Feline Health
Caring for Cats
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A Winn Feline Foundation Health Article On ...
Feline Dental Pathology and Care
Jan Bellows, DVM
Diplomate, American Veterinary Dental College
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-pharyngitis 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, megestrol acetate, and laser care. An effective approach to diagnosis and care is to first check for feline leukemia virus, feline 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 ensure 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%
chlorhexidine. If these diagnostics and treatments do not work within two
months, then all teeth are removed distal to the canines. 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 affected
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 affected with wry bites which are typified as uneven on the right and
left sides of the mandible and/or maxilla.
Related Link:
This article reprinted, with permission, from The British Cat (The Official Newsletter of the British Shorthairs Fanciers), Volume 4, Issue 3, May/June 1998.
Please Note: The Winn Feline Foundation provides the feline health
information on this site as a service to the public. Diagnosis and
treatment of specific conditions should always be in consultation with
one's own veterinarian. The Winn Feline Foundation disclaims
all warranties and liability related to the veterinary advice and
information provided on this site.
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