Feline Health Topics for Veterinarians

Feline Health Topics for veterinarians Volume 6 , Number 4 Feline Oral and Dental Diseases John E. Saidla, D.V.M. Although oral and dental diseases occur frequently The maxillary PM’s are PM2, PM3 and PM4, in the cat, they are often overlooked. Performing an while the mandibular are PM3 and PM4. The decidu oral examination on a cat can be problematic, partially ous incisors and canine teeth of the cat erupt between due to the relatively tight lips that surround the cat’ s 3 to 4 weeks and the premolars between 5 to 6 weeks. small oral cavity. Also, many of the common dental The incisors are replaced between 3 1/2 and 5 1/2 and oral problems cause significant pain, making months, the canines between 5 1/2 and 61/2 months, cats even less tolerant of the examination. Therefore, the premolars between 4 to 5 months, and the molars anesthesia or sedation is usually required to perform between 5 to 6 months. a thorough oral examination and radiography of the Permanent Dentition: cat’ s mouth. (13/3, C l/1 , PM 3/2, M l/1 ) x 2 = 30 teeth Anatomy The camassial teeth are maxillary PM4 and man Knowing the dental anatomy and formulas are espe dibular M l. The premolars are designated the same cially important since cats have fewer teeth as numbers as in the deciduous dentition.7 There is one compared to other mammals. Knowing which teeth root for each incisor and canine tooth, the maxillary are anatomically missing improves the probability PM3 has two roots, PM4 has three roots, M l has two that one can identify truly missing teeth. roots. Mandibular PM3 and 4 have two roots, and M l has two roots. Deciduous Dentition: (13/3, C l/1 , PM 3/2) x 2 = 26 teeth Anatomical Defects Hypodontia (missing teeth) is common in the cat. The loss of one or more or the complete absence of Inside this issue... all incisors is frequently seen (figure 1). Missing Oral and Dental Diseases page 1 premolars and molars would follow in frequency. Supranumery teeth can occur resulting in crowding The Cat's Meow page8 and/or rotation of teeth. Retained deciduous canine teeth result in possible misplacement of the perma Holiday Schedule page 8 nent canine teeth. ^ Special Insert: Malocclusions occur in many purebred and do A Message from the Director mestic cats. Rostral displacement of the mandibular canine teeth, which may be associated with uneven Feline Health Topics 2 Recording the information obtained by history and physical examination is just as important as gathering the information. Long-term comprehen sive care cannot be provided without meticulous recording of the data during each examination. Gingivitis and Periodontitis Supragingival plaque is responsible for the develop ment of gingivitis in the cat. Plaque is comprised of salivary glycoproteins, bacteria and free polysac charides. Normally saliva washes each tooth as the saliva flows from the crown into the gingival sulcus Fig. 1: Hypodontia—all incisors are missing. and back out again into the oral cavity (figure 3). When this washing action is impaired by any material length of the mandibles as in the wry mouth (figure or substance on the crown and/or around the gingival 2), is a common problem. cuff, bacteria and cellular debris accumulate. This Dental Examination accumulation reduces the washing action of saliva To facilitate a thorough examination most cats w ill need some form of chemical restraint. A complete oral examination includes careful inspection of the lips, gingiva and the entire oral cavity and the oro / \ pharynx. Examine each tooth for plaque, gingivitis, supragingival and subgingival calculus, exposed roots, loose or missing teeth, rotated or displaced Feline Health Topics teeth, fractured or discolored teeth, deep periodontal pockets, gingival and osseous recession, and cervi A publication for veterinary professionals cal line lesions. Examine, measure and record the The ultimate purpose of the Cornell Feline Health Center is to depth of gingival and periodontal pockets. improve the health of cats everywhere, by developing methods to prevent or cure feline diseases, and by providing continuing education to veterinarians and cat owners. All contributions are tax-deductible. Director: Fredric W. Scott, D.V.M., Ph.D. Assistant Director: James R. Richards, D.V.M. Editor: Ju n e E. Tuttle Secretaries: Sheryl A. Thomas, Gwen Frost, : J 0 Julie Elzer This publication is made possible, in part, by a grant from 9-Lives Cat Foods. We grate f ^ fully acknowledge this interest and support it llM in the furthering of feline health. This acknowledgement of our gratitude is not an endorsement of any particular company or U f t i product. © 1991 by Cornell University on behalf of the Cornell Feline Health Center, College of Veterinary Medicine, Ithaca, NY 14853. All rights reserved. Permission to reprint se lected portions must be obtained in writing. Cornell University is an equal opportunity, Fig. 2: Wry mouth—uneven length of mandibles with rostral affirmative action educator and employer. displacement of the mandibular canine teeth. © 3 these immunoglobulins.3 The reaction of antibodies and bacterial antigens within the gingival sulcus creates a potential for adverse or excessive tissue responses. The adverse tissue response, immune complexes or Arthus reactions, result in osteoclastic alveolar bone. Swelling and a local tissue reaction occurs within the cuff as periodontal disease progresses. This causes an inflammatory reaction that is fueled by bacteria which change to more aggressive forms as perio dontal disease progresses. Toxic waste products, produced by the bacteria, aid in tissue destruction and in the advancement of periodontal disease. Progression of periodontal disease, from the gingival cuff down the periodontal ligament, causes Fig. 3: Schematic of the gingival cuff area representing the alveolar bone loss and soft tissue destruction. This anatomy of the gingival sulcus. increases tooth mobility, and finally results in tooth loss. Periodontal disease is the most common cause and allows more debris to form. Calcium and other of tooth loss in almost all animal species. minerals, from both food and water, attach to the Gingivitis is the early stage of periodontal dis plaque-forming calculus or tartar. This hard sub ease and its pathology is completely reversible by stance forms a protective area for bacteria to grow having a professional dental prophylaxis performed and develop. Both plaque and calculus accumulate and by initiating daily oral hygiene with brushing principally in areas that are protected against friction and/or oral rinses. In the classification of periodontal from the tongue and hard food, such as the buccal disease, both early and late stage gingivitis are recog- surfaces of the premolars and molars. Plaque pro nized.When gingivitis is not controlled it leads to gresses from the crown into the gingival sulcus when periodontitis. the cat’ s body defenses are compromised by a variety of diseases and conditions or when local defenses are Periodontitis is irreversible, however in many overwhelmed by the bacteria in the plaque. cases it is controllable. Periodontal disease can be either chronic or acute. An established periodontal The gingival sulcus or cuff is a very specialized lesion does not always advance. A balance is usually and significant area in normal oral physiology and is struck between the bacteria occupying the periodon very important in the development of periodontal tal pocket and the host’s defenses. When this balance disease. It is within the gingival cuff that many of the is altered, the bacteria undergo rapid growth and the body’s defensive mechanisms occur that protect the attachment structures holding the tooth in the socket individual from the advance of periodontal disease. are lost.6 Important immunological processes take place in the sulcus as well.6 The cat’s immune system responds G ingivitis and periodontitis are not the same to chronic inflammation with the production of anti disease, but are part of periodontal disease. Gingivi bodies. The mature plasma cells are the source of tis is an inflammatory process that affects only the Feline Health Topics Scheduling the next prophylaxis is based on the condition of the cat’s teeth— Annual— gingivitis but no stomatitis or periodontal disease. Basically healthy teeth and gums. Semiannual— mild periodontal disease and/ or stomatitis. Every 3 to 4 months— Moderate and advanc Healthy teeth and gingiva Gingivitis Periodontitis ed periodontal disease and cervical line lesions. Fig. 4: Progression of periodontal disease from the normal tooth to calculus, and deepening periodontal pockets from loss Fluoride Therapy— Fluoride has been shown to of gingiva and alveolar bone. reduce plaque and bacteria, desensitize exposed dentin, and strengthen enamel. It is most effective when applied during the first 18 months of life, soft tissues. Periodontitis involves the periodontium although it does provide some benefits after dental (the gingiva, the alveolar and supporting bony por defects have developed. tion of the mandible and maxilla, the periodontal ligament and cemental surfaces of the teeth).1 The end In cases of root and dentin exposure, 1.2 percent fluoride phosphate gel is applied after the prophy result of periodontitis is bone and tooth loss (figure laxis while the animal is still anesthetized. The gel is 4). applied with a cotton-tipped applicator and allowed Treatment to remain on the teeth for four minutes. Any excess is then wiped away. Dental Prophylaxis— Scaling and polishing are the key elements of a complete prophylaxis. Hand instruments or an ultrasonic scaler can be used. Special gingival curets have been developed for the unique shape of cats’ teeth and the small gingival sulcus area. If the scaling is performed with an ultrasonic scaler, very strict attention needs to be given to the length of time the tip is in contact with an individual tooth.

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