Is a 20% reduction in calculus likely to make any significant difference in the progression of periodontal disease?

RE: Is a 20% reduction in calculus likely to make any significant difference in the progression of periodontal disease?

Arlo Guthrie — Thu, 21 Apr 2022 07:44:08 GMT

[quote userid="4331" url="~/001/veterinary-clinical/small-animal/dentistry/f/discussions/30271/is-a-20-reduction-in-calculus-likely-to-make-any-significant-difference-in-the-progression-of-periodontal-disease/237006#237006"]I wrote a lengthy discourse at lunchtime and it seems not to be here ! [/quote]

Hi Norman Johnston - I think that you posted it under the story? https://www.vetsurgeon.org/news/b/veterinary-news/posts/animalcare-launches-plaqtiv-dental-care-range.

RE: Is a 20% reduction in calculus likely to make any significant difference in the progression of periodontal disease?

Norman Johnston — Thu, 21 Apr 2022 07:39:42 GMT

I spent some time today looking into this. The reference for VOHC is just the list of what a product requires to be evaluated.

The VOHC does not list Plaqtiv and it's not on the Animalcare site either. The VOHC did list a product called Tropicare in 2021 which this might be with the following contents. Active Ingredients per ½ capful (5ml): Cetylpyridinium Chloride (4mg), Green Tea Extract (0.6mg), Zinc Gluconate (0.5mg) Inactive Ingredients: Citric Acid, Glycerin, Sodium Benzoate, Water.
If information is that hard to find with disingenuous references it almost looks like they don’t want you to know what’s in it.

Personally I like a company that introduces a “novel” product to the UK to be up front and transparent about it and ensure sales staff are fully briefed and able to answer the hard questions.

A company a few years back introduced a vet version of Arm and Hammer toothpaste. This contains sodium bicarbonate. Humans rinse and spit while dogs swallow their toothpaste. Had this potential overload of salts been checked? I asked and never got an answer and shortly after it seemed to disappear.

if you are potentially going to stock something I’d make sure that it has a real benefit for your patient and can explain what it does to the owner. They deserve nothing less from a vet professional

RE: Is a 20% reduction in calculus likely to make any significant difference in the progression of periodontal disease?

Norman Johnston — Thu, 21 Apr 2022 07:38:06 GMT

I’m going to try and access the VOHC submission to find out a bit more. The reduction in calculus is not the big picture. A consistent reduction in plaque on a daily basis is what would be useful. Plaque becomes pathogenic over time - not much time usually - whereby calculus is inert and forms more slowly on top of undisturbed plaque. In itself the significance of calculus is the rough surface that encourages more plaque to form, apart from being unsightly. My initial thoughts were that the aims are nothing new and unless the chemistry is novel I’m not overly impressed.
Having said that anything that adds to the armoury and engages the owner is worthwhile but nothing - absolutely nothing- compares to daily brushing.
A wee story. I didn’t brush my own dog’s teeth that diligently and every 6-9 months he accumulated enough calculus to make a dental procedure necessary. The last thing I did as a real vet was to clean his teeth. Since that date more than three years ago I’ve brushed his teeth daily and he still doesn’t need a dental procedure anytime soon. Although brushing is only the buccal surfaces the toothpaste seems to have enough of a calculus retarding effect to remove the calcium and other minerals from tye mouth and slow down calculus formation.
So the real story might be putting more resources into education of owners assisting them getting brushing going rather than some spray or additive that can’t really match the brush for effectiveness. It’s always easier to sell something that has a grand claim than take the time and effort to educate, motivate and assist an owner.
The bottom line always is that brushing is cheap and very effective.

The toothpaste I use is Virbac enzymatic. It’s been around since the late 1980’s.

RE: Is a 20% reduction in calculus likely to make any significant difference in the progression of periodontal disease?

Norman Johnston — Wed, 20 Apr 2022 18:51:47 GMT

Good replies both Evelyn and Paul

I wrote a lengthy discourse at lunchtime and it seems not to be here !

RE: Is a 20% reduction in calculus likely to make any significant difference in the progression of periodontal disease?

Paul Cooper — Wed, 20 Apr 2022 18:09:26 GMT

Evelyn, you have written an answer that should be compulsory reading for any veterinary surgeon offering small animal dentistry to clients. I become very depressed as (currently) a locum when practices have booked in dental cases for me and I ask where their sub-gingival curette is. "What is that" or "Why do you want/ need one of those, it's only a scale and polish" are typical replies. When teaching new graduates I try to emphasise that they remove the coronal calculus for the benefit of the client, but MUST remove the subgingival calculus and plaque for the benefit of the patient. Your text succintly reminds everyone where the real danger lies - well done.

RE: Is a 20% reduction in calculus likely to make any significant difference in the progression of periodontal disease?

George Cooper — Wed, 20 Apr 2022 18:03:19 GMT

A concise Masterclass in oral misdemeanours - which I wish I had had unrolled before me many moons ago, prior to "retirement". Thank you Evelyn, for both the content and the style of delivery.

I await further discussions from other erudite dental practitioners.

RE: Is a 20% reduction in calculus likely to make any significant difference in the progression of periodontal disease?

Evelyn Barbour-Hill — Wed, 20 Apr 2022 16:37:16 GMT

The swift answer to the question that forms the title to this thread is: NO.

But let us discuss this further.

The question raises a dozen more questions!

Let us assume for the moment that calculus is important. What does "a 20% reduction" mean? That one tooth in five loses all its calculus while the others are unchanged? That all the teeth lose one-fifth of their calculus? If the latter, is it that the calculus still covers the same areas, but is only 80% of the thickness? Is it that 20% of the area previously holding calculus becomes free of calculus? If the latter, which area becomes free? Just random, or the more coronal areas, or the area close to the gum line, or what?

Or maybe this "20% reduction" means that following a professional Complete Oral Health Assessment and Treatment (COHAT) calculus forms again but at only 80% of the rate? Or maybe just as rapidly but on only 80% of the area?

Next question: if we assume that calculus is a primary cause of periodontal disease, what reduction in periodontal disease would result from 20% reduction in calculus? Nobody can say, without doing the research and actually measuring it.

Next question: is calculus pathogenic? If not, can it be an aggravating factor? If not, is it of any significance other than a cosmetic one? To which I reply, and you can argue if you wish, that calculus is not pathogenic. Calculus is dead. It is a sort of mineral accretion based considerably upon the bodies of dead bacteria. How can it do harm? It is rough, and a great place for fresh plaque to form – sometimes. If very thick and rough it can abrade the overlying cheek, and even cause ulceration as it holds a layer of plaque against that cheek – sometimes (it doesn't always – sometimes very thick calculus is also very smooth. There are probably a number of factors involved here). It can if thick form a sort of lip overlapping the gum margin, trapping plaque and encouraging the formation of thick "matue" plaque.

So, it's not pathogenic but it can aggravate periodontal disease.

True, since calculus can reasonably be described as mineralised dead plaque, it is quite a useful indicator when it forms that plaque removal is not being achieved, either generally or in a certain spot. No plaque means no calculus; but it doesn't work the other way. An absence of calculus does not mean an absence of plaque!

Periodontal disease is caused by plaque. Plaque is a very complex biofilm that develops on the surface of teeth. (Periodontal disease is not an infection, it is the result of the interactions between the biofilm and the host tissues – fortunately, we don't need to go into that on this thread). To be more exact, periodontal disease is caused by plaque in the gingival cleft: that little tiny valley between tooth and free gingiva is where it all happens.

Plaque on more coronal parts of the tooth may be unpleasant but is of almost no significance to periodontal health. Clearly, if all plaque can be removed from the gingival cleft and immediately adjacent, and its subsequent re-formation slowed down (re-formation cannot be prevented!); if the plaque in the gingival cleft can be constantly disturbed and harassed so that it never gets thick and mature (which is the whole aim of toothbrushing); thse measures are very significant to periodontal health.

So, if a product has been demonstrated to achieve x percentage decrease in plaque it might be an aid to periodontal health. Or it might not. As I said when talking about calculus, what does "percentage reduction" actually mean? And which plaque has been "reduced" – high coronal plaque (little significance), or subgingival plaque (great significance), or what? And having settled those questions, we are still left with the big one: what is the mathematical relation between percentage reduction in plaque and reduction in periodontal disease? NOBODY KNOWS. I'm sure it is not linear. I'm pretty sure that there is a certain threshold that has to be crossed – i.e. up to a certain level, reduction in plaque will not have the slightest effect on periodontal disease. My guess is that this threshold is quite high.

There is a plethora of "dental" products for cats and dogs. For some of them the manufacturers have taken the trouble to have their claims of "calculus reduction" approved by the Veterinary Oral Health Council. This means almost nothing for periodontal health. Considerably fewer products have had claims for "plaque reduction" approved. That's good, but the trouble is, there is no saying whether they do any good for periodontal health. The scientific staff of the more reputable manufacturers will admit this, if you ask them directly. But in promotion to the public, and indeed to this profession, there's no mention of it. The marketing people are not that daft.