VETgirl April 2024 Beat e-Magazine

QUARTERLY BEAT / APRIL 2024

There are five stages of tooth resorption as defined by the American Veterinary Dental College.

Tooth resorption is further divided into three types based on radiographic appearance:

CATS ARE NOT SMALL DOGS: FELINE DENTAL AND ORAL DISEASES

• Type 1: The appearance of the tooth is relatively normal radiopacity and a normal periodontal ligament space with either a focal or multifocal radiolucency. • Type 2: The appearance of the tooth has either focal or multifocal radiolucency within the tooth and a loss or narrowing of the periodontal ligament space. • Type 3: This includes both Type 1 and Type 2 and is only seen in multi-rooted teeth. There will be areas of normal and narrowed periodontal ligament space with either focal or multifocal radiolucency. 4

• Stage 1 (TR 1): Mild dental hard tissue loss of the enamel and/or cementum. This is the hardest stage to identify. It may be visual, but also may only be tactile and identified by running an explorer along the tooth. • Stage 2 (TR 2): Moderate dental hard tissue loss of the enamel and dentin, or the cementum and dentin without extending into the pulp. • Stage 3 (TR 3): Deep dental hard tissue loss of the enamel or cementum and dentin, extending into the pulp chamber or canal. Most of the tooth retains its integrity. • Stage 4 (TR 4): Extensive hard dental tissue loss extending into the pulp. Most of the tooth has lost its integrity. This stage is divided into substages: » TR 4a: Crown and root are equally affected. » TR 4b: Crown is more affected than the root. » TR 4c: Root is more affected than the crown. • Stage 5 (TR 5): The crown is no longer visible and there is no recognizable tooth structure remaining of the crown or root. There may be hard bump of tissue still present.

DENISE S. ROLLINGS CVT, VTS (Dentistry) Pet Dental Education, LLC. , Fort Myers, FL

In this VETgirl veterinary technician webinar "Cats Are Not Small Dogs: Feline Dental and Oral Diseases" on February 28, 2024, Denise Rollings reviews the top oral pathologies seen in cats! Tune in to learn details of feline oral and dental disease and potential treatment options — check it out HERE!

The standard of care and recommended treatment for any affected tooth to be extracted is that the complete periodontal ligament and entire root is extracted. The roots should not be drilled out, as this does not completely remove the root and can damage the bone and nerves. A crown amputation with intentional root retention can be performed with Type 2 tooth resorption when there is no visible periodontal ligament on the radiographs. This treatment is less invasive and can only be performed if there is no periodontal disease, endodontic disease, or mucositis (stomatitis). In the case of Stage 5 tooth resorption, if there are no root remnants and the gingiva has healed over and is smooth, no further treatment is needed. GINGIVOSTOMATITIS Gingivostomatitis is the inflammation of the gingiva and oral mucosa with ulcerative or proliferative lesions. These lesions can occur on the lateral aspects of the tongue, pharyngeal walls, palatal glossal folds, buccal mucosa, lips, and gingiva. It is very painful and debilitating. As with tooth resorption, there is no known cause.

Understanding our unique feline patients including the oral and dental diseases they can develop, helps us provide better treatment, thus improving the quality of their lives. The primary tooth eruption schedule for kittens is as follows: the incisors erupt at 2-3 weeks, the canines at 3-4 weeks, the premolars at 3-6 weeks, and there are no deciduous molars. A kitten has 26 teeth. The permanent tooth eruption schedule for a cat is as follows: the incisors erupt at 3-4 months, the canines at 4-5 months, the premolars at 4-6 months, and the molars at 4-5 months. 1 Felines are naturally missing their maxillary first premolars and their mandibular first and second premolars. The Triadan tooth numbering system reflects this and cats do not have 105, 205, 305, 306, 405, and 406. TOOTH RESORPTION Tooth resorption has been referred to using various names over the years including cervical neck lesion, cervical line lesion, and feline odontoclastic resorptive lesion (FORL). It is currently referred to as tooth resorption, also developed by many other species outside of cats.

Tooth resorption is the destruction (resorption) of the hard-dental tissue by odontoclasts. 2 Odontoclasts are also responsible for the resorption of deciduous teeth. The etiology of tooth resorption is not yet definitively known. Tooth resorption can be seen in cats of any age; however, the average age is 4-6 years of age. 3 The number of lesions also increases with age. While any tooth can develop tooth resorption, there seems to be an increased predilection of teeth 307 and 407 to develop it first. There is no way to predict which teeth will develop tooth resorption or predict how fast it will progress. The unknown can cause frustration for the pet parent so it is important to provide as much information as we have available on the disease process, the treatment, and the prognosis. Tooth resorption cannot be prevented with teeth brushing as it is not bacterial in nature. We know that once a cat has tooth resorption, it is highly likely that the cat will progressively develop more over time, although there is no way to predict when that will happen or which teeth will be affected.

food, oral bleeding, or less commonly, anorexia. Clients may notice missing teeth because as the disease progresses, the tooth is destroyed, and granulation tissue fills in the defect. To diagnose tooth resorption, a complete oral exam needs to be performed with the patient under anesthesia. This exam should include the use of a dental explorer, as well as full mouth intraoral dental radiographs. Tooth resorption cannot be diagnosed or treated properly with out dental radiographs. The plaque and calculus should first be scaled off. The explorer is run along the tooth; the most likely area for tooth resorption is the cementoenamel junction. The explorer will “stick” in the lesion; be sure to check any areas of granulation tissue as well.

One theory is that it is caused by a hyperimmune response to the plaque bacteria in the oral cavity. Viral etiologies such as

WEBINAR HIGHLIGHTS

Tooth resorption is painful because it exposes dentinal tubules and pulp. Signs include jaw chattering, head shaking, dropping

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