The Veterinary Dental Patient: A Multidisciplinary Approach. Группа авторов

charts, and should include:

       Age of the patient

       Type of diet fed (dry, mixed [dry and soft], or soft food; home‐made foods are classified as soft)

       Extent of home oral hygiene (active or passive):Regular home careIrregular home careA complete lack of home care

      The basic oral clinical exam should include an assessment of the size of the mandibular lymph nodes on palpation, the presence and amount of dental deposits, and the presence and degree of periodontal disease.

      The size of the mandibular lymph nodes is classified as:

       Normal

       Slightly enlarged

       Moderately to severely enlarged

      The presence of dental deposits is determined visually on the most severely affected tooth and is recorded as:

       Absent

       Up to 50% of the crown affected

       More than 50% of the crown affected

      The presence of periodontal disease features is also determined visually on the most severely affected tooth. Gingivitis is recorded when there is inflammation of gingival tissue, which is determined as abnormal redness, swelling, or bleeding of the gums. Periodontitis is recorded when a tooth has gingival recession or is mobile on digital palpation (Gawor et al. 2006).

Scores are presented in Table 5.1.

The summation of scores obtained for the preceding three parameters plus the patient's diet and their level of home care provides the oral health index (OHI), where 0 points indicates optimal oral health and 10 points indicates the worst possible oral health (Gawor et al. 2006). Patients scoring 0–2 receive prophylactic advice. For patients scoring 3–6, significant improvements to the home prophylactic program are required, and a professional dental cleaning may be recommended. Patients scoring 7–10 require immediate exam and treatment under general anesthesia.

This simplified method of oral assessment is useful for public campaigns such as the “Pet Smile” campaign and “National Pet Dental Health Month,” and for inclusion in leaflets and brochures offering free dental exams. It can be easily performed by first‐contact veterinarians, students, and nurses after brief training. Smartphone apps are being prepared to help pet owners know when they should make an appointment with a veterinarian or dental specialist. Apps focused on at‐home oral cavity assessment are also available (e.g. Dental Index, offered by Hill's Pet Nutrition) (Figure 5.1).

Table 5.1 Oral health parameters assessed during patient examination and interview.

Score parameter	0	1	2
Size of mandibular lymph nodes on palpation	Normal	Slightly enlarged	Moderately to severely enlarged
Presence of dental deposits (plaque, calculus, and stain)	Absent	Up to 50% of the dental crown affected	More than 50% of the dental crown affected
Presence of periodontal disease	Absent	Gingivitis	Periodontitis
Diet fed	Home‐prepared, soft diet	Mixed (soft/dry)	Dry
Home care	None	Irregular	Regular

      

Figure 5.1 Dental Index app.

5.3 Established Regular Oral Home Care

      5.3.1 Importance of Home Dental Care

Home care is an essential component of effective periodontal therapy. Bacterial plaque forms on tooth surfaces within 24 hours of cleaning (Boyce et al. 1995; Wiggs and Lobprise 1997) and will begin to calcify into calculus within one day (Tibbitts and Kashiwa 1998) (Figure 5.2). Without regular home care, therefore, gingival infection and inflammation quickly recurs (within two weeks) (Payne et al. 1975; Corba et al. 1986a,b; Fiorellini et al. 2006; Rober 2007; Debowes 2010). A human study found that professional cleanings were of little value without home care (Needleman et al. 2005).

      In cases of established periodontal disease, home care is even more important. A human study found that periodontal pockets become reinfected within two weeks of a prophylaxis and that pocket depth returns to pretreatment depths within six weeks of therapy if home care is not performed (Rober 2007).

      5.3.2 Client Discussion/Instruction

The benefits of routine home care should be conveyed to each client on a regular basis. Homecare should ideally be discussed on their first visit to the practice, which is often the well puppy/kitten or vaccination visit (Wiggs and Lobprise 1997) (Figure 5.2). Early institution of dental home care provides the greatest benefit, as the frequency of care can be lessened if it is started before periodontal disease (even gingivitis) begins (Tromp et al. 1986a,b). More importantly, early institution of home care increases acceptance by the patient and makes training easier. The importance of home care should also be discussed following each dental cleaning. Compliance may be increased by providing detailed instructions and demonstrations. Ideally, such instruction should be offered and respected by the entire staff (Wiggs and Lobprise 1997).

Figure 5.2 Dental plaque identification is part of pet owner education, and should be discussed ideally on the first visit to the practice.

      5.3.3 Goals of Home Plaque Control

      The primary goal of home plaque control is to limit or reduce the amount of plaque on the teeth (Perry 2006). This in turn should decrease the level of gingival inflammation and, ultimately, of periodontal disease. However, it will not eliminate the need for professional cleanings (Hale 2003).

      It is important to note that supragingival plaque and calculus has little to no effect on periodontal disease. It is the plaque at and below the gingival margin that creates inflammation and initiates periodontal disease (Harvey and Emily 1993; Westfelt et al. 1998; Niemiec 2008). Therefore, controlling marginal and subgingival plaque is the key to maintaining periodontal health. Keep this in mind when reviewing various home care options. Information on the suitability of different methods of plaque control is covered later.

      Brushing