In practice, as periodontitis is often associated with type 1 tooth resorption, extraction is often required, but the slender and delicate nature of feline tooth roots, compounded by the destructive nature of tooth resorption, can frustrate extraction attempts. As highlighted in this article, iatrogenic damage to teeth is also a real risk if periodontal therapy procedures (including scaling and polishing) are not performed carefully. The challenges of providing home care in the cat are additionally discussed.

EVIDENCE BASE

The authors have drawn upon, wherever possible, an evidence base relating strictly to the feline patient. Where there is a lack of published research, evidence from canine and human studies is assessed.