Stomatitis Flashcards
What is the biggest difference between stomatitis and gingivitis?
stomatitis – inflammation of the mucous lining of any of the structures in the mouth extending beyond the mucogingival line (can include caudal oropharynx)
gingivitis – inflammation of the gingiva only.
__________ is caused by an inappropriate immune response to oral antigenic stimulation to dental bacteria.
feline chronic gingivostomatitis (stomatitis)
T/F: some viruses like FCV, FeLV, FIV, FHV, and bartonella can cause stomatitis in cats.
false – these are not causative but they can contribute to morbidity and affect prognosis
what are the clinical signs of stomatitis in cats?
- severe halitosis
- oral pain
- salivation
- chattering
- anorexia
- weight loss
- lethargy
- vocalization
- cry when opening mouth
- decreased grooming
- hiding or behavior changes
T/F: stomatitis lesions in cats are generally symmetrical
true
How can you diagnose stomatitis?
- physical exam *
- CBC/Chem/UA – hyperglobulinemia
- FeLV and FIV testing (for prognosis)
- histopath – rarely warrented unless unilateral lesions
what is the treatment for stomatitis in cats?
- medical management: minimize oral bacteria (COHAT, home care)
- Surgical extraction – partial (caudal to canines) OR full mouth
gold standard is extractions, med management is not rewarding.
T/F: its ok to leave root remnants when performing extractions as treatment for stomatitis in cats. This is because the teeth roots will resorb over time without issue.
false – tooth root remnants will not allow for resolution.
what are some additional recommendations you make to owners when their cat is undergoing full mouth extractions as treatment for stomatitis?
- transition them to canned food prior to procedure
- appetite stimulant (mirtazapine transdermal)
- pain management - bupSR (Simbadol or Zorbium), gaba, NSAIDs (Onsior)
how long should you wait after caudal mouth extractions to determine if a case of stomatits is truly “refractory” and is going to require additional surgery (to remove canines and incisors) or medical treatment?
3 months since the cheek teeth are removed.
Then you can try prednisolone or cyclosporine
At what age does feline juvenile periodontitis occur?
5-7 months following permanent teeth eruption
what is the cause of feline juvenile periodontitis?
unknown etiology, but there is rapid proliferation of plaque and subsequent inflammation which leads to early bone loss and periodontal disease. It is less painful than stomatitis.
how do you differentiate stomatitis from feline juvenile periodontitis?
no caudal mucositis
what is the treatment for feline juvenile periodontitis?
start COHATs at 9 months and repeat them every 3-6 months.
Home care is required since this disease is plaque-driven.
You can extract teeth that have advanced periodontal disease or that are resporptive
T/F: feline juvenile periodontitis often resolves after 2 years of age.
true
what is the age of onset for hyperplastic feline juvenile gingivitis?
young – 5-7 months
how can you differentiate hyperplastic feline juvenile gingivitis from stomatitis, feline juvenile periodontitis, or gingivitis?
there is generally NO periodontal disease associated with hyperplastic feline juvenile gingivitis.
Just inflammation and overproduction of attached gingiva.
what is the treatment for hyperplastic feline juvenile gingivitis?
COHAT every 3-4 months with gingivectomy (trimming hyperplastic tissue)
+ religious home care
T/F: hyperplastic feline juvenile gingivitis is certainly a lifelong disease and does not regress.
false – it can regress after 2 years.
what does CUPS stand for?
chronic ulcerative paradental stomatitis
Also now called canine chronic ulcerative stomatitis (CCUS)
other names: ulcerative stomatitis, idiopathic stomatitis, lymphocytic-plasmaytic stomatitis, plaquereactive stomatitis
what is the hallmark lesion for CUPS?
paradental contact or kissing lesions
but also: gingivitis, advanced periodontitis, recession, bone loss, furcation exposure, periodontal disease
what is the etiology for CUPS?
antigenic stimulation from bacteria/plaque
but also maybe oral microbiome of lesions is unique to dogs with CUPS…
what are clinical signs of CUPS?
inappetance, anorexia
fetid halitosis
ptalyism (thick, ropy, bloody saliva)
oral pain
chattering, abn chewing
difficulty prehending food
what is the treatment for CUPS?
COHAT (xrays, extractions of teeth with PD disease, selective extractions in areas with crowding)
analgesics
antibiotics
aggressive plaque control after extractions heal
what are the 2 options for medical treatment of CUPS?
- Triple therapy: pentoxyfylline + doxycycline + niacinamide.
(if no doxy, then you can also use metro.)
OR
- Double therapy: cyclosporine + metronidazole
how often should dogs receive COHATs and participate in home care when they have CUPS?
COHATs – every 6-12 months
home care – brush 2x/day, weekly oravet, dental diet
How would you approach extractions in dogs with CUPS / which teeth have to go?
extract either the teeth that are adjacent to ulcerated areas OR full mouth extractions
this is 100% curative.
what is gingival hyperplasia secondary to?
Secondary to a chronic inflammatory response
- bacteria in plaque
- food impaction
- dental malposition
- resorptive lesions
why is gingival hyperplasia of significance?
it creates pseudopockets and can lead to periodontal disease.
the gingiva also becomes fibrous and ossified.
what is the treatment for gingival hyperplasia?
gingivectomy
extract teeth that have periodontal disease
note: it will recur and require periodic resection. Home care is required.
what tool is used to trim excess gingiva in cases of gingival hyperplasia?
flame tipped diamond bur
what drugs can cause gingival enlargement?
cyclosporine
phenytoin derivatives
calcium channel blockers
note: is reversible d/c of drug, but if you are unable to d/c drug, then home care and routine cleaning and resection is necessary.
A cat presents to your clinic with a unilateral mass near the last left mandibular molar. The owner is worried its cancer. What do you inform them?
you first biopsy it.
if it comes back as pyogenic granuloma then you can tell the owners this is benign and is likely from trauma created by the upper premolar rubbing against the gingiva.
what is the treatment for pyogenic granulomas?
surgical removal of lesion
might also consider removing the inciting cause (maxillary PM4 or odontoplasty)
