VDEC · Created Date: 5/29/2010 10:35:49 AM
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Drinking Water Additive Decreases Plaque andCalculus Accumulation in Cats David E.Clarke, BVSc, MACVSc Introduction Periodontal disease is diagnosed commonly in companion animal practice in adult cats.l2 There is a direct relationship betweenthe development of periodontal disease, in particular gingivitis, and accumulation of dental plaque on the tooth surface.3 Gingivitis is reversible and can be prevented with thorough plaque removal by the veterinarian and continued supragingival plaque control by the cat owner.a Plaque confrol by mechanical removal during toothbrushing with a toothpaste continues to be the most effective and widely employed oral hygiene method in humans.sHowever, toothbrushing may be technically difficult for many cat o\ryners, resulting in low compliance and ineffective plaque removal. The use of a drinking water additive may improve oral health in cats. The purpose ofthe study reported here was to evaluate the reduction in plaque and calculus accumulation using a commercially available drinking water additive" containing xylitol. Materials and Methods Adult male and female domestic shorthair cats (n : 30), ranging in age from 2 to l4-years, were initially used rn this study. The cats were considered in good health based on physical examination and the results of laboratory tests (full hematology examination, biochemistry analysis, urina$sis). The cats were privately owned by two clients and were housed at their individual homes throughout the study period. The study was performed in accordance with guidelines proposedby the VeterinaryOral Health Council (VOHC).6 The study was conducted as a two-period, parallel crossovertrial. Each study period consistedof a 56-day test phase. The cats were grouped into two blocks based on their housing arrangements. The cats in the first group received Eukanuba adult chicken and rice dry biscuitso and fresh untreated water each day during the initial test phase.The cats in the second group received the same biscuits,but had access to fresh drinking water treated with xylitol at 0.005 o/o eachday. Drinking water was supplied from the owner's household source located in Melbourne, Australia and supplied ad libitum throughout the studyperiod. Biscuits were fed to eachcat based on calculatedbody weight and basal requirements. No other food or dental hygiene products were provided during the study period. Cats received professional teeth cleaning (including supra-and subgilrgivalscaling) and tooth polishing at the start ofeach test phase to ensure the absence ofplaque and calculus on tooth surfaces and to insure all cats startedeach test phase at the sameoral health baseline. All catswere anesthetized for teeth cleaning, as well as for plaque and calculus evaluations, which were performed at the end of each test phase.At the initial evaluation, assessment of periodontal probing depth (PPD) and probing attachmentlevel (PAL) demonstrated that periodontal disease was absent. All cats had full dentition and did not have grossly visible dental resorptive lesions. For all teeth scored, the PPD did not exceed 0.5-mm and there was no attachment loss using the cementoenamel junction as a reference point. Oral examination and professional teeth cleaning were performed following the administration of a general anesthetic. Cats received intravenous Hartmanns solution" via a cephalic cathetet'; premedication using a combinationof buprenorphine" (0.008 mg/kg SQ), acepromaziner(0.05 mglkg SQ), and glycopyrrolatee (0.01mg/kg SQ); inductionusing a combination of ketamineb (5 mglkg IV) and diazepam' (0.25 me&g IV); followed by maintenancewith isoflurand in oxygen via an endotracheal tube. Fourteen teeth were scored in each cat including the maxillary canine, and third and fourth premolar teeth; and mandibular canine, third and fourth premolaq and first molar teeth bilaterally. During the second test phase, cat #19 escaped out of the ffont door of the owner's house and was subsequently involved in a car accident, which resulted in the catb death. The mean tooth scores (Table1) andthe total mouth meanscores (Table 2), which involve the statisticalcomparisons, do not include data flom cat #19. The final resultswere recorded using 29 cats.Each of the 29 cats were involved in both 56-daytestphases, and therefore each cat had access to the untreatedwater during one test phase and water treated with the additive during the other test phase. This study designallowed eachcat to act as its own control. One-way analysis of variance (ANOVA) was used to compare the test regimes for differences in the plaque and calculus measurements. Comparisonsbetween the individual group mean scores for plaque and calculus were performed J.VET.DENT. Vol.23No.2 June2006
Transcript of VDEC · Created Date: 5/29/2010 10:35:49 AM
Drinking Water Additive Decreases Plaque and CalculusAccumulation in Cats
David E. Clarke, BVSc, MACVSc
IntroductionPeriodontal disease is diagnosed commonly in companion
animal practice in adult cats.l2 There is a direct relationshipbetween the development of periodontal disease, in particulargingivitis, and accumulation of dental plaque on the toothsurface.3 Gingivitis is reversible and can be prevented withthorough plaque removal by the veterinarian and continuedsupragingival plaque control by the cat owner.a Plaque confrolby mechanical removal during toothbrushing with a toothpastecontinues to be the most effective and widely employed oralhygiene method in humans.s However, toothbrushing may betechnically difficult for many cat o\ryners, resulting in lowcompliance and ineffective plaque removal. The use of adrinking water additive may improve oral health in cats. Thepurpose ofthe study reported here was to evaluate the reductionin plaque and calculus accumulation using a commerciallyavailable drinking water additive" containing xylitol.
Materials and MethodsAdult male and female domestic shorthair cats (n : 30),
ranging in age from 2 to l4-years, were initially used rn thisstudy. The cats were considered in good health based onphysical examination and the results of laboratory tests (fullhematology examination, biochemistry analysis, urina$sis).The cats were privately owned by two clients and were housedat their individual homes throughout the study period. Thestudy was performed in accordance with guidelines proposed bythe Veterinary Oral Health Council (VOHC).6
The study was conducted as a two-period, parallelcrossover trial. Each study period consisted of a 56-day testphase. The cats were grouped into two blocks based on theirhousing arrangements. The cats in the first group receivedEukanuba adult chicken and rice dry biscuitso and freshuntreated water each day during the initial test phase. The catsin the second group received the same biscuits, but had access
to fresh drinking water treated with xylitol at 0.005 o/o each day.Drinking water was supplied from the owner's household sourcelocated in Melbourne, Australia and supplied ad libitumthroughout the study period. Biscuits were fed to each cat basedon calculated body weight and basal requirements. No otherfood or dental hygiene products were provided during the studyperiod.
Cats received professional teeth cleaning (includingsupra- and subgilrgival scaling) and tooth polishing at the startofeach test phase to ensure the absence ofplaque and calculuson tooth surfaces and to insure all cats started each test phaseat the same oral health baseline. All cats were anesthetized forteeth cleaning, as well as for plaque and calculus evaluations,which were performed at the end of each test phase. At theinitial evaluation, assessment of periodontal probing depth(PPD) and probing attachment level (PAL) demonstrated thatperiodontal disease was absent. All cats had full dentition anddid not have grossly visible dental resorptive lesions. For allteeth scored, the PPD did not exceed 0.5-mm and there was noattachment loss using the cementoenamel junction as areference point.
Oral examination and professional teeth cleaning wereperformed following the administration of a general anesthetic.Cats received intravenous Hartmanns solution" via a cephaliccathetet'; premedication using a combination of buprenorphine"(0.008 mg/kg SQ), acepromaziner (0.05 mglkg SQ), andglycopyrrolatee (0.01 mg/kg SQ); induction using a combinationof ketamineb (5 mglkg IV) and diazepam' (0.25 me&g IV);followed by maintenance with isoflurand in oxygen via anendotracheal tube. Fourteen teeth were scored in each catincluding the maxillary canine, and third and fourth premolarteeth; and mandibular canine, third and fourth premolaq andfirst molar teeth bilaterally.
During the second test phase, cat #19 escaped out of theffont door of the owner's house and was subsequently involvedin a car accident, which resulted in the catb death. The meantooth scores (Table 1) and the total mouth mean scores (Table 2),which involve the statistical comparisons, do not include dataflom cat #19.
The final results were recorded using 29 cats. Each of the29 cats were involved in both 56-day test phases, and thereforeeach cat had access to the untreated water during one test phaseand water treated with the additive during the other test phase.This study design allowed each cat to act as its own control.
One-way analysis of variance (ANOVA) was used tocompare the test regimes for differences in the plaque andcalculus measurements. Comparisons between the individualgroup mean scores for plaque and calculus were performed
J.VET.DENT. Vol .23 No.2 June 2006
Mean Tooth Plaque Scores Mean Tooth Calculus Scores
Cat #
12o
4
b
7891011121314tc
to
1718192021222324252627282930
Dry DietOnly
18.2815.858.07
18.8512.858.50
15.5713.2113.1415.4211.8513.147.009.357.92
tc.Jo
6.506.42
DNCS8.719.28
10.218.359.007.859.218.858.787.009.71
Dry Diet andXylitolTreatedWater
6.425.353.215.285.352.924.786.784.575.855.713.715.574.072.003.852.924.00
DNCS4.575.286.856.644.855.285.285.717.855.786.92
Dry DietOnly
3.283.425.502.574.002.925.714.004.354.213.005.354.923.O75.21
11.573.782.50
DNCS3.644.714.288.072.573.213.212.853.144.003.O7
Dry Diet andXylitolTreatedWater
1.351.143.421.001.070.85o.781.711.781.281.001.352.OO1.35o.922.712.282.21
DNCS2.422.213.004.071.782.422.502.282.353.212.28
l
u:::iii:x
Total Mean Tooth Percent ReductionScore +/- SD
Significance WhenCompared to TreatedWater
Plaque Dry Diet Only 10.72 +l- 3.48 52.58 % P < 0.001
Dry Diet + Xylitol 5.08 +/- 1.36Treated Water
Calculus Dry Diet Only 4.21 +l- 1.86 53.49 "/" P < 0.01
Dry Diet + Xylitol 1.96 +l 0.84Treated Water
J.VET.DENT. Vol.23 No.2 June 2006
using Tukey's multiple comparisons test. A value of P < 0.05was considered significant.
Plaque scores were determined based on visual assessmentof plaque thickness and surface area coverage (%) on the buccalor labial crown surface aided by the applicationof a2 %o eosindisclosing solutionk.T The same examiner graded plaqueaccumulation throughout the test phases. Grading criteria forplaque coverage: 0 : no plaque detected; | : < 25 %;2:25 -50 %; 3 : 50 -7 5 %; 4 : 7 5 - 100 %. Grading criteria for plaquethickness: 1 : light; 2 : medium; 3 : heavy. The buccal toothsurface was divided into gingival and coronal halves. Each toothhalfwas scored for plaque coverage and thickness. The coveragescore was multiplied by the thickness score to obtain a grngivaland coronal plaque score for each halfofthe tooth. The gingivaland coronal plaque scores for each tooth were added to obtain atotal tooth score for each tooth. The total mouth score wasobtained by adding all 14 individual total tooth scores. The totalmean tooth score was obtained by dividing the total mouth scoreby 14.
Calculus scores were determined based on visualassessment ofcalculus thickness and surface area coverage (7o)on the buccal or labial crown surface.'The disclosing solutionwas removed from the tooth srnface with a toothbrush, followedby rinsing with water and air drying. The same examiner gradedcalculus accumulation throughout the test phases. Gradingcriteria for calculus coverage: 0: no calculus detected; I : <
25%; 2 -- 25 - 50 %; 3 : s0 -7s %; 4 : 75 - 100 %. Granngcriteria for calculus thickness: I : ( < 0.5-mm );2: ( 0.5 - 1.0mm ); 3 : ( > lmm ). The buccal tooth surface was divided intomesial and distal halves. Each tooth half was scored for calculuscoverage and thickness. The coverage score was multiplied bythe thickness score to obtain a mesial and distal score for eachhalf of the tooth. The mesial and distal calculus scores for eachtooth were added to obtain a total tooth score for each tooth. Thetotal mouth score was obtained by adding all 14 individual totaltooth scores. The total mean tooth score was obtained bydividing the total mouth score by 14.
ResultsAll cats accepted and readily drank the treated water. When
cats had access to the treated water, each individual cat as wellas the whole group had significantly less plaque and calculusaccumulations than when they had access to untreated water(Table 1). For cats drinking untreated water, the mean toothplaque score was 10.7 +l- 3.5 compared with a mean toothplaque score of 5.1 +l- 1.4 when drinking treated water. Plaqueaccumulation decreased by 52.3 % when drinking treated water.For cats drinking untoeated water, the mean tooth calculus scorewas 4.2 +/- |.9 compared with a mean tooth calculus score of2.0 +l- 0.8 when drinking treated water. Calculus accumulationdecreased by 53.5 Yo when drinking treated water (Table 2).
DiscussionPeriodontal disease is a significant disease in client-ormed
domestic breed cats, as plaque rapidly forms on teeth when no
oral hygiene is performed. Although there have been a number
of studies demonstrating the plaque reducing abilities of tooth-
brushing in the dog,&e there are few studies that have beenperformed in the cat.10 In companion animal practice, it is
difficult to convince clients to brush their cats' teeth, andmoreover, the majority of cats resist having their teeth cleanedwith a toothbrush. For these reasons, the compliance of
toothbrushing in client-owned cats is generally 1ow. Therefore,
the use of an effective method that also has positive o'wnercompliance is especially warranted in the cat. The results
reported here demonslrate that a drinking water additiveimproves oral health in the cat.
Xylitol is a five-carbon natural sugar alcohol or pentitol,
which has been shown to have both an antibacterial effect onoral bacteria and dental plaque, as well as anti-calculus formingproperties.l'-r3 The non-fermentability or very low fermentabilityofxylitol by dental plaque leads to a number ofconsequentialphenomena of possible significance that include: uptake by
bacteria and inhibition ofbacterial growth; formation of solubleextracellular polysaccarides that make plaque less adhesive to
the tooth surface; an4 inhibition of spontaneous precipitation ofcalcium phosphate, decreasing the formation and accumulationof dental calculus.t3
The antibacterial ptoperties and the xylitol metabolism of
dental plaque may be interpreted by rurderstanding that dentalplaque contains bacteria. The bacteria, via the fructosephosphotransferase system, take up xylitol. Xylitol ismetabolised into xylitol-5-phosphate within the bacterial cell.Xylitol-5-phosphate inhibits glycolysis and the uptake ofglucose in the cell, which results in inhibition of bacterialgro'ffth.12
It is generally accepted that chewing xylitol sweetened gum
after meals may reduce plaque formation and gingival
inflammation in humans.'n''5 The results of two l2-month
clinical studies showed that xylitol significantly reduced dentalplaque when incorporated into chewing gum or a dentalsnack.r6''7 Subjects in these studies also had less inflammation ofthe periodontal tissues. In another study, the daily use of axylitol-containing chewing gum in humans reduced the weightof plaque formed in comparison to when no chewing gum wasused." [n these trials, the inability of chewing gum per se toremove plaque from the tooth surfaces indicated that thedecrease in plaque formation when using a xylitol-containingproduct was due to the chemical activity of xylitol.
Microbiological studies add validity to these observations.A sigrrificant reduction in Streptococctls mutans, in both plaque
and saliva compared with pre-treatment values, has beenreported in humans chewing xylitol gums for 4-weeks.'eAnother study confirmed a significant decrease in salivaryStreptococcus mutans after 2-monlhs of chewing xylitol-containing gum.'o In general, xylitol has been shown to reducethe bacterial growth rate.''
The xylitol molecule also has the ability to form complexeswith certain cations, such as Ctt, Cri* and Fe'*, based on itspo$ol properties.22 The habitual consumption of xylitol has
J.VET.DENT. Vol.23 No.2 June 2006 81
shown that it not only concentrates calcium in plaque, but alsokeeps calcium ions in a soluble form, reducing calculusaccumulation on the tooth surface.a
In the study presented here, the daily addition of xylitol tothe drinking water of cats significantly reduced theaccumulation of plaque and calculus following professionalteeth cleaning (supra- and subgingival scaling and polishing).The results of this study showed that cats drinking water treatedwith xylitol had approximately half the plaque and calculusaccumulation compared to when they were drinking untreatedwater. Xylitol is a useful adjunct in maintaining the oral healthof cats during the period between professional teeth cleaningprocedures,
" Breathalyser, imRex Ltd, London, Canadao Iams Company, Dayton, Ohio, USA
" Baxter Healthcare Pty Lt4 Old Toongabbie, NSIY Austaliau Optiuu,MedexMedicalLtd,UK
" Temgesic, Reckitt Benckiser, West Ryde, NSW, Australia
' 4.C.P.2, Delvet Pty Ltd, Seven Hills, NSW, Austra.liag Glycosate Vet Injectioru Naturevet, Glenorie, NSW, Ausfaliah Ketamine, Pamell Laboratories, Alexandria, NSW, Austalia
' PamlirL Parnell Laboratories, Alexandria, NSW Australiaj Isorrane, Baxter Healthcare Pty Ltd, OldToongabbie, NSWIAustalia
" Plaque disclose gel, Professional Dental Supplies, BayswaterNorth,
Victoria, Australia
Author InformationDental Care for Pets, 55 Belgrave-Hallam Road, Hallarn, Victori4Austnali4 3803.Email: [email protected].
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