10 - Feline Dentistry

Question 1

What are three common oral conditions felines experience whereas in other species they are rare

Answer 1

Chronic ulcerative gingivostomatitis (CUGS)
Tooth resorption (TR)
Eosinophilic granuloma complex

Question 2

What is CUGS?

Answer 2

feline chronic ulcerative gingivostomatitis
an inflam of mucous lining of any of the sutures in the mouth
more severe than regular gingivitis associated with PD dz
can be an individual inappropriate immune response from cat to a variety of antigenic triggers (ex. pasteurella bact, plaque back, and calicivirus)

Question 3

Why is CUGS so debilitating? What does it result in

Answer 3

leads to loss of all teeth in cats at a very early age
heightened immune response -> severe oral inflam, oral ulcers, foul breath, resorption of hard dental tissue, dysphagia
some patients have large areas of their oral cavity affected w/ painful, raw areas
tx is extensive, long-term, w/ dangerous side effects and some drugs being used off-label
important to note that whole mouth extractions may be necessary

Question 4

What is an off-label drug?

Answer 4

using a drug not for its intended purpose

Question 5

What are the clinical signs of CUGS?

Answer 5

gingival bleeding is earliest sign
inflamed gingiva + mucosa may appear swollent, cobblestone-textured,b right red or rasberry-like
light touch of gingiva = spontaneous hemorrhage
hypersalivation -. saliva is ropy and thick
many stop eating bc of pain

Question 6

How do we diagnose CUGS?

Answer 6

full mouth exam inc dental rads and PD charting is required
good quality photographs also aid ability to make comparisons and gauge the success of the tx regime set out
may reveal info about the cause of the individual’s stomatitis
complete hx and PE required
A complete blood count, thyroid, biochem tests, rule out FeLV + FIV
Autoimmune testing + food testing to rule out allerg reaction to diet

Question 7

How do we help diagnose CUGS under anesthesia?

Answer 7

exam all surfaces for color, shape, texture, pain response and gingival bleeding
biopsy to determine probably etiology
intraoral rads necessary to eval teeth w/ erosive dz

Question 8

How do we manage stage 1 of CUGS?

Answer 8

Complete oral health assessmet + tx inc intraoral rads
all teeth affected by resorption or periodontitis must be extracted
any retained root tips extracted
Ab’s + NSAID’s and pain meds prescribed
after procedure, aggressive home care is instituted (tooth brushing, dental diet, antiseptic oral gels + rinses, dental checks every 6mo, frequent dental cleanings every 6-12mo)

Question 9

How do we manage stage 2 CUGS

Answer 9

If stage 1 tx fails, Owner unwilling/unable to do homecare
involves numerous tooth extractions - minimally all of caudal teeth (P’s + M’s), must ensure all tooth roots + PD ligament is removed, may require extraction of I’s and C’s in some patients if gingivitis is significant
still dental rechecks every 6mo

Question 10

How do we manage stage 3 of CUGS?

Answer 10

extract all remaining teeth
remove all roots + PD ligaments
trials show promise w/ omega interferon (local injection and daily dosing) but its not available in CAD or US except by Emergency Drug Release

Question 11

What is stage 4 management of CUGS?

Answer 11

up to 30% of cats continue to have significant oral inflam despite extraction of all teeth and removal of PD ligament
long term antibiotic and steroid therapy, may have gold salt therapy and Interferon’s
euthanasia is unable to adequately control dz

Question 12

What is CUPS in dogs?

Answer 12

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 tx as for CUGS in cats

Question 13

What is tooth resorption in cats? What % of all cats are affected by it?

Answer 13

AKA feline odontoclastic resoprtive lesion (FORL), neck lesions, cervical line lesions and cat cavities
~50% affected with TR
effects of TR is resorption of tooth, proliferation of gingiva or pulp to cover resulting lesion
Clin signs is paid, behave changes, dec appetite, drops food or hiss at it

Question 14

What is the etiology of TR?

Answer 14

dunno why it occurs
results from activation of cells called odontoclasts responsible for normal remodeling of tooth structure, in dz process - continue to resorb tooth structure until entire tooth is lost, at same time have proliferation of gingiva which covers resulting lesion
tend to occur at or just below gumline but may affect only root structure
rads necessary to dx and tx TR

Question 15

What teeth are most commonly affected in TR?

Answer 15

premolars -> molars -> canines
majority of lesions on buccal surface
most common is 307/407

Question 16

Cats are very good at hiding their pain, what are ways we can tell how painful a cat is with TR?

Answer 16

if we prove one of lesions under GA, cat will have jaw tremor (but most cats don’t show evidence of oral pain)
signs vary and difficult to determine but range from behave changes (inc aggression or hiding) to dec appetite
many show no signs that O can identify but these lesions are VERY painful went they reach the pulp

Question 17

What are some clinical signs of TR?

Answer 17

area of focal gingivitis, be suspicious of gingivitis on 307/407
progression to invasion of the gingiva into enamal defect on tooth
once pulp cavity reach, will have jaw tremor on probing of lesion
eventually loss of most of enamel and dentin and has visible hole in tooth
crown is eventually lost, gums grow over root

Question 18

How do we classify stage 1 of TR

Answer 18

mild dental hard tissue loss
cementum or cementum and enamel affected
tiny defect in tooth surface may be felt with explorer
no jaw tremor on probing (not painful)
often no other evidence in mouth
frequently no gingivitis at this stage
difficult to ID on rads

Question 19

What is stage 2 of TR?

Answer 19

cementum or cementum and enamal w/ progression into loss of dentin
does NOT extend into pulp cavity
defect in tooth surface will be felt with the explorer if it is ableve the gumline
no jaw remor on probing (not painful)
often focal gingivitis at area of lesion, gingival tissue may grow into defect, often see a defect in dental hard tissue on rads

Question 20

How do we classify stage 3 TR?

Answer 20

Deep dental hard tissue loss
cementum or cementum and enamel with loss of dentin
extends into pulp cavity
detect in tooth surface will be felt with the explorer if it is above gumline, tooth keeps its integrity
jaw tremor on palpation - is painful
focal gingivitis at the site of the lesion often w/ gingival tissue growing into the defect
obvious hard tissue defect on rads

Question 21

How do we classify stage 4 of TR?

Answer 21

extensive dental hard tissue loss
cementum or cementum and enamel with loss of dentin extending to pulp cavity
most of tooth has lost its integrity
defect in tooth surface will be felt with explorer
jaw tremor on palpation - is painful
focal gingivitis at site of lesion with gingival tissue growing into defect
dramatic hard tissue loss on rads

Question 22

How do we classify stage 5 TR?

Answer 22

Loss of crown
no visible crown on oral examination, gingival tissue grown over roots of tooth
usually a bulge in gingiva present where tooth previously existed
remnants of dental hard tissue are only visible as irregular radiopacities, gingivitis usually resolved at this stage
no longer painful

Question 23

What is the difference btw stage 3 vs 4 TR?

Answer 23

Stage 3 looks like a normal tooth but has a hole into the pulp cavity
Stage 4 has lost its integrity

Question 24

What tx options for TR do we do for each stage in simple terms

Answer 24

Stage 1 - no tx
Stage 2-4 - extraction or coronal amputation if no PD ligament visible
Stage 5 - no tx required unless there is gingivitis

Question 25

Explain tooth resorption in dogs

Answer 25

uncommon, usually only subgingival tissue affected, fusion of associated root to alveolar bone, may be linked to chewing hard objects, no tx req. if does not extend to the crown, may predispose tooth to fracture

Question 26

What is the eosinophilic granuloma complex?

Answer 26

a grouping of skin and oral conditions that often occur together in an individual animal, are characterized by eosinophilic info, frequently related to allergic dz (flea allergy, food allergy, atopy), usually respond to steroids

Question 27

Give simple characteristics of TR dz in cats from stage 1-5

Answer 27

Stage 1: Cementum and/or enamal effected, no pain, often no gingivitis, difficult to ID on rads
Stage 2: Cementum and or enamal will loss of dentin. Not in pulp cavity, no pain, defect felt with explore if above gumline, focal gingivitis, defect visible on rads
Stage3: Cementum and/or enamel loss of dentin, into pulp cavity, defect felt w/ explorer above gumline

Question 28

How might TR present in dogs compared to cats?

Answer 28

uncommon, usually only subgingival tissue affected, fusion of associated root to alveolar bone, may be linked to chewing hard objects, do not require tx if not extending to the crown, may predispose the tooth to fracture

Question 29

What is a eosinophilic granuloma complex?

Answer 29

a grouping of skin and oral conditions that;
often occur together in an individual animal, are characterized by eosinophilic inflam, frequently related to allergic dz (flea, food, atopy), usually respond to steroids

Question 30

What are the common forms for eosinophilic granuloma complex and their clinical signs

Answer 30

usually raised red-to-yellow plaques on the skin or in the oral cavity. Some skin lesions may be edematous and ulcerate/weeping
1. linear granuloma
eosinophilic plaque
3. oropharyngeal granuloma
4. indolent or rodent ulcer

Question 31

Explain the 4 common forms of eosinophilic granuloma complex

Answer 31

1. Linear granuloma’s - often on the caudal aspect of both hind limbs
2. Eosinophilic plaque - often in groin, medial thighs, or axilla
3. oropharyngeal granuloma - nodule on the tongue or other locations in the mouth
4. indolent or rodent ulcer - ulcerative lesion on the lips, usually on the upper lip

Question 32

How do we diagnose an oral granuloma?

Answer 32

they have a characteristic clinical appearance
requires biopsy to confirm

Question 33

How can we diagnose a rodent ulcer?

Answer 33

usually made from the classic appearance of an ulcerative lesion on the upper lip.
if the lesions do not heal, biopsies should be done to rule out squamous cell carcinoma

Question 34

How do we treat eosinophilic granuloma complex?

Answer 34

treat underlying hypersensitivity - hypoallergenic food trial, aggressive flea control in warmer climates
steroids often rapidly resolve lesions. May need antibiotics if lesions are secondarily infected (rodent ulcer)
consider atopica if long term tx is needed for environmental alergies