Is flushing and packing adequate for diastema treatment?

The 6 cheek teeth (CT) of the horse should act as a single grinding unit with tight interproximal contact due to the opposing angulation of the 06s, 10s and 11s. Diastemata (inappropriate gaps between the CT) and associated periodontal disease is recognised as the main cause of oral pain and quidding in referral cases [1–3]. Diastemata can be divided into ‘valve-type’ or ‘open-type’ and most frequently involve the caudal 2 mandibular interdental spaces – making diagnosis and treatment a challenge [1]. They may also be divided into primary (developmental) diastemata and secondary diastemata. Primary diastemata occur due to inadequate angulation of the 06s, 10s and 11s or due to the embryonic dental buds developing too far apart [2]. Secondary diastemata develop due to displacement of CT or supernummery CT [2]. The true incidence of diastemata is unknown with various studies showing a prevalence of between 29% and 60% that tends to increase with age [4–6]. A recent UK first opinion practice study showed that 49.9% of horses having dental examinations had diastemata, with 40% of these diastemata being associated with periodontal disease [7].
Extensive evidence would suggest that periodontal disease in human patients is primarily bacterial in nature, initiated by plaque, which contains a complex microbial community [8,9]. A similar aetiology is present in canine periodontal disease [10]. Treatment of periodontal disease in humans is divided in phase 1 (nonsurgical) and phase 2 therapies. Based on the knowledge that plaque is the major aetiological agent in periodontal disease, one specific aim of phase 1 therapy is effective plaque removal and home maintenance [11]. Removal of plaque is achieved using ultrasonic scaling and pulsed irrigation [12,13], with daily maintenance by tooth brushing, interdental brushing and interdental flossing. Phase 1 therapy also includes calculus removal and management of carious lesions. The long-term success of periodontal treatment depends predominantly on maintaining the results of phase 1 therapy and much less on specific surgical procedures [11].  […]