Lecture 10: Feline dentistry Flashcards
What are common cat dental disease that arent seen in other species
1) Chronic ulcerative gingivostomatitis (CUGS)
2) Tooth Resorption (TR)
3) Eosinophilic Granuloma Complex
Feline Chronic Ulcerative Gingivostomatitis (CUGS) is
Is an inflammation of the mucous lining of any of the structures in the mouth
More severe than regular gingivitis associated with periodontal disease
Feline Chronic Ulcerative Gingivostomatitis (CUGS) is casued by
Can be thought of as an individual inappropriate immunologic response from the cat to a variety of antigenic triggers
Such as Pasteurella bacteria, plaque bacteria, and calicivirus
Evidence suggests that this disease may be immune-mediated
It is a very debilitating disease that will frequently lead to loss of all the teeth in cats at a very early age
The heightened immune response leads to severe oral inflammation, oral ulcers, foul breath, resorption of hard dental tissues, and difficulty in eating
Some patients have large areas of their oral cavity affected with painful, raw areas
Treatment of CUGS
Treatment is extensive and long-term, with treatments having dangerous side effects and some drugs being used off-label
It is important to note that whole mouth extractions may be necessary
Clinical signs of CUGS
Gingival bleeding is one of the earliest signs of the disease
Inflamed gingiva and mucosa may appear swollen, cobblestone-textured, bright red, or raspberry-like
Light touch of gingiva can result in spontaneous hemorrhage
Hypersalivation is common→often saliva is ropy and thick
Many cats will stop eating secondary to oral pain
What history is needed for CUGS
Intensive diagnostic testing beyond the physical exam is required.
May reveal information about the cause of the individual patient’s stomatitis
Full mouth exam including dental radiographs and periodontal charting is also required
Good quality photographs also aid the ability to make comparisons and gauge the success of the treatment regime set out
What would you use to diagnose CUGS
History and a complete physical exam are required
A complete blood count, thyroid, and biochemical tests should be performed
Viral infections such as FeLV (feline leukemia virus) and FIV (feline immunodeficiency virus) must also be ruled out as a causative agent
Autoimmune testing should be considered
Food allergy testing may also be done to rule out an allergic reaction to a component of the diet
Prescription hypoallergenic diet trial
What to examine in cats mouth for CUGS under anesthesia
An extensive exam of the oral cavity is required
Examining all surfaces for color, shape, texture, pain response and gingival bleeding etc.
A biopsy may be required to determine probable etiology
Intraoral radiographs are necessary, to evaluate teeth with erosive disease
CUGS stage 1 is
Complete oral health assessment and treatment including intraoral radiographs
All teeth affected by resorption or periodontitis must be extracted.
Any retained root tips must also be extracted
Antibiotics, NSAIDs and pain meds are prescribed
CUGS stage 1 home care can be
After the procedure, aggressive home care is instituted
Tooth brushing
Dental diet
Antiseptic oral gels and rinses
Dental checks at least every 6 months
Frequent dental cleanings (every 6-12 months)
Stage 2 CUGS is
If stage 1 treatment fails or owner is unable/unwilling to do home care
Involves numerous tooth extractions
Minimally all of the caudal teeth (premolars and molars)
Must ensure all of the tooth roots and periodontal ligament is removed
May require extraction of incisors and canines in some patients if gingivitis in that area is significant
Still requires dental checks minimally every 6 months
Stage 3 CUGS is
For cats that do not respond to treatments offered in stage 1 and 2
Extraction of all remaining teeth
Must completely remove all roots and periodontal ligament
Trials showing promise with Omega Interferon (local injection and daily dosing)
Currently not available in Canada or the US (except by Emergency Drug Release)
Stage 4 CUGS is
For cats who fail to respond to treatments in stages 1-3
Up to 30% of cats continue to have significant oral inflammation despite extraction of all of the teeth and removal of the periodontal ligament
Long term antibiotic and steroid therapy are mainstays
Gold salt therapy?
Interferon?
Euthanasia if unable to adequately control disease
CUPS in dogs is
Chronic Ulcerative Proliferative Stomatitis
Uncommon in dogs
Also involves an overexaggerated immune response to plaque
May be immune-mediated
Causes severe gingivitis and gingival recession
Classic “kissing lesions” on mucosa that touches plaque- covered teeth
Similar aggressive treatment as for CUGS in cats
Tooth resorption is
Also known as feline odontoclastic resorptive lesion (FORL), neck lesions, cervical line lesions and cat cavities
Most research suggests that just under 50% of the cat population is clinically affected with TR
Effects of TR
Resorption of the tooth
Proliferation of the gingiva or pulp to cover resulting lesion
Signs of TR
Pain
Behavior changes
Decreased appetite
Drop food or hiss at it
Clinical signs of TR
Often starts as an area of focal gingivitis
If you notice gingivitis centered on 307/407, be suspicious of TR
Progresses to invasion of the gingiva into an enamel defect on the tooth
Once the pulp cavity is reached, you will elicit a jaw tremor on probing of the lesion
Eventually you get loss of most of the enamel and dentin and there is a visible hole in the tooth
The crown is eventually lost, and the gums grow over the roots
Etiology of TR
Do not know why TR occurs
It results from the activation of cells called odontoclasts, which are responsible for the normal remodeling of tooth structure
In this disease process:
Continue to resorb tooth structure until the entire tooth is lost
At the same time have proliferation of the gingiva which covers the resulting lesion
What would you see in the mouth for TR
They tend to occur at and just below the gumline but they may affect only the root structure
Dental radiographs are necessary to accurately diagnose and treat TR
The teeth most commonly affected are the premolars, followed by the molars and finally the canines
The majority of the lesions are on the buccal surface
Most common teeth affected are 307/407
These lesions can be excruciatingly painful, especially when they are advanced
How to know if a TR lesion is painful
If you probe one of the lesions even under general anesthetic, the cat will react with a jaw tremor - however, most cats will not show evidence of oral pain
Signs of pain vary and can be difficult to determine
Range from behavior changes (increased aggression or hiding) to decreased appetite
Many cats show no clinical signs of pain that the owner can identify but these lesions are always painful when they reach the pulp!
Stage 1 of TR is classified as
Mild dental hard tissue loss
Cementum or cementum and enamel affected
Tiny defect in tooth surface may be felt with the explorer
No jaw tremor on probing (not painful)
Often no other evidence in mouth
Frequently no gingivitis at this stage
May be difficult to identify on radiographs
Stage 2 TR is noticed by
Moderate dental hard tissue loss
Cementum or cementum & enamel with progression into loss of dentin
Does not extend into pulp cavity
Defect in tooth surface will be felt with the explorer if it is above the gumline
No jaw tremor on probing (not painful)
Often focal gingivitis at the area of the lesion
Gingival tissue may grow into defect
Often see a defect in the dental hard tissues on radiographs
Stage 3 of TR is
Deep dental hard tissue loss
Cementum or cementum and enamel with loss of dentin
Extends into the pulp cavity
Defect in tooth surface will be felt with the explorer if it is above the gumline
The tooth keeps its integrity
Jaw tremor on palpation – is painful!
Focal gingivitis at the site of the lesion often with gingival tissue growing into the defect
Obvious hard tissue defect on radiographs
