Chlorhexidine Causes Calculus

Yada, Yada, Yada

ERNIE SMITH will be spelling relief for DANNY SCOTT at Cornell for 6 of the next 12 months. Although Danny and BILL MILLER are two of the finest dermatologists (both are authors in our definitive text Small Animal Dermatology published by Saunders), the "real world" practice experiences of Ernie should offer a useful perspective to Cornell students. Good luck, Ernie and Danny.

MEREDITH MILLER worked well with the MedRx folks at a surprisingly busy AVMA meeting in Nashville. CHRIS PERRY visited the Potomac office where he serviced my MedRx videoscope.

Crash and Burns. MICHELE BEZJAK, while riding with AMY PLINSKY, a Burns rep, had enough of a fender bender to require Michele to wear a sling . Trooper that she is, she didn't miss a day of work, although our own GARY BOUGE did carry her bags and drive for her. When Amy asked how she was, Michele responded, " Bad enough that you need to be out selling DermaPet real hard." The previous week, one day after riding with Webster rep PAUL MURPHY, Michele visited the Hamilton Animal Hospital in Baltimore, MD owned by TODD FAUBLE that was tragically fire damaged (all animals were rescued.) Our best advice is to keep Michele thinking positive thoughts by buying what she asks.

JACK WHITE again worked on his birthday in Houston for the MedRx seminar where he ran into slick MIKE MARK. AMY MOATS organized 31 vets (4 were paid no-shows) coming from as far away as Oklahoma City.

Chlorhexidine Causes Calculus

Chlorhexidine has long been known to be a problem if used in ears; the FDA has forbidden its use in products labeled for use in ears. Now, it appears its use in dental products, whose primary goal it is to reduce dental calculus formation, is in question since it actually increases calculus along with many other side effects.

Please note the following comments:

NATALIE WILSON of the Shaffer Animal Hospital in Ovieda, FL, a graduate of an accredited 2 year dental hygiene program for humans and a certified veterinary technician asked ."During the course of my education, I learned that in humans, the use of products containing chlorhexidine (Peridex, Periogard) causes an increased formation of calculus (tartar) build-up.". My question is, have there been any studies relating to this issue in animal dentistry? To my knowledge, chlorhexidine is an effective antimicrobial, but has no benefit of protection against the accumulation of calculus.

Dental guru JAN BELLOWS responded "Chlorhexidine is an effective product to inhibit plaque formation. Chlorhexidine binds to the dental pellicle reducing the absorption of plaque forming bacteria. Additionally, Chlorhexidine renders existing plaque non-pathogenic. Chlorhexidine has bacteriostatic and bactericidal effects against most oral bacteria and some viruses. Once absorbed it binds to oral tissues providing residual antibacterial effect for up to 24 hours. Potential disadvantages include staining of the teeth, unpleasant taste, desensitizing taste buds, and is potentially ototoxic. Additionally, chlorhexidine can actually enhance the precipitation of salivary minerals to speed the development of calculus."

Practice Tips

EPA (Eicosapentaenoic acid) is recommended at 180 mg/10 pounds per day for chronic inflammation including pruritus, allergy, derm, arthritis, cardiac, behavioral, kidney, bladder, pancreas and cancer cases. This dose is a component to all of my Pruritic Clinical Trials. Up to this point, there is no veterinary product that adequately fills this need.

Many dermatologists are recommending that fluorquinolones not be placed in ears unless it or another fluoroquinolone is used systemically. The argument is based on the fact they are one of the easiest drugs for bacteria to develop resistance. Experts are seeing increased fluoroquinolone resistant Pseudomonas and other organisms, which they say is largely due to topical overuse.

Our otic protocols clearly indicate a preference for fluorquinolones, systemically and topically; we are not changing this position. When considering ototoxicity, fluorquinolones remain the safest effective topical antibiotic. The clarification is that it should only be used topically with a concurrent systemic antibiotic.
TrizEDTA is Aqueous

Aqueous TrizEDTA, our ready to use, USP only, preservative-free, stable liquid form of our "crystal" TrizEDTA is on the market and selling briskly.

Imitation is the sincerest form of flattery. Rumor has it that an attempt has been made to copy our TrizEDTA. The merits of our USP pure version speak for themselves. For a highlighted comprehensive comparison chart, people should go to our web page, request one by email or fax.

TrizEDTA, with a shelf life of 3 years, uses USP only ingredients and is aqueous; it contains no alcohol, a substance that is considered ototoxic in cases where there is a ruptured tympanum. It is not suggested you 'taint' our Crystal TrizEDTA with alcohol. Research does not support alcohol as an additive; all research published over the last 20 years was based on the aqueous form. It is preservative free, with a stable three-year expiration date. The pH is 8.0 (7.5 to 8.0 is ideal for efficacy). It only contains de-ionized, demineralized water, which is key since minerals from water will deactivate it's efficacy; one mechanism of action is to chelate minerals in the cell wall of bacteria. This product is safe to use in cases with ruptured tympanum, which is most often the case with Pseudomonas Otitis (the #1 indication) since it "secretes" enzymes, which virtually eat away tissue.

"What are your favorite ear cleansing agents"
Otology Roundtable, Comp CE, 24, 3(A), 2002

Rod Rosychuk: ..As a mild cleansing agent with apparently superior germicidal effects to acetic acid, we also use a 2% acetic acid/2% boric acid cleanser (DermaPet). This product appears to work well for ears complicated by Malassezia colonization/infection, and we use it for chronic maintenance regimens (i.e., once or twice weekly flushing) in allergic patients prone to Malassezia infections.

MEETINGS

DermaPet will be at the CVC meeting in KC on August 17-19. While Gary and Jack cover that I will be heading for AUSTRALIA for a meeting in DARWIN where RALPH MUELLER and SONJA BETTENAY-MUELLER will be presenting. I should also be doing seminars on Otology and Topical Therapy in SYDNEY August 15 or 16 and MELBOURNE August 25 or 26. I will be in Nice for the ESVD meeting Oct 26-29 followed by a lecture on "A New Approach to Pruritic Otitis" for IVENTA (International Veterinary Ear, Nose and Throat Academy) at the WSAVA in Granada, Spain. After the George Muller Derm meeting from Oct 20-to Nov 6 in Kona, I will be going to Osaka, Japan on Nov 17 where I will present the same lecture.

LISA LORENZINI and I will visit the UC/Davis Derm Dept on August 12 on the same day I fly to Australia.

MedRx is offering CE with EAR Seminars and LOU GOTTHELF on the road next in KNOXVILLE on AUGUST 11, MIAMI on AUGUST 25, INDIANAPOLIS on SEPT 8 and LAS VEGAS on SEPT 22. Call 888-392-1234 to register or find out when one is coming near you. "Small Animal Ear Diseases: An Illustrated Guide" by Lou Gotthelf at http://www.harcourthealth.com/fcgi-bin/displaypage.pl?isbn=0721677509

"10th Anniversary" SPECIALS

Buy One Get one FREE: Allay Oatmeal, DermaHypoCs, DermaSebs, DermaBenSs shampoos and Allay Oatmeal Conditioner. MalAcetic Shampoo and Conditioner are Buy 9 get 3 FREE.

Call your DermaPet Distributor or 800 755 4738 for ordering information.

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DermaPet IS the largest veterinary dermatological company in "virtual reality"-cyberspace, for those who might otherwise misunderstand the phrase- and the fastest growing. Our Newsletter list, now approaching 18,000, is the largest in the industry with countless more that read it forwarded by colleagues, reposted in newsgroups or lists. Those who receive this newsletter and wish to pass it along to colleagues, please do.

Steve Melman VMD
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