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What’s In A Name?

Feline Resorptive Disease

and

Feline Chronic Gingivostomatitis

Michaela P. Meissner, BS, LVT, VTS (Dentistry)

Nomenclature

Caries

Feline Odontoclastic Resorptive Lesions

(FORLS)

Resorptive Lesions (RL)

Cervical Lesions

Neck Lesions

Tooth Resorption (TR)- AVDC

Feline Resorptive Disease

Very common in cats

Prevalence rate of 20% - 70% (depending

on cat population and investigative

methods)

Seen more commonly in older cats

Feline Resorptive Disease

Tooth Resorption (TR)

◦ Process in which the dentin in a tooth erodes

and eventually become irreparably damaged

Radiographic Types 1-3

Stages 1-5

Stage 1 (TR1)

Mild dental hard

tissue loss

Cementum or

cementum and

enamel

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Stage 2 (TR2)

Moderate dental

hard tissue loss

Cementum or

cementum and

enamel

Loss of dentin

that does not

extend to the

pulp cavity

Stage 3 (TR3)

Deep dental hard

tissue loss

Loss of dentin that

extends to the

pulp chamber)

Most of the tooth

retains its integrity

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Stage 4a (TR4a)

Extensive dental

hard tissue loss

Loss of dentin that

extends to the pulp

chamber

Most of the tooth

has lost its integrity

Crown and root

are equally affected

Stage 4b (TR4b)

Extensive dental

hard tissue loss

Loss of dentin that

extends to the pulp

cavity

Crown is more

severely affected

than the root

Stage 4c (TR4c)

Extensive dental hard tissue loss

Loss of dentin that extends to the pulp chamber

Most of the tooth has lost its integrity

Root is more severely affected than the crown

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Stage 5 (TR5)

Remnants of dental

hard tissue are

visible only as

irregular

radiopacities

Gingival covering is

complete

Radiographic Type 1

Focal or multifocal radiolucency

Normal periodontal ligament space

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Type 1 Type 1

Radiographic Type 2

Narrowing or disappearance of

periodontal ligament space

Radiographic Type 3

Both Type 1 and Type 2 present in the

same tooth

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Etiology Theories

Local pH changes

Inflammation associated with periodontal

infection

◦ TR1?

High levels of vitamin D in diet

Diagnosis

Signal tooth

◦ Mandibular third premolar

Diagnosis

Signal tooth

◦ Mandibular third premolar

Clinical signs

◦ Usually none

◦ Orally exposed resorptive lesion

◦ Gingiva or granulation tissue growing up the

crown

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Diagnosis

Intraoral

Radiographs

Treatment

Do nothing

Treatment

Do nothing

Restoration with glass ionomer or root

canal therapy

Treatment

Do nothing

Restoration with glass ionomer or root

canal therapy

Crown Amputation

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Treatment

Do nothing

Restoration with glass ionomer or root

canal therapy

Crown amputation

Surgical extraction

Prevention

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Feline Chronic

Gingivostomatitis

Definitions

Gingivitis

◦ Inflammation of the gingiva

Stomatitis

◦ Inflammation of the mucous lining of any of the structures in the oral cavity

Gingivostomatitis

Inflammation and proliferation of the gingiva and oral mucosa

Caudal Mucositis

◦ Inflammatory involvement of fauces

Gingivitis Gingivostomatitis

Feline Chronic Gingivostomatitis

with Caudal Mucositis

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Etiology

Theories

Possible viral component

◦ Calicivirus, Herpes virus, Feline Leukemia

virus, Feline Immunodeficiency virus,

Bartonella henselae

Higher serum IgG, IgM and IgA

concentrations and lower salivary IgA

levels

Diagnosis

Clinical signs

Simultaneous Feline TR and/or

periodontitis

Presence of caudal mucositis

Symmetrical distribution of proliferated

and inflamed tissue

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Diagnostics

Oral exam (conscious and complete)

Intraoral radiographs

FIV/FeLV status

CBC and blood chemistries with

electrolytes

+/- FCV testing

+/- Bartonella testing

Differential diagnostics

Treatment

Goal- resolution or minimalization of oral

inflammation

Options

◦ Medical management

◦ Extractions

Full mouth vs all cheek teeth (premolars and

molars)

Treatment

Medical management

◦ Immaculate plaque control

◦ Antibiotics

◦ Topical rinses or gels

◦ Glucocorticoids

◦ NSAIDs

◦ Cyclosporin A

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Post-Surgery

Pain management

◦ Buprenorphine

◦ Gabapentin

◦ +/- Metacam injection

Antibiotics

Appetite stimulant

+/- Feeding tube

+/- Topical rinses

Post-Surgery

Recheck exams

◦ 2-3 weeks post-surgery

◦ 6-8 weeks post-surgery

Improvement to some degree in ~60 %

Marked improvement in ~20%

No improvement in ~20%

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Refractory Stomatits

No improvement in caudal mucositis

Very difficult therapeutic challenge

◦ Immunosuppressive drugs

◦ Feline Recombinant Interferon Omega

◦ CO2 laser therapy

Immunosuppressive Drugs

Low-dose Prednisolone

◦ Undesired side effects- PU/PD, thinning

haircoat, diabetes mellitus

Cyclosporin

◦ Blocks IL-2 and IL-4 gene transcription =>

Inhibits T cell activation

◦ Atopica

◦ Monitor whole blood cyclosporin trough

levels

◦ Side effects- transient vomiting and diarrhea

Feline Recombinant Interferon

Omega Not readily available in USA

◦ Only accessible through the FDA

Compassionate Use Program & imported on

individual basis

As effective as Prednisolone

No adverse side effects

CO2 Laser Therapy

Goal- char the inflamed tissue and create

scar tissue formation

Veterinarian must be extremely proficient

Also used in conjunction with

hospitalization, esophagostomy tube and

corticosteroid therapy

Adipose-Derived Mesenchymal

Stem Cell (ASC) Therapy Hypothesis-

◦ Systemic immune modulation

◦ Inflammatory lesion reduction

◦ Clinical signs of improvement in inflammation

(cure or substantial reduction)

Not approved for wide-spread use yet

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Questions?

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