Feline Dentistry and Oral Medicine

Feline dentistry and oral medicine

CATS

• Several oral diseases and lesions are specific to cats– Buccal bone expansion– Tooth resorptions/Resorptive lesions– Viral-induced oral disease– Lymphocytic-Plasmacytic Gingivostomatitis– Eosinophilic granuloma complex

• Often idiopathic• Oral neoplasia is relatively uncommon but highly

aggressive

Buccal bone expansion

• Expression of periodontal disease in cats• Most commonly affecting the maxillary canines• Mandibular canines may also be affected to a

lesser degree• Histologically, granulation tissue intercalated

within the alveolar bone– May see some horizontal and vertical bone loss as

well– Granulation tissue tends to form apically and extrudes

canine teeth– Mistakenly referred to as “supereruption”



• Treatment– If >50% attachment loss, extract tooth

SURGICALLY• Debride disease buccal bone• **Close the extraction site**

– If <50% attachment loss, meticulous subgingival scaling

• Prevention– Good home dental care

Tooth Resorptions• Etiology unknown

– Does not seem to be an inflammatory process– No infectious process has been found– Hypervitaminosis from commercial diets suggested

• Pathogenesis unknown– Suspected to be an imbalance between odontoblasts

and odontoclasts– Similar to osteoporosis?

• Nomenclature changes frequently– Resorptive lesions/FORLs– Neck lesions– Cat cavities– Cat caries

Tooth Resorptions

• Lesions are staged according to the dental tissues affected– Stage 1 – Enamel or cementum

• Diagnosed with explorer tip– Stage 2 – Enamel or cementum and dentin

• First stage that can be detected radiographically– Stage 3 – Enamel/cementum, dentin, and pulp– Stage 4 – Major loss of tooth substance

• Stage 4a – Crown and roots equally affected• Stage 4b – Crown affected more than roots• Stage 4c – Roots affected more than crown

– Stage 5 – End stage resorption

Tooth Resorptions

• Clinical signs– Often see severe focal gingivitis or gingival

hyperplasia over the lesion– Teeth that have excessive calculus

accumulation should also raise suspicion– “Pink teeth” in cats usually indicate advanced

resorption covered by gingiva– Lesions are painful– Lesions progress without treatment

Tooth Resorptions

• Treatment– Only definitive treatment is extraction or

coronectomy• Extraction is the gold standard treatment• Advanced resorptions cannot be extracted

completely• Coronectomy is acceptable in this case unless the

cat has stomatitis

Tooth Resorptions

Tooth Resorptions

• Prevention– None as etiology is still unknown– Pamidronates(?)

Viral-induced Oral Disease

• FCV is a common disease in cats– 10% to 40% of the domestic and feral cat

population affected– Can occur in all breeds, ages, sexes– Frequently seen in high-density populations– Disease is often self-limiting– Many cats will remain chronic carriers

• ssRNA structure of the virus means mutation is common

• Vaccines do not always provide protection


• FCV– Oral manifestations are

common expressions of FCV

• Vesiculation• Ulceration of the tongue and

palate• Acute but self-limiting type

of stomatitis


• Treatment– Usually none needed

• Viral diseases usually self-limiting• Viruses do not respond to antibiotics

– Supportive care– Secondary infections

• Can occur if immunosuppressed• Antibiotics may help with secondary BACTERIAL

infections


• Prevention– Environmental disinfection– Quarantine new cats in the household– Good hygiene

Lymphocytic-Plasmacytic Gingivostomatitis (LGPS)

• Characterized by clinical signs and presence of lymphocytes and plasma cells on histopathologic examination

• NOT FCV-induced stomatitis• Etiology unknown

– Thought to be a hyperimmune response to plaque components or plaque bacteria

– Bartonella henselae has been postulated as an etiologic agent but no positive correlation found

• One study actually found a negative correlation– FHV, FCV, FeLV, and FIV have NOT been shown to

have a causal relationship


• Clinical signs– Severe inflammation of the oral cavity extending

beyond the mucogingival junction– Often focused on the caudal oropharynx in the area

lateral to the palatoglossal folds• “Faucitis” is a misnomer – this region is NOT the fauces• Fauces - The passage from the back of the mouth to the

pharynx, bounded by the soft palate, the base of the tongue, and the palatine arches.

– May have concurrent periodontal disease and/or tooth resorptions but not always the case


• Clinical signs– Most other clinical signs are associated with oral pain

• Ptyalism• Bleeding from the mouth• Pawing at the mouth• Running from the food bowl• Poor haircoat from reluctance to groom

– Often see hyperproteinemia with severe hyperglobulinemia and reflex hypoalbuminemia

– Often no other changes on CBC/Chem panel



• Treatment– Conservative management

• Professional periodontal treatment to remove existing plaque and calculus

• Extract teeth with obvious lesions– Tooth resorptions– Periodontitis

• Oral home care for continued plaque control– Tooth brushing– Antiseptic rinse– Often very difficult because of the severity of pain


• Treatment– Conservative management

• Antibiotics– Clavamox is first choice (>90% susceptibility)– Clindamycin is second choice (~86-88% susceptibility)

• Pain management– Buprenorphine (sublingual or buccal mucosal

application)– Tramadol– Meloxicam – if not on steroids

• Corticosteroids• Usually only temporarily effective


• Treatment– Surgical management (extractions)

• Start with premolars and molars• If stomatitis is present at the canines and incisors,

extract those as well• Consider extractions sooner rather than later

– Long-term treatment with steroids can lead to other problems (diabetes)

– Possibly increased risk of developing SCC in stomatitis cats

– May take longer to see improvement in cats with prolonged medical management.


• Treatment– Cyclosporine

• Cats who are refractory to treatment• Alternative to extractions• Usually compound cyclosporine into liquid

suspension• Dose depends on formulation of cyclosporine• Generally 5mg/kg• Checking cyclosporine levels?


• Prognosis– Good prognosis with extractions

• Approximately 60% of cats are cured• Approximately 20% of cats are significantly

improved• The remaining 20% show little to no improvement

and will need subsequent management– Continued conservative management– Consider cyclosporine


• Prognosis– Cats with concurrent FIV and/or FeLV

infection tend to have a poorer prognosis• Often do not improve even with complete

extraction of all teeth and medical management with steroids and antibiotics

• Prevention– None known– Cannot treat disease if etiology is unknown

Eosinophilic Granuloma Complex

• Unknown etiology– Thought to be part of an allergic reaction pattern– Commonality is the presence of eosinophils– Females tend to be more affected– Young to middle-aged cats– No breed predilection

• Complex consists of 3 types of lesions– Indolent Ulcer *– Eosinophilic Plaque– Eosinophilic Granuloma *



• Treatment– Lesions are non-painful so may not require

treatment– Eosinophilic granulomas may cause

dysphagia– Immunosuppressive doses of corticosteroids– Adjunct therapy

• Hypoallergenic diet• Fatty acid supplementation• Environmental modification


• Prognosis– Good with or without treatment

• Prevention– None known

Oral neoplasia

• Oral neoplasia is relatively rare in cats– Approximately 3-8% of malignant neoplasms occur in

the oral cavity– It is the 4th most common location for neoplasia– Benign neoplasms are extremely rare in the cat

• Squamous cell carcinoma is the most common malignant neoplasm (60-80%) in the oral cavity

• Fibrosarcoma is the second most common, followed by lymphoma, others

• Acanthomatous ameloblastomas (previously called adamantinoma in the cat) are extremely uncommon but can occur

Oral Nesoplasia

• Oral squamous cell carcinoma– Occurs mainly in older cats– No breed predisposition– Previous studies show increased risk in urban

populations and smoking households• Similar to human risk factors• Environmental factors?

Oral Neoplasia

• Oral Squamous Cell Carcinoma– Behaves differently from SCC in other

locations– Extremely aggressive

• Often very osteolytic• Rapid progression of disease

– Variable in appearance• Ulcerative• Proliferative

Oral Neoplasia

Oral Neoplasia

• Oral Squamous Cell Carcinoma– Limited treatment options

• Not radiation sensitive• Resistant to most chemotherapeutic agents• Difficult to get good surgical margins

– Lesions are fairly large when detected– Size of cat makes 2cm margins virtually impossible

• Maybe multimodal approach?• Bisphosphonates?

Oral Neoplasia• Oral Squamous Cell Carcinoma

– Mainly hospice-type care• Pain management

– Piroxicam/Meloxicam– Buprenorphine

• Supportive care– Subcutaneous fluids– Parenteral feeding

– Prognosis is very poor• Survival time usually 4 – 8 weeks after diagnosis• Cats are euthanized because of quality of life

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Feline Dentistry and Oral Medicine