Chronic gingivostomatitis as a consequence of periodontitis and iatrogenic injuries

12 Chronic gingivostomatitis as a consequence of periodontitis and iatrogenic injuries




INITIAL PRESENTATION


Inappetance, drooling associated with gingivostomatitis.



PATIENT DETAILS


A 9-year-old, neutered female, domestic long-haired cat.



CASE HISTORY


There was no history of any oral disease or dental/periodontal therapy until 2 years ago, when the cat received ‘dental with extractions due to heavy accumulation of plaque and calculus’. Within 2 weeks of treatment the cat presented with inappetance and drooling, and gingivostomatitis was diagnosed by the referring veterinary surgeon.


In the last 2 years the cat had undergone five episodes of periodontal treatment. These had consisted of scaling, polishing and extraction (there was no record of which teeth had been extracted). There had been some improvement immediately following each treatment (the cat would start eating), but the inflammatory reaction had flared up again within weeks (the cat would stop eating). Several courses of antibiotics and the administration of long-acting steroid had shown initial improvement and then deterioration within a few weeks. The latest long-acting steroid injection had not had any beneficial effect at all. The cat was referred to us for management of the chronic gingivostomatitis. Prior to referral we requested haematology and biochemistry screen and FeLV and FIV testing to be performed by the referring veterinary surgeon. The cat was found to be negative to both FIV and FeLV and the only blood abnormality was elevated plasma globulins.



ORAL EXAMINATION – CONSCIOUS


This was an intensely uncomfortable cat that would not allow conscious examination of its face or oral cavity.



ORAL EXAMINATION – UNDER GENERAL ANAESTHETIC


See the front of the dental record sheet (Fig. 12.1) for details of findings.


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Figure 12.1 The front page of the dental record sheet is used to record all clinical findings. Remember that periodontitis is a site-specific disease. PPD is recorded on the occlusal view of the tooth on the dental record so that you can easily identify the precise site of disease. Normal periodontal probing depth (PPD) is not noted on the dental record to avoid clutter. However, when gingival recession is present, then PPDs are always recorded so that periodontal attachment level (PAL) can be calculated (GR + PPD) and entered on the record at its precise site in green ink. PAL is a more accurate assessment of attachment loss.


In summary, examination under general anaesthesia identified the following:


1. Moderate to severe gingivitis of incisors and canines

2. Missing all premolars and molars

3. Severe gingivostomatitis of the alveolar, buccal and glossopalatine mucosae

4. Marked hyperplasia of the inflamed glossopalatine mucosa (Fig. 12.2)

5. Complicated crown fracture (CCF) of 204

6. Gingival recession of 104, 204, 304 and 404

7. Increased periodontal probing depth of 104, 204, 304 and 404.

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Figure 12.2 Rostrocaudal photograph of the oropharynx. Note the hyperplastic and intensely inflamed glossopalatine folds.



FURTHER INVESTIGATIONS


A series of full-mouth radiographs (10 views) was taken.



RADIOGRAPHIC FINDINGS


Radiographs identified retained root remnants (presumably from previous extractions) of 108 (Fig. 12.3), 208, 307 (Fig. 12.4a), 308 (Fig. 12.4a), 309 (Fig. 12.4a), the mesial root of 408, and 409.


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Figure 12.3 Lateral radiograph of the right upper premolar and molar region. Note the retained root remnants of 108.


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Figure 12.4


(a) Preoperative radiograph of the left mandibular premolar and molar region. The roots of all the teeth in this quadrant (307, 308 and 309) are retained from previous surgery. This could, at best, be called partial extraction.

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Sep 3, 2016 | Posted by in SMALL ANIMAL | Comments Off on Chronic gingivostomatitis as a consequence of periodontitis and iatrogenic injuries
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