34 DENTISTRY VP JULY 2012 An updated approach to chronic feline gingivitis stomatitis syndrome (www.avdc.org) as: “Inflammation of tooth surface and elsewhere in the practice by a factor of 2:1. In the same the mucous lining of any of the mouth. case survey, the Maine Coon and structures in the mouth; in clinical use Not all cases of FCGS present in Siamese breeds do appear to have the term should be reserved to the same manner. A wide range of more affected individuals than any describe widespread oral inflammation severity of initial signs does commonly other. (beyond gingivitis and periodontitis) occur. Some cats respond well to In a survey of nearly 5,000 cats in that may also extend into sub-mucosal routine periodontal therapy and 12 practices over a 12 week period, 34 tissues (e.g. marked caudal mucositis improved hygiene alone while others cases of chronic FCGS were identified extending into sub-mucosal tissues will respond poorly to any treatment. and no breed bias was identified may be termed caudal stomatitis).” The implication is that some cats (Healey, 2007). Paradoxically, the condition is often have a very low threshold to the • Environmental factors. Colony cats present in the absence of significant trigger factors(s) whilst others have a or those in multi-cat households accumulation of calculus on the teeth. higher threshold approaching the level appear to be more commonly affected The syndrome can be seen at three for normal cats. Most intractable cases early in life. Increased stress levels plus Figure 1. distinct times in a cat’s life. Firstly, (87%) improve with elective tooth the close proximity of other cats around the time of kitten vaccinations, extraction and a few cases (13%) do allowing transmission of viruses and THE condition currently, and most oral inflammation can occasionally be not respond to any treatment (Hennet, other micro-organisms are held to be commonly, known as Feline seen. Whether this is an immune 1997; Girard and Hennet, 2005; significant factors. Chronic Gingivo-Stomatitis (FCGS) response to vaccinal elements or the Hennet, 2010). • Plaque bacteria. The oral bacteria is a relatively common and eruption of deciduous dentition and present in dental plaque matrix drives frustrating problem to the small consequential increased levels in dental Clinical signs the inflammatory response in normal animal practitioner. In a study of plaque is not known. Many, but not all, cats present with individuals. Cats that appear to be nearly 5,000 cats by 12 practices, A second period to see an increase dysphagia and pain due to extensive plaque intolerant show a variable the prevalence of FCGS was 0.7% in oral inflammation levels is when the oral inflammation and ulceration of threshold to the bacterial load of the (Healey, soft tissues. In some cases it can be mouth displaying an abnormal and 2007). NORMAN JOHNSTON hard to understand how the individual non-specific level of inflammation. Many outlines a logical method of eats or functions normally with such Specific bacteria, as seen in cases prove to investigation and treatment of extensive oral inflammation. periodontal disease, have been be extremely this relatively common and Inflammatory lesions may involve reported in these cats and Pasteurella frustrating frequently frustrating problem – some or all of the oral soft tissues. and Prevotella species are more highly with a based on the known evidence Most cases present with inflammation represented than others. Around half confusing base and ulceration of the tissues lateral to the cats seen by the author harvested number of the palatoglossal folds in addition to pure cultures of Pasteurella multocida different treatments in current use. permanent teeth erupt. Lastly, and the gingiva and mucosa overlying the (Dolieslager, 2011). The purpose of this article is to bring most commonly, FCGS is seen later in cheek teeth. Other oral tissues such as together a logical method of life with a mean age of seven years. the pharynx, tongue and the Viruses investigation and treatment for these This syndrome must be considered mandibular molar salivary glands can • Feline Calici Virus. Many papers cases based on the known evidence as part of a full oral cavity also be affected in severe cases. report a level above 70% of base where possible. examination. The presence of other Commonly reported signs include: chronically affected individuals with The syndrome is characterised by problems concurrently, such as tooth • anorexia and/or dysphagia; signs for over six months showing persistent and severe inflammation and resorption lesions (TRs), frequently • severe halitosis; positive testing to virus isolation ulceration of the oral soft tissues. adds to and confuses the picture. • weight loss – chronic or acute; following oropharyngeal swabbing for Many times this includes the tissues It has been known for some time • lack of (or an inability to) groom; Feline Calici Virus (Knowles, 1989; lateral to the palatoglossal folds that carriage of Feline Calici Virus • a reluctance to eat hard food; Thomson, 1984; Harbour, 1991). The (Figure 1) in addition to the gingiva, (FCV) is a co-factor in the induction • submandibular lymphadenomegaly – significance of this within the pharyngeal and lingual mucosa. or progression of the complex. The nodes often dramatically increased in syndrome is not known. Stomatitis is defined by the relationship between calici infection size and painful when palpated; It is possible that the virus American Veterinary Dental College and FCGS appears strong with 70- • variable, sometimes minimal, damages cell membranes allowing 90% of chronic stomatitis cats testing accumulation of plaque and calculus; easier antigenic penetration by other Norman Johnston, BVM&S, DipEVDC, positive compared with 20% of • teeth may be missing, affected by agents. However, other co-factors are DipAVDC, MRCVS, RCVS Recognised general population cats (Knowles, TRs or suffering from furcation required before this virus can cause Specialist in Veterinary Dentistry, 1989; Harbour, 1991). exposure and excessive mobility after disease as FCV carriage in the cat graduated from Edinburgh in 1976 It has also been reported that the recession of the periodontal tissues. population is around 20-30% and owns a dedicated referral dental relationship between FCV and FIV (Knowles, 1989; Zicola, 2009). and oral surgical practice near Edinburgh. He is a diplomate of both appears strong but the association Aetiology One research study (Hennet and the American and European between the two has never been This is a complex multifactorial Boucrault-Baralon, 2005) considered Veterinary Dental Colleges and a established for FCGS cats (Knowles, condition and there is no simple that chronic palatoglossitis lesions, as Fellow of the Academy of Veterinary 1989 and 1991). aetiological agent for the syndrome. opposed to buccostomatitis lesions, to Dentistry. He has been a registered Many cats also present with a Certain factors are thought to have an be more specifically associated with RCVS Specialist in Veterinary Dentistry hypergammaglobulinaemia (Harley, effect but the most commonly held calicivirus carriage. since 2002. He is a past president of 1999; Harley, 2003). This implies B view is that these cats suffer from an • Feline Immunodeficiency Virus (FIV) the European Veterinary Dental lymphocyte proliferation and therefore immunological over-reaction to low infection may have a role in producing College, the British Veterinary Dental no humoral immune response levels of oral antigens – dental plaque oral lesions by predisposing the cat to Association and also a past chair of depression. It is probable that affected mainly. Factors involved are: secondary infections. Both FIV and VETTrust, an educational veterinary cats are intolerant to even small • Breed. Mixed breed cats make up the FeLV may contribute to an aberrant charity based in Scotland. quantities of bacterial plaque on the majority of cases seen in the author’s immune response to oral antigens but VP JULY 2012 DENTISTRY 35 a recent study (Dolieslager, 2011) • Bacteriology (O): for both aerobic assessment of showed a group of FCGS cats to have and anaerobic bacteria – a high information by the 4% prevalence for positive FIV and proportion of cats tested show pure owner regarding FeLV which is similar to the UK cat cultures of Pasteurella multocida appetite, grooming, population as a whole. However, this is (Dolieslager, 2011). comfort and activity. not the hyperimmune response that • Biopsy (O) of affected areas – The remaining eight characterises the main syndrome. necessary to eliminate neoplasms (e.g. criteria require the • Dental disease. The presence of any sqamous cell carcinoma, Lymphoma, clinician to score concurrent dental disease is important. etc.) and other immunopathologies; separate areas of soft Either periodontal disease, TRs or very important if lesions not tissues from zero to both can have an exacerbating effect symmetrical. 3. on the syndrome. • Dental chart and full mouth dental Zero signifies radiographic survey (E) to assess normal tissue. One is Diagnostic testing periodontal status of teeth, bone for mild A standard diagnostic approach is quality and locate broken root tips or inflammation or advocated for all cats affected. Some those with resorptive lesions. ulceration, two for of this can be considered optional in moderate and three some cases and some are essential. Management and treatment for severe. Severe These tests are marked appropriately