VETgirl April 2024 Beat e-Magazine

QUARTERLY BEAT / APRIL 2024

calicivirus, herpes virus, feline leukemia, feline immunodeficiency virus, and feline infectious peritonitis along with Bartonella henselae infection, have been suspected, although a cat with gingivostomatitis does not mean it has one of these viruses. The most common signs we see in our patients with gingivostomatitis include severe halitosis, blood-tinged saliva, screaming while eating or yawning, running away from the food bowl, drooling, and weight loss. The affected tissue is red, swollen, and ulcerated. To accurately diagnose gingivostomatitis, a complete oral exam and biopsy of the affected tissue should be obtained and sent out for histopathology. The histopathological description is often lymphoplasmacytic stomatitis. 5 This rules out other diseases such as squamous cell carcinoma, severe periodontal disease, or eosinophilic granuloma complex. In addition, full mouth radiographs and blood work, including viral screening, are recommended. Gingivostomatitis is difficult and complicated to treat. The goal is to reduce or remove the plaque in the mouth. Often a combination of treatments is necessary to control the disease. Medical management does not cure the disease, but rather it is an attempt to control pain and inflammation. Analgesics, anti- inflammatories, antibacterials, immunosuppressants, antivirals, and steroids are often used. Cats have a high sensitivity to NSAIDS. Extreme caution must always be used, especially with long-term use. Fentanyl and buprenorphine are easy to give transmucosal or transdermal. Antivirals may help if herpes is the known cause. The body can begin to destroy its own tissues and create significant inflammation when the immune system is activated, therefore, immunosuppressives such as prednisolone or cyclosporine may help provide relief. Antibiotics may help decrease the bacterial load in the mouth. Home care includes daily tooth brushing, which may be exceedingly difficult in an extremely painful cat. The most successful treatment is extraction of the premolars and molars including the periodontal ligament and retained tooth roots if present. 6 If the inflammation extends toward the canine teeth, extraction of the canine teeth and incisors is indicated. 6 If teeth remain, it is ideal for the owner to provide home dental care such as brushing to reduce the bacterial plaque in the mouth. Some veterinarians prefer to extract all cheek teeth and try to leave the canines and incisors, knowing the remaining teeth may need to be extracted in the future. Daily brushing to control the plaque on the remaining canines and incisors is essential. It is also important to inform the owner that further extraction may be required and of the importance of committing to daily home care. Other veterinarians prefer to do full mouth extractions and not take the chance of leaving the canines and incisors. In either case, medical management may still be needed.

It can take 3-6 weeks to see resolution of the inflamed tissue following extractions. Multiple recheck appointments are necessary to make sure the cat is responding and comfortable. Another option for treatment is laser therapy to help reduce the proliferative inflamed tissue, and therefore decreasing the bacterial holding surfaces. Medical management and extraction may still be needed. Early diagnosis and treatment are imperative for the best outcome for the patient. 7 SQUAMOUS CELL CARCINOMA Squamous cell carcinoma (SCC) is the most common oral tumor that occurs in cats. It occurs most often in the premolar and molar region of the maxilla, and the premolar area of the mandible along with the sublingual region. The lips, buccal mucosa, tongue, oropharynx, and tonsillar region are also common. There does not appear to be a sex predilection. SCC is highly malignant and locally aggressive. Treatment for SCC is surgical excision with 1-2 cm margins from radiographic evidence of the mass involvement. Due to the already small size of the cats’ oral cavity and depending on the location and size of the tumor, this can be difficult. Radiation therapy for palliative treatment is an option, and this can be used in combination with surgery. Chemotherapy agents do not appear to be effective in treatment SCC. Regardless of any or all treatments, SCC has an extremely poor prognosis. 8 EOSINOPHILIC GRANULOMA COMPLEX Eosinophilic granuloma complex (EGC) is a general term used to describe a variety of cutaneous, mucocutaneous, and lesions of the oral cavity in the cat and dog. This condition is typically described as plaques or nodules on the soft palate or raised masses on the tongue. The lesions can also be seen on the prepuce, flanks, digits, ventral abdomen, external ear canal, cheeks, nasal plane, and trachea. Most cases of EGC are due to allergies. One or more allergies may be involved and may be caused by fleas, other parasites and insects, contact or airborne allergies, and/or food. In some cases, an allergy cannot be identified. Other factors may include genetic, viral, bacterial, stress, and/or psychogenic etiologies. A biopsy is needed for a definitive diagnosis because other conditions such as fungal or bacterial infections, or tumors that may prevent similarly. Since most cases of EGC are caused by allergies, treatment is often directed towards reducing or eliminating the allergic condition. Antibiotics, antihistamines, and/or corticosteroids may be used. Intensive flea prevention for all pets in the environment is necessary. For cases that respond poorly or recur quickly, other diagnostics and treatments may be needed. Referral to a veterinary dermatologist for allergy testing, food trial or dietary restrictions, and advanced medical management may be needed. Generally, surgical removal is not recommended because lesions often return if the underlying cause is not corrected.

subgingival space between the free gingiva and the tooth surface. The periodontal ligament is a group of specialized tissue fibers that hold or anchor the tooth to the alveolar bone. The cementum is the connective tissue on the outside of the root. Periodontal disease is caused by plaque, a biofilm that contains bacteria. Plaque is the filmy, soft deposit on our teeth that can be removed by brushing. Plaque mineralizes to form calculus (tartar), using the minerals in saliva. The hard, rough calculus increases the surface area for more plaque to stick to. The biproducts of the plaque bacteria are toxic to the gingival tissues and, along with the hosts own immune response, break down collagen, eventually leading to attachment loss or the destruction of the periodontium. Contributing factors to periodontal disease are malocclusions resulting from crowded and rotated teeth, calculus, restorations, orthodontics, genetics, xerostomia, gingival enlargements, and systemic health. Periodontal disease is staged by severity. PD Stage 0 has no gingivitis. Stage 1 PD is solely gingivitis, inflammation of the gingiva, without attachment loss. Stage 2 PD is gingivitis with <25% attachment loss. Stage 3 PD is gingivitis with 25-50% attachment loss. Stage 4 PD is gingivitis with >50% attachment loss. 10 Periodontal disease stages may be used for generalized staging or focal staging. To properly stage periodontal disease, once must perform a comprehensive oral exam.

PERIODONTAL DISEASE Periodontal disease (PD) is one of the most common diseases of domestic dogs and cats. Periodontal disease is progressive and deeply affects our patient’s comfort and quality of life. It also can have an impact on the systemic health of our patients. Uncontrolled periodontal disease can lead to pain, abscesses, decreased chewing ability, tooth loss, and potentially a pathological jaw fracture. One must understand the process and progression of periodontal disease to recommend appropriate care for our patients. Periodontal disease is the inflammation of the periodontium, the structure that anchors the teeth. It includes the gingiva, alveolar bone, periodontal ligament, and cementum. 9 The gingiva is the mucosa surrounding and supporting the teeth. There is attached gingiva, which is keratinized epithelium firmly attached to the bone extending from the free gingiva to the alveolar mucosa. The mucogingival line is the area of separation between the alveolar mucosa and free gingiva. It is the line between the soft fleshy mucous membrane and the tough gingiva. Alveolar mucosa is gingival surrounding the alveolar bone. The alveolar bone is the thickened ridge of bone that holds the teeth in the alveolus or socket. Free gingiva is the gingiva that forms the gingival sulcus. The gingival margin is the highest point of the gingiva surrounding the tooth. The gingival sulcus is the normal

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