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Feline dentistry and oral medicine. CATS. Several oral diseases and lesions are specific to cats Buccal bone expansion Tooth resorptions/Resorptive lesions Viral-induced oral disease Lymphocytic-Plasmacytic Gingivostomatitis Eosinophilic granuloma complex Often idiopathic

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slide2
CATS
  • Several oral diseases and lesions are specific to cats
    • Buccal bone expansion
    • Tooth resorptions/Resorptive lesions
    • Viral-induced oral disease
    • Lymphocytic-Plasmacytic Gingivostomatitis
    • Eosinophilic granuloma complex
  • Often idiopathic
  • Oral neoplasia is relatively uncommon but highly aggressive
buccal bone expansion
Buccal bone expansion
  • Expression of periodontal disease in cats
  • Most commonly affecting the maxillary canines
  • Mandibular canines may also be affected to a lesser degree
  • Histologically, granulation tissue intercalated within the alveolar bone
    • May see some horizontal and vertical bone loss as well
    • Granulation tissue tends to form apically and extrudes canine teeth
    • Mistakenly referred to as “supereruption”
buccal bone expansion5
Buccal bone expansion
  • Treatment
    • If >50% attachment loss, extract tooth SURGICALLY
      • Debride disease buccal bone
      • **Close the extraction site**
    • If <50% attachment loss, meticulous subgingival scaling
  • Prevention
    • Good home dental care
tooth resorptions
Tooth Resorptions
  • Etiology unknown
    • Does not seem to be an inflammatory process
    • No infectious process has been found
    • Hypervitaminosis from commercial diets suggested
  • Pathogenesis unknown
    • Suspected to be an imbalance between odontoblasts and odontoclasts
    • Similar to osteoporosis?
  • Nomenclature changes frequently
    • Resorptive lesions/FORLs
    • Neck lesions
    • Cat cavities
    • Cat caries
tooth resorptions7
Tooth Resorptions
  • Lesions are staged according to the dental tissues affected
    • Stage 1 – Enamel or cementum
      • Diagnosed with explorer tip
    • Stage 2 – Enamel or cementum and dentin
      • First stage that can be detected radiographically
    • Stage 3 – Enamel/cementum, dentin, and pulp
    • Stage 4 – Major loss of tooth substance
      • Stage 4a – Crown and roots equally affected
      • Stage 4b – Crown affected more than roots
      • Stage 4c – Roots affected more than crown
    • Stage 5 – End stage resorption
tooth resorptions8
Tooth Resorptions
  • Clinical signs
    • Often see severe focal gingivitis or gingival hyperplasia over the lesion
    • Teeth that have excessive calculus accumulation should also raise suspicion
    • “Pink teeth” in cats usually indicate advanced resorption covered by gingiva
    • Lesions are painful
    • Lesions progress without treatment
tooth resorptions9
Tooth Resorptions
  • Treatment
    • Only definitive treatment is extraction or coronectomy
      • Extraction is the gold standard treatment
      • Advanced resorptions cannot be extracted completely
      • Coronectomy is acceptable in this case unless the cat has stomatitis
tooth resorptions11
Tooth Resorptions
  • Prevention
    • None as etiology is still unknown
    • Pamidronates(?)
viral induced oral disease
Viral-induced Oral Disease
  • FCV is a common disease in cats
    • 10% to 40% of the domestic and feral cat population affected
    • Can occur in all breeds, ages, sexes
    • Frequently seen in high-density populations
    • Disease is often self-limiting
    • Many cats will remain chronic carriers
      • ssRNA structure of the virus means mutation is common
      • Vaccines do not always provide protection
viral induced oral disease13
Viral-induced Oral Disease
  • FCV
    • Oral manifestations are common expressions of FCV
      • Vesiculation
      • Ulceration of the tongue and palate
      • Acute but self-limiting type of stomatitis
viral induced oral disease14
Viral-induced Oral Disease
  • Treatment
    • Usually none needed
      • Viral diseases usually self-limiting
      • Viruses do not respond to antibiotics
    • Supportive care
    • Secondary infections
      • Can occur if immunosuppressed
      • Antibiotics may help with secondary BACTERIAL infections
viral induced oral disease15
Viral-induced Oral Disease
  • Prevention
    • Environmental disinfection
    • Quarantine new cats in the household
    • Good hygiene
lymphocytic plasmacytic gingivostomatitis lgps
Lymphocytic-Plasmacytic Gingivostomatitis (LGPS)
  • Characterized by clinical signs and presence of lymphocytes and plasma cells on histopathologic examination
  • NOT FCV-induced stomatitis
  • Etiology unknown
    • Thought to be a hyperimmune response to plaque components or plaque bacteria
    • Bartonella henselae has been postulated as an etiologic agent but no positive correlation found
      • One study actually found a negative correlation
    • FHV, FCV, FeLV, and FIV have NOT been shown to have a causal relationship
lymphocytic plasmacytic gingivostomatitis lgps17
Lymphocytic-Plasmacytic Gingivostomatitis (LGPS)
  • Clinical signs
    • Severe inflammation of the oral cavity extending beyond the mucogingival junction
    • Often focused on the caudal oropharynx in the area lateral to the palatoglossal folds
      • “Faucitis” is a misnomer – this region is NOT the fauces
      • Fauces - The passage from the back of the mouth to the pharynx, bounded by the soft palate, the base of the tongue, and the palatine arches.
    • May have concurrent periodontal disease and/or tooth resorptions but not always the case
lymphocytic plasmacytic gingivostomatitis lgps18
Lymphocytic-Plasmacytic Gingivostomatitis (LGPS)
  • Clinical signs
    • Most other clinical signs are associated with oral pain
      • Ptyalism
      • Bleeding from the mouth
      • Pawing at the mouth
      • Running from the food bowl
      • Poor haircoat from reluctance to groom
    • Often see hyperproteinemia with severe hyperglobulinemia and reflex hypoalbuminemia
    • Often no other changes on CBC/Chem panel
lymphocytic plasmacytic gingivostomatitis lgps20
Lymphocytic-Plasmacytic Gingivostomatitis (LGPS)
  • Treatment
    • Conservative management
      • Professional periodontal treatment to remove existing plaque and calculus
      • Extract teeth with obvious lesions
        • Tooth resorptions
        • Periodontitis
      • Oral home care for continued plaque control
        • Tooth brushing
        • Antiseptic rinse
        • Often very difficult because of the severity of pain
lymphocytic plasmacytic gingivostomatitis lgps21
Lymphocytic-Plasmacytic Gingivostomatitis (LGPS)
  • Treatment
    • Conservative management
      • Antibiotics
        • Clavamox is first choice (>90% susceptibility)
        • Clindamycin is second choice (~86-88% susceptibility)
      • Pain management
        • Buprenorphine (sublingual or buccal mucosal application)
        • Tramadol
        • Meloxicam – if not on steroids
      • Corticosteroids
      • Usually only temporarily effective
lymphocytic plasmacytic gingivostomatitis lgps22
Lymphocytic-Plasmacytic Gingivostomatitis (LGPS)
  • Treatment
    • Surgical management (extractions)
      • Start with premolars and molars
      • If stomatitis is present at the canines and incisors, extract those as well
      • Consider extractions sooner rather than later
        • Long-term treatment with steroids can lead to other problems (diabetes)
        • Possibly increased risk of developing SCC in stomatitis cats
        • May take longer to see improvement in cats with prolonged medical management.
lymphocytic plasmacytic gingivostomatitis lgps23
Lymphocytic-Plasmacytic Gingivostomatitis (LGPS)
  • Treatment
    • Cyclosporine
      • Cats who are refractory to treatment
      • Alternative to extractions
      • Usually compound cyclosporine into liquid suspension
      • Dose depends on formulation of cyclosporine
      • Generally 5mg/kg
      • Checking cyclosporine levels?
lymphocytic plasmacytic gingivostomatitis lgps24
Lymphocytic-Plasmacytic Gingivostomatitis (LGPS)
  • Prognosis
    • Good prognosis with extractions
      • Approximately 60% of cats are cured
      • Approximately 20% of cats are significantly improved
      • The remaining 20% show little to no improvement and will need subsequent management
        • Continued conservative management
        • Consider cyclosporine
lymphocytic plasmacytic gingivostomatitis lgps25
Lymphocytic-Plasmacytic Gingivostomatitis (LGPS)
  • Prognosis
    • Cats with concurrent FIV and/or FeLV infection tend to have a poorer prognosis
      • Often do not improve even with complete extraction of all teeth and medical management with steroids and antibiotics
  • Prevention
    • None known
    • Cannot treat disease if etiology is unknown
eosinophilic granuloma complex
Eosinophilic Granuloma Complex
  • Unknown etiology
    • Thought to be part of an allergic reaction pattern
    • Commonality is the presence of eosinophils
    • Females tend to be more affected
    • Young to middle-aged cats
    • No breed predilection
  • Complex consists of 3 types of lesions
    • Indolent Ulcer *
    • Eosinophilic Plaque
    • Eosinophilic Granuloma *
eosinophilic granuloma complex28
Eosinophilic Granuloma Complex
  • Treatment
    • Lesions are non-painful so may not require treatment
    • Eosinophilic granulomas may cause dysphagia
    • Immunosuppressive doses of corticosteroids
    • Adjunct therapy
      • Hypoallergenic diet
      • Fatty acid supplementation
      • Environmental modification
eosinophilic granuloma complex29
Eosinophilic Granuloma Complex
  • Prognosis
    • Good with or without treatment
  • Prevention
    • None known
oral neoplasia
Oral neoplasia
  • Oral neoplasia is relatively rare in cats
    • Approximately 3-8% of malignant neoplasms occur in the oral cavity
    • It is the 4th most common location for neoplasia
    • Benign neoplasms are extremely rare in the cat
  • Squamous cell carcinoma is the most common malignant neoplasm (60-80%) in the oral cavity
  • Fibrosarcoma is the second most common, followed by lymphoma, others
  • Acanthomatous ameloblastomas (previously called adamantinoma in the cat) are extremely uncommon but can occur
oral nesoplasia
Oral Nesoplasia
  • Oral squamous cell carcinoma
    • Occurs mainly in older cats
    • No breed predisposition
    • Previous studies show increased risk in urban populations and smoking households
      • Similar to human risk factors
      • Environmental factors?
oral neoplasia32
Oral Neoplasia
  • Oral Squamous Cell Carcinoma
    • Behaves differently from SCC in other locations
    • Extremely aggressive
      • Often very osteolytic
      • Rapid progression of disease
    • Variable in appearance
      • Ulcerative
      • Proliferative
oral neoplasia34
Oral Neoplasia
  • Oral Squamous Cell Carcinoma
    • Limited treatment options
      • Not radiation sensitive
      • Resistant to most chemotherapeutic agents
      • Difficult to get good surgical margins
        • Lesions are fairly large when detected
        • Size of cat makes 2cm margins virtually impossible
      • Maybe multimodal approach?
      • Bisphosphonates?
oral neoplasia35
Oral Neoplasia
  • Oral Squamous Cell Carcinoma
    • Mainly hospice-type care
      • Pain management
        • Piroxicam/Meloxicam
        • Buprenorphine
      • Supportive care
        • Subcutaneous fluids
        • Parenteral feeding
    • Prognosis is very poor
      • Survival time usually 4 – 8 weeks after diagnosis
      • Cats are euthanized because of quality of life issues