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Recommendations for dental care in geriatric patients
Old cats and dogs are often very important family members. Good health care for pets can increase their life span, but with these extended lives, we need to be cognitive of their special needs as well. The oral cavity can play an important part in the well-being of all pets, and this is especially true with our senior patients.


Proper dental care must be constantly supervised in the older pet. Left untreated, dental disease can rapidly progress and contribute to a host of other medical problems facing older patients. Regular cleanings and examinations should be scheduled as part of routine wellness programs for senior pets.

Periodontal disease
As the most common oral problem, we face a number of challenges with periodontal disease. While optimal oral care, such as regular professional cleanings and home care, can minimize long term problems, often we are faced with patients that have had years of accumulative effects from both the bacteria associated with periodontal disease, as well as the hosts` own response, that can lead to loss of periodontal supportive tissues. This attachment loss is often progressive if left untreated, and with significant destruction of gingival tissue, periodontal ligament and alveolar bone, teeth can be lost or require extraction. Even moderate amounts of attachment loss can be challenging, particularly when deeper periodontal pockets develop.

One of the best ways to try to fight this attachment loss is by addressing the agents that initially cause the perio-dontal infection, the bacteria found in plaque that sticks to the tooth surfaces and develops below the gumline. As soon as the bacteria on the tooth surface contact the gingiva, inflammation and infection can occur. If the plaque is not removed with regular brushing, it will become mineralized, and turn into calculus or tartar. Then more plaque is deposited, more tartar is formed, and this biofilm can begin to encroach upon the deeper layers down the root of the tooth, wearing away at the gingiva, periodontal ligament and alveolar bone. If this material would stay on the tooth surface, the damage would not be severe, and it would be easily addressed with scaling or cleaning of the crown. But with the bacterial assault, often pockets start to form, allowing bacteria deeper into the tissues, where more virulent, gram-negative colonies may form. Again, left unchecked, the periodontal disease will progressively get worse, cause more attachment loss, and even special problems such as oronasal fistulation at the palatal aspect of the maxillary canine or substantial bone loss at the lower first molars that can predispose the pet to mandibular fractures.

And if the oral problems weren`t enough on their own - the bacteria associated with periodontal disease is in direct contact with the vasculature of the oral cavity, and with every movement, from chewing to therapeutic manipulation, showers of bacteria can erupt into the bloodstream, causing a bacteremia that may eventually have significant effects on distant organs, particularly if the pet already has a medical condition that compromises its health. This is of significant importance in our geriatric patients, where the predisposition to cardiac, renal, hepatic and respiratory disease puts these individuals at higher risk for complications, often with the possibility of a direct correlation to the oral infection.

Periodontal treatment
The ideal periodontal treatment plan would be one of prevention: adequate home care with brushing that would remove plaque from the tooth surfaces before it mineralizes into tartar and before any significant amounts of periodontal inflammation or attachment loss occur. Home care can be challenging with some pets, so while regular brushing is the ideal, alternative options may at least provide some benefit, alone, or in conjunction with brushing. Special diets that address the formation of plaque and calculus can be one tool in the battle. Hard, crunchy foods, including some made specifically to reduce plaque and tartar, tend to encourage less plaque buildup than a soft diet. One of the newer dental developments in pet foods has been the addition of hexametaphosphate (Eukanuba - Adult Dog and Cat and Senior Care Veterinary Diet). These diets have added innovative micro-cleansing crystals of hexametaphosphate (HMP) coating outside of the kibble that has been shown to embed in plaque and inhibit its mineralization between meals, thereby decreasing tartar formation. Certain chew toys or devices may also provide assistance, but harder objects may cause tooth fracture. All of these things can be a good first step to combine with a combination of regular professional cleaning to remove any remaining biofilm (plaque, tartar, etc), periodontal assessment (including periodontal probing and intraoral radiographs) and treatments of early lesions before they worsen, to help provide optimal oral health.

Real life often sneaks up on us, though, so we are more frequently faced with patients that have significant amounts of plaque and calculus, often with moderate to significant amounts of attachment loss. For adequate therapy, general anesthesia is needed, and with appropriate pre-operative work-ups, anesthetic protocols and monitoring, most geriatric pets will benefit from periodontal therapy.

Source: Robert Wiggs (2001): Dental care in geriatric pets. www.dvmnewsmagazine.com/dvm/









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