1/27/2020
What’s In A Name?
Feline Resorptive Disease and Feline Chronic Gingivostomatitis
Michaela P. Meissner, BS, LVT, VTS (Dentistry)
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Nomenclature Feline Resorptive Disease
Caries Very common in cats Feline Odontoclastic Resorptive Lesions Prevalence rate of 20% - 70% (depending (FORLS) on cat population and investigative Resorptive Lesions (RL) methods) Cervical Lesions Seen more commonly in older cats Neck Lesions
Tooth Resorption (TR)- AVDC
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Feline Resorptive Disease Stage 1 (TR1)
Tooth Resorption (TR) Mild dental hard ◦ Process in which the dentin in a tooth erodes tissue loss and eventually become irreparably damaged Cementum or cementum and Radiographic Types 1-3 enamel
Stages 1-5
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Stage 2 (TR2)
Moderate dental hard tissue loss Cementum or cementum and enamel Loss of dentin that does not extend to the pulp cavity
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Stage 3 (TR3)
Deep dental hard tissue loss Loss of dentin that extends to the pulp chamber) Most of the tooth retains its integrity
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Stage 4a (TR4a)
Extensive dental hard tissue loss Loss of dentin that extends to the pulp chamber Most of the tooth has lost its integrity Crown and root are equally affected
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Stage 4b (TR4b)
Extensive dental hard tissue loss Loss of dentin that extends to the pulp cavity Crown is more severely affected than the root
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Stage 4c (TR4c)
Extensive dental hard tissue loss Loss of dentin that extends to the pulp chamber Most of the tooth has lost its integrity Root is more severely affected than the crown
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Stage 5 (TR5)
Remnants of dental hard tissue are visible only as irregular radiopacities Gingival covering is complete
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Radiographic Type 1
Focal or multifocal radiolucency Normal periodontal ligament space
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Type 1 Type 1
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Radiographic Type 2
Narrowing or disappearance of periodontal ligament space
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Radiographic Type 3
Both Type 1 and Type 2 present in the same tooth
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Etiology Theories
Local pH changes Inflammation associated with periodontal infection ◦ TR1? High levels of vitamin D in diet
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Diagnosis
Signal tooth ◦ Mandibular third premolar
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Diagnosis
Signal tooth ◦ Mandibular third premolar Clinical signs ◦ Usually none ◦ Orally exposed resorptive lesion ◦ Gingiva or granulation tissue growing up the crown
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6 1/27/2020
Diagnosis Treatment
Intraoral Do nothing Radiographs
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Treatment Treatment
Do nothing Do nothing Restoration with glass ionomer or root Restoration with glass ionomer or root canal therapy canal therapy Crown Amputation
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7 1/27/2020
Treatment
Do nothing Restoration with glass ionomer or root canal therapy Crown amputation Surgical extraction
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Prevention
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8 1/27/2020
Definitions Feline Chronic Gingivitis Gingivostomatitis ◦ Inflammation of the gingiva Stomatitis ◦ Inflammation of the mucous lining of any of the structures in the oral cavity Gingivostomatitis Inflammation and proliferation of the gingiva and oral mucosa Caudal Mucositis ◦ Inflammatory involvement of fauces
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Gingivitis Gingivostomatitis
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Feline Chronic Gingivostomatitis with Caudal Mucositis
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9 1/27/2020
Etiology
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Theories Diagnosis
Possible viral component Clinical signs ◦ Calicivirus, Herpes virus, Feline Leukemia Simultaneous Feline TR and/or virus, Feline Immunodeficiency virus, periodontitis Bartonella henselae Presence of caudal mucositis Higher serum IgG, IgM and IgA Symmetrical distribution of proliferated concentrations and lower salivary IgA and inflamed tissue levels
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Diagnostics
Oral exam (conscious and complete) Intraoral radiographs FIV/FeLV status CBC and blood chemistries with electrolytes +/- FCV testing +/- Bartonella testing Differential diagnostics
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Treatment Treatment
Goal- resolution or minimalization of oral Medical management inflammation ◦ Immaculate plaque control Options ◦ Antibiotics ◦ Medical management ◦ Topical rinses or gels ◦ Extractions ◦ Glucocorticoids Full mouth vs all cheek teeth (premolars and ◦ NSAIDs molars) ◦ Cyclosporin A
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Post-Surgery Post-Surgery
Pain management Recheck exams ◦ Buprenorphine ◦ 2-3 weeks post-surgery ◦ Gabapentin ◦ 6-8 weeks post-surgery ◦ +/- Metacam injection Antibiotics Improvement to some degree in ~60 % Appetite stimulant Marked improvement in ~20% No improvement in ~20% +/- Feeding tube +/- Topical rinses
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12 1/27/2020
Refractory Stomatits Immunosuppressive Drugs
No improvement in caudal mucositis Low-dose Prednisolone Very difficult therapeutic challenge ◦ Undesired side effects- PU/PD, thinning ◦ Immunosuppressive drugs haircoat, diabetes mellitus ◦ Feline Recombinant Interferon Omega Cyclosporin ◦ CO2 laser therapy ◦ Blocks IL-2 and IL-4 gene transcription => Inhibits T cell activation ◦ Atopica ◦ Monitor whole blood cyclosporin trough levels ◦ Side effects- transient vomiting and diarrhea
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Feline Recombinant Interferon CO2 Laser Therapy Omega Not readily available in USA Goal- char the inflamed tissue and create ◦ Only accessible through the FDA scar tissue formation Compassionate Use Program & imported on Veterinarian must be extremely proficient individual basis Also used in conjunction with As effective as Prednisolone hospitalization, esophagostomy tube and No adverse side effects corticosteroid therapy
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Adipose-Derived Mesenchymal Stem Cell (ASC) Therapy Hypothesis- ◦ Systemic immune modulation ◦ Inflammatory lesion reduction ◦ Clinical signs of improvement in inflammation (cure or substantial reduction) Not approved for wide-spread use yet
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13 1/27/2020
Questions?
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