Breathalyser PLUS Water Additive (500 mL)

Drinking Water Additive Decreases Plaque and Calculus Accumulation in Cats

David E. Clarke, BVSc, MACVSc

Introduction

        Periodontal disease is diagnosed commonly in companion animal practice in adult cats. There is a direct relationship between the development of periodontal disease, in particular gingivitis, and accumulation of dental plaque on the tooth surface. Gingivitis is reversible and can be prevented thorough plaque removal by the veterinarian and control by the cat owner. Plaque control continues to be the most effective and widely employed oral hygiene method in humans. However, tooth brushing may be technically difficult for many cat owners, resulting in low compliance and ineffective plaque removal. The use of a drinking water additive may improve oral health in cats. The purpose of the 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), ranting in an age from 2 to 14-years, were initially used in this study. The cats were considered in good health based on physical examination and the results of laboratory tests (full hematology examination, biochemistry analysis, urinalysis). The eats 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 proposed by the Veterinary Oral Health Council (VOHC).

        The study was conducted as a two-period, parallel crossover trial. Each study period consisted of a 56-day test phase. The cats were gouped into two blocks based on their housing arrangements. The cats in the first group received Eukanuba adult chicken and rice dry biscuits 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% each day. Drinking water was supplied from the owner’s household source located in Melborne, Australia and supplied ad libitum thought the study period. Biscuits were fed to each cat based on calculated body weight and basal requirements. No other food or dental hygiene products where provided during the study period.

        Cats received professional teeth cleaning (including supra- and subgigvival scaling) and tooth polishing at the start of each test phase to ensure the absence of plaque and calculus on tooth surfaces and to insure all cats started each test phase at the same oral health baseline. All cats were 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 (PDD) and probing attachment level (PAL) demonstrated that periodontal disease was absent. All cats had full dentition and did not have grossly visable dental resorptive lesions. For all teeth scored, the PPD did not exceed 0.5-mm and there was no attachment loss using the comentoenamel junction as a reference point.

        Oral examination and professional teeth cleaning were performed following the administration of a general anesthetic. Cats received interavenous Hartmanns solution via a cephalic catheter; permediction using a combination of buprenorphine (0.008 mg/kg SQ), acepromazine (0.05 mg/kg SQ), and Glycopyrrolate (0.01 mg/kg IV) and diazepam (0.25 mg/kg IV); followed by maintenance with isoflurane in oxygen via an including the maxillary canine, and third and fourth premolar teeth; and, mandibular canine third and fourth premolar, and first molar teeth bilaterally.

        During the second test phase, cat #19 escaped out of the front door of the owner’s house and was subsequently involved in a car accident, which resulted in the cat’s death. The mean tooth scores (Table 1) and total mouth mean scores (Table 2), which involve the statistical comparisons, do not include data from cat #19.

        The final results were recorded using 29 cats. Each of the 29 cats were involved in both 56-day test phaases, and therefore each cat had access to the untreated water during one test phase and 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 to compare the test regimes for differences in the plaque and calculus measurements. Comparisons between the individual group mean sources for plaque and calculus were performed using Tuke’s multiple comparisons test. A value of P < 0.05 was considered significant.

        Plaque scores were determined based on visual assessment of plaque thickness and surface area coverage (%) on the buccal or labial crown surface aided by the application of a 2 % eosin disclosing solution. The same examiner graded plaque accumulation thought the test phases. Graded criteria for plaque cover: 0 = no detected; 1 = < 25 %; 2 = 25 – 50 %; 3 = 50 – 75 %; 4 = 75 – 100%. Grading criteria for plaque accumulation through the test phases. Grading criteria for plaque thickens: 1 = light; 2 = medium; 3 = 3 heavy. The buccal tooth surface was divided into gingival and coronal halves. Each tooth was surface was divided into gingival and coronal halves. Each tooth half was scored for plaque coverage and thickness. The coverage score was multiplied by the thickness score to obtain a gingival and coronal plaque scores for each tooth were added to obtain a total tooth score for each tooth. The oral mouth score was obtained by adding all 14 individual total mouth score by 14.

        Calculus scores were determined based on visual assessment of calculus thickness and surface area coverage (%) on the buccal or labial crown surface. The disclosing solution was removed from the tooth surface with a toothbrush, followed by rinsing with water and air drying. The same examiner graded calculus accumulation through the test phases. Grading criteria for calculus coverage: 0 = no calculus detected; 1 = < 25%; 2 = 25 – 50 %; 3 = 50 – 75 %; 4 = 75 – 100%. Grading criteria for plaque thickens: 1 = light; 2 = medium; 3 = 3 heavy. The coverage score was multiplied by the thickness score to obtain a mesial and distal score for each half of the tooth. The mesial and distal calculus scores for each tooth were added to obtain a total tooth score for each tooth. The total mouth score was obtained by adding all 14 individual total tooth scores. The total mean tooth score was obtained by dividing the total mouth score by 14.

Results

        All cats accepted and readily drank the treated water. When cats had access to the treated water, each individual cat as well as the whole group had significantly for less plaque and calculus accumulations than when they had access to untreated water (Table 1). For cats drinking untreated water, the mean tooth plaque score of 5.1 +/- 1.4 when drinking treated water. Plaque accumulation decreased by 52.3 % when drinking treated water. For cats drinking untreated water, the mean tooth calculus score was 4.2 +/- 1.9 compared with a mean tooth calculus score of 2.0 +/- 0.8 when drinking treated water. Calculus accumulation descred by 53.5 % when drinking treated water (Table 2).

Discussion

        Periodontal disease is a significant disease in client-owned 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, there are few studies that have been performed in the cat. In companion animal practice, it is difficult to convince clients to brush their clients teeth, and moreover, the majority of cats resist having their teeth cleaned with a toothbrush. For these reasons, the compliance of toothbrushing in client-owned cats is generally low. Therefore, the use of an effective method that also has positive owner compliane is especially warranted in the cat. The results reported here demonstrate that drinking water additive improves oral health in the cat.

        Xylitol is a five-carbon natural sugar alchol or pentitol, which has been shown to have both an antibacterial effect on oral bacteria and dental plaque, as well as anti-calculus forming properties. The non-fermentability or very low fermentability of xylitol by dental plaque leads to a number of consequential phenomena of possible significance that include: update by bacteria and inhibition of bacterial growth; formation of soluble extracellular polysaccarides that make plaque less adhesive to the tooth surface; and, inhibition of spontaneous perception of calcium phosphate, decreasing the formation and accumulation of dental calculus.

        The antibacterial properties and the xylitol metabolism of dental plaque may be interpreted by understanding that dental plaque contains bacteria. The bacteria, via the fructose phosphotransferase system, take up xylitol. Xylitol is metabolized into xylitol-5-phosphate inhibits glycolysis and the uptake of glucose in the cell, which results in inhabitation of bacterial growth.

        It is generally accepted that chewing xylitol sweetened gum after meals may reduce plaque formation and gingival inflammation in humans. The results of two 12-month clinical studies showed that xylitol significantly reduced dental plaque when incorporated into chewing gum or a dental snack. Subjects in these studies also had less inflammation of the periodontal tissues. In another study, the daily use of a xylitol –containing chewing gum in humans reduced the weight of plaque formed in comparison to when no chewing gum was used. In these trials, the inability of chewing gum was used. In the trails, the inability of chewing gum per se to remove plaque from the tooth surfaces indicated that the decrease in plaque formation when using a xylitol-containing product was due to the chemical activity of xylitol.

        Microbiological studies add validity to these observations. A significant reduction in Streptococcus mutans, in both plaque and saliva compared with pre-treatment values, has been reported in humans chewing xylitol gums for 4-weeks. Streptococcus mutans after 2-months of chewing xylitol-containing gum. In general, xylitol has been shown to reduce the bacterial growth rate.

        The xylitol molecule also has the ability to form complexes with certain cations, such as Ca, Cu and Fe, based on its polyol properties. The habitual consumption of xylitol has shown that it not only concentrates calcium in plaque, but also keeps calcium ions in a soluble form, reducing calculus accumulation on the tooth surface.

        In the study presented here, the daily addition of xylitol to the drinking water of cats significantly reduced the accumulation of plaque and calculus following professional teeth cleaning (subra- and subgingival scaling and polishing). The results of this study showed that cats drinking water treated with xylitol had approximately half the plaque and calculus accumulation compared to when they were drinking untreated water. Xylitol is a useful adjunct in maintaining the oral health of cats during the period between professional teeth cleaning procedures.

Author Information

Dental Care for pets, 55 Belgrave-Hallam Road, Hallam, Victoria, Australia, 3803.