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WSV18-0064
WSAVA DENTAL GUIDELINES
COMMON FELINE ORAL PATHOLOGY DIAGNOSIS AND TREATMENT
J. Gawor1
1Klinika Weterynaryjna Arka, Klinika, Kraków, Poland
Learning objective: Overview of cats dental oral pathologies will be presented. Most oral problems cause pain and infection, therefore appropriate diagnosis should be followed by management of the diagnosed diseases. For cats the focus will be on inflammatory diseases.
CAUDAL STOMATITIS is a severe inflammatory reaction of the oral tissues of cats. It is a clinical diagnosis of inflammation and proliferation of the gingiva and oral mucosa. Specifically, it is inflammation associated with the caudal mouth (mucositis), which is the delineating factor between caudal stomatitis and periodontal disease. Multiple etiologies may exist that, either singularly or combined, create the inflammation. Possible causative agents include an inflammatory response to plaque bacteria, viruses (FCV), Bartonella Henselae infection, or altered immune status (FeLV or FIV).
Caudal Stomatitis is a clinical syndrome and does not indicate a specific etiology or diagnosis. Diagnosis is made by visual inspection of the oral cavity. Diagnostic tests to further define the disease should minimally include: dental radiographs, a minimum data base (CBC, chemistry panel, t4, U/A) to evaluate for underlying and/or concurrent systemic health problems, and evaluation of FeLV/FIV status. A biopsy should be taken and submitted for histopathology, especially if the inflammation is asymmetrical or otherwise atypical, or if radiographic findings are suspicious for neoplasia. Surgical therapy
Controlling inflammation is the key to management of this disease process. Therefore, any tooth affected with inflammation from any cause should be extracted. All remaining teeth must receive strict homecare and routine professional cleanings to keep inflammation at bay. However, since the majority of patients have widespread inflammation, the most successful long-term treatment for cats with chronic gingivostomatitis is the COMPLETE extraction of all premolars and molars including the periodontal ligament as well as smoothing the alveolar bone. An additional step taken by many veterinary dentists is to perform careful aveloplasty to remove periodontal ligament remnants, which has anecdotally improved success rates.
Extraction of the canine and incisor teeth is indicated when the inflammation extends to include the gingiva surrounding them. Post-operative dental radiographs must be exposed to document complete extraction of all tooth roots.
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Medical therapy
In cases where owners are reluctant to have multiple extractions performed early in the course of treatment, medical management may be attempted to reduce bacterial load and inflammation. The majority of the products utilized are oral medications, which require daily to twice daily administration. This is difficult
to achieve in cats in general, and the oral pain and inflammation only serves to complicate matters. Finally, many of the products have significant side effects.
Systemic antibiotics may result in some improvement in the amount of oral inflammation. However, this is generally temporary at best, and most patients will relapse even during the course of antibiotic therapy. Rinsing with a. 0.12% Chlorhexidine gluconate solution may also be beneficial in some cases.
Corticosteroids are by far the most commonly used and effective drugs for immune modulation. However, long-term use of corticosteroids may have detrimental effects such as the induction of diabetes mellitus and opportunistic infections. Use the lowest effective dose and monitor biochemical values on a regular basis. Injectable treatment (methylprednisone 10-20 mg SC) is usually recommended initially, due to the degree of oral pain. This typically results in clinical improvement within 24-48 hours, and lasts for 3-6 weeks.
Cyclosporine A has been purported as an immunosuppressive drug for cats with chronic gingivostomatitis. Some have promoted as an alternative to extractions in order to avoid the use
of glucocorticoids. However, this author prefers to withhold its use to those cases where additional medical management is necessary post-extractions.
There is scant information which supports its use other than one unpublished veterinary study, which showed efficacy in cases refractory to extractions. However, it may provide an alternative to long-term steroid therapy.
Feline interferon. There is currently significant interest in the use of this product for caudal stomatitis. It is reported to not only provide an antiviral effect, but to also provide an immunomodulatory effect and bring about a return to normal local immune response. The preferred method at this point is to inject 5 MU intralesional (often at the time of extractions) and then follow this up with the remainder of the vial (5 MU) diluted into 100 cc of sterile saline and administered Per Os by the owner at a dose of 1 ml once daily for 100 days.
TOOTH RESORPTION (TR)
Completely subgingival TRs (those that have not progressed to the crown of the tooth) likely cause no discomfort for the patient. This presumption is based on the fact that similar lesions in humans are non-painful. Once lesions progress to the crown of the tooth they
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