Dental Pathology Flashcards
What is the most common dental disease in cats?
feline odontoclastic resorptive lesion
What is the best treatment for feline odontoclastic resorptive lesion?
extraction
Why is extraction the best method for feline odontoclastic disease?
- progressive
- unknown etiology
- poor success with other treatments
- comfort
What is the diagnosis tool for feline odontoclastic disease?
dental radiograph
What is the stage of this lesion?
Stage 1 resorptive lesion:
- only involves cementum
Characteristics of stage 1 feline odontoclastic lesion
- only involves cementum
- often undiagnosed
- not sensitive
What is the stage of this lesion?
Stage 2 resorptive lesion:
- progression through cementum into crown/ root dentin
Characteristics of stage 2 feline odontoclastic resorptive lesion
- progression into the dentin of the crown / root
- painful
- hyperplastic gingiva overlaying defect
What is the stage of this lesion?
stage 3:
- invaded into the pulp chamber & tooth canal
Characteristics of stage 3 feline odontoclastic resorptive lesion
- invasion of the lesion into the pulp chamber & tooth canal
- painful
- bleeding from pulp tissue upon probing
What stage is this lesion?
Stage 4:
- extensive structural damage
- tooth fractures easily
Characteristics of stage 5 feline odontoclastic resorptive lesion
- no crown with root remanant or vice versa
- have bulging & inflammed gingiva
What are the 2 stages/ types of feline resorptive lesions that potentially does not require extraction?
Type 2: crown amputation
Stage 5: if not inflammed, intact gingiva & no peripheral pathology, can leave alone
What is Type 1 feline odontoclastic resorptive lesion?
- focal or multifocal radiolucency in tooth
- otherwise normal
What is Type 2 feline odontoclastic resorptive lesion?
- narrowing or disappearance of periodontal ligament
- presence of dentoalveolar ankylosis & replacement
What is Type 3 feline odontoclastic resorptive lesion?
presence of both type 1 & type 2 on same tooth
What is Feline Chronic gingivostomatitis?
- painful oral inflammation
- can be local or generalized
- comprise of gingivitis & mucositis
Etiology of feline chronic gingivostomatitis
Multifactoral:
- FeLV
- FIV
- Bartonella
- Calicivirus
- oral bacteria/ endotoxin
- immune-mediated (reaction to plaque bacteria)
Examples of partial feline chronic gingivostomatitis
- caudal mucositis
- kissing ulcer
What causes kissing ulcer?
contact between oral mucosa & tooth
What is an example of generalized widespread feline chronic gingivostomatitis?
stomatitis
Work up for feline chronic gingivostomatitis
- FeLV/FIV
- Bartonella PCR
- Calicivirus PCR
- CBC
- Biochemistry ( hyperglobulinemia)
- oral exam
- biopsy: chronic, ulcerative lymphocytic-plasmocytic stomatitis
Medication used to manage feline chronic gingivostomatitis
- steroids for crisis (does not resolve primary cause)
- antibiotics for bartonella- associated stomatitis (Azithromycin & Doxycycline)
Best treatment for feline chronic gingivostomatitis
- full mouth extraction:
- 80% responds to treatment (full/ partial) - Dental cleaning with full mouth radiograph, selected extraction & biopsy
What is Chronic Ulcerative Paradental Stomatitis?
Canine stomatitis
What causes Chronic ulcerative paradental stomatitis?
unknown; some relationship with plaque bacteria
Presentation for Chronic ulcerative paradental stomatitis
- Maltese over-represented
- pain: drooling, difficulty eating, depression, head shy
- halitosis
- weight loss
Workup for chronic ulcerative paradental stomatitis
- PE: mandibular lymphadenopathy & lip fold dermatitis (drooling)
- CBC
- Biochemistry
- Oral exam
- Biopsy: chronic, ulcerative lymphocytic-plkasmacytic stomatitis
Treatment for chronic ulcerative paradental stomatitis
- Full dental cleaning: special care to remove all plaque & calculi
- extraction of diseased teeth
- dental sealant application
- home care important: better homecare, less drugs
What teeth are usually extracted in chronic ulcerative paradental stomatitis?
molars & premolars
When would medication be useful in treating chronic ulcerative paradental stomatitis?
Antibiotics:
- Short-term relief of soft tissue infection or systemic inflammation
- must be combined with cleaning & extractions
Steroids:
- anti-inflammatory
What is gingival hyperplasia?
pathologic growth of excessive gingival tissue
Why can gingival hyperplasia be problematic?
- creates pseudopocket around tooth that can trap hair, food and bacteria
- lead to periodontal disease
What causes gingival hyperplasia?
- Reaction to gingival inflammation due to chronic antigenic stimuli
- genetic plays a role too (usually recession) - Medication
What medication may cause gingival hyperplasia?
- calcium channel blocker
- phenytoin derivatives
- cyclosporin
What is required to treat gingival hyperplasia?
- full mouth radiograph
- gingivectomy ( repeated therapy)
- regular dental cleaning
- homecare
What is gingivectomy?
- Removal of excess gingiva
- preserve normal anatomy
How to perform gingivectomy?
- apply local anesthesia
- measure psuedopocket & mark gingiva with dots and remove excess
- fluted bur on high speed handpiece for contouring & hemostasis
Other differentials that can present as gingival hyperplasia
- neoplasia
- oral papilloma
- operculum
Need to send for histology
What is operculum?
incomplete loss of gingival tissue during tooth eruption
Home care after gingivectomy
- NSAID
- soft food
- no chew toys fopr 2 weeks
- no tooth brushing 1st week (chlorhexidine gel on teeth)
What are some common canine oral mass?
- hyperplastic gingiva
- epilude (acanthotomatous, fibromatous)
- papillomas
- malignant melanoma
- squamous cell carcinoma
- fibrosarcoma
What are some common feline oral mass?
- eosinophilia granuloma
- epiludes
- squamous cell carcinoma
- fibrosarcoma
Protocol for mass discovery
- radiograph to check fro bone involvement
- note tooth mobility, displacement, tooth loss or tooth destruction
- biopsy for histmpathology
What does the peripheral odontogenic fibromas originate from?
periodontal ligament
Characteristics of peripheral odontogenic fibromas
- slow growing
- non-invasive
- no destruction of underlying bone
- excision of mass not curative
Treatment for peripheral odontogenic fibroma
excision, tooth extraction & removal of periodontal ligament
What does decision on type of oral biopsy technique depend on?
- location
- size
- appearance
- adjacent structure
- evidence of bone destruction
Ratio for excised tissue & formalin fro biopsy
1:10 volume
