Page 946 - Small Animal Clinical Nutrition 5th Edition

980 Small Animal Clinical Nutrition

Table 47-1. Conditions affecting the oral cavity. Box 47-1. Compliance and Dental
VetBooks.ir Conditions primarily Conditions primarily affecting Homecare.
the periodontium/oral
affecting teeth mucosa Oral health is achieved through an effective periodontal man-
Abrasion Chemical or thermal burns
Attrition Gingival hyperplasia agement program that includes professional care and client-
Erosion Gingivitis provided homecare. Appropriate homecare recommendations
Fracture Gingivostomatitis consider the client and patient preferences and specifically
Intrinsic staining Neoplasia address the degree of oral pathologic change present and client
Odontoclastic resorption Periapical abscess
Pulpitis Periodontitis and patient compliance.
Ulcers Compliance is critical to effective homecare. Clients must be
willing and able to perform the recommended hygiene and the
patient must accept oral hygiene procedures. Noncompliance
may result from lack of an effective recommendation by the vet-
erinary health care team. A comprehensive study of compliance
demonstrated that appropriate periodontal therapy was not pro-
vided for approximately 15.5 million dogs and cats with record-
ed periodontal disease scores of 2, 3 or 4. No recommendation
for periodontal management was given in 66% of cases with a
recorded periodontal disease score of 1. In the same study, 19%
of patients lacked any notation of periodontal examination or
score in health records.
Even with client education and good pet compliance, some
owners are unable to provide routine and effective plaque con-
trol. Compliance failure may be due to: 1) lack of skill, 2) lack of
perceived benefit, 3) unpleasantness of procedure, 4) lack of
noticeable impact and 5) lifestyle constraints. Emphasizing the
benefits, including improved oral and systemic health, less
breath odor, cost effectiveness and strengthening of the owner-
pet bond, may increase compliance.
The most important part of periodontal therapy is how well a
patient maintains oral health. Long-term success depends on
Figure 47-1. Normal tooth and periodontal anatomy. the degree of plaque control the client is capable of providing
between professional visits.

disease of the teeth in the dog is so high that dental surgery
occupies a prominent place in the work of the veterinarian health maintenance program for pets. An adequate health his-
engaged in small-animal practice. The most common affection tory must include: 1) information about previous medical and
necessitating surgical interference is paradontal disease” (1939). surgical procedures, 2) current preventive measures such as vac-
Periodontal disease has been observed in dogs and cats of cination status and heartworm medication administration, 3)
varying breed, gender and age. Surveys from several countries the pet’s general environment, including confinement, 4) infor-
report prevalence rates of periodontal disease that range from mation about other household pets and 5) who in the house-
60 to more than 80% of dogs and cats examined (Gray, 1923; hold is responsible for primary care.
Bell, 1965; Rosenberg et al, 1966; Saxe et al, 1967; Gad, 1968; Inquiries specific to nutrition and oral care should include
Hamp et al, 1975; Hamp and Lindberg, 1971; Sorensen et al, past and present information about: 1) oral hygiene and level of
1980; Page and Schroeder, 1979; Golden et al, 1982; Reichart compliance, 2) presence of any signs that may be related to oral
et al, 1984; Isogai et al, 1989; Harvey, 1992; Hoffman and dysfunction, 3) chewing behavior, 4) access to rocks and other
Gaengler, 1996). materials that may cause occlusal trauma, 5) access to dental
Data from the National Companion Animal Study represent- treats and toys, 6) eating behavior and 7) foods eaten, with spe-
ing 54 veterinary practices across the United States confirmed cial attention given to texture and other factors.
that oral disease was the most frequent diagnosis in all age cat-
egories of 39,556 dogs and 13,924 cats (Lund et al, 1999). Physical Examination
Initial Oral Examination
Examination of the skull and oral cavity should be a regular
PATIENT ASSESSMENT part of every physical examination. An extraoral examination
should be done before opening the mouth to inspect the skull
History and facial areas for any abnormalities, such as muscle atrophy,
A complete history is important to diagnosis and treatment swelling, draining tracts and ocular or nasal discharge. Extraoral
planning and is an integral tool for developing a complete examination should also include inspection for facial symmetry,