Page 612 - WSAVA2018
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 25-28 September, 2018 | Singapore
bone is also lost. In some cases, the apical migration results in gingival recession. Consequently, tooth roots become exposed and the disease process is easily identified on conscious exam. In other cases, the gingiva remains at the same height while the area of attachment moves apically, thus creating a periodontal pocket.
This form is typically diagnosed only under general anesthesia with a periodontal probe. As attachment loss progresses, alveolar bone loss continues, resulting in tooth exfoliation. After this occurs, the area generally returns to an uninfected state, but the bone loss is permanent.
Severe local consequences:
· oral-nasal fistula (ONF)
· class II perio-endo abscess
· pathologic fracture
· blindness
· oral cancer
· Osteomyelitis
Severe systemic manifestations:
wet diet had a more diverse oral microbiome, but with an enrichment of bacteria associated with both gingival health and periodontal disease.
Dental diets and treats
Some dental foods and snacks have a texture which maximizes the contact with the teeth. Foods with the right shape, size and physical structure can provide plaque, stain and calculus control. A 6-month study comparing a dental diet to a typical maintenance
diet showed about a third less plaque and gingival inflammation with the dental diet. When a dental diet was fed to Beagles with pre-existing plaque, calculus and gingivitis, there was a significant decrease in
these, whereas they increased in the Beagles eating a maintenance diet. The type of fibre in the dental diets exercises the gums, promotes gingival keratinisation and cleans the teeth. Dental treats need to be very hard, and can sometimes fracture teeth.
Some diets and treats contain antibiotics or additives
to retard or inhibit plaque or calculus, e.g. sodium hexametaphosphate (HMP) forms soluble complexes with calcium and decreases the amount available for forming calculus. Adding HMP to a dry diet decreased calculus
in dogs by nearly 80%, although another study showed no difference in plaque or calculus when HMP-coated biscuits were fed to dogs for 3 weeks.
Vitamin deficiencies
Deficiencies in vitamin A, C, D and E and the B vitamins folic acid, niacin, pantothenic acid and riboflavin
have been associated with gingival disease. These
are adequate in diets which meet AAFCO or FEDIAF guidelines but can be deficient in diets which don’t meet those guidelines, such as many homemade diets.
Natural diets and feeding raw bones
Proponents of natural foods or of feeding raw bones have claimed that this will improve the cleanliness of pet’s teeth; further claims are sometimes made that feeding commercial petfood contributes to the high prevalence of periodontal disease in cats and dogs. However, a study in foxhounds fed raw carcasses, including raw bones, showed that they had varying degrees of periodontal disease and a high prevalence of tooth fractures. The skulls of 29 African wild dogs eating a “natural diet”, mostly wild antelope, showed evidence of periodontal disease (41%), teeth wearing (83%) and fractured teeth (48%).
Small feral cats on Marion Island (South Africa) which had been eating a variety of natural foods (mostly birds) showed periodontal disease in 61% cats, although only 9% had calculus. In Australia feral cats eating a mixed natural had less calculus compared to domestic cats
Systemic ramifications of periodontal disease are well documented. The inflammation of the gingiva and periodontal tissues that allows the body’s defenses to attack the invaders also allows these bacteria to gain access to the body. Studies suggest these bacteria negatively affect the kidneys and liver leading to decreased function. Furthermore, it has been suggested that these bacteria can become attached to previously damaged heart valves (i.e. valvular dysplasias) and cause endocarditis. Oral bacteremias have also been linked to cerebral and myocardial infarctions. Human studies have linked periodontal disease to an increased incidence of chronic obstructive respiratory disease, pneumonia and increased insulin resistance, resulting in poor diabetic control and increased severity of diabetic complications (wound healing, microvascular disease). Diabetes is
also a risk factor for periodontal disease. Periodontal disease and diabetes appear to have a bidirectional interrelationship where one worsens the other.
Diet and periodontal disease:
Dry vs moist petfoods
A common perception is that feeding dry pet foods decrease plaque and calculus and canned foods promote them. It would seem that the crunching action of biting into a hard kibble should clean the teeth. Moist foods may have a similar effect to a typical dry food on plaque and calculus accumulation. As the pet bites into a typical kibble it shatters and crumbles, which provides no mechanical cleaning.
In a study of 10 cats, those consuming a dry cereal-based kibble compared to a higher protein/lower carbohydrate

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