Feline Dentistry

Question 1

Tooth resorption

Answer 1

• AKA - ‘neck lesions’, (feline) odontoclastic resorptive lesions (FORL)
• Abnormal destruction of dental hard tissues + its replacement w/ granulation tissue or bone
• High prevalence in cats - 25 - 40% -> 80% for any cats getting dental work done

Question 2

Type 1 tooth resorption

Answer 2

• Associated w/ inflammation, present at cemento-enamel junction, tooth root unaffected
• Stimulates odontoclasts that eat into tooth surface cells -> loss of tooth structure
• Gingivitis, periodontal disease, gingival stomatitis
• Will need extracting from root
• See periodontal ligament

Question 3

Type 2 tooth resorption

Answer 3

• Replacement resorption, cellular activity on root surface (odontoclasts inappropriately activated)
• Cells replaced w/ pink granulation tissue - changes tooth into bone
• Nothing to extract - just remove the crown / weakened at base, gum will just peel off, exposing bone/pulp, crown amputation speeds process up, gets teeth through painful part
• Fluffy appearance, cannot see periodontal ligament, nothing to extract

Question 4

Type 3 tooth resorption

Answer 4

• Combination of type 1 & 2
• Inflam at cemento-enamel junction + replacement resorption - cellular activity on root surface

Question 5

What type of tooth resorption?

Answer 5

Type 2

Question 6

What type of tooth resorption?

Answer 6

Type 2

Question 7

What type of tooth resorption?

Answer 7

Question 8

What type of tooth resorption?

Answer 8

Question 9

What type of tooth resorption?

Answer 9

Question 10

What type of tooth resorption?

Answer 10

Question 11

Type 1 resorption Tx

Answer 11

• Complete extration of all remaining root structures
• Sx extraction via mucoperiosteal flap - single releasing incision, section teeth + luxate suture holes
• Post-extraction radiographs

Question 12

Type 2 resorption Tx

Answer 12

• Extraction preferable to avoid leaving any sensitive vital tissue e.g. pulp or periodontal ligament
• If no vital structures - if these are separated from oral cavity by an area of resorption (cannot see root) - crown amputation acceptable
• Triangle flap - incision along alveolar margin - remove crown at level of bone / parallel - diamond burr to sand down

Question 13

Feline chronic gingivostomatitis

Answer 13

• Painful and debilitating disease
• Last months -> years -> lifelong
• Inappropriate oral inflammation, in response to plaque?
• Prevalence: 0.7 – 12%

Question 14

Feline chronic gingivostomatitis - CS

Answer 14

• Systemically ill from dental disease
• Moderate to severe oral pain
• Halitosis
• Ptylism (pus in drool)
• Dec grooming
• Hyporexia (dec eating)
• Weight loss
• Irritability + withdrawn behaviour, and/or dec activity

Question 15

Feline chronic gingivostomatitis - histopathology

Answer 15

• Only biopsy if isolated lesion
• Lesions are 1y infiltrated by lymphocytes + plasma cells w/ fewer neutrophils, macrophage-like cells + mast cells
• CD3+ T cells present within epithelium + submucosa of oral mucosa w/ FCGS
• CD20+ B cells mainly present within subepithelial stroma

Question 16

Feline chronic gingivostomatitis - aetiology

Answer 16

• Inappropriate immune response to oral antigenic stimulatioin
• Potentially multifactorial in nature + possibly w/ varying inciting causes (variety of diseases)
• Systemic pathogens - feline calicivirus, herpes virus, leucaemia virus, immunodeficiency virus + Bartonella
• Dental disease - feline resorptive lesions, periodontal disease
• Hypersensitivity - overreaction to plaque bacteria, food allergies

Question 17

Feline chronic gingivostomatitis - Dx

Answer 17

• Appearance
• Ulcerative gingiva -> mucosal inflammation
• Proliferative - away from teeth

Question 18

Feline chronic gingivostomatitis

Answer 18

• 1). Immunosuppression - Corticosteroids, Cyclosporine
• Complications: PU/PD, 2y DM, skin fragility, diminishing effectiveness overtime
• 2). Sx - reducing surfaces that plaque can build up -> reduces stimulus of bacterial infection by extraction:
• Extraction or premolar + molar teeth or full dentition
• Complications: post-op pain + reduced func, owner psychological distress + financial expense
• 60% clinical remission rate, but 20% little to no improvement
• Sx = Statistically no significant difference

Question 19

Feline Chronic Gingivostomatitis - Tx, extractions, considerations

Answer 19

• 1/3 = Tx adequate + no further Tx required
• 1/3 = sig improvement but additional medical management may be required
• 1/3 = refractory to Tx + mucosal inflam persists

Question 20

Feline Chronic Gingivostomatitis - Tx, extractions, discussions w/ owner

Answer 20

• Extraction of diseased teeth - periodontitis, tooth resorption , Fx
• Elective extraction - caudal to canine teeth?, full mouth? teeth w/ area of mucositis surrounding them

Question 21

Feline Chronic Gingivostomatitis - Tx, medical

Answer 21

• Analgesia - e.g. transmucosal buprenorphine, NSAIDs - Meloxicam, local anaesthesia
• AB - make them feel better, to have healthy gingiva, healthy bone underneath
• Steroids
• Interferon - not massively helpful
• Cicosporin - immunosuppressive, less side effects compared to steroids, use in older cats, more expensive

Question 22

Tooth Fx + pulp necrosis

Answer 22

• Necrotic pulp -> tooth root abscess -> bacteraemia
• Common in RTA even if don’t have obvious facial injuries

Question 23

Fx teeth - Tx options

Answer 23

• 1). Extraction
• 2). Root canal Tx - when pulp exposed, if don’t want to lose tooth, v expensive