Feline Oral Disease Flashcards
describe feline chronic gingivostomatitis/FCGS
- aka stomatitis, caudal stomatitis
- painful and debilitating; refractory cases may result in euth
- multifactorial etiolgy
describe FCGS pathophysiology
- no association with age, breed, sex
- potentially a hypersensitivity reaction or inappropriate immune response to antigenic stimulation
- potentially infectious triggers:
-FCV, FLV, FIV potentially associated with increased prevalence
-but literature has not reported a poorer prognosis in FIV positive FCGS cats - plaque bacteria:
-theorized to be main inciting factors
-bacterial population less diverse
-pasteurella multicoda overrepresented - lymphoplasmacytic infiltrate
-ulcerations
-proliferation
-gingivitis
describe FCGS presentation
- history: painful, dropping food, hypersalivating, decreased grooming, weight loss, halitosis
- typically diagnosed on oral exam
- palatoglossal arch
- incongruity with perceived perio
- lesions extend past mucogingival junction
- 2 clinical phenotypes:
-ulcerative
-proliferative
-some patients will display both
describe FCGS diagnostics
- differentials:
-eosinophilic granuloma
-periodontal disease
-tooth resorption
-FCV
-uremia
-burns - routine labwork:
-hyperproteinemia
-neutrophilia
-both due to inflammation - retroviral testing
- +/- biopsy
-challenges: often at the same time as tooth extraction, tissue often very friable so difficult to obtain diagnostic sample
describe FCGS treatment
surgical:
1. current mainstay of therapy
2. full or partial mouth extractions lead to resolution or significant improvement in 60-80% of affected
-full vs caudal mouth (everything except canines and incisors) did not affect outcome
3. may take 100d post extraction for improvement
medical:
1. alternative or adjunctive to sx
2. home care: difficult bc cat is so painful
- prednisolone (palliative):
-often lose efficacy with repeated/longterm use; concerns with longterm use; may interfere with proper eval and treatment when used prior to extractions
-2-4mg/kg PO daily divided, taper to lowest effective dose or depomedrol if can’t give PO - antibiotics
- PAIN RELIEF: transmucosal or transdermal opioid
- cyclosporine!
-inhibits T cell activation and therefore inflammatory mediators
-side effects: GI, toxo reactivation
-shown to be effective in refractory (those with full mouth extraction and still FCGS) - recombinant feline interferon omega:
-not commercially available in US
-cytokines with antiviral and immune mediating properties
-potential side effects: hyperthermia, v/d, collapse
-well tolerated and showed promised when studied in FCV positive cats with refractory FCGS - mesenchymal stem cells:
-experimental, decrease T cell proliferation and alter their function
-side effects of IV transfusion: transfusion reaction (vomiting, tachypnea, treat supportively)
describe feline juvenile onset gingivitis/periodontitis
- often confused with FCGS
-not as severe or long lasting though
-pain variable - typically <9 months (6-18 month range)
-purebreds overrepresented - does not show caudal mouth involvement
- periodontal attachment loss as early as eruption
- tooth resorption possible
describe treatment for feline juvenile onset gingivitis/periodontitis
- requires client commitment for resolution
-possible in 1-2 years - routine COHATs every 3+ months
- aggressive homecare
-brushing
-chlorhexidine oral rinses or water additives
-dental diets/treats
describe tooth resorption
- formerly known as FORLs
- painful, progressive
- inflammatory, idiopathic
- treatment: extraction or crown amputation
- most commonly affected teeth are the mandibular 3rd premolars (307 and 407)
describe clinical signs of oral pain (8)
- hypersalivation
- oral bleeding
- difficulty eating
- messy eater
- repetitive lower jaw motion/chatter
- odd licking of the mouth
- aggression/hiding
- or nothing!!
-in the case of tooth resorption, can hide it and be stoic
describe incidence of tooth resorption
- wide range
- symmetrical in most cats
- cats missing teeth are liekyl to have had tooth resorption in the past
-dx radiographically - no breed or sex disposition
describe TR classification system
ON EXAM
TR type 1:
-focal or multifocal radiolucency with otherwise normal radiopacity and normal periodontal ligament space
-PD ligament space present
-must remove whole tooh
TR type 2:
-narrowing or disappearance of the periodontal ligament space in at least some areas and decreased radiopacity of some of the tooth
-roots no longer exist, cannot be extracted in the traditional sense, treatment is now crown amputation
-no PD ligament space
TR type 3:
-combinations of type 1 and type 2 in the same tooth
-combo treatment
special note for AVDC stages:
-stage 5 may not require treatment if gingival covering is complete and no root remnants remain
describe feline oral tumors
- 3-10% of cancers in cats and 90% are malignant
- types:
-squamous cell carcinoma
-fibrosarcoma
-epulis, lymphoma, osteosarcoma, adenocarcinoma - possible signs:
-loose teeth
-poor wound healing
-unilateral lesion/swelling
-unexplained lucency on rads - how biopsy?
-probs can’t get entire thing with margins or without radical sx; shave off a piece and stick it in formalin
-treat based on biopsy results
describe alveolar osteitis
- gingival swelling adjacent to upper or lower canine teeth
-teeth appear super erupted or protruding from alveolus (tooth socket)
-can become unable to close mouth = frantic because can get entrapped with other teeth
-audible clicking, grinding sound - secondary to periodontitis
-tooth socket becomes infected, inflamed, and thickened under gum - treatment: extraction, address periodontal disease
