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.

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 atopy
is a common dermatologic problem observed scabies. Allergic otitis externa is commonly is diagnosed based on historical and clinical
in 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 STRATEGIES
proteins, which results in disease, most including conjunctivitis, epiphora, and Atopic dermatitis is typically a life-long
commonly allergic dermatitis. Access to these possibly secondary complications of infectious disease and characteristically intensifies with
proteins is now believed to be primarily via conjunctivitis with mucopurulent discharge. age, showing less responsiveness to commonly
skin absorption; common allergens include Most animals demonstrate a seasonal pattern used drugs over time. In addition, the
grass, tree, and weed pollens; mold spores; before progressing to a nonseasonal (year- development of complicating problems
house dust; dust-mite antigen; insects; round) problem. Eventually, as many as 75% becomes more prevalent. Therapy may be
and 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), and
disease. 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 been
more prevalent or that have an increased cases of chronic atopic dermatitis with shown to be helpful in controlling allergen
presence 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 that
characteristically observed in dogs between 6 may be seen include demodicosis and
months 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 allergic
and as old as 7 years of age. Predominant diseases may occur with canine atopy. Flea Canine Periodontal Disease........ 5
features 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. 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 has
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• NOVEMBER 2005 • VOL. 3, NO. 4

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 of
Figure 3— Allergic pododermatitis is that are problematic for a given animal. In allergens, thereby prohibiting its use in
often seen as part of the triad of general, 65% to 75% of dogs treated with many practices. Interpretation of test results
distribution patterns (face, ears, and feet) ASIT show a good to excellent response. requires correlation with the historical
seen in canine atopy, as shown in the dog These animals classically require integration features of the disease, with particular
from Figure 1. Concurrent Malassezia
of antihistamines, essential fatty acids, and reference to seasonal episodes of clinical signs.
pododermatitis is an important secondary
problem. 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 70
also 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 allergen
intermediate 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 the
atopic animals. Not only does it have an season of itchiness exceeds 3 months/year. need for drug withdrawal, sedation, and hair
antipruritic 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 many
before percutaneous absorption occurs. has been used in younger dogs with severe reputable laboratories can identify levels of
Shampoos are commonly integrated in problems and in which other diseases have circulating anti–allergen IgE. Techniques
this 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 given
chemicals, such as pramoxine, diphen- used in therapy is based on the results of geographic area may be quite different among
hydramine, or hydrocortisone. Shampoo serum and/or intradermal allergy testing laboratories, and the array of allergens must
therapy 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 rather
the bath. Rinses, leave-on conditioners, and
sprays may be more effective because of their
residual effect; such products may contain TABLE 1: Common Nonsteroidal Drugs Used in the
colloidal oatmeal or antipruritic chemicals Treatment of Pruritic Dogs
such as an analgesic, antihistamine, Agent Oral Dose
or glucocorticoid. The use of a low-
concentration triamcinolone spray has been Amitryptyline 1–2 mg/kg bid
helpful as adjunctive treatment. The goal of Astemizole 0.25 mg/kg bid
topical therapy is to decrease the need for Cetirizine 0.5–1.0 mg/kg or 5–10 mg once or twice/day
systemic therapy, particularly in avoiding Chlorpheniramine 4–12 mg bid–tid
increased dependency on glucocorticoids. Clemastine 0.05–0.1 mg/kg bid
Topical therapy also allows specific regions Cyproheptadine 0.3–2.0 mg/kg bid
of pruritus to be targeted without systemic Diphenhydramine 2.2 mg/kg tid
therapy. Doxepin hydrochloride 3–5 mg/kg bid
Fluoxetine 1 mg/kg/day for 4 wk, then adjust (controversial results
Allergen-Specific Immunotherapy with limited response in most cases)
ASIT is commonly known as Hydroxyzine hydrochloride 2.2 mg/kg tid (hydroxyzine pamoate may be used
hyposensitization treatment. It includes instead of HCl in the 25- and 50-mg size to avoid
parenteral administration of the same proteins higher costs)
to which the animal has known allergic Loratadine 0.25–0.50 mg/kg q24h
reactivity. 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-daily
immunologic response of Th2 cells, which therapy every other day)
signal B cells to produce the IgE. By
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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)
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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 be
disease seen in small animal practice, affecting by the accumulation of plaque bacteria on addressed under anesthesia. Only when
an estimated 80% of canine patients over the the tooth surface. In humans as well as in the patient has been anesthetized and a
age of 5.1 Left untreated, periodontal disease animals, certain bacteria have been labeled complete assessment of the oral cavity has
can cause oral pain, tooth loss, and systemic periodontopathogens and have been implicated been performed can an updated and accurate
disease from anorexia or bacteremia. Most as being primarily responsible for the bulk of account of the patient’s problems and
cases 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 necessary
tissues that attach the teeth to the jaws. These periodontopathogen. In the canine species, it treatments) can never be fully appreciated
structures 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 periodontal
and periodontal ligament. In periodontal However, it is an oversimplification to think disease, but the presence or absence of bad
disease, these tissues become progressively of periodontal disease as an infection by a breath does not specifically indicate a given
diseased 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 anaerobes
of periodontal disease not as “tooth disease” but specifically when directing therapy against Stage 1: Early Gingivitis
rather 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 accumulation
by a progressive loss or destruction of the as a patient’s age, diet, chewing habits, and mild hyperemia of the gum margins
periodontal tissues. The initial stage of the occlusion, and size, can determine the (marginal gingiva). This “reddening” of the
disease, gingivitis, is limited to the gingival eventual outcome of periodontal disease in gums is the earliest detectable sign of
tissues. 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 presence
deeper periodontal tissues (periodontal of plaque on the teeth. Plaque bacterial Stage 2: Established Gingivitis
ligament, alveolar bone, and cementum) endotoxin and other bacterial byproducts Stage 2 periodontal disease is characterized
become affected. In reality, the progression can primarily cause tissue destruction, but by plaque and/or calculus accumulation and
from health to gingivitis and then to the body’s inflammatory response, mounted hyperemia and edema (swelling) of the
periodontitis is not always a gradual linear by the oral immune system, can also be a marginal gingiva. Gentle probing of the
event, but this concept of progression can be significant factor in the degree of tissue gingival sulcus with a periodontal probe may
used to help understand the disease and inflammation and destruction. An over- induce bleeding, but the gingival sulcus (or
recommend 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 abnormalities
irreversible. This underscores the need for it in the first place. associated with this stage (Figure 1).
early intervention to prevent irreversible
destructive changes. Once irreversible perio- DIAGNOSIS Stage 3: Early Periodontitis
dontitis has occurred, effective treatments Periodontal disease is an ongoing process In stage 3 periodontal disease, the
can still be implemented to eliminate that can be broken down into stages for the deeper periodontal structures start to become
inflammation and halt further progression. purposes of diagnosis and treatment. In many diseased. Exaggerated gingival inflammation
In severe cases, tooth extraction is the only instances, the extent of disease is not evident may be seen clinically, but the deepening
solution. until the patient is examined (including of the periodontal pockets, especially on
periodontal probing and radiography) under the palatal side, may be evident only on
ETIOLOGY 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. 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 barrier
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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 an
Figure 4— Daily tooth brushing is the
best way for pet owners to promote good on each side of the mouth should be sufficient. excellent oral disinfectant. The chlorhexidine
oral 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 tartar
is introduced into a periodontal surgical site compared with “regular” dry diets. Pet foods References
to 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, in
procedures are best used in veterinary undergone extensive scientific testing and
Wiggs RB, Lobprise HB (eds): Veterinary Dentistry
periodontics 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, Material
been 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 surgical
Owner 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 nonsurgical
Extraction 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 SUMMARY
before or 2 hours after feeding for optimal and possible adverse effects, most often Single-modality therapy may be
absorption. The drug is typically administered gastrointestinal problems (vomiting and/or unsuccessful in treating atopic dogs. The ideal
daily for 30 days followed by alternate-day diarrhea). Administering the drug with a small treatment usually involves the integration of
treatment for the next month. Maintenance amount of food may improve this problem, and multiple therapeutic alternatives with the
therapy is then initiated based on clinical tolerance may develop with repeated therapy. attempt to reduce the need for glucocorticoid
response; the goal is to use the lowest amount CsA is used in select cases, usually in dogs in therapy to a minimum. Variation of symptom
necessary to control the clinical signs (e.g., which control is difficult to achieve through intensity may be variable, depending upon the
3 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 pruritic
using a reduced dosage (<5 mg/kg) by immunomodulator and may demonstrate threshold. Chronic monitoring of atopic dogs
integrating ketoconazole at 2.5 mg/kg/day, some application following further evaluation. is essential for maximal outcome. Recognition
which interferes with the excretory pathway of The cost of this treatment may be prohibitive of concurrent pruritic skin disease and its
the 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. Albert Ahn, DVM, is Corporate Vice President, Research &
Development at The Hartz Mountain Corporation.
ASK TH E VET
Q 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.
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