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RDVM’s are very unhappy with the long term results. It is very expensive and short term relief only.
Surgical Therapy: Extraction is currently the ONLY effective long term treatment for this disease process in cats. In our experience, the sooner this is done, the better that cats do both post-operatively as well as long term.
For extractions to be successful, the teeth must be COMPLETELY removed. Therefore post-operative radiographic confirmation of complete extraction of the tooth roots is recommended. Following the insurance of complete removal of the teeth, perform aveloplasty to remove the periodontal ligament and smooth rough bony edges. This is typically performed do this with a rough diamond bur. Studies report a 60% success rate when all teeth caudal to the canines are extracted, however our experience has not been as good. However, whole mouth extractions have a success rate of approximately 90-95% for clinical remission. Slight faucitis may remain, but pets are comfortable. In addition, the rare cases that don’t completely respond are generally much more responsive to medical therapy. If there is NO inflammation to the canines or incisors (which is rare), then the owner is given the option of leaving the canines. However, if these are inflamed, all teeth should be extracted.
Resistant Cases
In the rare cases where the teeth have been fully extracted but inflammation and pain continues, other therapies are needed. The current treatment of choice in the USA is cyclosporine. Another option, which appears to work better in Europe is feline interferon. Finally, UC Davis has had some success with Stem Cell Therapy.
Feline Juvenile (puberty) gingivitis/periodontitis
Definition: Juvenile periodontal disease is inflammation which occurs soon after permanent tooth eruption. This syndrome can be described in two categories, feline hyperplastic gingivitis and juvenile onset periodontitis.
Etiology: The etiology of this condition is unknown. However, in humans there is a period of increased susceptibility to gingivitis during the pubertal period.
A genetic predisposition towards feline juvenile onset periodontitis has been reported in Siamese, Somali, and Maine Coon cats.
Clinical Features: Hyperplastic gingivitis appears
as gingival enlargement and significant inflammation which is confined to the gingiva and begins during the eruptive period of the permanent dentition. Bleeding during mastication and on oral exam are common findings. While occasionally seen in dogs, this condition has a much higher incidence in cats. It is generally a non-painful condition for the patient, and halitosis is a common complaint. If left untreated, it typically proceeds quickly to periodontal disease, which may result in
early exfoliation of the teeth. This disease is commonly mistaken for caudal stomatitis. The distinguishing clinical sign is the lack of caudal inflammation in this disease
process. As the patient matures, susceptibility appears to subside at approximately two years of age.
In contrast, juvenile periodontitis does not involve enlargement of the gingiva and usually leads to the rapid proliferation of plaque and calculus and subsequent inflammation. This in turn results in significant early
bone loss, periodontal pocket formation, and furcation exposure. This is generally the worst in around the mandibular first molars. Treatment and effective management of these cases is often exceedingly difficult.
Diagnostics:
Histopathology (via incisional biopsy) should be considered to rule out other causes of gingival inflammation. Culture and sensitivity testing is generally unrewarding, but may be of value in non-responsive cases. Dental radiographs should be performed to evaluate the quality of the alveolar bone and also for early tooth resorption. Finally, Bartonella testing may be beneficial in some cases, especially in patients who do not respond to traditional management practices.
Management:
In the management of both of these conditions, early
(9 months of age) and frequent (q 6-9 months) dental prophylaxis (even if only minimal plaque is present) along with strict homecare is critical to decrease inflammation. Ideally, homecare consists of daily brushing, as it is
the gold standard of plaque control. Other homecare alternatives include chlorhexadine rinses as well
as plaque control diets and treats. In cases where gingival hyperplasia is present, early gingivectomy is recommended to remove psuedopockets, decrease inflammation, and facilitate plaque control (both professional and homecare). Finally, extraction of any significantly diseased teeth is warranted to decrease the degree of inflammation.
Key Points:
· The diagnostic key between caudal stomatitis and periodontal disease is the presence of inflammation in the caudal area.
· All fractured teeth in cats are suspect for endodontic disease
· Extraction is the treatment of choice for caudal sto- matitis and tooth resorption.
· Dental extractions are critical for proper therapy Further Reading:
Niemiec BA: Dental, Oral, and maxillofacial pathology, a color handbook. (Manson)
Niemiec BA: Dental Applications in Emergency Medicine (Practical Veterinary Publishing) www.practicalvetpublishing.com
Bellows, J: Feline Dentistry (Wiley Blackwell)
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