Jan Bellows, DVM

Diplomate, American Veterinary Dental College

All Pets Dental Clinic

9111 Taft St.

Pembroke Pines, FL 33024

(954) 432-1111

FELINE DENTAL PATHOLOGY AND CARE

Feline dental pathology and care are perhaps the most overlooked and

under-treated areas in small animal medicine. Many feline patients over five

years old will have oral lesions that require immediate care to relieve pain.

A common feline oral malady is feline oral resorptive lesion (FORL). A

majority of the cats affected are older than four years. These tooth defects

have also been called cavities, neck lesions, external or internal root

resorptions, and cervical line erosions. The location of FORL is usually at

the labial or buccal surface of the cemento-enamel junction (CEJ) where the

free gingiva meets the tooth surface. The most common teeth affected are the

maxillary third and fourth premolars and the lower third premolar and first

molars, however FORLs can be found on any tooth. The etiology is unknown,

however theories supporting an autoimmune response mediating cellular and

humoral factors, calici virus, and metabolic imbalances relating to calcium

regulation have been proposed.

Patients effected with FORLs may show hypersalivation, oral bleeding, or have

difficulty apprehending food. A majority of effected cats do not show

obvious clinical signs. Most times it is up to the clinician to diagnose the

lesions on oral examination. Diagnostic aids include a periodontal probe or

cotton tipped applicator applied to the suspected FORL. The lesion often

erodes into the sensitive dentin, causing the cat to show pain with jaw

spasms when the EOR is touched. Intraoral radiology is helpful in making

definitive diagnosis and treatment planning.

The FORL can present in many stages~ initially (Stage I) an enamel defect is

noted. The lesion is usually minimally sensitive in because it has not

entered the dentin. Therapy of this defect usually involves thorough

cleaning, polishing, and frequent (every three months) application of

fluoride cavity varnish. In Stage 2, lesions penetrate the enamel and dentin.

These teeth may be treated with self cured or light cured glass ionomer

restoratives, which release fluoride ions to desensitize the exposed dentin,

strengthen the enamel, and chemically bind to tooth surfaces. The long term

(greater than two years) effectiveness of restoration of Stage 2 lesions have

not been proven glass ionomer application to the FORL does not automatically

stop the progression or the disease. Intraoral radiography is essential to

determine if the lesions have entered the pulp chamber (Stage 3) requiring

either endodontics or extraction These teeth should not be filled and left

alone.

Radiographic appearance of FORLs vary from minute radiolucent defects of the

tooth at the cemento-enamel junction, to internal resorption and ankylosis of

the apex to the supporting bone In Stage 4 FORL, the crown has been eroded or

fractured. Gingiva grows over the root fragments leaving a sometimes painful

bleeding lesion upon probing. Treatment of choice is flap surgery and

extraction of the root fragments if they appear inflamed or painful to the

patient.

Cats can also be affected by stomatitis referred to as lymphocytic

plasmacytic gingivitis pharangitis syndrome. The etiology of this disease

has not been determined. An immune related cause is suspected due to large

amount of plasma cells on histopathology. Gingival signs in the effected cats

include dysphagia, weight loss, and ptyalism. Oral examination abnormalities

include "cobble stone"- like hyperplasia and hyperemia on the glossopalatine

and palatopharyngeal arches, soft palate, and oropharynx. In addition,

marked gingivitis and periodontitis exists around the premolars and molars.

Intraoral radiographs often reveal moderate to severe periodontal disease

with marked supportive bone loss. All stages of feline oral resorptive

lesions can also be apparent clinically and radiographically.

Traditional therapy options include thorough cleaning and polishing,

gingivectomy, extractions corticosteroids, gold therapy, Flagyl, megesrol

acetate, and laser care. An effective approach to diagnosis and care is to

first check for feline leukemia, immunodeficiency virus, chemical profile, &

urinalysis for metabolic abnormalities. Next intraoral radiographs are taken

of all the teeth and gingival areas of missing teeth. With the radiographic

findings each tooth can then be examined and treated individually. If a tooth

is affected by moderate to severe periodontitis typified by greater than 90%

bone loss, it should be extracted. In addition, all root fragments need to be

removed. Radiographs should be repeated after extraction to insure complete

tooth removal. Immediately following surgery, prednisone ( l mg/lb) is given

daily and tapered over a three week period. The client is advised and shown

how to daily brush their cat's teeth followed by irrigation with .2%

chiorhexidine. If these diagnostics and treatments do not work within two

months, then all teeth are removed distal to the canines. If this still does

not relieve the inflammation, then all the teeth distal to the canines are

extracted. In some cases all the teeth including the canines and incisors are

extracted for positive results to occur.

Cats are also effected by oral neoplasia Squamous cell carcinoma (SCC) is the

most prevalent type of oral cancer. SCC can arise from the oral epithelium

and is characterized by local extension and invasion. Morbidity and mortality

come from local disease rather than distant metastasis. Less common feline

oral malignancies include melanoma, fibrosarcoma, lymphosarcoma, and

undifferentiated carcinomas.

Not all feline oral swellings are malignant. Cats are frequently effected by

treatable oral foreign body granulomatous reactions, osteomyelitis arising

from dental disease, eosinophilic granulomas, mycotic infections, and

nasopharyngeal polyps. Biopsies are essential in that the clinical appearance

of malignancy can be deceiving.

Some cats have orthodontic problems. Commonly a lance or saber like

projection of the maxillary canines occur especially in Persians. Cats are

also effected with wry bites which are typified as uneven the right and left

sides of the mandible and/or maxilla.