Jane's 5 point oral medicine articles Flashcards
Smith MM. Surgical approach for lymph node staging of oral and maxillofacial neoplasms in dogs. Journal of the American Animal Hospital Association. 1995;31(6):514-518.
- Parotid LN – 1-3 nodes
- Location: located along the rostral edge of the parotid gland, at the level of the ventral zygomatic arch
- After incising skin, have to go through platysma and parotidoauricularis to get to the rostral edge of the parotid gland
- Drains : caudodorsal muzzle, eyes, ocular glands, side of cranium, external ear, TMJ, parotid salivary gland, temporal mm, masseter mm, zygomatic mm. bones: nasal, frontal, parietal, zygoma, temporal
- Mandibular is a chain of 1-5 nodes
- Location: ventral mandibular region, between the jugular vein bifurcation and where the linguofacial splits.
- Drains:
- All parts of the head not drained by the parotid, overlapping areas or the eyelids, TMJ, ocular glands, skin of the TMJ
- Also is where buccal node drains to if present.
- Medial retropharyngeal is a single node (Occasionally 2 and occasionally there is a lateral one also), the largest in dogs and cats.
- Location: incise adventitia at caudal aspect of mandibular salivary gland, retract it rostrally. Retract the brachiocephalicus and the sternocephalicus muscles dorsally, and it’s there. Sits on top of thyropharyngeus muscle
- Drains: all deep parts of the oral cavity that have lymphatics tongue, walls of oral cavity, paartyngeal passages, salivary glands, deep external ear, larynx, esophagus.
- ALSO drains efferents from mandibular and parotid,
Smith M. Surgical approach for lymph node staging of oral and maxillofacial neoplasms in dogs. Journal of veterinary dentistry. 2002;19(3):170-174.
Herring ES, Smith MM, Robertson JL. Lymph node staging of oral and maxillofacial neoplasms in 31 dogs and cats. Journal of Veterinary Dentistry. 2002;19(3):122-126.
- Palpation essentially useless
- Of enlarged nodes, 17% had metastases
- Of the metastases, only 54% were in the mandibular node
- 90% concurrence between pre-op cytology and histo for mandibular nodes.
- Post-op cytology (FNA of the node after excision) of 62 nodes had a concurrence of 80% with histo
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Winer JN, Arzi B, Verstraete FJM. Therapeutic Management of Feline Chronic Gingivostomatitis: A Systematic Review of the Literature. Frontiers in veterinary science. 2016;3:54.
- 2/16 studies have histology, which they required for evidence level A
- 5/16 have evidence design grade V, random, control, dbl-blind, prospective
- 10 medical treatment studies and 6 surgical treatment studies
- Major problems with FCGS research
- Most studies use different scoring systems
- No standardized control therapy
- Many studies single case reports
- Many studies didn’t meet inclusion criteria
- Recommendations
- Histopathology
- Use control groups and allow pain medication
- Switch control groups to test groups after a period of time (if failed)
- Test new treatments and stop repeating the same studies!
Svendenius L, Warfvinge G. Oral Pathology in Swedish Dogs: A Retrospective Study of 280 Biopsies. Journal of Veterinary Dentistry. 2010;27(2):91-97.
- Had 8 categories, but most samples fit into 3 different categories.
- reactive lesions 39 %,
- gingival FH (24 %).
- benign neoplasms 27 %,
- POF (21 %)
- AA (4 %)
- malignant neoplasias 15 %
- malignant melanoma (8 %)
- squamous cell carcinoma (1.4 %).
- Various other sarcomas comprised 5 % of the cases
- Boxer dogs were over-represented primarily in the classification of benign tumors (P < 0.001)
- Dachshund dog had a statistically significant predisposition for malignant neoplasms (P < 0.001).
- Study population differed from others in that this is an oral path lab, most cancers don’t get sent there and submissions primarily from dentists
Rusbridge C, Heath S, Gunn-Moore DA, Knowler SP, Johnston N, McFadyen AK.
Feline orofacial pain syndrome (FOPS): a retrospective study of 113 cases. J Feline Med Surg. 2010;12(6):498-508.
- A feline neuropathic pain condition is described characterized by episodic, typically unilateral, oral and/or tongue discomfort, triggered in many cases by mouth movements.
- Burmese cats are predisposed and an inherited disorder affecting trigeminal sensory processing is suspected. A history of first signs during eruption of permanent teeth is common and the disease is often recurrent and with time may become unremitting. Oral lesions may be an important predisposing cause.
- Any oral disease should be identified and dental radiographs to detect more subtle lesions are recommended. Environmental factors may also influence the disease and the history should be explored for possible contributory factors. Identification of social incompatibility in a multi-cat household is a key step.
- For analgesia, if licensed products such as a combination of NSAIDs and opioids are ineffective, then (unlicensed) adjuvant drugs useful for the treatment of neuropathic pain may be beneficial.
- Based on the experiences in this paper phenobarbital (dose rate 2-3 mg/kg twice daily) is a reasonable first choice for treatment and can be given by the oral or intramuscular route. Diazepam seems effective but avoid dt risks of hepatic failure.
- Further studies are necessary to establish which drugs are most effective for treating this disease and other anti-epileptic drugs such as carbamazepine or gabapentin may prove to be more appropriate. Periodic monitoring of liver function and drug serum concentrations is recommended for cats treated with anti-epileptic drugs.
Rawlinson JE, Goldstein RE, Reiter AM, Attwater DZ, Harvey CE. Association of periodontal disease with systemic health indices in dogs and the systemic response to treatment of periodontal disease. J Am Vet Med Assoc. 2011;238(5):601-609.
- Healthy dogs with periodontal disease, CBC, Chem, UA and CRP, microalbuminuria test
- Within dog, CRP decreased after treatment.
- BUN had a significant increase after treatment
- Correlation found
- Between increased platelet number and attachment loss/gingivitis
- between lower creatinine value and higher attachment loss – Poss dt dec., muscle mass
- Concluded that perio is associated with systemic inflammation.
Nemec A, Arzi B, Murphy B, Kass PH, Verstraete FJM. Prevalence and types of tooth resorption in dogs with oral tumors. American journal of veterinary research. 2012;73(7):1057.
- Retrospective of dogs with oral tumors presenting to UC Davis. Reviewed rads for TR lesions. Used a control group of non tumor dogs and split tumors into odontogenic and non-odontogenic for most analyses
- 53% dogs with nonodontogenic tumors had tooth resorption at tumor sites versus 35% of dogs with benign odontogenic tumors; Most common was external inflammatory resorption in both groups (NOT SIGNIFICANTLY different to one another)
- Non odontogenic tumor sites more commonly had EIRR (40% of dogs) than in odontogenic tumors (21% of dogs) (NOT SIGNIFICANT)
- NSD between prevalence of resorption at distant sites b/w tumor types
- OVERALL ALL DOGS WITH TUMORS
•3.2 times as likely to have external surface resorption and 83x more likely to have EIRR than control teeth
•Odontogenic tumors 6.7 times as likely to have external surface resorption and 34 times as likely to have EIRR AT DISTANT TEETH
•Dogs with non-odontogenic tumors were 169x more likely to have EIRR AT DISTANT TEETH
Efficacy of Cyclosporine for Chronic, Refractory Stomatitis in Cats: A Randomized, Placebo-Controlled, Double-Blinded Clinical Study
Milinda J. Lommer, DVM
- 16 cats, half in placebo group and half in the treatment group with refractory stomatitis
- Cyclosporine inhibits T cell activation by blocking the transcription of genes coding for specific pro-inflammatory cytokines, including IL-2 and IL-4. (inhibition of calcineurin) By reducing IL-2 expression, T cell proliferation will also be reduced
- Developed a SDAI clinical scoring system to standardize measures
- In treatment Group, 7/9 cats (77.8 %) demonstrated > 40 % improvement in SDAI, compared with 1/7 of cats in Group B (14.3%), at the end of the 6 week evaluation period.
- 4/7 cats in placebo, but none in treatment required rescue pain meds
- NSD for previous steroids or full versus partial mouth extractions
- Blood levels of >300ng/mL correlated with higher rate of improvement. 72% improvement in score if over this number, 28% improvement if below.
Experimental determination of a subantimicrobial dosage of doxycycline hyclate for treatment of periodontitis in Beagles
Se EunKim, DVM; SooheeKim, DVM; ManbokJeong, DVM, PhD; YesranLee, DVM; JeongTaekAhn, DVM; Young Woo Park, DVM; Jae Sang Ahn, DVM; EuiriLee, DVM; Doug-Young Ryu, DVM, PhD; KangmoonSeo, DVM, PhD
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•20 healthy beagles to determine dose relation to serum doxycycline level
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•1 and 2 mg/kg stayed under human MIC (<1μg/mL) from a single dose
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•Subantimicrobial doses of doxycycline (single dose) are 1-2 mg/kg
•Subantimicrobial doxycycline at 2mg/kg decreases bleeding on probing and clinical attachment loss over control or 1mg/kg
- Their drug half-life was longer than previously reported, so concerns about exceeding MIC with BID dosing were raised
- Humans there is a sustained release formulation
- Q12 dosing of 1 mg/kg or Q24h dosing of 2mg/kg were their recommendation
HennetPR, Harvey CE. Craniofacial development and growth in the dog. Journal of veterinary dentistry. 1992;9(2):11.
- Mandibles and maxillae grow in specific patterns.
- Lots of studies, none actually directed at dogs, but some used as models.
- There is resorption and simultaneous deposition of bone with particular patterns to accommodate growth and eruption.
Relationship between Feline calicivirus Load, Oral Lesions, and Outcome in Feline Chronic Gingivostomatitis (Caudal Stomatitis): Retrospective Study in 104 Cats
Isabelle Druet* and Philippe Hennet
- Some FME, some subtotal ME (all PM’s and M’s) , some partial ME (some teeth)
- Collected oropharyngeal swabs and quantitative PCR for feline calicivirus
- Scored lesions in the caudal part of the mouth (global caudal stomatitis intensity score [GCSIS]) and also on the buccal/alveolar surface (ASIS)
- Severity of pre-op lesions not correlated with any patient parameter including previous medical treatment
- Severity of stomatitis score not associated with viral load
- Presence of lingual ulcers was significantly correlated with FCV load (P=0.0325). Cats with a high FCV load had more risk to present a lingual ulcer
- Caudal stomatitis score and alveolar stomatitis score were not associated with FCV load (P=0.5150 and P = 0.1719) respectively.
- 56 cats returned for at least 1 follow up
- No significant relation was observed between clinical improvement and low or high FCV load or severity of caudal lesion (GCSIS).
•Cats with a low FCV load or a low severity of caudal oral lesions did not improve faster than cats with a high load or more severe lesions.
•Cats with low ASIS (alveolar/buccal lesions) improved significantly more rapidly than cats with high ASIS (P = 0.0294).
Arzi B, Mills-Ko E, Verstraete FJ, et al.
Therapeutic Efficacy of Fresh, Autologous Mesenchymal Stem Cells for Severe Refractory Gingivostomatitis in Cats. Stem Cells Transl Med. 2016;5(1):75-86.
- Cats with stomatitis that were non responders to conventional therapy
- MSCs inhibit T-cell proliferation, alter B-cell function, downregulate MHC II on antigen-presenting cells, and inhibit dendritic cell maturation and differentiation
- ASC Treatment Induced Marked Clinical Improvement in Cats With FCGS
- Biopsies essentially normalized, and no infiltration of CD20+ B lymphocytes and CD3 positive T lymphocytes
- Non responder stayed similar to baseline.
- T cell populations in circulation
- Stomatitis cats have high CD8+ T cells, and a low CD4:CD8 ratio
- Most responders had normalization of numbers and ratio at 6 months
- CD8lo subpopulation was lower in cats with stomatitis and increased in responders
- Cats With FCGS That Responded to ASC Transfusion Had Increased Serum IL-6 Levels
- Response took 2-4 months, and followed increase in IL-6 and increase in TNF-a in cats being cured
- 5/7 cats recovered, seems to be a safe and effective treatment
Peralta S, Arzi B, Nemec A, Lommer MJ, Verstraete FJ. Non-Radiation-Related Osteonecrosis of the Jaws in Dogs: 14 Cases (1996-2014). Front Vet Sci. 2015;2:7.
- Unremarkable bloodwork NO FEVER, oral signs (halitosis, lymphadenopathy most common)
- None treated with bisphosphonates,
- half of the cases were Scotties, and cocker/cocker mixes with chronic stomatitis and progressive dz
- Most common radiographic finding: bone loss, sequestrum formation, periosteal reaction
- Bone loss, periapical lucencies, external inflammatory TR
- Recent extractions in 11/14
•10/11 had ONJ lesion near a site of extractions
•60% maxilla, 40% mandible
•Rads underestimate the severity on the maxilla compared to CT/surgical exploration, but correlate well on the mandible.
Lewis JR, Tsugawa AJ, Reiter AM.
Use of CO2 laser as an adjunctive treatment for caudal stomatitis in a cat. J Vet Dent. 2007;24(4):240-249.
•Tissue response to thermal injury
•below 60° C, thermal injury may occur,
•temperature reaches 60-65° C, proteins are denatured and tissue necrosis occurs
•When tissue temperature reaches 60-65° C
•When tissue temperature reaches 100° C, the water in the tissue turns to steam, resulting in explosive vaporization
•When temperatures reach greater that 150° C, rapid protein breakdown results in a layer of carbonization commonly referred to as char.
•CO2 laser has wavelength of 10,600 nm and targets H2O. Delivered in non-contact mode.
•The higher concentration of water in soft tissue makes the mid-IR Er:YAG(2940 nm) and the far-IR CO2 (10 600 nm) lasers more efficient for soft tissue surgery
- Melanin and Hgb don’t absorb beyond 1000 nm
- Basically they charred the shit out of a stomatitis cat until it got better.
