Dental Pathology

Question 1

What is the most common dental disease in cats?

Answer 1

feline odontoclastic resorptive lesion

Question 2

What is the best treatment for feline odontoclastic resorptive lesion?

Answer 2

extraction

Question 3

Why is extraction the best method for feline odontoclastic disease?

Answer 3

• progressive
• unknown etiology
• poor success with other treatments
• comfort

Question 4

What is the diagnosis tool for feline odontoclastic disease?

Answer 4

dental radiograph

Question 5

What is the stage of this lesion?

Answer 5

Stage 1 resorptive lesion:
- only involves cementum

Question 6

Characteristics of stage 1 feline odontoclastic lesion

Answer 6

• only involves cementum
• often undiagnosed
• not sensitive

Question 7

What is the stage of this lesion?

Answer 7

Stage 2 resorptive lesion:
- progression through cementum into crown/ root dentin

Question 8

Characteristics of stage 2 feline odontoclastic resorptive lesion

Answer 8

• progression into the dentin of the crown / root
• painful
• hyperplastic gingiva overlaying defect

Question 9

What is the stage of this lesion?

Answer 9

stage 3:
- invaded into the pulp chamber & tooth canal

Question 10

Characteristics of stage 3 feline odontoclastic resorptive lesion

Answer 10

• invasion of the lesion into the pulp chamber & tooth canal
• painful
• bleeding from pulp tissue upon probing

Question 11

What stage is this lesion?

Answer 11

Stage 4:
- extensive structural damage
- tooth fractures easily

Question 12

Characteristics of stage 5 feline odontoclastic resorptive lesion

Answer 12

• no crown with root remanant or vice versa
• have bulging & inflammed gingiva

Question 13

What are the 2 stages/ types of feline resorptive lesions that potentially does not require extraction?

Answer 13

Type 2: crown amputation
Stage 5: if not inflammed, intact gingiva & no peripheral pathology, can leave alone

Question 14

What is Type 1 feline odontoclastic resorptive lesion?

Answer 14

• focal or multifocal radiolucency in tooth
• otherwise normal

Question 15

What is Type 2 feline odontoclastic resorptive lesion?

Answer 15

• narrowing or disappearance of periodontal ligament
• presence of dentoalveolar ankylosis & replacement

Question 16

What is Type 3 feline odontoclastic resorptive lesion?

Answer 16

presence of both type 1 & type 2 on same tooth

Question 17

What is Feline Chronic gingivostomatitis?

Answer 17

• painful oral inflammation
• can be local or generalized
• comprise of gingivitis & mucositis

Question 18

Etiology of feline chronic gingivostomatitis

Answer 18

Multifactoral:
- FeLV
- FIV
- Bartonella
- Calicivirus
- oral bacteria/ endotoxin
- immune-mediated (reaction to plaque bacteria)

Question 19

Examples of partial feline chronic gingivostomatitis

Answer 19

• caudal mucositis
• kissing ulcer

Question 20

What causes kissing ulcer?

Answer 20

contact between oral mucosa & tooth

Question 21

What is an example of generalized widespread feline chronic gingivostomatitis?

Answer 21

stomatitis

Question 22

Work up for feline chronic gingivostomatitis

Answer 22

• FeLV/FIV
• Bartonella PCR
• Calicivirus PCR
• CBC
• Biochemistry ( hyperglobulinemia)
• oral exam
• biopsy: chronic, ulcerative lymphocytic-plasmocytic stomatitis

Question 23

Medication used to manage feline chronic gingivostomatitis

Answer 23

• steroids for crisis (does not resolve primary cause)
• antibiotics for bartonella- associated stomatitis (Azithromycin & Doxycycline)

Question 24

Best treatment for feline chronic gingivostomatitis

Answer 24

1. full mouth extraction:
   - 80% responds to treatment (full/ partial)
2. Dental cleaning with full mouth radiograph, selected extraction & biopsy

Question 25

What is Chronic Ulcerative Paradental Stomatitis?

Answer 25

Canine stomatitis

Question 26

What causes Chronic ulcerative paradental stomatitis?

Answer 26

unknown; some relationship with plaque bacteria

Question 27

Presentation for Chronic ulcerative paradental stomatitis

Answer 27

- Maltese over-represented - pain: drooling, difficulty eating, depression, head shy - halitosis - weight loss

Question 28

Workup for chronic ulcerative paradental stomatitis

Answer 28

- PE: mandibular lymphadenopathy & lip fold dermatitis (drooling) - CBC - Biochemistry - Oral exam - Biopsy: chronic, ulcerative lymphocytic-plkasmacytic stomatitis

Question 29

Treatment for chronic ulcerative paradental stomatitis

Answer 29

- Full dental cleaning: special care to remove all plaque & calculi - extraction of diseased teeth - dental sealant application - home care important: better homecare, less drugs

Question 30

What teeth are usually extracted in chronic ulcerative paradental stomatitis?

Answer 30

molars & premolars

Question 31

When would medication be useful in treating chronic ulcerative paradental stomatitis?

Answer 31

Antibiotics: - Short-term relief of soft tissue infection or systemic inflammation - must be combined with cleaning & extractions Steroids: - anti-inflammatory

Question 32

What is gingival hyperplasia?

Answer 32

pathologic growth of excessive gingival tissue

Question 33

Why can gingival hyperplasia be problematic?

Answer 33

- creates pseudopocket around tooth that can trap hair, food and bacteria - lead to periodontal disease

Question 34

What causes gingival hyperplasia?

Answer 34

1. Reaction to gingival inflammation due to chronic antigenic stimuli - genetic plays a role too (usually recession) 2. Medication

Question 35

What medication may cause gingival hyperplasia?

Answer 35

- calcium channel blocker - phenytoin derivatives - cyclosporin

Question 36

What is required to treat gingival hyperplasia?

Answer 36

- full mouth radiograph - gingivectomy ( repeated therapy) - regular dental cleaning - homecare

Question 37

What is gingivectomy?

Answer 37

- Removal of excess gingiva - preserve normal anatomy

Question 38

How to perform gingivectomy?

Answer 38

- apply local anesthesia - measure psuedopocket & mark gingiva with dots and remove excess - fluted bur on high speed handpiece for contouring & hemostasis

Question 39

Other differentials that can present as gingival hyperplasia

Answer 39

- neoplasia - oral papilloma - operculum Need to send for histology

Question 40

What is operculum?

Answer 40

incomplete loss of gingival tissue during tooth eruption

Question 41

Home care after gingivectomy

Answer 41

- NSAID - soft food - no chew toys fopr 2 weeks - no tooth brushing 1st week (chlorhexidine gel on teeth)

Question 42

What are some common canine oral mass?

Answer 42

- hyperplastic gingiva - epilude (acanthotomatous, fibromatous) - papillomas - malignant melanoma - squamous cell carcinoma - fibrosarcoma

Question 43

What are some common feline oral mass?

Answer 43

- eosinophilia granuloma - epiludes - squamous cell carcinoma - fibrosarcoma

Question 44

Protocol for mass discovery

Answer 44

- radiograph to check fro bone involvement - note tooth mobility, displacement, tooth loss or tooth destruction - biopsy for histmpathology

Question 45

What does the peripheral odontogenic fibromas originate from?

Answer 45

periodontal ligament

Question 46

Characteristics of peripheral odontogenic fibromas

Answer 46

- slow growing - non-invasive - no destruction of underlying bone - excision of mass not curative

Question 47

Treatment for peripheral odontogenic fibroma

Answer 47

excision, tooth extraction & removal of periodontal ligament

Question 48

What does decision on type of oral biopsy technique depend on?

Answer 48

- location - size - appearance - adjacent structure - evidence of bone destruction

Question 49

Ratio for excised tissue & formalin fro biopsy

Answer 49

1:10 volume