Feline Dentistry

10 Feline Dentistry



Outline



Feline Chronic Ulcerative Gingivostomatitis,


Tooth Resorption,


Feline Orofacial Pain Syndrome,



Learning Objectives


When you have completed this chapter, you will be able to:



• Differentiate between stomatitis, gingivitis, and periodontitis.


• Differentiate between type 1 and type 2 feline chronic ulcerative gingivostomatitis.


• List the diagnostic testing used for evaluation of patients with suspected feline chronic ulcerative gingivostomatitis.


• Describe the management of patients with feline chronic ulcerative gingivostomatitis.


• Describe the classification scheme used to stage tooth resorption.


• List possible causes for feline orofacial pain syndrome.



Key Terms


Association of American Feed Control Officials


Calicivirus


Caudal stomatitis


Chronic ulcerative gingivostomatitis


Feline orofacial pain syndrome


Hyperglobulinemia


Hyperproteinemia


Mucositis


Pasteurella species


Stomatitis


Tooth resorption


Cats have most of the conditions discussed in the other chapters. However, three conditions of the oral cavity are more common in cats than they are in other species. This chapter focuses on these conditions but is not intended to minimize the importance of other diseases previously discussed with regard to all species. One condition associated with cats is chronic ulcerative gingivostomatitis (CUGS). The second condition discussed is tooth resorption (TR), most recently called feline odontoclastic resorptive lesion (FORL), which afflicts many cats and is challenging to prevent. A third condition that is even less frequent but more difficult is the feline oral pain syndrome (FOPS).



Feline Chronic Ulcerative Gingivostomatitis



Cause


Stomatitis is defined as “inflammation of the mucous lining of any of the structures in the mouth.” In clinical use the term should be reserved to describe widespread oral inflammation beyond gingivitis and periodontitis. When it extends into the mucosal tissues, it is known as mucositis. When it extends into the tissues of the lateral palatine folds, it may be termed caudal stomatitis. In other words, gingivitis and periodontitis do not constitute stomatitis unless they are part of a broader inflammation involving the mucosal tissues in the mouth.


Feline CUGS is frustrating and can be difficult to manage. Type 1 cases involve only alveolar and labial/buccal mucositis/stomatitis, and type 2 cases include caudal mucositis/stomatitis (with or without alveolar and labial/buccal mucositis/stomatitis). Type 1 cases may be manageable and teeth can be maintained, whereas type 2 cases tend to be less so (Figure 10-1).


image

FIGURE 10-1 Type 2 stomatitis.


Feline CUGS can be thought of as an individual inappropriate immunologic response from the cat to a variety of antigenic triggers. The trigger factors probably include Pasteurella species, plaque bacteria, and calicivirus. Factors that can complicate management due to their contribution to overall inflammation and/or immunomodulation are feline immunodeficiency virus (FIV), feline leukemia virus (FeLV), and dietary antigens. Some evidence suggests that this disease is immune-mediated. From the onset the client should be advised that initial treatment is extensive and long-term, therapies have potentially dangerous side effects, and some drugs used have not been approved for use in cats. An important concept in the treatment of feline CUGS is that whole mouth extraction may be necessary and even with that 30% of cases will require continued medical management.


Diagnostics should go beyond a brief physical examination. They should include testing for calicivirus, FeLV, and FIV. They should also include a blood biochemistry profile and a complete blood count (CBC) in light of future treatment options involving anesthesia and the use of pain relief. Although these tests are often negative, they may reveal information about the cause of the individual patient’s stomatitis. Most cats with classic stomatitis have elevated blood protein (hyperproteinemia) and elevated globulin (hyperglobulinemia). A full-mouth examination under general anesthesia must include intraoral dental radiographs and periodontal charting. Good quality photographs also aid the ability to make comparisons and gauge treatment success. Diagnosis begins with a history and a complete physical examination of the mouth, which may require chemical restraint. The examination should include observation of the buccal mucosa, tongue, gingiva, teeth, pharynx, tonsillar region, and the hard and soft palates. All surfaces should be examined for color, shape, size, consistency, surface texture, ease of bleeding, and response to pain. Gingival bleeding is one of the earliest signs that may be noted. Inflamed gingiva and mucosa may appear swollen, cobblestone-textured, bright red, or raspberry-like, which is often symptomatic of stomatitis. Light touching of the gingiva of the patient can result in spontaneous hemorrhage.


A biopsy of unusual appearing or unilateral different appearing tissue will rule out conditions such as eosinophilic granuloma or squamous cell carcinoma. Careful harvesting technique avoids inaccurate results.


One of the difficult diagnostic challenges is to determine whether the CUGS is an allergic reaction to an additive in commercial pet foods. Colorants, preservatives, binders, and other chemicals are added to commercial pet foods to make them more attractive to the cat and owner. If the client is cooperative, food-related causes should be investigated. Some holistic practitioners have made claims of resolution with “raw diets.” There have been no studies to prove or disprove these theories.


Currently there are no approved treatments specifically for this syndrome. Management practices come in the following four stages:



Stage 1: Complete oral health assessment and treatment (COHAT) and intraoral radiographs are mandatory. Teeth affected by resorption or periodontitis must be extracted. Retained tooth root tips must be extracted. If the client is unwilling or unable to provide this care, extraction of all caudal teeth may be a more appropriate option. Antibiotics, steroids, nonsteroidal antiinflammatory drugs (NSAIDs), and pain medications are prescribed as indicated for “rescue therapy.”


Stage 2: When the client cannot perform home care, extraction of all teeth caudal to the canines may be helpful. The canines and incisors can be spared if (1) the gingiva and bone are in perfect health, (2) the client is willing and able to brush the remaining teeth daily, (3) the client realizes that COHAT of the remaining teeth will be necessary every 4 to 12 months, and (4) the client accepts that quite often the canines and incisors need to be removed some time in the future. After this treatment, rescue therapy is provided again as appropriate.


Stage 3: For those cats that still do not respond, the next step is extraction of all teeth. Early trials are showing promise with Omega Interferon, which may be administered by local injection and followed by daily oral dosing. At this time, Omega Interferon must be imported from Europe, does not have United States Department of Agriculture (USDA) approval, and must be handled very carefully to maintain potency.


Stage 4: For those cats that still do not respond, long-term antibiotic and steroid therapy is used to control the patient’s condition. This treatment will need to be continuous and adapted to each patient.

Related posts:

  1. Marketing Veterinary Dentistry
  2. Periodontal Therapy
  3. Introduction to Veterinary Dentistry
  4. Home-Care Instruction and Products

Stay updated, free articles. Join our Telegram channel
Tags:
Oct 9, 2016 | Posted by in GENERAL | Comments Off on Feline Dentistry

Full access? Get Clinical Tree
Get Clinical Tree app for offline access