Canine & Feline Oral Conditions - Dentistry Lecture 2

• Feline Dental Disease includes Periodontal Disease, Tooth Resorptive Lesions, Juvenile Gingivitis, and Feline Chronic Gingivostomatitis.

Feline Periodontal Disease

• Daily home cleaning, dental diets, and regular professional cleanings can prevent this disease.

Tooth Resorptive Lesions

• Staging involves visual and tactile examination.

• Typing involves radiograph.

• Intra-oral dental radiography is essential for the accurate assessment and proper treatment of tooth resorption, regardless of the species.

• Format with tooth resorptive lesion: TR-S_-T_ - Tooth Resorptive Lesion (TR)- Stage (S)-Type (T).

Juvenile Hyperplastic Gingivitis

• Commonly seen in young cats, around 6-8 months old.
• Tissue begins to cover the teeth when permanent teeth are erupting.
• Impacts chewing and oral hygiene.
• Treatment includes Gingivectomy, COHAT, and regular monitoring.

Feline Chronic Gingivostomatitis

• Often there is a history of juvenile hyperplasia.
• A very painful disease is characterized by severe inflammation of the gingiva, buccal mucosa, and caudal oral mucosa.
• CGS affects 0.7% to 10% of the general cat population.
• Gingivitis is inflammation of the gingiva, while stomatitis is inflammation of the mucous lining of structures in the mouth.
• Mucogingival (MG) line provides a landmark.
• Caused by an inappropriate immune response to oral antigenic stimulation
• Initiating triggers include periodontal disease, tooth resorption, oral bacteria, calicivirus, and herpesvirus.
• Dental plaque bacteria, even in very small amounts, stimulate the immune system.
• Complicating management of disease: feline leukemia virus [FeLV] and immunodeficiency virus [FIV].

Clinical Signs of Feline Chronic Gingivostomatitis

• Pain can cause behavior changes, weight loss, lack of grooming, or dropping food.
• Hypersalivation
• Food aversion
• Oral malodor
• Caudal mucositis

Management of Feline Chronic Gingivostomatitis

• Four stages are COHAT, XSS, Abx/Steroids/Pain Management “Rescue Therapy", extraction of all teeth caudal to canines, homecare*, rescue therapy, full mouth extractions (FME), and long-term Abx + Steroid.
• Successful treatment requires minimizing oral bacteria.
• Partial or full-mouth complete tooth extractions is generally the end result.
• Extraction of teeth in areas of oral inflammation provided substantial improvement or complete resolution of stomatitis in more than two-thirds of affected cats.
• The effectiveness of dental extractions is 55% cure, 35% markedly improved, and 10% no improvement.

Canine Specific Issues

• Chronic Ulcerative Paradental Stomatitis (CUPS)
• Caries
• Dental Trauma- Attrition, Abrasion

Dog's Age By His Teeth

• 8 weeks: All puppy teeth are in
• 6-7 months: All Adult teeth are in
• 1-2 years: Teeth are duller and back teeth may have yellowing
• 3-5 years: teeth may have some tartar starting to buildup
• 5-10 years: Teeth more wear and signs of disease
• 10-15 years: Heavy tartar buildup, teeth are wearing down or broken/missing

CUPS

• Patients Intolerance to microbial constituents in the mouth
• Patients may experience oral pain, bad breath, be reluctant to open his/her mouth, or may drool. Patients develop painful ulcers
• Commonly affected breeds are Maltese, King Charles Spaniel, Terrier, the German Shepherd, and Greyhound
• Lesions on the oral mucosa correspond with areas that contact teeth, and the lateral surface of the tongue is often affected
• Swollen lymph nodes, gingivitis, stomatitis, and advanced periodontitis are often present.

Diagnosis and Treatment of CUPS

• Biopsy of the area is often confirmatory.
• COHAT – radiography, remove any diseased teeth and perform thorough scaling and polishing
• ORAVET – waxy barrier, applied weekly to teeth, acts as a plaque retardant
• Chlorhexidine rinses daily for impeccable oral care
• Long-term antibiotic (Clavamox, Clindamycin, Tetracycline) with anti-inflammatory therapy (prednisone)
• Lifelong management and often leads to full mouth extraction

Caries

• 5% of dogs can be affected but never cats (true carnivores)??
• Dogs have a high salivary pH.
• Most animals are fed commercial diets (low in fermentable carbohydrates).
• Uncommon dogs are fed a diet that causes a caries.
• Bacterial decay of the tooth structure from acid release due to oral bacteria fermenting carbohydrates on the tooth surface.
• Plaque bacteria uses fermentable carbohydrates (sugar) as source of energy.
• With caries, fermentation products are acidic and demineralize enamel.
• A tooth surface is required to allow the acids to pool.
• Tactile examination of high-risk teeth.
• A dental explorer will reveal soft spots (demineralized enamel ) ... early lesion, or a rough-edged hole,, advanced lesion (various sizes).
• Rads should always be performed on suspicious teeth. Treatment is extraction or endodontic procedure

Dental Trauma

• Abrasion is tooth surface wear that is not in contact with each other
• Attrition is abnormal or excessive wear of occluding tooth surfaces
• Can be normal with grooming, mastication, play & work however animals can be very hard on thier teeth
• Start discussion with owners involving chewing habits and types of toys
• Initial owner meetings should include a chewing toy habit discussion
• Usually only seen in canines mouths
• Chewing history usually the key with abrasion.
• Always check for fractions
• Attrition usually seen with malocclusion
• Take time to perform tactile examination and rads, as well as looking for edge on exposed pult

Pulp Canal

• Touch or probe for soft/hard pulp and brown discoloration to determine treatment plan of extraction or incerceptive endontics

Abrasion and Attrition effects

• With either Particularly Abrasion or Attrition effects of chronic inflammation and pressure effects its composistion and its ability for resistance of periodontal ligaments changing its its copistion causing external absorbtion

Fractures

• Often a "dog thing" can be caused by the patient behavior, with Cats only affected due to fighting/falling
• Use classifcation guides
• Know which structucture(s)
• Can be uncomplicated or compilcated
• Look for pulp expoer in the mouth
• Pulp exposure is painful
• Extraction ro endodontic if its importiant to the patient (service dogs)
• Always have conversations with clients regarding specialist consults
• Calculus and shape conttributes to frature