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.