Oral Medicine Flashcards by Jennifer Kelley

In the study, “Iatrogenic Nasolacrimal Duct Obstruction Following Tooth
Extraction in a Cat” what is ‘no’ in the diagram and why is this structure important?

‘no’ is the nasolacrimal ostium, this is where the nasolacrimal duct drains into the nasal cavity

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In the study, “Iatrogenic Nasolacrimal Duct Obstruction Following Tooth
Extraction in a Cat” the arrow is pointing to what structure and why was it important in this study?

The arrow is pointing to the portion of the nasolacrimal duct that is medial to the canine alveolar wall. The authors suspect alveolar curettage caused acute edema and iatrogenic extraluminal obstruction of the nasolacrimal duct.

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In the study, ““Iatrogenic Nasolacrimal Duct Obstruction Following Tooth
Extraction in a Cat”, what is slc, ilc, ls, and lsf in the image depicted?

slc - superior lacrimal canaliculus
ilc - inferior lacrimal canaliculus
ls - lacrimal sac
lsf - lacrimal sac fossa

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In the study, “Mandibular Blastomycosis in a 5-Year-Old Dog” JVD 2022.3 how did they diagnose localized oral mandibular blastomycosis?

Urine antigen testing –> Bone biopsy with Gomori’s methenamine silver stain identified budding yeast organisms

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In Castejon-Gonzalez’s 2018 paper “Treatment Outcome of 22 Dogs with Masticatory Muscle Myositis (1999-2015),” relapse occurred in what percent of cases and what factor was associated with relapse?

Reiter. JVD 2018

relapse occurred in 27% of cases
Longterm treatment was significantly associated with relapse

No sig difference in number of relapses for dogs that medium or short term treatments vs long-term treatments

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In Castejon-Gonzalez’s 2018 paper “Treatment Outcome of 22 Dogs with Masticatory Muscle Myositis (1999-2015),” greatest improvement in clinical signs was noted over what time period, and how long do the authors recommend keeping dogs on pred?

Reiter JVD 2018

Greatest improvement in clinical signs over first 3-4 weeks
Keep dogs on pred 1 year

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In Castejon-Gonzalez’s 2018 paper “Treatment Outcome of 22 Dogs with Masticatory Muscle Myositis (1999-2015),” what factor was associated with normal vertical mandibular ROM within 4 weeks?

Reiter. JVD 2018

Medium or high vmROM at diagnosis sig associated with normal vmROM within 4 weeks compared to low vmROM

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In the study, “Mandibular Blastomycosis in a 5-Year-Old Dog” JVD 2022.3 how did they treat the localized oral mandibular blastomycosis?

Itraconazole therapy 5mg/kg/day for four and a half months, patient was Antigen negative at 3 1/2 months, but they continued the medication for another 30 days

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Describe the radiographic lesions in the study, “Mandibular Blastomycosis in a 5-Year-Old Dog” JVD 2022.3.

Generalized mottled appearance, with loss of trabecular bone pattern and bony architecture, and punctate lucencies throughout
the mandible. This pattern crossed the symphysis.

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What were the main takeaways in Rejec’s 2017 study, “Evaluation of Complete Blood Count Indices (NLR, PLR, MPV/PLT, and PLCRi) in Healthy Dogs, Dogs With Periodontitis, and Dogs With Oropharyngeal Tumors as Potential Biomarkers of Systemic Inflammatory Response”?

JVD 2017

There were no significant associations between CBC indices and periodontal disease.

Both NLR and PLCRi were significantly higher in in dogs with OT when compared to HD and dogs with PD - this could be an indicator of a tumor associated inflammatory response

Neutrophil to lymphocyte ratio (NLR)
Platelet large cell ratio index (PLCRi)

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The digastricus muscle is composed of what type of muscle fibers predominately?

Reiter Am, Schwarz T. Computed tomographic appearance of masticatory myositis in dogs:
7 cases (1999-2006). JAVMA 2007

Temporalis, masseter, pterygoid predominately 2M

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In Reiter’s 2007 study “Computed tomographic appearance of masticatory myositis in dogs: 7 cases (1999-2006),” what was the most reliable CT finding for MMM and localization of where to perform muscle biopsies?

JAVMA 2007

Contrast enhancement with predominately homogenous distribution pattern in temporalis, masseter, and pterygoid muscles in all dogs

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According to Reiter’s 2007 study “Computed tomographic appearance of masticatory myositis in dogs: 7 cases (1999-2006),” what are the previously published rates of serum circulating antibodies againist Type 2M fibers in dogs with MMM?

JAVMA 2007

81% (Shelton 1987)
63% (Neumann 2006)

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In Blazejewski’s 2018 article “Trismus, masticatory myositis and antibodies against type 2M fibers in a mixed breed cat,” what testing and results were performed?

JFMS 2018

ELISA 2M antibody titers 1:1000
Post mortum histopath –> end stage MMM

canine 2M antibody testing can be used in cats

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In the study, “Clinicopathological Features, Risk Factors and Predispositions, and Response to Treatment of Eosinophilic Oral Disease in 24 Dogs (2000-2016)” JVD 2019.1, what were the 3 most represented breeds in descending order?

Cavalier King Charles Spaniel, Labrador Retriever and West Highland White Terrier

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In the study, “Clinicopathological Features, Risk Factors and Predispositions, and Response to Treatment of Eosinophilic Oral Disease in 24 Dogs (2000-2016)” JVD 2019.1, what cell mediated hypersensitivity is suspected to play a role in this disease process?

Type 1 cell-mediated hypersensitivity

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In the study, “Clinicopathological Features, Risk Factors and Predispositions, and Response to Treatment of Eosinophilic Oral Disease in 24 Dogs (2000-2016)” JVD 2019.1, what was the only statistically significant association that was made?

There was a statistically significant association between body weight and location of the lesions. Smaller dogs tended to have lesions on their tongue or palate. Whereas larger dogs had lesions in the “other” location i.e. lips or mucosa.

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All of the dogs with palatal lesions were asymptomatic at their last visit.

There was a correlation in resolution and the use of antibiotics and prednisone. Greater likelihood of resolution WITHOUT using this drug combination.

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In the study, “Clinicopathological Features, Risk Factors and Predispositions, and Response to Treatment of Eosinophilic Oral Disease in 24 Dogs (2000-2016)” JVD 2019.1, what conclusions can be made about the most effective treatment method?

No conclusions can be made. Small sample size, and multimodal tx approaches make it difficult to determine.

Although important to know that many lesions will resolve on their own or with allergen therapy alone if dogs were asymptomatic (70%).

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In Hennet’s 2011 study “Comparative efficacy of a recombinant feline interferon omega in refractory cases of calicivirus-positive cats with caudal stomatitis: a randomised, multi-centre, controlled, double-blind study in 39 cats,” what was the main conclusion regarding efficacy of IFN for treatment of refractory stomatitis?

J Feline Med Surg 2011

Daily oromucosal treatment with 0.1 MU interferon omega associated with sig improvement of clinical lesions (caudal stomatitis and alveolar/buccal mucositis) and a decrease of pain scores from D0 to D90

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In the study, “A Salivation Abnormality with Trigeminal Nerve Dysfunction in Dogs” JVD 2019.1, what clinical abnormalities were present in 100% of the dogs ?

They all had accumulation of thick, foamy saliva on the dorsal/caudal part of the oral cavity that was affected. They also, all had severe muscle atrophy of the masseter and temporalis muscles on the affected side. Last but not least, the parotid gland in all dogs was smaller on the affected side.

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Name the developmental abnormality of the pictured canine tooth of a dog:

Frontiers 2016, Boy et al, Developmental Structural Tooth Defects in Dogs – Experience From Veterinary Dental Referral Practice and Review of the Literature

Gemination

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What virus infection leads to enamel hypoplasia and how?

Frontiers 2016, Boy et al, Developmental Structural Tooth Defects in Dogs – Experience From Veterinary Dental Referral Practice and Review of the Literature

Canine distemper virus - known to produce diffuse hypoplasia as a result of direct infection and destruction of ameloblasts

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What breed is gemination (aka schizodontism) seen more often?

Frontiers 2016, Boy et al, Developmental Structural Tooth Defects in Dogs – Experience From Veterinary Dental Referral Practice and Review of the Literature

Boxers

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In the 2015 study on non-radiation-related ONJ in dogs, what % had reported previous extractions due to dental disease? ## Footnote Frontiers 2015, Peralta et al

11/14 (78%)

What's your diagnosis for this 1-year-old male, intact French bulldog presenting for inabilty to open the mouth? ## Footnote Frontiers 2022

pterygoid myositis ossificans

In the 2020 paper "Histological, Immunological, and Genetic Analysis of Feline Chronic Gingivostomatitis", what circulating cells were higher in FCGS cats than healthy cats? ## Footnote Frontiers 2020

Neutrophils CD8+ effector memory cells Activated CD8+ T cells

In Bellei et al 2019 paper "A Clinical, Radiographic and Histological Study of Unerupted Teeth in Dogs and Cats: 73 Cases (2001–2018)" what % of unerupted teeth have evidence of a dentigerous cyst? ## Footnote Frontiers 2019

Dentigerous cysts were found radiographically and/or histopathologically in 44.4% of unerupted teeth.

What is your differential diagnosis for this 10 yo FS Weimaraner? ## Footnote JVD 2015 issue 2

Chronic Kidney Disease and Renal Secondary Hyperparathyroidism

In the paper "Osteonecrosis of the jaws in dogs in previously irradiated fields: 13 cases (1989-2014)" what is the reported incidence of osteoradionecrosis in dogs oral cavity? ## Footnote Frontiers 2015

Canine oral tumors → 6-7.6% (Theon et al) CAA → 5% (Thrall)

In Hennet's 2011 study "Comparative efficacy of a recombinant feline interferon omega in refractory cases of calicivirus-positive cats with caudal stomatitis: a randomised, multi-centre, controlled, double-blind study in 39 cats," what did the authors conclude about use of IFN vs pred for treatment of refractory stomatitis? ## Footnote J Feline Med Surg 2011

Oromucosal IFN administration shown to be at least as good as short term pred

In Hennet's 2011 study "Comparative efficacy of a recombinant feline interferon omega in refractory cases of calicivirus-positive cats with caudal stomatitis: a randomised, multi-centre, controlled, double-blind study in 39 cats," a clinical cure was achieved in what percent of cases overall and what percent of cases that were cured were in the IFN vs pred groups?

Clinical cure achieved in 10% or less overall IFN 45% Pred 23%

In Hennet's 2011 study "Comparative efficacy of a recombinant feline interferon omega in refractory cases of calicivirus-positive cats with caudal stomatitis: a randomised, multi-centre, controlled, double-blind study in 39 cats," what was the protocol for prednisolone administration in the postiive control group (group B)? ## Footnote J Feline Med Surg 2011

1mg/kg/day first 7 days, 1mg/kg EOD for 7 days, 0.5mg/kg EOD 7 days

In Lommer's 2013 article " Efficacy of Cyclosporine for Chronic, Refractory Stomatitis in Cats: A Randomized, Placebo-Controlled, Double-Blinded Clinical Study," at what time frame was there a stat sig difference between mean SDAI scores for the cyclosporine treatment group vs placebo? ## Footnote JVD 2013

At T3 (6 weeks) there was a stat sig difference between mean SDAI scores between Group A (7.2) and B (14.2) ## Footnote Mean improvement in Group A at T3 53% Mean improvement in Group B at T3 12%

In Lommer's 2013 article " Efficacy of Cyclosporine for Chronic, Refractory Stomatitis in Cats: A Randomized, Placebo-Controlled, Double-Blinded Clinical Study," in the cyclosporine treatment group was there a sig difference in improvement between edentulous cats vs those with canines/incisors and cyclosporine reduced oral inflammation in how many treated cats? ## Footnote JVD 2013

No sig difference in improvement in Group A cats that had canine or incisor teeth (5) vs edentulous cats (4) Cyclosporine reduced oral inflammation in 8/9 cats

In Lommer's 2013 article " Efficacy of Cyclosporine for Chronic, Refractory Stomatitis in Cats: A Randomized, Placebo-Controlled, Double-Blinded Clinical Study," above what level of cyclosporine trough scores was a 70% reduction in SDAI scores seen? ## Footnote JVD 2013

> 300 ng/ml ## Footnote Stat sig difference in improvement in SDAI scores for cats with cyclosporine levels > 300 vs cats < 300 ng/ml

In Lommer's 2013 article " Efficacy of Cyclosporine for Chronic, Refractory Stomatitis in Cats: A Randomized, Placebo-Controlled, Double-Blinded Clinical Study," what percent of cats on longterm cyclosporine were clinically cured? ## Footnote JVD 2013

45% (5/11 cats) ## Footnote 6/11 remained on cyclosporine life long which managed their symptoms

In Kornya's 2014 article "Association between oral health status and retrovirus test results in cats," what was the overall oral disease prevalence and what percent of cats were seropositive for FIV and FeLV respectively? ## Footnote JAVMA 2014

Overall oral disease prevalence: 40.6% FIV 4.6% seropositive FeLV 3.6% seropositive

In Kornya's 2014 article "Association between oral health status and retrovirus test results in cats," what was the association between inflammatory oral disease and risk of FIV and FeLV seropositivity? ## Footnote JAVMA 2014

Cats with inflammatory oral disease at a sig higher risk to be seropositive for FIV and FeLV

The open arrow, black arrow and white arrowhead represent what? ## Footnote Farcas, Lommer, Verstraete. Dental radiographic findings in cats with chronic gingivostomatitis (2002-2012). JAVMA 2014

Open arrow: feline resorptive lesion Black arrow: external inflammatory root resorption White arrowhead: calculus

In Farcas's 2014 article "Dental radiographic findings in cats with chronic gingivostomatitis (2002-2012)," there were no statistical sig differences between FCGS cases and controls associated with what factors? ## Footnote Lommer, Verstraete. JAVMA 2014

No stat sig differences between cases and controls in breed, sex, presence of TR or buccal bone expansion

In Farcas's 2014 article "Dental radiographic findings in cats with chronic gingivostomatitis (2002-2012)," what was the association with periodontal disease between cats with FCGS and controls? ## Footnote Lommer, Verstraete. JAVMA 2014

Extent and severity of periodontitis sig different between groups with more moderate to severe periodontitis in FCGS group than controls ## Footnote FCGS cases' perio dominated by horizontal bone loss

In Farcas's 2014 article "Dental radiographic findings in cats with chronic gingivostomatitis (2002-2012)," FCGS cases were more likely than controls to have what radiographic findings?

Moderate to severe generalized perio external inflammatory root resorption Retained tooth roots ## Footnote Not feline resorptive lesions or buccal bone expansion!

In Jennings' 2015 study "Effect of tooth extraction on stomatitis in cats: 95 cases (2000-2013)," overall substantial improvement or complete resolution was seen in what percent of cats and what percent of those cats that responded favorably to tooth extractions required extended medical management for a finite period? ## Footnote Lewis, Soltero-Rivera, Reiter. JAVMA 2015.

Overall improvement 67% 69% of those cats required EMM for finite period

In Jennings' 2015 study "Effect of tooth extraction on stomatitis in cats: 95 cases (2000-2013)," how did the number of cats that achieved complete resolution with extractions in this study compare to previous studies? ## Footnote Lewis, Soltero-Rivera, Reiter. JAVMA 2015

The number of cats that had complete resolution of stomatitis was sig lower in this study than prior studies (Bellei 2008, Hennet 1997) ## Footnote 28% complete resolution in present study

In Jennings' 2015 study "Effect of tooth extraction on stomatitis in cats: 95 cases (2000-2013)," what was the association of PME vs FME on overall response to treatment and what percent of casts showed no improvement with extractions? ## Footnote Lewis, Soltero-Rivera, Reiter. JAVMA 2015

Extent of tooth extraction (PME vs FME) not associated with overall response to treatment No improvement 6.3% ## Footnote No improvement rates similar to previous studies

In Jennings' 2015 study "Effect of tooth extraction on stomatitis in cats: 95 cases (2000-2013)," cats had a stat sig better long-term response to tooth extraction when what was observed? ## Footnote Lewis, Soltero-Rivera, Reiter. JAVMA 2015

resolution of abnormal behavior decrease in oral inflammation lack of need for follow-up medical management with antimicrobials

In Jennings' 2015 study "Effect of tooth extraction on stomatitis in cats: 95 cases (2000-2013)," what was the association of response to treatment with duration of clinical signs prior to treatment?

No sig difference in response to treatment between groups with different duration of clinical signs

In Arzi's 2015 study "Feline foamy virus adversely affects feline mesenchymal stem cell culture and expansion: Implications for animal model development," MSCs from what source often form multinucleated giant cells and undergo proliferation arrest? ## Footnote Stem Cells Dev 2015

MSCs from non specific pathogen-free cats (SPF)

In the study, "Lingual lesions in the dog and cat recognition, diagnosis and treatment," JVD 2011.3, what nerve innervates both extrinsic and intrinsic muscles of the tongue?

Hypoglossal nerve - CN XII

In the study, "Lingual lesions in the dog and cat recognition, diagnosis and treatment," JVD 2011.3, what type of lingual lesion is identified in this picture?

A horseshoe ulcerative lesion, caused by a chemical injury

In the study, "Lingual lesions in the dog and cat recognition, diagnosis and treatment," JVD 2011.3, the photograph included shows erythematous nodules in a cat that were diagnosed as?

Complex eosinophilic granulomas

In the study, "Lingual lesions in the dog and cat recognition, diagnosis and treatment," JVD 2011.3, what are treatment options for sublingual mucoceles (i.e. ranulas)?

Removal of the affected salivary gland or marsupialization of the mucocele

In the study, "Lingual lesions in the dog and cat recognition, diagnosis and treatment," JVD 2011.3, cutaneous vasculitis is described to be idiopathic about 50% of the time and is considered to be autoimmune. What is the treatment of choice for this disease process and why?

Pentoxifylline is the tx of choice, it provides anti-inflammatory and immunomodulatory effects, while improving microvascular blood supply

In the study, "Lingual lesions in the dog and cat recognition, diagnosis and treatment," JVD 2011.3, what are differentials for benign tumors that are typically unpigmented, slightly raised and smooth?

Plasma cell tumor, granular cell tumor, lipomas and fibromas ## Footnote Plasma cell tumor and granular cell tumor most common benign lingual tumors

In Arzi's 2015 study "Feline foamy virus adversely affects feline mesenchymal stem cell culture and expansion: Implications for animal model development, administration of what drug was shown to restore the proliferative properties of FFV-infected fMSCs with variable viral clearance? ## Footnote stem cell dev 2015

Tenofovir

In Arzi's 2016 study "Therapeutic Efficacy of Fresh, Autologous Mesenchymal Stem Cells for Severe Refractory Gingivostomatitis in Cats," how many cats completed the study and responded to treatment and how many of those cats had complete clinical remission vs substantial clinical improvement respectively? ## Footnote Stem Cells Transl Med 2016

7 completed trial 5/7 responded 3/5 complete clinical remission 2/5 substantial clinical improvement

In Arzi's 2016 study "Therapeutic Efficacy of Fresh, Autologous Mesenchymal Stem Cells for Severe Refractory Gingivostomatitis in Cats," what was the correlation of SDAI clinical scores and tissue inflammation on histo and what lympocytes were absent in cats with complete clinical remission on histo?

All cats that showed improvement in SDAI clinical scores showed improved tissue inflammation on histo CD3 and CD20 lymphocytes absent in cats with complete clinical remission on histo

In Arzi's 2016 study "Therapeutic Efficacy of Fresh, Autologous Mesenchymal Stem Cells for Severe Refractory Gingivostomatitis in Cats," cats with a full clinical response had what changes in circulating cytokines and neutrophils following treatment?

Increase in IL-6 Normalization of CD4/CD8 ratio Reduction in blood neutrophil number General reduction in proinflammatory serum cytokines IFN-gamma and IL-1Beta

In Arzi's 2016 study "Therapeutic Efficacy of Fresh, Autologous Mesenchymal Stem Cells for Severe Refractory Gingivostomatitis in Cats," what was the relationship between increased percentage of CD8 cytotoxic T cells and response to therapy?

Cats with < 15% cytotoxic CD8 T cell → 100% predictive of positive response to ASC therapy Cats with > 15% cytotoxic CD8 T cells → nonresponders

In Arzi's 2016 study "Therapeutic Efficacy of Fresh, Autologous Mesenchymal Stem Cells for Severe Refractory Gingivostomatitis in Cats," what were the hematologic characteristics of nonresponders to therapy?

No change in neutrophil counts following therapy > 15% cytotoxic CD8 T cells prior to therapy Higher total serum globulin and lower serum IgA levels than responding cats prior to therapy

In Arzi's 2017 study "Therapeutic Efficacy of Fresh, Allogeneic Mesenchymal Stem Cells for Severe Refractory Gingivostomatitis in Cats," what was the responsive rate to treatment of allogeneic vs autologous ASCs?

Allogeneic 57% (4/7) Autologous 71% (5/7)

In Arzi's 2017 study "Therapeutic Efficacy of Fresh, Allogeneic Mesenchymal Stem Cells for Severe Refractory Gingivostomatitis in Cats," how was the time frame for response to treatment of allogeneic ASCs compared to autologous ASCs?

Response to allogeneic ASC delayed compared to autologous ASC treatment

In Arzi's 2017 study "Therapeutic Efficacy of Fresh, Allogeneic Mesenchymal Stem Cells for Severe Refractory Gingivostomatitis in Cats," how did allogeneic ASC administration alter blood lymphocyte status as compared to autologous ASC therapy?

Allogenic ASC administration did not predictably alter blood lymphocyte status like in previous autologous ASC study - only 50% of cats that responded to therapy showed an increase in percentage of CD8 low T cells → in contrast to previous study where increase in CD8 low T cells 100% predictive of response to therapy

In Arzi's 2017 study "Therapeutic Efficacy of Fresh, Allogeneic Mesenchymal Stem Cells for Severe Refractory Gingivostomatitis in Cats," how did allogeneic treatment affect cytokine measurements?

IL-6 and other cytokines did not consistently increase after therapy → allogeneic ASCs may have different MOA than autologous

In Arzi's 2017 study "Therapeutic Efficacy of Fresh, Allogeneic Mesenchymal Stem Cells for Severe Refractory Gingivostomatitis in Cats," what was the evidence given for allogeneic ASC therapy being less effective in cats with more severe systemic inflammation?

Cats that did not respond to therapy had higher initial neutrophil counts, globulin concentrations, serum IFN-gamma and TNF alpha concentrations

What is Experimental Design Grade Evidence I-III? ## Footnote Winer, Arzi, Verstraete. Therapeutic Management of Feline Chronic Gingivostomatitis: A Systematic Review of the Literature. Frontiers 2016.

I: Randomized, controlled, double blinded prospective trials II: Prospective clinical trials (+/- control group) III: Retrospective case series, n > 10, case-control study

What is Experimental Design Grade IV and V? ## Footnote Winer, Arzi, Verstraete. Therapeutic Management of Feline Chronic Gingivostomatitis: A Systematic Review of the Literature. Frontiers 2016.

IV: Retrospective case series, n < 10 V: Single patient case report, expert opinion

In Winer's 2016 study "Therapeutic Management of Feline Chronic Gingivostomatitis: A Systematic Review of the Literature," what were the key ideal components of an FCGS study and did any articles meet all four criteria? ## Footnote Arzi, Verstraete. Frontiers 2016

Large enough study population to be representative Prospective experimental design Quantitative or at least semi-quantitative scoring system for disease severity Long enough duration of follow up to convince the reader that the results will be sustained indefinitely None of the articles in the review met all four criteria

In Winer's 2016 study "Therapeutic Management of Feline Chronic Gingivostomatitis: A Systematic Review of the Literature," how many cases were small retrospective case series or single patient case reports that lacked any statistical power?

6/16

In Winer's 2016 study "Therapeutic Management of Feline Chronic Gingivostomatitis: A Systematic Review of the Literature," what were the two most common Experimental Design Grades (EDG)?

EDG V: 5 EDG I: 4

What is the following a picture of?

Lateral periodontal cyst

In the study, "Suspected Lateral Periodontal Cyst Presenting Concurrently with Canine Acanthomatous Ameloblastoma in a 2 Year old Standard Poodle" JVD 2017.3 what dental structure did the authors believe played a role in the development of both distinct pathologies (i.e. CAA and lateral periodontal cyst)?

Remnants of the dental lamina

In the study, Cryptococcal Maxillary Osteomyelitis and Osteonecrosis in a 18-Month-Old Dog,", what cryptococcal species did the authors suspect the dog in this study was infected with?

Cryptococcus gattii

In the study, Cryptococcal Maxillary Osteomyelitis and Osteonecrosis in a 18-Month-Old Dog," what was the dog treated with and for how long?

Fluconazole (11 months) and surgical debridement --> was titer negative after 8 months of medical therapy

In the study, "Oral Manifestations of Chronic Kidney Disease and Renal Secondary Hyperparathyroidism: A Comparative Review" what are the differences between hyperostotic and isostotic dystrophy?

Hyperostotic dystrophy - tends to happen in younger dogs more often, they will develop osseous swelling and distortion of the skull and mandible dues to fibrous replacement of demineralized bone Isostotic dystrophy - Tends to happen in older dogs, they develop rubber jaw without bone swelling

In the study, "Oral Manifestations of Chronic Kidney Disease and Renal Secondary Hyperparathyroidism: A Comparative Review" what were the age categories and their respective distributions for the 42 dogs with renal osteodystrophy?

< 2 years - 26/42 dogs (62%) >2 years - 7 years - 9/42 (21.4%) >7 years - 7/42 dogs (16.6%)

What is the following a picture of?

Rubber jaw with a pathologic fracture ## Footnote

True or False: Maxillofacial distortion is common in cats with renal osteodystrophy.

False.

According to the study, "Modified Conservative Treatment of an Extensive Dentigerous Cyst in a Dog" JVD 2014.4, where do dentigerous cysts originate from?

The enamel organ or reduced enamel epithelium that surrounds the crown during odontogenesis

What are the histologic characteristics of a dentigerous cyst?

Non-keratinized stratified squamous epithelium that is 4-6 layers thick

In the study, "Sublingual Reactive Histiocytosis in a Dog," JVD 2011.3, how did they treat the sublingual reactive histiocytosis?

Surgical debulking, and tetracycline and niacinamide over 8 months.

In the study, "Sublingual Reactive Histiocytosis in a Dog," JVD 2011.3, what IHC stains were positive indicating that the mass was dendritic in cell origin?

CD18, CD11c, CD1c, vimentin

In the study, "Clinicopathologic Characterization of Oral Pyogenic Granuloma in 8 Cats, " JVD 2014.2 - what was the percentage of cats that had bilateral lesions? And what were the percentage of cats that had traumatic contact with the ipsilateral maxillary PM4?

50 % & 50%

In the study, "Clinicopathologic Characterization of Oral Pyogenic Granuloma in 8 Cats, " JVD 2014.2 - what were the 3 treatment options and their corresponding recurrence rates?

1. Surgical excision - 100% 2. Surgical excision and ODY of Maxillary PM4 - 25% 3. Surgical excision and XSS of Maxillary PM4 - 10%

In the study, "Suspect Odontogenic Infection Etiology for Canine Lymphoplasmacytic Rhinitis" JVD 2015.1, what parentage of cases were attributed to odontogenic infection and what percentage of cases were NOT?

55% and 10% respectively

What disease process is suspected in this 5 month old cat?

Congenital hypothyroidism

In Soltero-Rivera's "Mesenchymal stromal cell therapy for feline chronic gingivostomatitis: Long term experience," what was the overall positive response rate as perceived by owners, was the autologous or allogeneic response rate higher and was the difference stat sig? ## Footnote Frontiers 2023

Overall positive response rate 65.5% Autologous higher (71%) than allogeneic (60%) but difference not stat sig

In Soltero-Rivera's "Mesenchymal stromal cell therapy for feline chronic gingivostomatitis: Long term experience," what variable was found to be predictive of long-term response to MSC therapy? ## Footnote frontiers 2023

6 month status (none to partial improvement vs substantial improvement to resolution) predictive of long-term response

In Soltero-Rivera's "Mesenchymal stromal cell therapy for feline chronic gingivostomatitis: Long term experience," there was no correlation of outcome with what factors? ## Footnote Frontiers 2023

No significant correlation of outcome with use of allogeneic vs autologous MSC treatment, severity of SDAI at entry or exit

In Soltero-Rivera's "Mesenchymal stromal cell therapy for feline chronic gingivostomatitis: Long term experience," what percent of cases had adverse effects (mostly transfusion reactions), and what percent of owners would be willing to pursue MSC treatment again? ## Footnote Frontiers 2023

34% adverse effects 90% of owners willing to pursue MSC therapy again ## Footnote 2x more transfusion reactions in autologous group likely due to faster transfusion rates used in earlier experiments

In Arzi and Peralta's 2020 study "A multicenter experience using adipose-derived mesenchymal stem cell therapy for cats with chronic, non-responsive gingivostomatitis," did ASCs retain their viability, phenotype, and function after shipment and what was the overall response rate? ## Footnote Stem Cell Research 2022

ASCs did ship well Overall response rate of 72%

In Arzi and Peralta's 2020 study "A multicenter experience using adipose-derived mesenchymal stem cell therapy for cats with chronic, non-responsive gingivostomatitis," what significant decreases in biomarkers did responder cats have post treatment? ## Footnote Stem Cell Research 2020

Sig decreased percentages CD8 lo cells prior to and 3 months after therapy Sig decreased circulating globulins Histo decreased CD3+ T cells CD20+ B cells ## Footnote Adverse effects noted in 23.5%

How does canine chronic ulcerative stomatitis present histologically? ## Footnote Boutoille, Hennet. Maxillary osteomyelitis in two Scottish Terrier Dogs with Chronic Ulcerative Paradental Stomatitis. JVD 2011

lymphocytic and plasma cell infiltrates in lamina propria and epithelium

What breeds are predisposed to develop CCUS?

Maltese Cavalier King Charles Spaniel Labrador Retriever Greyhound Terrier breeds

In Anderson's 2017 article, "Clinical and Histopathologic Characterization of Canine Chronic Ulcerative Stomatitis," what were the main findings on biopsy?

buccal mucosal stomatitis with variable subepithelial **lichenoid plasmacytic-lymphocytic infiltrate **with vascular proliferation and epithelial degeneration

In Anderson's 2017 article, "Clinical and Histopathologic Characterization of Canine Chronic Ulcerative Stomatitis," what leukocytes and cytokines were absent in normal mucosa but present in histo of CCUS lesions?

CD79a + B cells FoxP3 (Forkhead box protein) IL-17 ## Footnote C3 + T cells also present but normal mucosa had them in the epithelium-subepithelial interface

In Anderson's 2017 article, "Clinical and Histopathologic Characterization of Canine Chronic Ulcerative Stomatitis," was there a correlation between CUSDAI scoring systemc and histologic leukocytes and what was the most common stage of periodontal disease?

no significant correlation between CUSDAI score and histologic leukocyte score PD2 most common

In Anderson's 2017 article, "Clinical and Histopathologic Characterization of Canine Chronic Ulcerative Stomatitis," what were the most common signalments?

MN dogs Less than 10kg Terriers

Why is it discouraged to call canine ulcerative stomatitis canine ulcerative paradental stomatitis? ## Footnote Anderson. Immunopathogenesis of canine chronic ulcerative stomatitis. PLoS ONE 2020

Because 40% of lesions are adjacent to edentulous areas

In Anderson's 2020 study "Immunopathogenesis of canine chronic ulcerative stomatitis," what were the most common leukocytes involved in the pathogenesis of CCUS?

FoxP3 + CD3 -/IL17 + cells

In the study, "Incidence of Radiographic Cystic Lesions Associated With Unerupted Teeth in Dogs." JVD 2016.4, what were the 4 brachycephalic breeds that were overrepresented?

Boxer, pug, Shih Tzu, Boston Terrier

In the study, "Incidence of Radiographic Cystic Lesions Associated With Unerupted Teeth in Dogs." JVD 2016.4, of the 62 cystic lesions how many were diagnosed via histopath? And of those how many were dentigerous cysts?

Histopath - 28/62 (45.1%) Dentigerous cyst diagnosis - 20/28 (71.4%)

In the study, "Incidence of Radiographic Cystic Lesions Associated With Unerupted Teeth in Dogs." JVD 2016.4, how many brachycephalic breeds were diagnosed with dentigerous cysts?

17 brachycephalic dogs were diagnosed with dentigerous cysts

In the study, "Incidence of Radiographic Cystic Lesions Associated With Unerupted Teeth in Dogs." JVD 2016.4, how many of the teeth were mandibular first premolars?

146/213 (68.5%)

In the study, "Incidence of Radiographic Cystic Lesions Associated With Unerupted Teeth in Dogs." JVD 2016.4, what is the difference between and impacted and embedded tooth?

Impacted tooth - physical obstruction to complete eruption process Embedded tooth - Properly positioned but lacks sufficient eruption forces to clear alveolar margin

In the study, "Incidence of Radiographic Cystic Lesions Associated With Unerupted Teeth in Dogs." JVD 2016.4, what are the arrows pointing to?

Dental follicle

In the study, "Incidence of Radiographic Cystic Lesions Associated With Unerupted Teeth in Dogs." JVD 2016.4, what are the sources/structures they discuss that could become odontogenic oral cysts?

Tooth germ, enamel epithelium of the crown, the epithelial cell rests of Malassez, dental lamina remnants, basal layer of oral epithelium

In Anderson's 2020 study "Immunopathogenesis of canine chronic ulcerative stomatitis," what leukocytes were negatively correlated with clinical scores?

IL17 + cells

In Anderson's 2020 study "Immunopathogenesis of canine chronic ulcerative stomatitis," what evidence was found that supports the inflammatory nature of CCUS?

Direct IF did not support autoantibody auto-immune disease process

In Anderson's 2020 study "Immunopathogenesis of canine chronic ulcerative stomatitis," what was the difference in cell type between PD and CCUS?

Perio lesions mostly B cells (CD20, Mum1)

In Anderson's 2020 study "Immunopathogenesis of canine chronic ulcerative stomatitis," what are the 3 histological subtypes of CCUS?

granulomatous lichenoid inflammation deep stomatitis

In Anderson's 2021 article "Characterization of the Oral Microbiome in Canine Chronic Ulcerative Stomatitis," what were the most prevalent bacterial species in the ulcer lesions?

Tannerella forsythia-like phylotype and Porphyromonas gingivicanis ## Footnote The microbial profile of the supragingival plaque of the abutting tooth to the ulcer revealed similar pathogens

In the study, "Bilateral Dentigerous Cysts in a Dog" what are sources dentigerous cysts?

Reduced enamel epithelium and/or enamel organ

In Ford's 2023 article "Medical Management of Canine Chronic Ulcerative Stomatitis Using Cyclosporine and Metronidazole," what protocol was used? ## Footnote JVD 2023

Cyclosporine 5mg/kg PO q24h After 9 days, metro 15-20mg/kg PO q24h Minimum of 3 weeks on both drugs Then cyclosporine tapered to lowest effective dose

In Ford's 2023 article "Medical Management of Canine Chronic Ulcerative Stomatitis Using Cyclosporine and Metronidazole," what was the relationship between time interval in days of therapy with CUSDAI score? ## Footnote JVD 2023

Significant reduction in CUSDAI score from day 0 to day 8 with cyclosporine alone Sig further reduction from Day 8 to Day 22 with addition of metronidazole but not after

The parasympathetic preganglionic cell bodies for the parotid and zygomatic glands are located in the parasympathetic nucleus of what nerve?

Glossopharyngeal nerve ## Footnote Kent. A Salivation Abnormality with Trigeminal Nerve Dysfunction in Dogs. JVD 2019

The parasympathetic preganglionic cell bodies of the mandibular and sublingual glands are located in the parasympathetic nucleus of what nerve? ## Footnote Kent. A Salivation Abnormality with Trigeminal Nerve Dysfunction in Dogs. JVD 2019

Facial nerve

Lack of adequate levels of what hormone can lead to unerupted teeth?

Thyroid hormones ## Footnote Jacobson. Congenital Feline Hypothyroidism With Partially Erupted Adult Dentition in a 10-Month-Old Male Neutered Domestic Shorthair Cat: A Case Report. JVD 2018.

In Jacobson's 2018 study "Congenital Feline Hypothyroidism With Partially Erupted Adult Dentition in a 10-Month-Old Male Neutered Domestic Shorthair Cat: A Case Report," what treatments were performed?

gingivectomies/operculectomies thyroid supplementation

incompletely erupted permanent dentition covered by thickened gingival tissue, short stature, a broad, flattened face, short neck, pendulous abdomen, kitten-like hair coat, and goiter

What is the most common lingual tumor in the dog and cat respectively? ## Footnote Buelow. Lingual Lesions in the Dog and Cat: Recognition, Diagnosis, and Treatment. JVD 2011

Dogs: malignant melanoma Cats: SCC

What are the extrinsic muscles of the tongue? ## Footnote Buelow. "Modified Conservative Treatment of an Extensive Dentigerous Cyst in a Dog" JVD 2014

Styloglossus Hyoglossus Genioglossus

What is the lyssa of the tongue?

Rod shaped structure within the apex of the tonue that is composed of skeletal muscle and fat surrounded by thick fibrous capsule Acts as a stretch receptor for apex of tongue

What stain can be used to confirm presence of Crytococcus and other fungi? ## Footnote Block. Cryptococcal Maxillary Osteomyelitis and Osteonecrosis in a 18-Month-Old Dog.

Gomori Methenamine-Silver

How many dentinal tubules are present in a mm^2?

30,000 to 75,000 dentinal tubules per mm^2

What is the difference between erythema multiforme and epitheliotropic lymphoma in respect to involvement of the oral cavity? ## Footnote Nemec, Verstraete. Erythema multiforme and epitheliotropic t-cell lymphoma in the oral cavity of dogs: 1989-2009. J Small Anim Prac 2012

Epitheliolotropic lymphoma can be limited to the oral cavity Erythema mutliforme CANNOT be limited to the mouth ## Footnote 32% erythema multiforme cases have an oral component

In Nemec's 2012 article, "Erythema multiforme and epitheliotropic t-cell lymphoma in the oral cavity of dogs: 1989-2009," solitary masses were more common for dogs with what differential and 5/7 cases of what differential were controlled or resolved with periodontal treatment? ## Footnote Verstraete. J Small Anim Prac 2012

Solitary masses common with epitheliotropic lymphoma 5/7 erythema multiforme lesions resolved with perio treatment

In Nemec's 2012 article, "Erythema multiforme and epitheliotropic t-cell lymphoma in the oral cavity of dogs: 1989-2009," what leukocytes can help confirm epitheliotrophic lymphoma on histo?

CD3+ T cells

In Riehl's 2014 study "Clinicopathologic Characterization of Oral Pyogenic Granuloma in 8 Cats," what were the recurrence rates for excision alone, odontoplasty and excision, and extraction and excision? ## Footnote JVD 2014

Excision alone: 100% Odontoplasty and excision: 25% Extraction and excision: 10% ## Footnote Overall recurrence rate 43%

In Riehl's 2014 study "Clinicopathologic Characterization of Oral Pyogenic Granuloma in 8 Cats," what percent of cases had maxillary 08 contact? ## Footnote JVD 2014

50%

In Riehl's 2014 study "Clinicopathologic Characterization of Oral Pyogenic Granuloma in 8 Cats," what are the histopath characteristics of an oral pyogenic granuloma? ## Footnote JVD 2014

1.) Endothelium lined vascular spaces 2.) Inflammatory infiltration (PMN, lymphocytes, plasma cells) 3.) Ulceration 4.) Granulation tissue/proliferating fibroblasts

What is the primary dental abnormality in cats with congenital hypothyroidism? ## Footnote Bates. Medical Management of Dental Abnormalities Related to Congenital Hypothyroidism in a Cat. JVD 2023

Delayed dental eruption

In Bates' 2023 case report "Medical Management of Dental Abnormalities Related to Congenital Hypothyroidism in a Cat," how long was the cat supplemented with oral thryoid hormone before clinicallly normal dentition was noted?

16 weeks after initiation of therapy in a 5 month old cat ## Footnote No surgical intervention needed: in contrast to previous report in which GV/OP was performed in addition to thyroid supplementation

In the study, "A case series analysis of dental extractions' outcome in cats with chronic gingivostomatitis carrying retroviral disease, " what were the significant findings?

When compared to control cats, FELV + had significantly less proliferative lesions and tended to have more lingual ulcers. FELV+ cats had significantly less TR lesions. FELV+ cats had a significantly worse outcome, they were 7.5x more likely to have no improvement post XSS.

In the study, "Periodontal disease is associated with cognitive dysfunction in aging dogs: A blinded prospective comparison of visual periodontal and cognitive questionnaire scores", what was the overall takeaway?

There was a significant (p < 0.05) association between periodontal and cognitive scores, with higher cognitive impairment scores being more likely in dogs with more severe periodontal disease and vice versa. No associations were identified between age and either periodontal disease or cognitive impairment.

In the study, "Unraveling the Risk Factors and Etiology of the Canine Oral Mucosal Melanoma: Results of an Epidemiological Questionnaire, Oral Microbiome Analysis and Investigation of Papillomavirus Infection" what was the study's only significant finding?

Tannerella forsythia and Porphyromonas gingivalis were significantly increased in case dogs compared to the controls. In humans these two bugs cause PD and esophageal cancers, further studies required as there were only 15 dogs with OMM.

In the study "Placebo-controlled trial of daily oral cannabidiol (CBD) as adjunctive treatment for cats with chronic gingivostomatitis," what was found to be statistically significant?

A significant improvement in the SDAI scores of cats medicated with CBD was found

In the study "Placebo-controlled trial of daily oral cannabidiol (CBD) as adjunctive treatment for cats with chronic gingivostomatitis," what was the overall take away?

The protocol is safe since severe adverse effects and biochemical changes were not observed during the treatment period. The results suggest that CBD, included in a multimodal approach to FCGS, was beneficial and safe since those cats medicated with CBD had a significantly higher level of comfort and activity as perceived by the owners.

In the study, "Oral Extramedullay Plasmacytoma Treatment Using a Combination of Marginal Excision and Strontium-90 Therapy in 5 Dogs," what was the main consensus?

All five cases had narrow or incomplete margins on histo and therefor were treated with strontium-90 pleisotherapy. They ALL experienced no recurrence after combination therapy. The combination of plesiotherapy and marginal excision may offer an alternative to wide surgical excision for non-invasive oral EMPs.

What is the MOA of cyclosporine?

Inhibits T-cell functions. Inhibits calcineurin which is critical for synthesis of cytokines such as IL2, IL-4, TNF-alpha, and INF by T-cells. Tends to concentrate in the skin suspect it will do so in oral mucosa.

What is the MOA of metronidazole when treating CCUS?

Decreases leukocyte-endothelial cell adhesion and the migration of leukocytes from the blood to the tissue

Oral Medicine Flashcards

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