Exam 2 - Feline Oral Disease Flashcards
what is the difference between a stage & grade in regards to dental disease?
a grade is a set entity while a stage is a progressive problem
periodontal disease is a progressive problem so we don’t use grades
what is the pathogenesis of periodontal disease?
plaque accumulation leads to gingival inflammation
as gingival inflammation continues, plaque gets up under the gum lines & pocket formation occurs
how is periodontal disease diagnosed? why?
must use a radiograph!!!! you can not tell the stage of disease just by looking in the mouth, you have to have a radiograph to know what stage you’re in
how is periodontal disease prevented?
prevention of the accumulation of plaque - need to control or prevent plaque to prevent/control disease requiring collaboration between the veterinarian, owner, & pet
what are the normal gingival sulcus depths for dogs & cats?
dogs: 1-3mm
cats: 0-0.5mm
what is stage 1 of periodontal disease?
gingivitis - with minimal inflammatory changes & minimal to no changes in sulcus depth
up to 0.5mm sulcus depth in cats usually due to gingival swelling & not attachment loss
is there any bone involvement in stage 1 periodontal disease?
no
what is seen with the gingiva that clues you in to a likely diagnosis of stage 1 periodontal disease?
the gingiva will get swollen with periodontal disease & start to curve in - on this cat, with stage one, the gingiva is pretty flat/straight line along the margin of the gingiva
this is a radiograph of a cat with stage 1 periodontal disease - is the 1st molar diseased? what tooth is this cat missing?
no - it always looks like it has an abscess, but it is the normal appearance
missing their 06 tooth
what is stage 2 of periodontal disease?
early periodontal disease - inflammation of the periodontal ligament, gingival edema, onset of crestal bone loss (25% of ,1mm), may have areas of root exposure due to gingival recession, & the beginning of attachment loss
is there any bone involvement in stage 2 of periodontal disease?
yes - onset of crestal bone loss, so 25% or <1mm, but no mobility of the teeth at this point! may see some root exposure due to gingival recession
cementum is exposed & cementum is rougher than enamel, so plaque will readily stick to this rougher surface
what is the calculus index used on teeth?
1 - not much calculus present on the tooth
2 - calculus covers 1/2 of the tooth
3 - calculus covers entirety of tooth
what is feline juvenile gingivitis/periodontitis?
can be a self-limiting disease or bad disease that happens in young cats - depends on bone loss
if no bone loss occurs, cat will likely recover
if bone loss occurs, cat will likely lose their teeth
what is stage 3 of periodontal disease?
moderate periodontitis - moderate attachment loss, pocket depth/root exposure increases up to 2mm, alveolar bone loss 25-50%, & slight tooth mobility
what periodontal stage is 309?
stage 3 - alveolar bone loss, root exposure
what is stage 4 of periodontal disease?
advanced periodontitis - deep pockets/root exposure >2mm, alveolar bone loss >50%, moderate/great tooth mobility, root exposure can be extensive over cuspids, & maxillary alveolar bone may have bulbous appearance around cuspids which can progress to osteopenia & gradual extension of cuspids
severe severe bone loss! bye bye teeth!
what is alveolar osteitis?
alveolar bone expansion - severe periodontal disease around the canine that causes the bone around it to expand which forces the tooth to start erupting/exfoliating so the canine tooth is hanging over the lips
what pathology is shown here?
alveolar osteitis
T/F: technically, each tooth has its own stage of disease but the mouth is assigned one stage as a whole
true
what is stage 5 of periodontal disease?
exfoliation - loss of teeth, healing of empty alveolus, inflammation recedes, & dental ledge atrophies & smooth epithelium covers the gingival surface
what are some names used for feline tooth resorption?
feline odontoclastic resorptive lesions
feline neck lesions
cervical line lesions
what are the 3 types of feline tooth resorption? what do they mean?
- inflammatory - something is infected either periodontal or endodontal
- non-inflammatory - surface resorption or replacement resorption where you can’t tell the difference between root & bone on these radiographs
- combination of 1 & 2 - one tooth can have a lot going on
why do we care about the type of tooth resorption in cats?
the type tells you how to treat it!!!!
class tells you the progression of the absorption
how many stages of resorption are there?
5
what is stage 1 of tooth resorption?
mild dental hard tissue loss (cementum or cementum & enamel)
what stage of tooth resorption is shown here?
type 1 - starting to eat away at the cementum & maybe the enamel some
T/F: in stage 1 of tooth resorption, even radiographs won’t pick up on any changes
true - will still see periodontal ligament, bone, & root
what is stage 2 of tooth resorption?
moderate dental hard tissue loss (cementum or cementum & enamel with loss of dentin that DOES NOT extend into the pulp cavity)
what stage of tooth resorption is shown in the photo?
stage 2 - eaten its way through cementum or cementum/enamel/dentin but not in pulp chamber!
what is stage 3 of tooth resorption?
deep dental hard tissue loss (cementum or cementum & enamel with loss of dentin that EXTENDS into the pulp cavity) & most of the tooth retains its integrity
what stage of tooth resorption is shown here?
stage 3 - gingival overgrowth trying to cover the defect (similar to proud flesh in horses)
if you see a little hump of gingiva on oral exam, what should you do? why?
need to poke the tooth & see if the animal is painful - the gingival overgrowth is seen in stage 3 of tooth resorption
what is the most common site of tooth resorption in cats? what is it followed by?
starts at the 7th tooth (either maxillary or mandibular)
followed by mandible 09
followed by maxilla 08
what is stage 4 of tooth resorption?
extensive dental hard tissue loss (cementum or cementum & enamel with loss of dentin that extends to the pulp cavity) & most of the tooth has lost its integrity
T/F: you need to do a radiograph of the mouth to distinguish between types 1 & 2 of tooth resorption
true
what is stage 5 of tooth resorption?
remnants of dental hard tissue are visible only as irregular radiopacities & gingival covering is complete
can tell that there used to be a tooth there
when can you do a crown amputation on a tooth undergoing resorption?
only if there is no infection down at the root of the tooth
what is the treatment for stage 1 of tooth resorption?
clean teeth, apply fluoride varnish to desensitize & harden enamel, & seal tubules
what is the treatment for stage 2 of tooth resorption?
clean teeth, restore defect with glass ionomer, & cover with fluoride varnish
what is the treatment for stages 3-5 of tooth resorption?
extraction of all involved teeth & root fragments or crown amputation depending on the type
when can you leave roots during extractions for resorptive teeth?
can leave if:
there is no discomfort on probing
no radiographic evidence of endodontic pathology or periodontal pocketing
what is the etiology of caudal stomatitis/lymphocytic/plasmacytic stomatitis in cats/
unknown - implicated bacteria, viruses, & immune status
what is the pathogenesis of caudal stomatitis?
hyperimmune response to plaque in the mouth - non-responsive to oral hygiene, antibiotics, anti-inflammatories, & immunomodulators
why does caudal stomatitis sometimes not resolve even with the extraction of involved teeth?
the tongue is still a source of plaque in the mouth, so the tongue can still set off the immune response
what cats are especially hard to work with if they have caudal stomatitis? what should you do to start?
calicivirus positive cats - find out their viral status to start because it will give you information on how this can be a long term issue
what anatomic structure is commonly involved in caudal stomatitis?
bilaterally affects the palatoglossal folds
what pathology is shown here?
caudal stomatitis affecting the palatoglossal folds
what should you do if you think a cat has caudal stomatitis, but the area affected in the mouth is unilaterally affecting the palatoglossal folds?
need to do a biopsy to rule out squamous cell carcinoma
when can you do partial extractions for caudal stomatitis?
where you only remove the cheek teeth - can do this if the canines & incisors are not inflamed
what are some other names used for eosinophilic granuloma complex?
eosinophilic granulomas
linear granuloma
eosinophilic ulcer
eosinophilic plaque
who should you do a consult with if you have a cat present with an eosinophilic granuloma? why?
dermatology - often occur in association with various allergies
what cats are typically affected by eosinophilic plaques?
young cats 2-6 years old, more commonly females than males
what is the eosinophilic granuloma complex?
can be an isolated lesion or with eosinophilic plaques - raised linear lesions, yellowish-pink in color that can be on the mucosa, hard palate, soft palate, or base of tongue
associated with insect bite or food allergies, atopy, immunosuppression, or bacterial/viral (calici) causes
what is an eosinophilic ulcer? what cats does it usually affect?
can be a single lesion or within the complex - well circumscribed lesion usually on the upper lip that is associated with the lower canine bumping on the upper lip causing trauma
middle aged female cats
what lesion is shown here?
eosinophilic ulcer/rodent ulcer
what is the most aggressive/invasive benign oral tumor in cats?
acanthomatous epulis
why are acanthomatous epulis bad in cats & not as bad in dogs?
in cats - the most aggressive & invasive, so you have to remove a lot of bone to get it out & cats do not do well with this surgery
dogs - usually need to remove the tooth & some of the surrounding bone & they will do fine
what is the most common oral tumor in the cat?
squamous cell carcinoma, often proliferative & ulcerative that are red/friable - can be tonsillar or non-tonsillar with more rostral tumors carrying a better prognosis
what is the treatment for oral squamous cell carcinomas in cats? what is the prognosis?
surgery & radiation - not optimistic in cats
poor prognosis
if you’re poking around in a cat’s mouth, & a tooth comes out very easily, what should you do? why?
radiographs & biopsy - concerned about cancer (SCC)
why is it bad that this SCC has affected this cat’s tongue?
once it gets to the tongue, it is bad news - tongue gets hard like wooden tongue in cattle, so they have a hard time eating & it is where they meet their demise
