When studying feline dentistry, advanced education is the key. The understanding of feline periodontal pathology, feline resorptive lesions, feline oral radiology diagnostics, feline oncology and feline oral inflammatory pathology are all essential in correct diagnosis and creating a proper treatment plan. This is not a comprehensive listing but it is the most commonly confronted pathology that you will note in the feline. If the wellness exam at your hospital does not include a complete oral examination, add it to your assessment today. Mastering the Normal The feline dental formula, eruption times, root numbers, and the modified Triadan numbering system must be mastered. Good sources for studying these topics are "Veterinary Dentistry Principles and Practice," Wiggs/Lobprise Editors; Lippincott-Raven;1987, and "An Atlas of Veterinary Dental Radiology," DeForge/Colmery, Editors; Iowa State University Press/Blackwell Publishing; 2000. These texts are an important starting point. Drs. Wiggs and Lobprise discuss the intricacies of the normal and the abnormal of the feline oral condition. "An Atlas of Veterinary Dental Radiology" gives a radiographic visualization of oral structures in the feline and the canine Quick Study of Terms Feline gingivitis: The gingiva tissue overlies the bony alveolar processes of the maxilla and mandible and surrounds the tooth. It is the first line of defense against periodontal disease protecting the bone and supporting tooth structures. Any inflammation of these tissues is termed gingivitis. Both gingivitis stage one and two are reversible with professional care and a daily client periodontal maintenance homecare program. Feline periodontitis: A disease of the tooth-supporting apparatus. Inflammation of these tissues leads to progressively destructive changes and loss of bone and periodontal ligament. Attachment loss can be 25 percent to 50 percent. Radiographic changes of horizontal, vertical, furcation and oblique bone loss are common. Oral radiology diagnostics are essential in feline periodontitis. Soft tissue, bony tissue and dental changes evidence numerous areas of pathology because of inflammation from plaque bacteria. Periodontitis is an irreversible form of periodontal disease that can be controlled with professional care and exceptional individualized client periodontal maintenance homecare programs. It is very important to differentiate this pathology from other pathologies listed below and to biopsy and refer to an oral care specialist in resistant cases. Post-dental recalls are important and doctor and technical consults with the client about rechecks and homecare programs are a must. Attachment loss: A main feature of active phase periodontitis. It is characterized by the destruction of the periodontal supporting apparatus (i.e. soft tissue and bony tissue). Attachment loss will be under-estimated or underscored if gingival recession has occurred and it will be overscored if gingival enlargement (gingival hypertrophy/hyperplasia) is present. To eliminate these errors, always measure attachment loss from the cementoenamel junction. Feline Resorptive Lesions: Many names have been assigned over the years to this pathology, including feline dental resorptive lesions, feline odontoclastic-osteoclastic resorptive lesions, subgingival resorptive pathology and feline cervical resorptive lesions. The etiology of these lesions is unknown and they are commonly found at the cementoenamel junction of the tooth just apical to the gingival margin covered with hyperplastic gingival. Minor lesions can progress leading to pulp involvement, root resorption and crown dissolution. Radiography is essential for diagnosis and treatment. Many times, lesions can be identified apical to the cementoenamel junction and only identifiable with radiology. Never use an explorer with an awake patient to search for these lesions; use general inhalation anesthesia. If you attempt exploration without anesthesia you will precipitate a severe pain reaction if the lesion is in juxtaposition to pulp tissue. All cats with advanced periodontal pathology should undergo full-mouth oral radiology for periodontal assessment and to examine for resorptive pathology; resorptive lesions are non-restorable lesions with exodontia being the course of treatment as the lesions approach pulp tissue. Biopsy may be indicated in cases of subgingival pathology to differentiate resorptive disease from neoplasia and osteomyelitis. All can co-exist. Feline resorptive lesions are also commonly found in patients with oral inflammatory pathology (i.e. stomatitis) and in patients with eosinophilic granuloma complex. Exodontia can be difficult because resorptive root lesions can have irregular roots and indistinct endodontic systems with concurrent ankylosis. Refer to an oral care specialist if uncertain about exodontal techniques. Feline oral inflammatory disease (stomatitis): The etiology of this disease is unknown. Common names include lymphocytic plasmacytic stomatitis, gingivo-stomatitis and immune-mediated refractory stomatitis. It is a chronic, non-responsive, generalized and painful oral inflammation involving the free gingival margins, mucosa, palate, tongue, sublingual area, glossopharyngeal arches, commissures and pharynx. Histologic appearance is characterized by a predominance of plasma cells, lymphocytes and neutrophils. A polyclonal gammopathy is commonly presented. Once reported as most common in purebred lines i.e. Abyssinian, Siamese, Himalayans today, this disease is acknowledged to cross all lines and breeds of felines including the domestic short hair with juvenile, adult, and late-onset forms. Stomatitis is the most misunderstood oral pathology of general practice. Non-responsive to long-term glucocorticoids, initial response can be positive, leading to more frequent injections or higher dosages to reduce general oral inflammation. The glucocorticoid treatment regimen can precipitate transient diabetes, liver or kidney disease, adrenal disease and other organ dysfunction. There is no direct connection established at this time between feline Bartonella disease and feline stomatitis. Some of the juvenile (under 1 year of age) feline Bartonella-positive cats respond to Zithromax therapy and professional periodontal care. The adult cats with feline oral inflammatory disease are surgical patients. These cats respond excellently, with complete remission, to a new surgical protocol that is coupled with histopathology, oral radiology diagnostics, osseous surgery and bone grafting. --- Dr. DeForge is a fellow of the Academy of Veterinary Dentistry and adjunct instructor at Northwestern Connecticut Community College in oral radiology and periodontology. He is co-editor of "An Atlas of Veterinary Dental Radiology." His website is www.vetdent.com, and he may be reached at DonDeForge@aol.com.
