**4. Prevention of periodontal disease**

Prevention s considered essential for the maintenance of the animals' teeth throughout their lives, making it impossible for the formation of the periodontal disease process (Lyon, 1991). Brushing, chewable products, promoters of friction and the use of antimicrobial substances

Periodontal Disease in Dogs 131

may also help in effective biofilm removal (Jensen et al., 1995; Lima et al. 2004; Niemiec, 2008), used in conjunction with a toothbrush, added to toothpaste or employed as solutions, minimising the ineffective brushing technique in some inaccessible places in the animal's

The brushing technique should be used properly because inappropriate use can increase the prevalence of periodontal disease, as occurs in humans (Jongenelis & Wiedemann, 1997). One of the indicated techniques uses circular movements on the dental surfaces, with the

Some studies have been conducted with the intention of establishing new therapies to combat dental plaque accumulation on the face of the tooth, both for the aid in brushing as for the use as a preventive agent of choice against periodontal disease when the practice of brushing is inefficient, as in wayward animals that do not allow the mechanical handling of

Various forms of introduction of these therapies in the animal management have been tested, including the use of cookies and chewing objects for oral hygiene (Gioso & Carvalho, 2004; Niemiec, 2008), additives to drinking water with an inhibitory effect on the growth of bacteria (Clarke, 2006) and oral rinse solutions as well as leather and biscuits with the

Topical application of a drug to control the disease is considered desirable, in view of the lower incidence of side effects when compared to other routes of application. For the

brush tilted at an angle of 45 ° from the gingival margin (Niemiec, 2008).

Fig. 7. Dog's Tooth brushing by an owner.

oral practices (Gioso & Carvalho, 2004; Pieri, 2010).

addition of antimicrobial agents (Addy, 1997; Niemiec, 2008).

mouth.

Fig. 6. At the end of the red arrow: extensive root exposure with dental calculus in the lower right medial incisor, indicating severe periodontitis in an old mongrel dog.

are considered preventive techniques that remove supra and sub-gingival plaque. The effectiveness of the preventive technique should be monitored by a veterinarian and in most cases will require their intervention, performing dental prophylaxis in order to eliminate residual plaque and calculus in places of difficult access in the teeth (Lima et al., 2004).

The tooth brushing (Figure 7), which acts by removing the biofilm through friction (Dupont, 1998), is considered a technique with greater effect to reduce the buildup of plaque on the tooth (Hennet, 2002). The frequency of tooth brushing in the animals should be daily, to constantly avoid the formation of dental plaque (Niemiec, 2008) and to establish a routine between the owner and the animal. However, because less than 10% of owners agree with these recommendations for the dental care of their dogs (Lima et al., 2004) and because of the time required for the organisation of the plaque, dog tooth brushing procedure has been recommended three times a week with satisfactory results (Dupont, 1998; Niemiec, 2008).

There are numerous veterinary toothbrushes on the market today, but a child brush with soft bristles is considered effective for removal of the biofilm in dogs. Many veterinary toothpastes are also available, with flavours to facilitate animal acceptance of the brushing, besides the fact that it increases friction promoted with brushing (Niemiec, 2008). It is clear, however, that the use of correct brushing techniques minimises the need for this additive effect of toothpaste on the attrition of the teeth (Lima et al., 2004). Antimicrobial substances

Fig. 6. At the end of the red arrow: extensive root exposure with dental calculus in the lower

are considered preventive techniques that remove supra and sub-gingival plaque. The effectiveness of the preventive technique should be monitored by a veterinarian and in most cases will require their intervention, performing dental prophylaxis in order to eliminate residual plaque and calculus in places of difficult access in the teeth (Lima et al., 2004).

The tooth brushing (Figure 7), which acts by removing the biofilm through friction (Dupont, 1998), is considered a technique with greater effect to reduce the buildup of plaque on the tooth (Hennet, 2002). The frequency of tooth brushing in the animals should be daily, to constantly avoid the formation of dental plaque (Niemiec, 2008) and to establish a routine between the owner and the animal. However, because less than 10% of owners agree with these recommendations for the dental care of their dogs (Lima et al., 2004) and because of the time required for the organisation of the plaque, dog tooth brushing procedure has been recommended three times a week with satisfactory results (Dupont, 1998; Niemiec, 2008). There are numerous veterinary toothbrushes on the market today, but a child brush with soft bristles is considered effective for removal of the biofilm in dogs. Many veterinary toothpastes are also available, with flavours to facilitate animal acceptance of the brushing, besides the fact that it increases friction promoted with brushing (Niemiec, 2008). It is clear, however, that the use of correct brushing techniques minimises the need for this additive effect of toothpaste on the attrition of the teeth (Lima et al., 2004). Antimicrobial substances

right medial incisor, indicating severe periodontitis in an old mongrel dog.

Fig. 7. Dog's Tooth brushing by an owner.

may also help in effective biofilm removal (Jensen et al., 1995; Lima et al. 2004; Niemiec, 2008), used in conjunction with a toothbrush, added to toothpaste or employed as solutions, minimising the ineffective brushing technique in some inaccessible places in the animal's mouth.

The brushing technique should be used properly because inappropriate use can increase the prevalence of periodontal disease, as occurs in humans (Jongenelis & Wiedemann, 1997). One of the indicated techniques uses circular movements on the dental surfaces, with the brush tilted at an angle of 45 ° from the gingival margin (Niemiec, 2008).

Some studies have been conducted with the intention of establishing new therapies to combat dental plaque accumulation on the face of the tooth, both for the aid in brushing as for the use as a preventive agent of choice against periodontal disease when the practice of brushing is inefficient, as in wayward animals that do not allow the mechanical handling of oral practices (Gioso & Carvalho, 2004; Pieri, 2010).

Various forms of introduction of these therapies in the animal management have been tested, including the use of cookies and chewing objects for oral hygiene (Gioso & Carvalho, 2004; Niemiec, 2008), additives to drinking water with an inhibitory effect on the growth of bacteria (Clarke, 2006) and oral rinse solutions as well as leather and biscuits with the addition of antimicrobial agents (Addy, 1997; Niemiec, 2008).

Topical application of a drug to control the disease is considered desirable, in view of the lower incidence of side effects when compared to other routes of application. For the

Periodontal Disease in Dogs 133

The diagnosis of periodontal disease is based on history, clinical examination and radiological evaluation. Any changes in apprehension and chewing of food, as well as in general conditions and in the behaviour of animals, can be associated with oral disorders. Certain physical and behavioral changes are highly suggestive of dental disorders, including abnormal ways of eating and drinking, acute reactions to the ingestion of cold water, selective appetite (preference for soft foods), anorexia and weight loss, salivation, bleeding, epitaxy, digging of the ground, behavior of rubbing their feet on the face, shaking of the head, oronasal fistulas, abnormal aggressive behavior (because of pain) and distress and anguish (Emily & Penman, 1994; Pachaly, 2006; Gorrel, 2004). When it comes to periodontal disease, the main complaint of the owner will always be halitosis (Emily & Penman, 1994; Gorrel, 2004; Gioso, 2007) due to tissue decay and bacterial fermentation in

Like any other clinical examination, the examination in dentistry should be preceded by thorough history and general physical examination. At the end, the oral cavity should be examined. It is necessary to do a complete oral examination to assess the presence of periodontal disease and other diseases, such as fractures or dental malocclusions. The intraand extraoral structures should be assessed, including bone surfaces, the jaw muscles, salivary glands and regional cervical lymph nodes (Gorrel., 2004). Ideally, the complete periodontal examination should be performed in anaesthetised dogs (Harvey, 1992; Gorrel, 2004; Gioso, 2007). The evaluation of the tooth must be made with an explorer and periodontal probe (Gioso, 2007). The examination must be careful; incorrect handling of the probe may damage the soft tissues and lead to misdiagnosis of periodontal lesions (Gorrel, 2004). The changes observed should be recorded in an appropriate medical record and serve

The periodontal examination includes the evaluation of teeth mobility, of injuries or furcation exposure, gingival retracting or hyperplasia, the evaluation of the depth, the presence of dental plaque, of gingivitis and dental calculus The furcation is the area between the roots of teeth that have more than one root. This area is usually filled with alveolar bone. During exploration, a depression can be felt while passing the extremity of a probe perpendicular to the tooth crown and below the gingival margin. In the presence of periodontitis, the furcation bone can be resorbed and probe inserted between the roots. Changes in the furcation are classified on a scale ranging from 0 to 3, where in grade 3 lesions the probe passes freely through the furcation, from the vestibular part to the

The gingival sulcus is the space between the free gingiva and the tooth crown. In dogs, the depth of the gingival sulcus should be less than 3mm, and in giant breed dogs less than 4 mm (Gioso, 2007). When periodontitis is established, the junctional epithelium, the region of the gingival tissue inserted to the tooth surface, migrates apically along the root. If the apical migration is not accompanied by a receding gingiva then the periodontal pocket is formed, which has a depth greater than 3mm (Gorrel, 2004). Values above 3 mm mean loss of clinical attachment of the junctional epithelium with bone destruction (periodontitis) and

The periodontal probe is essential in the examination and diagnosis of periodontal disease. This thin probe has a tip calibrated in millimetres, measuring the depth of the gingival

**5. Diagnosis** 

the sulcus or periodontal pocket (Gioso, 2007).

as the basis for the therapeutic treatment (Pachaly, 2006).

lingual/palatal tooth (Gorrel, 2004).

periodontal pocket formation (Gioso, 2007)

prevention of periodontal disease, taking into account the least harmful nature of bacteria in the onset of the disease and higher prevalence of supragingival plaque, it is recommended that the use of topical oral solutions such as mouthwashes is sufficient to combat bacteria in question with great advantage because of its easy application in most patients (Ciancio & Niezengard, 1997).

Among the chemicals, that can be used this way to reduce the accumulation of plaque on dental surfaces, the bisguanids, quaternary ammonia and phenols have been widely evaluated. Chlorhexidine appears as a substance that has the greatest efficacy in the inhibition of oral plaque (Hennet, 2002) and has good antiseptic activity against all oral pathogens, more directly on the bacterial plaque organisms (Harvey & Emily, 1993). Its main concentration is the commercial use of alcoholic solution at 0.12% and it is also found in alcohol-free solutions and in gel form (Robinson, 1995).

Despite the above indications for the use of chlorhexidine in the fight against dental plaque, it presents a series of unpleasant effects when used for prolonged therapy, such as loss of taste by the patient, pigmentation of the enamel, burning and even ulceration of the buccal mucosa (Zanini et al., 1995). These effects justify the use of this material only for few days (Gioso, 2007), which makes its application not recommended in the prevention of periodontal disease, which requires a prolonged use of the antimicrobial agent chosen for this purpose (Lascala & Moussalli, 1995).

The natural sweetener xylitol has been used in human patients in chewing gum, mouthwashes and toothpastes in order to reduce plaque. There is also one xylitol based product in the veterinary market today, which when added to the animal drinking water has a lowering effect on oral bacterial plaque formation (Dunayer & Gwaltney-Brant, 2006).

Recently, the ozonised sunflower oil was tested, with positive results on microbial reduction in human patients with periodontal disease (Fiorini et al., 2006) and copaiba oil was applied topically on dogs and the results were equal to those obtained with chlorhexidine on the oral microbial population (Pieri, 2010). Additionally, some in vitro tests were performed to analyse the antimicrobial activity of Copaiba oil on plaque-forming bacteria (Simões, 2004; Pieri, 2010; Valdevite et al., 2007) and the evaluation of the inhibition of *Streptococcus* sp. adherence in glass capillaries caused by the same phytotherapic (Pieri, 2010), obtaining in both cases positive results. A actual work has been conduced to evaluate the copaiba oil as antimicrobial against bacterial isolates from initial dental plaque of dogs, aiming identify a potential drug to prevent the plaque formation and consequently the periodontal disease (personal data).

Many researchers continue their analysis looking for natural drugs as propolis (Swerts et al., 2005), *Camellia sinensis* (Chang et al., 2009), *Mimosa tenuiflora* (Macedo-Costa, 2009), *Vitis amurensis* (Yim et al., 2010), *Rhinacanthus nasutus* (Puttarak et al., 2010), *Murraya koenigii*, *Allium sativum* and *Melaleuca alternifolia* (Prabhakar *et al., 2009)* to its use in the prevention of periodontal disease by inhibiting plaque formation.It important that this drug combine properties such as antimicrobial activity that does not induce bacterial resistance, and inhibition of microbial adherence on tooth surfaces that suggest a great potential for use in therapies in the oral cavity and as an aid in oral hygiene (Sudo et al., 1986; Corner et al., 1988; Pieri, 2010). For the use in the treatment of domestic animals it is suggested the inclusion of this antimicrobial and non-adherent agent in formulations containing the base flavours of chicken, beef, fish, etc. (De Marco & Gioso, 1997).
