Stefani Sabrodin,
6th year veterinary student from Estonian University of Life Sciences
Animal data:
- Donskoy cat
- 6 years 10 months old
- Spayed
- Weight 3,66kg
Anamnesis morbi:
Owners came to visit, because of halitosis and cats’ loss of appetite. Cat has also lost some weight in previous months. Cat lives mostly inside and was not vaccinated for any diseases over 2 years.
Clinical examination:
Gingiva was very red, inflammatory and gums were bleeding when the mouth was opened. Opening a mouth was painful for the cat and ulcers on the tongue were visualised (Figure1). Cat had also a lot of calculus and she was hypersalivating. Due to the fact that cat was not vaccinated, a FeLv/FIV snap test was done, and it was negative. Also hematology and biochemistry were evaluated. In biochemistry liver and kidney values were mostly within normal limits (WNL) Only UREA was a bit low (4,5mmol/L) but it might be due to the starvation. Electrolytes were also controlled and they were WNL. In hematology only mild leukocytosis was seen.
Treatment:
After the first visit, a dental appointment was planned. The cat got one subcutaneous injection of cefovencin (Convenia) 8mg/kg and went home with oral meloxicam 0,05mg/kg for 3 days. She came to tooth removal surgery in seven days. A cat was sedated with dexmedetomidine, butorphanol, and ketamine intramuscularly. TIVA with propofol was used during surgery. Cat got 5ml/kg/h of Ringer-Lactate during the procedure and free flow oxygen was given. Buprenorphine (0,01 mg/kg) intramuscularly and meloxicam (0,3 mg/kg) subcutaneously were given for analgesia and lidocaine was used for nerve blocks. Dental radiographs were made pre-and postoperatively (Figures 2). Figure 3 shows how important are dental radiographs. 301 was broken during the extractions but it was unclear if remnant got out or not. An x-ray was made and the root was visualised. Then the root remnant was removed and a new x-ray was taken.
During the procedure, clinical picture (gingivitis II-III in all dens, 204 had gingival pocket of 2mm. 404 had gingival hyperplasia and also pocket of 2mm) and full mouth radiographs were evaluated. All teeth except canines were extracted. A cat went home with oral meloxicam (0,05 mg/kg) for 5 days. A new checkup was in 7 days. Figure 5 shows that gingiva is not so inflamed anymore. Cat started eating with a good appetite already the next day after the extractions.
This picture shows how much we actually need radiographs. 301 was broken during the extractions but we were not sure if we got the remnant out or not. We made an x-ray and saw the root. Then we removed root remnant but unfortunately I have no pictures of the last x-ray, but it was clean.
Figure 2. (a) 409 has a tooth resorption (TR). (b) 309 is missing. (c) and (d) are made after extractions.
Figure 4. was made right after the extractions.
Background
Feline chronic gingivostomatitis (FCGS) is a common syndrome, but its’ aeitology is unclear. FCGS causes inflammation and proliferation for the gingiva and oral mucosa. Inflammation can be mild to severe and it worsens with time. Mucosal ulcers are commonly seen in cats with FCGS. Ulcers are the most commonly on gingiva, tongue, buccal mucosa, lips, palatoglossal folds, and the lateral pharyngeal walls.
Aetiology is unclear, but it might be due to bacteria (usually from plaque Pasteurella spp↑, Prevotella spp↑), viruses or immune-mediated. Feline calicivirus (FCV), feline herpesvirus (FHV-1), feline immunodeficy virus (FIV), feline leukemia virus (FeLV), feline coronavirus (FeCoV) may cause FCGS.
The most obvious clinical changes are bilateral focal or diffuse chronic gingival and oral mucosal inflammation, ulcers and hyperplasia. Cats with FCGS has halitosis, dysphagia, ptyalism, bloody saliva, anorexia, and bleeding gingiva. Caudal part of the oral cavity is also with lesions. There is no sex, age or breed predilection.
For diagnostics, laboratory examinations are mandatory. Complete blood count (CBC), biochemistry (glucose and kidney values) and serological assays (FeLV/FIV) should be done.
Since the aetiology of the disease is unclear then treatment is empirical. In some cases, conservative treatment may help. Administration of antibiotics (amoxicillin/clavulanate, clindamycin, metronidazole), corticosteroids (not a good choice, because of side effects) , megestrol acetate (was used widely in the past, but now it’s not recommended due to the side effect), sodium salicylate, gold salts, lactoferrin (in mild cases, inflammation and salivation↓), interferon (poor results without extractions), professional tooth cleaning 3-4 times per year, chlorhexidine mouth rinses (usually not tolerated by cats for a long time) and teeth cleaning have been reported. The best cure is still full-mouth extractions.
References
Holmstrom, S.E. Veterinary Dentistry: A Team Approach, 2nd edition. Elsevier 2012, 10:228- 230
Niemiec, B.A. Small Animal Dental, Oral & Maxillofacial Disease: A Colour Handbook. Manson Publishing 2012. 6:176-181
Correl C., Nind, F. Saunders Solutions in Veterinary Practice: Small Animal Dentistry. Saunders 2008. 12-15:79-97
Gorrel, C. Veterinary Dentistry for the General Practitioner 2nd Edition. Saunders, 2013
Tutt,C., Deeprose, J.& D.A. Crossley. BSAVA Manual of Canine and Feline Dentistry, 3rd edition. BSAVA. 2007.8:137-144
