Lecture 10: Feline dentistry

Question 1

What are common cat dental disease that arent seen in other species

Answer 1

1) Chronic ulcerative gingivostomatitis (CUGS)
2) Tooth Resorption (TR)
3) Eosinophilic Granuloma Complex

Question 2

Feline Chronic Ulcerative Gingivostomatitis (CUGS) is

Answer 2

Is an inflammation of the mucous lining of any of the structures in the mouth
More severe than regular gingivitis associated with periodontal disease

Question 3

Feline Chronic Ulcerative Gingivostomatitis (CUGS) is casued by

Answer 3

Can be thought of as an individual inappropriate immunologic response from the cat to a variety of antigenic triggers
Such as Pasteurella bacteria, plaque bacteria, and calicivirus
Evidence suggests that this disease may be immune-mediated
It is a very debilitating disease that will frequently lead to loss of all the teeth in cats at a very early age
The heightened immune response leads to severe oral inflammation, oral ulcers, foul breath, resorption of hard dental tissues, and difficulty in eating
Some patients have large areas of their oral cavity affected with painful, raw areas

Question 4

Treatment of CUGS

Answer 4

Treatment is extensive and long-term, with treatments having dangerous side effects and some drugs being used off-label
It is important to note that whole mouth extractions may be necessary

Question 5

Clinical signs of CUGS

Answer 5

Gingival bleeding is one of the earliest signs of the disease
Inflamed gingiva and mucosa may appear swollen, cobblestone-textured, bright red, or raspberry-like
Light touch of gingiva can result in spontaneous hemorrhage
Hypersalivation is common→often saliva is ropy and thick
Many cats will stop eating secondary to oral pain

Question 6

What history is needed for CUGS

Answer 6

Intensive diagnostic testing beyond the physical exam is required.
May reveal information about the cause of the individual patient’s stomatitis
Full mouth exam including dental radiographs and periodontal charting is also required
Good quality photographs also aid the ability to make comparisons and gauge the success of the treatment regime set out

Question 7

What would you use to diagnose CUGS

Answer 7

History and a complete physical exam are required
A complete blood count, thyroid, and biochemical tests should be performed
Viral infections such as FeLV (feline leukemia virus) and FIV (feline immunodeficiency virus) must also be ruled out as a causative agent
Autoimmune testing should be considered
Food allergy testing may also be done to rule out an allergic reaction to a component of the diet
Prescription hypoallergenic diet trial

Question 8

What to examine in cats mouth for CUGS under anesthesia

Answer 8

An extensive exam of the oral cavity is required
Examining all surfaces for color, shape, texture, pain response and gingival bleeding etc.
A biopsy may be required to determine probable etiology
Intraoral radiographs are necessary, to evaluate teeth with erosive disease

Question 9

CUGS stage 1 is

Answer 9

Complete oral health assessment and treatment including intraoral radiographs
All teeth affected by resorption or periodontitis must be extracted.
Any retained root tips must also be extracted
Antibiotics, NSAIDs and pain meds are prescribed

Question 10

CUGS stage 1 home care can be

Answer 10

After the procedure, aggressive home care is instituted
Tooth brushing
Dental diet
Antiseptic oral gels and rinses
Dental checks at least every 6 months
Frequent dental cleanings (every 6-12 months)

Question 11

Stage 2 CUGS is

Answer 11

If stage 1 treatment fails or owner is unable/unwilling to do home care
Involves numerous tooth extractions
Minimally all of the caudal teeth (premolars and molars)
Must ensure all of the tooth roots and periodontal ligament is removed
May require extraction of incisors and canines in some patients if gingivitis in that area is significant
Still requires dental checks minimally every 6 months

Question 12

Stage 3 CUGS is

Answer 12

For cats that do not respond to treatments offered in stage 1 and 2
Extraction of all remaining teeth
Must completely remove all roots and periodontal ligament
Trials showing promise with Omega Interferon (local injection and daily dosing)
Currently not available in Canada or the US (except by Emergency Drug Release)

Question 13

Stage 4 CUGS is

Answer 13

For cats who fail to respond to treatments in stages 1-3
Up to 30% of cats continue to have significant oral inflammation despite extraction of all of the teeth and removal of the periodontal ligament
Long term antibiotic and steroid therapy are mainstays
Gold salt therapy?
Interferon?
Euthanasia if unable to adequately control disease

Question 14

CUPS in dogs is

Answer 14

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 treatment as for CUGS in cats

Question 15

Tooth resorption is

Answer 15

Also known as feline odontoclastic resorptive lesion (FORL), neck lesions, cervical line lesions and cat cavities
Most research suggests that just under 50% of the cat population is clinically affected with TR

Question 16

Effects of TR

Answer 16

Resorption of the tooth
Proliferation of the gingiva or pulp to cover resulting lesion

Question 17

Signs of TR

Answer 17

Pain
Behavior changes
Decreased appetite
Drop food or hiss at it

Question 18

Clinical signs of TR

Answer 18

Often starts as an area of focal gingivitis
If you notice gingivitis centered on 307/407, be suspicious of TR
Progresses to invasion of the gingiva into an enamel defect on the tooth
Once the pulp cavity is reached, you will elicit a jaw tremor on probing of the lesion
Eventually you get loss of most of the enamel and dentin and there is a visible hole in the tooth
The crown is eventually lost, and the gums grow over the roots

Question 19

Etiology of TR

Answer 19

Do not know why TR occurs
It results from the activation of cells called odontoclasts, which are responsible for the normal remodeling of tooth structure
In this disease process:
Continue to resorb tooth structure until the entire tooth is lost
At the same time have proliferation of the gingiva which covers the resulting lesion

Question 20

What would you see in the mouth for TR

Answer 20

They tend to occur at and just below the gumline but they may affect only the root structure
Dental radiographs are necessary to accurately diagnose and treat TR
The teeth most commonly affected are the premolars, followed by the molars and finally the canines
The majority of the lesions are on the buccal surface
Most common teeth affected are 307/407
These lesions can be excruciatingly painful, especially when they are advanced

Question 21

How to know if a TR lesion is painful

Answer 21

If you probe one of the lesions even under general anesthetic, the cat will react with a jaw tremor - however, most cats will not show evidence of oral pain
Signs of pain vary and can be difficult to determine
Range from behavior changes (increased aggression or hiding) to decreased appetite
Many cats show no clinical signs of pain that the owner can identify but these lesions are always painful when they reach the pulp!

Question 22

Stage 1 of TR is classified as

Answer 22

Mild dental hard tissue loss
Cementum or cementum and enamel affected
Tiny defect in tooth surface may be felt with the explorer
No jaw tremor on probing (not painful)
Often no other evidence in mouth
Frequently no gingivitis at this stage
May be difficult to identify on radiographs

Question 23

Stage 2 TR is noticed by

Answer 23

Moderate dental hard tissue loss
Cementum or cementum & enamel with progression into loss of dentin
Does not extend into pulp cavity
Defect in tooth surface will be felt with the explorer if it is above the gumline
No jaw tremor on probing (not painful)
Often focal gingivitis at the area of the lesion
Gingival tissue may grow into defect
Often see a defect in the dental hard tissues on radiographs

Question 24

Stage 3 of TR is

Answer 24

Deep dental hard tissue loss
Cementum or cementum and enamel with loss of dentin
Extends into the pulp cavity
Defect in tooth surface will be felt with the explorer if it is above the gumline
The tooth keeps its integrity
Jaw tremor on palpation – is painful!
Focal gingivitis at the site of the lesion often with gingival tissue growing into the defect
Obvious hard tissue defect on radiographs

Question 25

Stage 4 of TR is

Answer 25

Extensive dental hard tissue loss
Cementum or cementum and enamel with loss of dentin extending to the pulp cavity
Most of tooth has lost its integrity
Defect in tooth surface will be felt with the explorer
Jaw tremor on palpation – is painful!
Focal gingivitis at the site of the lesion with gingival tissue growing into the defect
Dramatic hard tissue loss visible on radiographs

Question 26

Stage 5 of TR is

Answer 26

Loss of crown
No visible crown on oral examination
Gingival tissue has grown over the roots of the tooth
Usually, a bulge in the gingiva is present where the tooth previously existed
Remnants of dental hard tissue are only visible as irregular radiopacities
Gingivitis usually resolved at this stage
No longer painful!

Question 27

What does TR affect

Answer 27

In some cases, only the root is affected
If it does not affect above the gumline, these lesions may not require treatment
May be more prone to fracture as they usually are fused to the surrounding alveolar bone

Question 28

Treatment of TR by stages

Answer 28

Stage 1
-No treatment
Stage 2-4
-Extraction or coronal amputation if no periodontal ligament visible
Stage 5
-No treatment is required unless there is gingivitis

Question 29

Tooth resorption in dogs is

Answer 29

Uncommon
Usually only subgingival tissue affected
Fusion of associated root to alveolar bone
May be linked to chewing hard objects
Do not require treatment if does not extend to the crown
May predispose the tooth to fracture

Question 30

Eosinophilic Granuloma Complex is

Answer 30

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

Question 31

Clinical signs of Eosinophilic Granuloma Complex

Answer 31

Usually raised red-to-yellow plaques on the skin or in the oral cavity. Some skin lesions may be edematous and ulcerated/weeping.

Question 32

Common forms of Eosinophilic Granuloma Complex

Answer 32

Linear granulomas – often on the caudal aspect of both hind limbs
Eosinophlic plaque – often in the groin, medial thighs, or axilla and are usually very itchy
Oropharyngeal granuloma – nodule on the tongue or other locations in the mouth
Indolent or Rodent ulcer – ulcerative lesion on the lips, usually on the upper lip

Question 33

Eosinophilic Granuloma Complex dignosis

Answer 33

Oral Granuloma
Often have a characteristic clinical appearance
Requires biopsy to confirm
Rodent ulcer
Diagnosis 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

Treatment of 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 treatment is needed for environmental allergies