From acupuncture and herbal medicine to laser and ozone therapies, a wide range of modalities can speed healing, reduce complications, and relieve discomfort in veterinary dentistry.

The importance of animal dentistry is gaining momentum thanks to our growing knowledge that oral disease significantly affects systemic health in both animals and humans.^1,2 It is also important to note that periodontal disease is the single most common medical problem diagnosed in small animal patients.^3,4 Despite these facts, oral disease is often overlooked in veterinary medicine, especially when it comes to addressing chronic systemic diseases. It is not possible to achieve “whole body” health if poor oral health exists. As integrative practitioners, it is extremely important that we emphasize oral and dental health to our clients, and discuss its impact on wellness. Furthermore, many integrative approaches can maintain oral health and support patients needing dental care.

Client education

It really all starts here. It is imperative to have a brief discussion with clients about the importance of oral health to whole body health. It is also beneficial to discuss the advantages of being proactive with homecare and professional cleanings. Clients really need to know that they shouldn’t wait for advanced pathology in order to take action with either of these steps. I also find it helpful to explain the reasons anesthesia is required for proper dental treatment, along with the health risks associated with leaving dental disease in the body, especially if clients are very keen on avoiding anesthesia. It may be helpful to encourage clients to consider pet health insurance, as many plans include dental coverage; this may dramatically increase client compliance for prophylactic cleanings, whether annually or as needed.

Host modulation

The key to addressing periodontal disease from a holistic perspective is host modulation.⁵ This approach supports the whole patient to control the body’s response to inflammation and infection. Although bacterial plaque is considered the etiologic agent of periodontal disease, it is actually the body’s inflammatory cascade triggered by the plaque that causes both local periodontal disease and chronic illness in other organs.

Nutrition and supplements are the cornerstone to a healthy mouth as well as a healthy body.⁶ Diet is a key topic that has been covered in more depth in previous articles.⁷ The important points include:

1. Dry food (kibble) does not improve oral health, as demonstrated in specific studies.⁸

2. Processed foods inherently promote inflammation and contain higher percentages of carbohydrates/sugars.

3. Fresher, less-processed food actually promotes better oral health, especially with the addition of food items that require actual chewing.

Nutritional supplements can also provide valuable benefits.

• Antioxidants such as vitamins C and E play an important role in periodontal health, protecting oral tissues from inflammation.⁹

• Supplementation of CoQ10 (both systemic and topical) also has beneficial effects on periodontal health.^10,11,12

• Another option includes a particular fatty acid called 1-Tetradecanol complex. This is an esterified monounsaturated fatty acid that inhibits inflammatory cell infiltration.¹³ This product (1-TDC, Elite Science) offers a proactive approach to supporting host resilience to inflammation, and therefore minimizes the progression in the periodontal disease cycle.

• Recent information promotes the use of probiotics, both orally and topically, to support oral health. A growing awareness of the microbiome focuses on the critical role it plays in systemic immune system function and chronic inflammation. Canine and human studies show significantly reduced probing depth of periodontal pockets,and decreased periodontal inflammatory mediators, with the use of orally-ingested and topically-applied probiotics.¹⁴

Routine dental homecare 

Dental care performed by clients at home can be an effective way to achieve plaque removal, if done consistently. The greatest benefit comes from the action of regular tooth brushing.¹⁵ The product used on the toothbrush is not as important as the mechanical action of disrupting (wiping away) the plaque biofilm.

That said, several natural products are helpful when applied directly onto the gums or used on a toothbrush. These include coconut oil and/or therapeutic grade essential oils. Coconut oil is rich in lauric acid, has effective antimicrobial properties, and the additional bonus of being palatable!

Many essential oils (EOs) have powerful antimicrobial, anti-inflammatory, pain-relieving benefits, so are specifically beneficial for oral tissues. Medical literature supports the use of several different EOs for treating oral diseases, such as clove, lemon, orange, myrrh and copaiba. Mixing EOs with coconut oil (for dilution and better palatability) is a great option for a customized toothpaste that can be made and sold by the veterinary practice, or made by the pet owner. A particular EO blend, Dog Breath, has been formulated specifically for gingival application in the support of oral health in dogs and cats. It contains fractionated coconut oil, copaiba, peppermint, helichrysum and myrrh.

Integrative treatments for dental disease

Many integrative modalities are very effective when used perioperatively to support improved healing, recovery and patient comfort. These therapies can also provide a gentler experience for the patient, and increase client compliance if presented and discussed as such.

Acupuncture/acupressure

Acupuncture can be utilized for its analgesic and anti-inflammatory benefits. Clients can be shown acupressure points to do at home during the initial stages of recovery after a dental procedure. Gentle pressure applied to LI 4 (Large intestine 4) on the front foot/paw is an excellent choice for oral pain, if tolerated by the pet.

Laser therapy

Cold laser therapy, also called Low Level Laser Therapy (LLLT) promotes tissue repair and reduces pain and inflammation¹⁶ by enhancing cellular energy production and blood flow. Consequently, laser therapy is an excellent option to speed the healing of oral tissues, reduce swelling/pain, and support post-operative recovery.¹⁷

Laser treatments should be done immediately post-op, and ideally a second laser treatment performed a minimum of one hour later. According to Dr. Bill Inman, it has been found that performing two laser treatments at least one hour apart is three times more effective than just one laser treatment alone. This protocol also provides a great advantage in avoiding the need to bring the client and patient back within the next few days after the dental procedure.

In my practice, I use an Erchonia class II laser which is equipped with both red and violet beams and has settings designed for gingivitis and stomatitis. Dr. Inman recommends specific frequencies that are useful for dental procedures, including 300, 100, 111 and 279, which correspond to increased capillary vascularity, increased blood supply, scar tissue and inflammatory pockets. The violet beam offers more bacteriostatic and bacteriocidal properties than just the red beam alone. The red beam (635nm) offers anti-inflammatory effects, decreases pain and stimulates ATP production. The violet beam (405 nm) has antibacterial/antiviral effects which help the body’s defenses to eliminate infection.

Ozone therapy

Ozone (O3) therapy is extremely beneficial for oral treatments and is utilized by most biologic/natural dentists in the US, with even more acclaimed use in Europe. In fact, ozone therapy is actually approved by the ADA (American Dental Association) for dental abscesses. The therapeutic effects of ozone extend well beyond its ability to kill pathogens; it also increases oxygen delivery to tissues, even those that are hypoxic.¹⁸ Ozone acts on the tissues to decrease inflammation, pain and swelling, and increase healing. Saline and/or olive oil are percolated with ozone for 30 minutes to achieve therapeutic solutions, which are then stable for about 30 minutes before the ozone breaks down (dismutates). Therefore, ozone cannot be stored and used later.

Ozone therapy applications in dentistry include: flushing the gums and oral lesions with ozonated saline pre- and post-procedures; flushing periodontal pockets before and after dental cleaning; injecting ozonated gas around an infected tooth; and using ozonated olive oil topically on the gums post-operatively, as a homecare protocol.

Dr. Margo Roman reports good success treating dental abscesses with injections of ozone gas intra-periodontally. One example involves a 15-year-old canine patient diagnosed with liver cancer and dental infection. In order to avoid an anesthetic dental procedure, ozone therapy was chosen to treat this dog’s abscessed lower third premolar. The
dental abscess healed after two ozone injection therapies. Follow-up over two
years shows no recurrence.

Herbal medicine

Many different herbal options can be chosen to address pain/inflammation and improve healing. These may include California poppy, corydalis, boswellia, turmeric and CBD oil. I have had great success using both CBD oil post-operatively, as well as the Poppy Scutellaria formula from Animal Essentials/Animal Apawthecary. Patients appear more comfortable in the initial and extended recovery phases, and return to eating more quickly. Yunnan Baiyao can be used to mitigate any post-operative bleeding, and is often given pre operatively if bleeding is expected. Some veterinary dental specialists are now using Yunnan Baiyao for jaw surgeries, neoplasia removals and complicated extractions.

Homeopathy

Homeopathy provides an excellent treatment option for addressing pain, inflammation and bleeding following dental procedures. Liquid or pellets are applied directly onto the gums and absorb quickly with no ingestion required, generally making them easy to administer immediately after dental surgery. Good choices include Arnica to address swelling/bruising and blunt trauma; Hypericum for nerve pain resulting from gingival incisions/suturing, extractions etc.; and Phosphorus to address bleeding post-operatively/post-trauma. Homeopathic remedies can be used frequently in these circumstances, such as every 30 minutes post-operatively for an initial four doses, followed by a few times daily for three days.

When homeopathic medicines are prescribed for the whole individual, various dental issues may resolve, such as retained deciduous teeth, abscesses (even in the tooth root) and gum problems.

Chiropractic/veterinary orthopedic manipulation (VOM)

The activator tool provides an excellent option for addressing TMJ issues, and cervical chiropractic adjustments can support improved nerve conduction and blood flow to the mouth and facial structures. TMJ pain can result from unilateral joint fixation, which causes decreased ROM. Massaging the masseter muscles on the affected side can restore ROM and correct the problem.

Additionally, misalignments in the cervical spine can lead to TMJ problems, and specifically adjusting C1 may be beneficial. It can also be very helpful to perform chiropractic therapy on post-operative dental patients, especially if extractions or other surgical techniques involved head or neck manipulation during the procedure. Many human dentistry patients seek chiropractic care within a few days after a lengthy procedure, to address cervical pain or discomfort resulting from extended periods of head and neck tension and/or awkward positioning for dental procedures.

Conclusion

The application of various integrative techniques in veterinary dentistry can provide improved outcomes for our patients – with faster healing, decreased complications (such as infection/hemorrhage/pain) and improved levels of comfort.

References

¹Niemiec BA. “Local and regional eff ects of periodontal disease”. Veterinary Periodontology. Niemiec BA Ed), Jon Wiley and Sons, 69-80, 2013.
²Niemiec BA. “Systemic manifestations of periodontal disease”. Veterinary Periodontology. Niemiec BA Ed), Jon Wiley and Sons, 80-91, 2013.
³Companion Animal Study. University of Minnesota Center for Companion Animal Health. Uplinks: pp 3, 1996.
⁴Lund EM, Armstrong PJ, Kirk CA, et al. “Health status and population characteristics of dogs and cats examined at private veterinary practices in the United States”. J Am Vet Med Assoc. 1999;214:1336-1341.
⁵Niemiec BA. “Host Modulation Therapies”. Veterinary Periodontology. Niemiec BA Ed), Jon Wiley and Sons, 299-304, 2012.
⁶Kangas K. “The Importance of Oral Health on Whole Body Health: Methods of Integrative Oral Health Care”. AHVMA Journal Vol 48, Fall 2017
⁷Kangas K. “Integrative & Nutritional Support for Oral & Dental Health”; IVC Journal, Winter 2016
⁸Harvey CE, Shofer FS, Laster L: Correlation of diet, other chewing activities, and periodontal disease in North American client-owned dogs. J Vet Dent. 13: 101-5, 1996.
⁹Pavlica Z, Petelin M, Nemec A, et al. “Measurement of total antioxidant capacity in gingival crevicular fluid and serum in dogs with periodontal disease”. Am J Vet Res. 65 (11)1584-8, 2004.
¹⁰Wilkinson EG, Arnold RM, Folkers K, Hansen I, Kishi H. “Bioenergetics in clinical medicine. II. Adjunctive treatment with coenzyme Q in periodontal therapy”. Res Commun Chem Pathol Pharmacol. 12(1):111-23, 1975.
¹¹Hanioka T, Tanaka M, Ojima M, Shizukuishi S, Folkers K. “Eff ect of topical application of coenzyme Q10 on adult periodontitis”. Mol Aspects Med. 15 Suppl:s241-8, 1994.
¹²Wilkinson EG, Arnold RM, Folkers K. “Bioenergetics in clinical medicine. VI. adjunctive treatment of periodontal disease with coenzyme Q10”. Res Commun Chem Pathol Pharmacol. 14(4):715-9, 1976.
¹³Hasturk H, Goguet-Surmenian E, Blackwood A. “1-Tetradecanol complex: therapeutic actions in experimental periodontitis”. J Periodontol. 80(7):1103-13, 2009.
¹⁴Lee JK, Kim SJ, Ko SH, Ouwehand AC, Ma DS: Oral Dis. 2015 Sep;21(6):705-12. Epub 2015 Apr 20. Modulation of the host response by probiotic Lactobacillus brevis CD2 in experimental gingivitis.
¹⁵Hale FA: Home care for the veterinary dental patient. J Vet Dent 20(1) 52-4, 2003.
¹⁶Cotler HB, Chow RT, Hamblin MR, Carroll J. “The Use of Low Level Laser Therapy (LLLT) For Musculoskeletal Pain Orthop Rheumatol”. 2015;2(5). pii: 00068. Epub 2015 Jun 9.
¹⁷Calderhead RG, Kim WS, Ohshiro T, Trelles MA, Vasily DB. “Adjunctive 830 nm light emitting diode therapy can improve the results following aesthetic procedures”. Laser Ther. 2015 Dec 30;24(4):277-89.
¹⁸Isik A, Peker K, Gursul C, Sayar I, Firat D, Yilmaz I, Demiryilmaz I. “The eff ect of ozone and naringin on intestinal ischemia/reperfusion injury in an experimental model”. Int J Surg. 2015 Sep;21:38-44.

AUTHOR PROFILE

Katie Kangas, DVM, CVA, CVCP

Dr. Katie Kangas owns and operates Integrative Veterinary Care in San Diego, California. She achieved her CVA certification at the Chi Institute in 2008, and followed with additional training in Advanced Acupuncture, Food Therapy, Herbal Medicine and Veterinary Orthopedic Manipulation (VOM). Her areas of interest include nutrition, dental health, and pain management. Dr. Kangas also lectures and writes and has worked as a shelter veterinarian for more than 15 years. She currently works part-time for the San Diego County Department of Animal Services, and previously served as full-time medical director for the San Diego Humane Society and SPCA.