A NEWSLETTER OF PRACTICAL MEDICINE FOR VETERINARY PROFESSIONALS                                                           ...
A NEWSLETTER OF PRACTICAL MEDICINE FOR VETERINARY PROFESSIONALS                                                           ...
administering large amounts of allergen, the          initiating allergen-specific immunotherapy.                         ...
TABLE 2: Oral Glucocorticoid Therapy for Dogs    Drug                                                 Dose                ...
Canine Periodontal Disease                                                                   Daniel T. Carmichael, DVM, FA...
Figure 1— Established gingivitis                         Figure 2— Periodontitis (stage 3  (stage 2 periodontal disease) i...
treatment must include extraction of the               products as “nylon bones,” cow hooves, and                         ...
Albert Ahn, DVM, is Corporate Vice President, Research &                      Development at The Hartz Mountain Corporatio...
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Hartz Companion Animal - Treatment of Canine Atopy


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Atopic dermatitis, also known as atopy
(previously called allergic inhalant dermatitis),
is a common dermatologic problem observed
in dogs, with an estimated incidence of 3% to
15% of the canine population. It is considered
a genetically based condition whereby animals
produce IgE antibody against environmental
proteins, which results in disease, most
commonly allergic dermatitis. Access to these
proteins is now believed to be primarily via
skin absorption; common allergens include
grass, tree, and weed pollens; mold spores;
house dust; dust-mite antigen; insects;
and other miscellaneous environmental
substances. Geographic variation affects the
development and presentation of clinical
disease. The incidence of atopic dermatitis in
dogs may be greater in areas where fleas are
more prevalent or that have an increased
presence of pollens and other proteins.

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Hartz Companion Animal - Treatment of Canine Atopy

  1. 1. A NEWSLETTER OF PRACTICAL MEDICINE FOR VETERINARY PROFESSIONALS NOVEMBER 2005 VOLUME 3, NUMBER 4 Treatment of Canine Atopy J. M. MacDonald, MEd, DVM, DACVD Professor of Dermatology Department of Clinical Sciences College of Veterinary Medicine Auburn University Atopic dermatitis, also known as atopy feet (Figure 3). Other diseases with similar food or food allergy may be a coexisting(previously called allergic inhalant dermatitis), clinical features include food allergy and problem in 15% to 20% of dogs. Canine atopyis a common dermatologic problem observed scabies. Allergic otitis externa is commonly is diagnosed based on historical and clinicalin dogs, with an estimated incidence of 3% to seen as part of the clinical presentation and examination findings combined with the rule-15% of the canine population. It is considered is the major primary cause of otitis externa out of other differentials.a genetically based condition whereby animals leading to secondary infection in dogs.produce IgE antibody against environmental Ophthalmic problems may also be observed, TREATMENT STRATEGIESproteins, which results in disease, most including conjunctivitis, epiphora, and Atopic dermatitis is typically a life-longcommonly allergic dermatitis. Access to these possibly secondary complications of infectious disease and characteristically intensifies withproteins is now believed to be primarily via conjunctivitis with mucopurulent discharge. age, showing less responsiveness to commonlyskin absorption; common allergens include Most animals demonstrate a seasonal pattern used drugs over time. In addition, thegrass, tree, and weed pollens; mold spores; before progressing to a nonseasonal (year- development of complicating problemshouse dust; dust-mite antigen; insects; round) problem. Eventually, as many as 75% becomes more prevalent. Therapy may beand other miscellaneous environmental of affected dogs will develop year-round signs separated into four categories: avoidance,substances. Geographic variation affects the in the southeastern United States. Both symptomatic therapy (Table 1), allergen-development and presentation of clinical bacterial (Staphylococcus spp) and yeast specific immunotherapy (ASIT), anddisease. The incidence of atopic dermatitis in (Malassezia spp) infections are commonly immunomodulation therapy.dogs may be greater in areas where fleas are observed. Scaling and crusting are common in Avoidance techniques have recently beenmore prevalent or that have an increased cases of chronic atopic dermatitis with shown to be helpful in controlling allergenpresence of pollens and other proteins. complications and may mimic features of exposure in selected situations. House dust and Canine atopic dermatitis is other conditions. Other complications thatcharacteristically observed in dogs between 6 may be seen include demodicosis andmonths and 3 years of age, although onset has dermatophytosis. Secondary ear infections are ALSO IN THIS ISSUE:been observed in dogs as young as 2.5 months frequently observed. Coexisting allergicand as old as 7 years of age. Predominant diseases may occur with canine atopy. Flea Canine Periodontal Disease........ 5features include pruritus affecting the face allergy is observed in flea-infested areas in as Ask the Vet ................................ 8(Figure 1), legs, ears (Figure 2), ventrum, and many as 80% of cases. Adverse reaction to
  2. 2. A NEWSLETTER OF PRACTICAL MEDICINE FOR VETERINARY PROFESSIONALS NOVEMBER 2005 VOLUME 3, NUMBER 4 Consulting Editors Albert Ahn, DVM Corporate Vice President, Research & Development The Hartz Mountain Corporation Bruce Truman A B Senior Director Figure 1— (A) Canine atopy frequently affects the facial area, as shown in this dog Animal Health and Nutrition with periocular dermatitis and accompanying conjunctivitis. (B) Hyperpigmentation is a The Hartz Mountain Corporation common postinflammatory response. Associate Editors Jill A. Richardson, DVM house dust mites are common allergens Director—Consumer Relations associated with atopy. Efforts to eliminate The Hartz Mountain Corporation house dust mites and associated allergens from David Levy controlled environments have decreased the incidence of clinical disease in dogs. A Assistant Manager Animal Health and Nutrition commercial product is available for premise The Hartz Mountain Corporation treatment to neutralize dust mite, dander, and cockroach allergens. A shampoo is also HARTZ® COMPANION ANIMAL SM available to neutralize dust mite allergens on is produced for The Hartz Mountain pets. Another product is also available to Corporation by Veterinary Learning eliminate house dust mites and control fleas Systems, 780 Township Line Rd., in the house. Figure 2— Canine atopy is the most Yardley, PA 19067. common primary cause of otitis externa, as shown in the dog from Figure 1. The Copyright © 2005 The Hartz Mountain Symptomatic Therapy complicating factor in this case is Corporation. All rights reserved. Symptomatic therapy includes the use secondary Malassezia otitis, as determined of antihistamines, essential fatty acids, by microscopic examination of the waxy Hartz® and other marks are owned by glucocorticoids, and topical therapy (e.g., exudate. The Hartz Mountain Corporation. shampoos, rinses, leave-on conditioners, Printed in U.S.A. No part of this sprays). Symptomatic therapy requires no publication may be reproduced in any knowledge of the specific allergens causing “washout” period before trying the next form without the express written the allergic condition. Antihistamine therapy antihistamine. Scoring the pruritus and permission of the publisher. alone rarely resolves pruritus to the extent recording the data for follow-up evaluation is necessary for acceptable control but may ideal. Antihistamines do have a reputation of For more information on The Hartz Mountain Corporation, visit provide sufficient response in an integrated inducing tolerance whereby they lose their www.hartz.com. treatment plan to merit its inclusion. Adverse effectiveness, necessitating a switch to reactions other than drowsiness are rarely another chemical. observed. In general, approximately 30% Essential fatty acids have been investigated of dogs placed on antihistamine therapy and demonstrate considerable benefit in Glucocorticoids are a group of steroid demonstrate a good response. No one atopic dogs. Those of most benefit include compounds used as antiinflammatory agents particular antihistamine is recognizably the omega-3 fatty acids, which contain the in the treatment of atopic dermatitis. superior to others, although the more chemical eicosapentaenoic acid (EPA), Glucocorticoid therapy is best used in a commonly used include diphenhydramine, usually in combination with docosahexaenoic restricted manner with administration of clemastine, hydroxyzine hydrochloride or acid (DHA). Omega-3 fatty acids are the least amount necessary to control clinical pamoate, amitriptyline, and doxepin commonly derived from fish oil or plant signs. Although injectable steroids are hydrochloride. Trial periods are necessary to sources. They may have some beneficial commonly used in practice, the ideal evaluate the effect of specific antihistamines antipruritic effect and have negligible adverse treatment regimen includes the use of short- on the clinical condition and also to reactions. Integration with antihistamine acting, low-potency oral steroids, typically determine tolerance in individual animals. therapy may produce an enhanced effect. administered on an alternate-day basis Pet owners are asked to try different The commonly used dosage for EPA is for maintenance therapy. Prednisone, antihistamines at 14-day intervals with approximately 40 mg/kg/day. A variety of prednisolone, and methylprednisolone are consistent therapy followed by a 5- to 7-day commercial products are available. commonly used (Table 2). Triamcinolone has2 HARTZ COMPANION ANIMAL ® SM • NOVEMBER 2005 • VOL. 3, NO. 4
  3. 3. administering large amounts of allergen, the initiating allergen-specific immunotherapy. balance between Th1 and Th2 cells is shifted Allergy testing is not used for diagnostic toward the Th1 response, which favors IgG purposes because of the variability of animal production over IgE production. This reactivity. Two types of tests are used: ultimately results in less IgE antibody and intradermal testing (IDT) and serum allergy therefore decreased clinical signs. The testing (SAT). IDT is a common diagnostic therapeutic effect of this technique is variable tool predominantly used by specialists for and quite dependent on the extent and the assessment of regionally known allergens. accuracy of identifying the specific allergens It requires selection and maintenance ofFigure 3— Allergic pododermatitis is that are problematic for a given animal. In allergens, thereby prohibiting its use inoften seen as part of the triad of general, 65% to 75% of dogs treated with many practices. Interpretation of test resultsdistribution patterns (face, ears, and feet) ASIT show a good to excellent response. requires correlation with the historicalseen in canine atopy, as shown in the dog These animals classically require integration features of the disease, with particularfrom Figure 1. Concurrent Malassezia of antihistamines, essential fatty acids, and reference to seasonal episodes of clinical signs.pododermatitis is an important secondaryproblem. occasionally glucocorticoid therapy in Previous drug therapy (e.g., antihistamines, combination with topical management. glucocorticoids) may cause animals to fail to Overall, the effect is significant in dogs reveal positive reactivity. Usually 40 to 70also been used, albeit on an every-third-day that respond, making it a very beneficial allergens are tested in this investigation,administration schedule because of its treatment. Treatment is ongoing and is which remains the gold standard for allergenintermediate duration of effect. commonly required for the life of the animal. identification. False-negative reactions are Topical therapy is quite helpful in treating ASIT is typically restricted to animals whose usually the greatest limitation, although theatopic animals. Not only does it have an season of itchiness exceeds 3 months/year. need for drug withdrawal, sedation, and hairantipruritic effect, but it also assists in It is also preferable to submit candidates for removal are other drawbacks.removing surface allergens from the skin ASIT at or after 1 year of age, although it SAT has become more popular, and manybefore percutaneous absorption occurs. has been used in younger dogs with severe reputable laboratories can identify levels ofShampoos are commonly integrated in problems and in which other diseases have circulating anti–allergen IgE. Techniquesthis treatment approach; they may contain been ruled out. vary by facility, which may affect the results.oatmeal, aloe vera, or other antipruritic The development of the allergen solution Selection of allergens respective to a givenchemicals, such as pramoxine, diphen- used in therapy is based on the results of geographic area may be quite different amonghydramine, or hydrocortisone. Shampoo serum and/or intradermal allergy testing laboratories, and the array of allergens musttherapy is limited, however, because the (Figure 4). Allergy testing is limited to the be considered when choosing a laboratory.product is removed in the rinsing phase of identification of specific allergens before Some facilities test allergens in groups ratherthe bath. Rinses, leave-on conditioners, andsprays may be more effective because of theirresidual effect; such products may contain TABLE 1: Common Nonsteroidal Drugs Used in thecolloidal oatmeal or antipruritic chemicals Treatment of Pruritic Dogssuch as an analgesic, antihistamine, Agent Oral Doseor glucocorticoid. The use of a low-concentration triamcinolone spray has been Amitryptyline 1–2 mg/kg bidhelpful as adjunctive treatment. The goal of Astemizole 0.25 mg/kg bidtopical therapy is to decrease the need for Cetirizine 0.5–1.0 mg/kg or 5–10 mg once or twice/daysystemic therapy, particularly in avoiding Chlorpheniramine 4–12 mg bid–tidincreased dependency on glucocorticoids. Clemastine 0.05–0.1 mg/kg bidTopical therapy also allows specific regions Cyproheptadine 0.3–2.0 mg/kg bidof pruritus to be targeted without systemic Diphenhydramine 2.2 mg/kg tidtherapy. Doxepin hydrochloride 3–5 mg/kg bid Fluoxetine 1 mg/kg/day for 4 wk, then adjust (controversial resultsAllergen-Specific Immunotherapy with limited response in most cases) ASIT is commonly known as Hydroxyzine hydrochloride 2.2 mg/kg tid (hydroxyzine pamoate may be usedhyposensitization treatment. It includes instead of HCl in the 25- and 50-mg size to avoidparenteral administration of the same proteins higher costs)to which the animal has known allergic Loratadine 0.25–0.50 mg/kg q24hreactivity. Production of IgE against specific Trimeprazine 1–2 mg/kg tid (Temaril-P [Pfizer Animal Health]allergens occurs in atopic animals by contains both trimeprazine [5 mg] and prednisone [2 mg]; maintenance therapy requires twice-dailyimmunologic response of Th2 cells, which therapy every other day)signal B cells to produce the IgE. By HARTZ® COMPANION ANIMALSM • NOVEMBER 2005 • VOL. 3, NO. 4 3
  4. 4. TABLE 2: Oral Glucocorticoid Therapy for Dogs Drug Dose Induction Maintenance Prednisone or prednisolone 0.5–1.0 mg/kg } Every other day Methylprednisolone 2.0 mg/5–10kg Daily or divided bid for 10 days Every other day Triamcinolone 0.05 mg/kg Every third day than individually; such an approach is less positive response to ASIT is seen, although 3 useful in developing the allergen solution for to 5 months is more typical. Early response therapy. False-positive and false-negative has been reported within the first 28 days of results are possible. treatment. The attributes of ASIT include Cost may be an issue for pet owners, and long-term control and thus a decreasing the animal’s personality influences acceptance need for adjunctive therapy, particularly of injection therapy. ASIT is restricted to glucocorticoids. Complete desensitization has parenteral administration, conventionally by been observed in rare situations. In general, subcutaneous injection. Because of the ASIT is thought to have a better chance of excellent safety record of this treatment, being effective if started early in the disease Figure 4 — Intradermal testing owners can usually administer it at home. progression. Because of its appealing response revealed many strong positive reactions in The injection schedule is somewhat variable rate, ASIT has become the mainstay of this atopic dog. The vast majority of depending on the laboratory or dermatologist treatment alternatives; it does not, however, positive reactions are pollens of grasses, preparing the allergen solution, but therapy eliminate the need for adjunctive therapy in weeds, and trees. Animals with this extent of allergen reactivity are excellent classically starts with one or two vials of most cases but does decrease the intensity of candidates for allergen-specific dilute solution before proceeding with the concurrent medication. ASIT is not indicated immunotherapy. more concentrated maintenance formulation. for the treatment of flea allergy; rather, Rush allergen immunotherapy is a form of aggressive and persistent flea control is ASIT in which incremental doses of allergen advised. Likewise, dietary allergy is controlled are administered over a short period until the exclusively through avoidance and restricting of solution. ASIT response requires maintenance dose is achieved. Using the rush the diet to foods that fail to demonstrate intermittent evaluation, with treatment interval method, full induction can occur in as little as clinical reactivity, such as a limited-ingredient and volume of allergen adjusted accordingly. 6 to 8 hours with injections administered or hypoallergenic diet. Since atopic dogs either have existing flea every 20 to 30 minutes compared with 30 to Failure to respond to ASIT may be allergy or are at risk for developing flea allergy, 40 days when using a conventional schedule; related to unidentified coexisting problems, ongoing parasiticidal therapy is necessary in the rush method requires close observation including dietary allergy, canine scabies, or flea-infested areas. Routine bathing should also and preparedness for an allergic emergency, complicating infections such as bacterial be incorporated in a maintenance program. although this is unlikely to happen. pyoderma, cutaneous Malassezia infection, The dose and frequency of administration dermatophytosis, or demodicosis. Incomplete Immunomodulation Therapy of maintenance therapy depend on individual recognition of offensive allergens may require Cyclosporine (CsA) is a polypeptide product patient response and tolerance of the treatment. repeat allergy testing to identify additional from the fungus Tolypoladium inflatum. It is a Dosing schedules can range from once or twice problematic allergens in a given animal. potent immunosuppressant compound used in weekly to once every 3 weeks. Some animals Inconsistent treatment or less than optimal humans after organ transplantation and has respond better to smaller, more frequent doses regimens may also lead to failure. A full year shown significant contributions in the control versus larger, less frequent doses. Animals of treatment is necessary to accurately assess of atopic dermatitis. It specifically affects the weighing less than 10 kg should receive doses efficacy. Nonresponders may represent as portion of the immune system associated with no larger than 0.5 ml of the maintenance many as 25% to 35% of the animals placed atopic dermatitis (i.e., Th2 cells), making solution. Animals demonstrating intolerance on therapy. Dogs with a large number of it a desirable immunosuppressant. Other may require a more dilute solution to avoid allergic reactions on allergy testing may be mechanisms of action are reported that would increased pruritus. Modification of the dosing good responders and should be considered be helpful in this treatment, including the schedules may enhance the response in many eligible candidates for allergen therapy. Dogs inhibition of interleukin-2, messenger cases. Weekly injections of 0.35 to 0.5 ml of in which more than 20 to 30 allergens have RNA transcription, and possibly mast cell maintenance solution may be preferable to 1.0 been identified have been some of the better degranulation. Up to 70% of atopic dogs ml every 21 days. Injections administered every responders. The maximum number of allergens treated with CsA may demonstrate appreciable 2 weeks may require 0.4 to 0.6 ml of solution, that can be included in a single vial is limited to control; however, as many as 30% may require and some animals may respond best to a small 10 to 17 depending on the individual preparing adjunctive therapy, including glucocorticoids. amount (0.15 to 0.3 ml) given twice weekly. the solution. Animals with a larger number of The dosage is critical for optimal response and It may take 5 to 7 months before a identified allergens often require multiple vials should be close to 5 mg/kg/day, ideally (continues on page 7)4 HARTZ COMPANION ANIMAL ® SM • NOVEMBER 2005 • VOL. 3, NO. 4
  5. 5. Canine Periodontal Disease Daniel T. Carmichael, DVM, FAVD, DAVDC Adjunct Assistant Professor of Dentistry Columbia University School of Dental and Oral Surgery Chief of Dentistry The Center For Specialized Veterinary Care Westbury, New York Periodontal disease is the most common associated with periodontal disease is initiated least one problem that would best bedisease seen in small animal practice, affecting by the accumulation of plaque bacteria on addressed under anesthesia. Only whenan estimated 80% of canine patients over the the tooth surface. In humans as well as in the patient has been anesthetized and aage of 5.1 Left untreated, periodontal disease animals, certain bacteria have been labeled complete assessment of the oral cavity hascan cause oral pain, tooth loss, and systemic periodontopathogens and have been implicated been performed can an updated and accuratedisease from anorexia or bacteremia. Most as being primarily responsible for the bulk of account of the patient’s problems andcases of advanced periodontal disease in dogs the disease process. In humans, Porphyromonas treatment recommendations be rendered.could have been prevented. gingivalis is a black-pigmented, gram-negative Clients should always be advised that Periodontium refers to the group of anaerobe that has been identified as a the extent of pathology (and necessarytissues that attach the teeth to the jaws. These periodontopathogen. In the canine species, it treatments) can never be fully appreciatedstructures include the gingiva, alveolar bone, is becoming clear that certain Porphyromonas on an awake patient.cementum (which covers the root of the tooth), spp are also acting as periodontopathogens.2,3 Halitosis is a hallmark sign of periodontaland periodontal ligament. In periodontal However, it is an oversimplification to think disease, but the presence or absence of baddisease, these tissues become progressively of periodontal disease as an infection by a breath does not specifically indicate a givendiseased and destroyed while the tooth itself single species of bacteria. Nevertheless, it is stage of disease.remains unaffected. Therefore, one should think helpful to target the gram-negative anaerobesof periodontal disease not as “tooth disease” but specifically when directing therapy against Stage 1: Early Gingivitisrather as “around-the-tooth disease.” periodontal infection. Stage 1 periodontal disease is Periodontal disease is characterized A multitude of other factors, such characterized by mild plaque accumulationby a progressive loss or destruction of the as a patient’s age, diet, chewing habits, and mild hyperemia of the gum marginsperiodontal tissues. The initial stage of the occlusion, and size, can determine the (marginal gingiva). This “reddening” of thedisease, gingivitis, is limited to the gingival eventual outcome of periodontal disease in gums is the earliest detectable sign oftissues. Periodontitis is the more advanced a given patient. A major factor appears to be periodontal disease.stage of periodontal disease in which the the patient’s “host reaction” to the presencedeeper periodontal tissues (periodontal of plaque on the teeth. Plaque bacterial Stage 2: Established Gingivitisligament, alveolar bone, and cementum) endotoxin and other bacterial byproducts Stage 2 periodontal disease is characterizedbecome affected. In reality, the progression can primarily cause tissue destruction, but by plaque and/or calculus accumulation andfrom health to gingivitis and then to the body’s inflammatory response, mounted hyperemia and edema (swelling) of theperiodontitis is not always a gradual linear by the oral immune system, can also be a marginal gingiva. Gentle probing of theevent, but this concept of progression can be significant factor in the degree of tissue gingival sulcus with a periodontal probe mayused to help understand the disease and inflammation and destruction. An over- induce bleeding, but the gingival sulcus (orrecommend rational treatments. exaggerated immune response may cause pocket) depth remains normal (<3 mm). Gingivitis is reversible; periodontitis is more damage than the bacteria that elicited There are no radiographic abnormalitiesirreversible. This underscores the need for it in the first place. associated with this stage (Figure 1).early intervention to prevent irreversibledestructive changes. Once irreversible perio- DIAGNOSIS Stage 3: Early Periodontitisdontitis has occurred, effective treatments Periodontal disease is an ongoing process In stage 3 periodontal disease, thecan still be implemented to eliminate that can be broken down into stages for the deeper periodontal structures start to becomeinflammation and halt further progression. purposes of diagnosis and treatment. In many diseased. Exaggerated gingival inflammationIn severe cases, tooth extraction is the only instances, the extent of disease is not evident may be seen clinically, but the deepeningsolution. until the patient is examined (including of the periodontal pockets, especially on periodontal probing and radiography) under the palatal side, may be evident only onETIOLOGY anesthesia. A goal when performing an oral probing during a more thorough intraoral The inflammation and destruction examination on an awake patient is to find at examination. HARTZ® COMPANION ANIMALSM • NOVEMBER 2005 • VOL. 3, NO. 4 5
  6. 6. Figure 1— Established gingivitis Figure 2— Periodontitis (stage 3 (stage 2 periodontal disease) is periodontal disease) is commonly seen on characterized by gingival edema and the palatal aspect of the maxillary canine erythema (arrow). Halitosis is also often teeth (arrow). It is important to probe 360° present. Dental prophylaxis should be around every tooth. recommended at this stage. Clinical signs of early periodontitis— Treatment of early gingivitis (stage 1) is increased pocket depth (up to 5 mm), gingival done at home. Owners should be instructed recession, and furcation exposure (Figure 2)— about how to provide regular home care Figure 3— End-stage periodontitis are related to the destruction of periodontal (including daily toothbrushing) to retard the (stage 5 periodontal disease). (A) The tissue. This is the earliest stage in which accumulation of plaque on their pet’s teeth periodontal lesion on the distal root of this radiographic evidence of disease can be and when to seek professional treatment. mandibular fourth premolar (arrow) has appreciated. Radiographic changes associated Treatment of established gingivitis (stage progressed all the way to the root apex with periodontitis are visualized as the loss of 2) requires a periodontal prophylaxis, which (perio-endo lesion). (B) Dental radiography was necessary to make the diagnosis. The alveolar bone; bone loss may be horizontal minimally involves scaling the calculus and only treatment option for this root (arrow) is (suprabony) or vertical (infrabony) and is plaque from the tooth crown surface extraction (including extraction or expressed as a percentage; in stage 3 (supragingival scaling), removing the plaque endodontic treatment of the mesial root). periodontitis, the bone loss is 0% to 30%. and calculus from the teeth below the gum line (subgingival curettage), polishing the Stage 4: Established Periodontitis teeth, irrigating the sulcus, and recording strokes are used to plane each root surface. Stage 4 periodontal disease is characterized abnormalities in a medical record. This can When root planing is complete, the surface by deepening periodontal pockets (>5 mm), only be accomplished under general of the root is clean and smooth. Doxycycline gingival recession and root exposure, loss of anesthesia. Detailed protocols for performing gel is useful in treating moderately deep alveolar bone (sometimes exposing the root dental prophylaxis are well documented in the (4 to 6 mm) periodontal pockets. It has been furcations), and mild tooth mobility. Radio- literature.4,5 shown to result in significant gain (2 to 3 graphically, 30% to 75% bone loss is seen. Treatment of early periodontitis (stage 3) mm) of attachment level. This product is starts with periodontal prophylaxis. Intraoral not a substitute for periodontal surgery Stage 5: End-Stage Periodontitis radiography is highly advised to document when surgery is indicated and will not be Stage 5 or “end-stage” periodontitis is pathology and plan more advanced successful if proper root planing is not characterized by bone loss exceeding 75%. treatments. The most import aspect of performed. Single-rooted teeth exhibit mobility, but treatment is the complete removal of bacterial Treatment for advanced periodontitis multirooted teeth may not be loose if one or plaque and calculus from the root surface. (stage 4) requires a firm commitment from more roots remain with some degree of bone Only after this is done can healing occur and the owners for home care and frequent attachment. Therefore, a tooth does not have disease progression be halted. The goal of follow-up visits. Mucoperiosteal surgery to be loose for the patient to have end-stage root planing is to remove all plaque and encompasses a variety of procedures designed periodontal disease (Figure 3). calculus from the root surface. This can be to gain access to deep periodontal defects and accomplished without surgical exposure to recontour or reposition gingival tissue. In TREATMENT (closed root planning) for pockets less than pockets deeper than 6 mm, it is impossible to Dogs have 42 teeth, and each should 6 mm. Root planing is performed with hand adequately scale and plane the root surfaces be considered separately. In a given dog, instruments and/or special ultrasonic without surgical exposure. Once the surgical individual teeth can be in a variety of stages of instrumentation designed to work subgingivally. root planing (open curettage) has been periodontal disease. The goal of treatment is The curette is inserted into the depth of the accomplished, the flaps may be repositioned to perform the necessary therapy indicated for pocket, and a pulling movement is used to to reduce pocket depth. Guided tissue that stage of disease on a tooth-by-tooth basis. “scrape” the root surface; many overlapping regeneration is a procedure in which a barrier6 HARTZ COMPANION ANIMAL ® SM • NOVEMBER 2005 • VOL. 3, NO. 4
  7. 7. treatment must include extraction of the products as “nylon bones,” cow hooves, and whole tooth.6,7 “real bones” are too hard and often are associated with slab fracture of the carnassial PREVENTION teeth. Tennis balls are notorious for causing Owners should be encouraged to brush attrition (mechanical wearing of the tooth their pet’s teeth daily (Figure 4) with pet (not surface), and dogs should not be allowed to human) toothpaste. The toothbrush should be chew on a ball for hours a day. held at a 45° angle to the tooth surface, with the Oral rinses, sprays, and other such products bristles pointing toward the gingival margin. also have a role in home care. Some are used This allows cleaning of the gingival sulcus after oral surgery, when brushing is not during the brushing process. The toothbrush appropriate, or may be the only option for should be worked in a circular motion, home care in pets that refuse to allow their concentrating around the canine teeth and teeth to be brushed. Chlorhexidine gluconate, upper fourth premolars; brushing for 30 seconds formulated as an oral rinse and a gel, is anFigure 4— Daily tooth brushing is thebest way for pet owners to promote good on each side of the mouth should be sufficient. excellent oral disinfectant. The chlorhexidineoral hygiene. Several commercial diets have been binds to gingival tissue, where it can then exert scientifically researched and shown to its antibacterial effects over 24 to 48 hours. significantly reduce plaque and tartaris introduced into a periodontal surgical site compared with “regular” dry diets. Pet foods Referencesto retard the initial soft-tissue reattachment labeled with the Veterinary Oral Health 1. Harvey CE, Emily PP: Small Animal Dentistry. St. Louis, Mosby, 1993, p 89.and allow true bony regeneration. Such Council (VOHC) seal of approval have 2. Wiggs RB, Lobprise HB: Periodontology, inprocedures are best used in veterinary undergone extensive scientific testing and Wiggs RB, Lobprise HB (eds): Veterinary Dentistryperiodontics when treating deep vertical been shown to be effective. Principles and Practice. Philadelphia, Lippincott,defects on the palatal aspects of the maxillary Rawhide treats for dogs are readily available 1997, p 193.canine teeth. Advanced study and continuing and are effective in controlling and removing 3. Harvey CE: Management of periodontal disease:education are recommended before plaque and tartar from dogs’ teeth. Rawhide is Understanding the options. Vet Clin North Am Small Anim Pract 35(4):819–836, 2005.attempting these procedures. highly digestible and has not been observed to 4. Holmstrom SE, Frost-Fitch P, Eisner ER: Teeth in the end stage of periodontal cause digestive problems in the numerous Veterinary Dental Techniques, ed 3. Philadelphia,disease (stage 5) are generally considered studies documenting its antiplaque effects. WB Saunders, 2004.candidates for extraction. Teeth that have Various types and designs of compressed 5. Bellows J: Small Animal Dental Equipment, Materialbeen this severely compromised are no longer rawhide and other chew toys have also been and Techniques. Ames, IA, Blackwell Publishing, 2004.helping the animal’s masticatory function. shown to be beneficial for promoting good 6. Carmichael DT: How to perform a surgicalOwner consent should always be secured oral health. Some chew toys on the market extraction. Vet Med 100(7):476–482, 2005.before extracting any of their pet’s teeth. today are not recommended because of their 7. Carmichael DT: How to perform a nonsurgicalExtraction of teeth for periodontal disease tendency to cause tooth fractures. Such extraction. Vet Med 100(5):341–346, 2005.Treatment of Canine Atopy (continued from page 4)administered on an empty stomach (1 hour limitations of this therapy include the cost SUMMARYbefore or 2 hours after feeding for optimal and possible adverse effects, most often Single-modality therapy may beabsorption. The drug is typically administered gastrointestinal problems (vomiting and/or unsuccessful in treating atopic dogs. The idealdaily for 30 days followed by alternate-day diarrhea). Administering the drug with a small treatment usually involves the integration oftreatment for the next month. Maintenance amount of food may improve this problem, and multiple therapeutic alternatives with thetherapy is then initiated based on clinical tolerance may develop with repeated therapy. attempt to reduce the need for glucocorticoidresponse; the goal is to use the lowest amount CsA is used in select cases, usually in dogs in therapy to a minimum. Variation of symptomnecessary to control the clinical signs (e.g., which control is difficult to achieve through intensity may be variable, depending upon the3 days/week). more conventional means. Recombinant animal reactivity, presence of problematic Successful response has also been achieved interferon-Ω has been investigated as an allergens, and the individual’s pruriticusing a reduced dosage (<5 mg/kg) by immunomodulator and may demonstrate threshold. Chronic monitoring of atopic dogsintegrating ketoconazole at 2.5 mg/kg/day, some application following further evaluation. is essential for maximal outcome. Recognitionwhich interferes with the excretory pathway of The cost of this treatment may be prohibitive of concurrent pruritic skin disease and itsthe CsA (cytochrome P-450 enzymes). The except in unusual circumstances. elimination is necessary for successful control. HARTZ® COMPANION ANIMALSM • NOVEMBER 2005 • VOL. 3, NO. 4 7
  8. 8. Albert Ahn, DVM, is Corporate Vice President, Research & Development at The Hartz Mountain Corporation. ASK TH E VETQ How is Hartz helping pets and people affected by the recent hurricanes? year’s supply of parasite control products, assorted toys, a collar and leash, vitamins, and food and water bowls. Hartz Introduces Hartz® VetPals™A Welcome Home Hartz Baskets for Pets Hartz is also supporting American Veterinary Medical Foundation NBC’s “The Today Show” and Habitat for Humanity International (AVMF) efforts through the introduction of Hartz® VetPals™. These joined forces in an unprecedented effort to help the Gulf Coast rebuild cute plush dog toys were developed to help raise funds for the AVMF, one nail at a time. During the last week in September, Rockefeller Plaza which has helped save thousands of animals from hurricanes, fires, became “Humanity Plaza” for 5 days as homes were built around the floods, earthquakes, and other disasters. The Hartz® VetPals™ represent clock for families displaced by Hurricane Katrina. The Hartz Mountain six different animal species—parrot, cat, dog, gerbil, rabbit, and horse— Corporation, in conjunction with the American Veterinary Medical and wear green scrub shirts with the AVMA logo. Each toy comes with Association (AVMA), will be giving each Habitat for Humanity home a a descriptive tag that tells a dramatic animal rescue story and explains welcome home basket for the family’s pet. Each basket will contain the AVMF’s mission. A portion of the proceeds from each of the various Hartz® products, such as a food/water bowl, leash/collar, toys, Hartz® VetPals™ sold will be donated to the AVMF. treats, and vitamins. Hartz Contributes to Friends of Amigo’s “Be Kind” Collars Hartz Helps Hurricane Hounds Hartz is a proud contributor to the Friends of Amigo Foundation’s Be Quarantined in New Jersey Kind collar campaign. Be Kind collars are light blue canine collars worn Hartz is also working with local aid organizations to provide relief for to support the animal victims of Hurricane Katrina. Proceeds from the hurricane-displaced dogs that are being brought to the Garden State. sale of these collars will be donated to the Humane Society of the So far, 19 dogs displaced by the recent hurricanes were sent from a United States’ rescue fund. rescue site in Louisiana to Sussex County, New Jersey. For safety The 24-inch collars are made of silicone and imprinted with the purposes, the dogs are being quarantined for a 2-week period. slogan “Be Kind.” They can be easily cut to fit any sized dog. Matching Hartz has provided a range of products to help keep the dogs bracelets are also available for humans. Hartz donated several thousand healthy during their quarantine. Hartz donated Hartz® Advanced Care components that were used to create these collars, which are on sale at 4 in 1 Flea and Tick Drops, Rid Worm chewable tablets, and Rid-Flea www.bekind.org at a cost of $3 each. shampoo. In addition, basic supplies such as water and food bowls, collars, and leashes were also provided to help support the effort. Hartz and Its Employees Donate to Red Cross After the quarantine is lifted, these dogs will be assigned through Hartz and its employees donated $50,101 to the American Red Cross’ St. Hubert’s Animal Shelter and made available for adoption. Each Hurricane Katrina Relief Fund Effort through a matching contribution adopted dog will receive a Hartz Doggie Basket, which will contain a program. Additional newsletters may be obtained by contacting us at feedback@hartz.com or by phone at 800-275-1414.Veterinary Learning Systems PRESORTED STANDARD780 Township Line Road U.S. POSTAGEYardley, PA 19067 PAID BENSALEM, PA PERMIT #118 402186