Feline Gingivitis and Stomatitis – The Sore & Painful Kitty Mouth

Gingivitis and stomatitis of the cat mouth is a very frustrating condition to try and manage. Gingivitis refers to inflammation of the gums. Stomatitis refers to inflammation of the mouth (often the back of the mouth but it can advance onto the roof of the mouth or even onto the tongue). In severe cases cats cannot eat and blood tinged saliva drips from their mouths. Pain and discomfort is severe.

So why does this develop? We don’t know! The types of cells present suggest it might be an immune response. The speculation is that the body has an excessive response to the bacteria in the mouth. (The type of cells present gives this form of gingivitis its full name – lymphocytic plasmacytic gingivitis and stomatitis. For the sake of simplicity in this article, I’ll simply call it gingivitis.) It’s a disease that tends to affect the younger cat.

This disease is managed, not cured. That’s the first thing to understand or you’ll be very frustrated.

What are the first steps your vet will take when trying to manage this disorder? They will probably test for the viruses Feline Leukemia Virus and Feline Immunodeficiency Virus. They will also do a full general health screen to detect and correct any underlying health issues. They may test for Calicivirus or the bacterium Bartonella. Underlying problems need to be corrected first.

The next step is to start the cat on antibiotics. Azithromycin is a favourite choice of antibiotic because Bartonella is associated with so many cases of gingivitis. (And obviously, azithromycin kills Bartonella.) Unfortunately, the infection with Bartonella is not the full answer.

The teeth then need to be cleaned. Hygiene is extremely important. Remember, this seems to be a reaction to the bacteria in the mouth. Bacteria adhere to plaque and calculus. In the early stages dental home care (minimally done once daily, preferably twice daily) may slow the progression of the disease. But this is difficult to do for most cat owners. And later on, as the gingivitis worsens, it is too painful. Professional veterinary dental cleanings every six months may slow the progress.

Cortisone injections & oral steroids are often attempted because of the belief that this may be an immune based problem. These treatments initially are effective but their value tends to wane and within 6 months to 2 years the steroids do little to reduce inflammation in the mouth.

As the disease progresses it becomes necessary to extract healthy teeth to reduce bacteria in the mouth. Many cats will improve adequately and have a good quality of life with the extraction of all but the canine teeth and incisors. Sometimes these need to come out as well if the gingivitis is extending towards these teeth.

Dental radiographs need to be taken to ensure all the roots are removed in cases of gingivitis unless root resorption to bone is occurring. In these cases, it has been advised to ‘atomize’ the root. This can only be done with monitoring using dental radiographs to ensure all the roots are gone and not too much other damage has been done. (In other words, it gets a bit tricky.)

The majority of cats do well with full mouth extractions. A few will still have problems. These problem cats need to be tested for shedding of the calicivirus. If this is found, treatment with interferon may help.

Ultimately, this painful disease can be managed but it will be a long journey. Cats never make our jobs easy!

- As written for ‘Abbotsford Today’ by Dr. I. Elizabeth Borgmann,
Whatcom Road Veterinary Hospital

Feline Odontoclastic Resorptive Lesions...
a mouthful of words for a poorly understood dental disorder!

This is a common disorder of cats where the roots are replaced with bone and painful enamel lesions appear at or under the gum line. Whoa. That is the very over-simplified version! There are estimates of affected cats ranging from 20 to 70% (most studies suggest about 50% of cats are affected). So read on. There is a good chance your cat (or one of your cats) may have this happening in their mouth(s)!

This is a very odd process where odontoclasts start working on the root ligament and start chewing up tooth root, replacing it with bone. Over time, the root and bone becomes indistinguishable. As the process proceeds holes will appear in the enamel, usually just below the gum line.

If you look in your cat’s mouth you would see spots of bright red gums. Touch these areas and your cat will go through the roof. These areas are painful because the outside world is in contact with the root nerve. Ever need a root canal? That is the kind of pain we are talking about.

Are there any signs to look for in your pet that suggests you should open that mouth and have a good look? Yes. Watch for aggression or hiding. Watch for a decrease in appetite (due to pain). Watch for dropping of food and hissing at food.

These lesions, when spotted in the mouth of your cat, truly are a ‘tip of the iceberg’ type of problem. A lot has been happening under the gum line involving the roots well before you see that red reactive gum tissue. Periodontal disease will follow these resorptive lesions.

This is a fairly new problem, appearing over the last four decades. Its incidence is beyond that which would be expected from simply learning to diagnose the problem. So what is causing it?

Research is ongoing. An area of current research is centering on the role of excess vitamin D. Cats don’t need a lot of vitamin D. Is this problem caused by excess vitamin D in the diet? Especially since fish contains a lot of vitamin D? Or is it something else? Speculation has also revolved around abnormal chewing forces with dry food, problems with dental hygiene, and the acidic nature of food.

The bottom line is...at this time we don’t know what causes these resorptive lesions. And therefore we can’t prevent them.

Currently, the recommendations are to control periodontal disease & plaque. Pet food companies are starting to reduce the amount of vitamin D in the diets. And research is occurring that is looking at mediators to control cell differentiation and mediators that affect bone morphogenic proteins. (Oh my, more mouthfuls of words...let’s just say researchers are working on it!)

So how will your vet treat these teeth? First, they will start with dental radiographs. Often more than one tooth is involved. Teeth that have enamel lesions may need to be extracted or amputated.

More often than not these teeth cannot be extracted because the tooth root has started to turn to bone. In these cases, a flap is made on both sides of the tooth, the crown is amputated below the gum line, the bone is smoothed off, and the gums are sutured. The goal is to remove the pain that comes from the exposure of the centre of the tooth to the outside.

Teeth that have been amputated need to be monitored for full resorption. Follow up radiographs are usually taken after six months.

There is a more rare form of enamel resorption that occurs secondary to periodontitis that does not involve the root resorption and transformation into bone. These need to be extracted in their entirety. The two types of resorption can only be differentiated with radiographs.

Those teeth that are fusing to bone, but have not broken to the outside, need to be monitored. Repeat radiographs will probably be recommended, usually around 6 to 12 months later.

Once these have been identified in your cat, you can expect ongoing follow up to be necessary. Meanwhile, let’s just hope that the research that is ongoing provides us with some solutions....soon!

- As written for ‘Abbotsford Today’ by Dr. I. Elizabeth Borgmann,
Whatcom Road Veterinary Hospital

Dental Radiographs on Pets? – What is that all about?

You are probably wondering why your vet is recommending or requiring dental radiographs on your pet when they undergo a veterinary dental procedure. You’re probably thinking...wait a minute...’my previous vet never did that!’ or ‘you didn’t do that last time!’ or ‘isn’t that a bit excessive?’ Is this a money grab? Is this going too far for pets?
Well, for some people, doing anything for the health and well being of their pets beyond providing food, water, shelter and the most basic medical care is excessive. But does that apply to you? Is your pet a family member? Do you expect the same level of care for your pet as for your children? If yes, then dental radiographs become part of the package.
Why did your vet not do them last time? Because medicine and medical care changes with time. It’s a good sign that your vet is offering them now. It means they are staying in tune with the times! The more we learn, the more it’s become evident that dental radiography offers better dental care. And more and more veterinarians are acquiring dental x-ray equipment.
Stop and think. Why does your dentist take dental x-rays every time you go for a cleaning? Does that mean they are not doing a good job of looking at your teeth and probing or does it mean some pathology, or problems, lie hidden where the naked eye and the dental probe don’t reach?

So what will your veterinarian look for in those radiographs?

• Are there any missing teeth? Are they missing because they are fractured? Or did they never form (congenitally missing)? Are they impacted? Did they fail to erupt?
• If there are missing teeth present do any of these pose a potential source for problems? (For example: abscessed retained roots; cyst formation around impacted teeth or around teeth that failed to erupt).
• If it is obvious that a tooth needs to be extracted, is there a problem with the bone surrounding the tooth? Are the roots curved? Are the roots fusing with the bone?
• If a tooth is discoloured it is probably dead. Are there any abscesses forming at its base?
• If a tooth is fractured, is it abscessing?
• Did an infected tooth result in an opening from the upper jaw into the nasal cavity whereby bacteria, food, water and debris enters the nasal cavity?
• If periodontal disease is present, is there any attachment loss of the periodontal ligament and is there any bone loss?
• Is that swelling in the mouth due to a tumour or an abscess? (Just be aware, if it looks like a tumour, it is a good idea to x-ray the chest and look for spread of that tumour.)
• Cats with resorptive lesions REALLY need x-rays! Are those roots fusing with bone?
• Are there any root fractures?
• Are worn teeth showing any signs of abscessing at the base?
• Are there any hidden abscesses in apparently healthy teeth?

The above just gives you a hint at the types of problems unearthed by dental x-rays!
Your veterinarian needs this information to decide on how to proceed (or not to proceed) with a procedure. Be aware, with this information at hand, they may decide it is better to send you to a specialist than proceed themselves with a potentially disastrous procedure.
Just as with most things in life...the more we learn...the more complicated it gets! And as technology improves, the more care we can provide our companions to allow them to lead healthy and pain-free lives!

-As written for ‘Abbotsford Today’ by Dr. I. Elizabeth Borgmann,
Whatcom Road Veterinary Hospital

Whatcom Road Veterinary Hospital Dental Home Care Packages Include...

• An oral health exam 
• Any necessary lab work prior to anesthesia
• Analgesics, anesthesia, and monitoring
• IV fluids during dental cleaning
• Teeth cleaning & extractions as needed
• Polishing
• Dental X-rays
• Hospitalization for the day
• Pain medication to go home if necessary
• Dental follow up exams
• Dental X-rays in 6 months if advised
• Dental home care information package
• Pre & Post dental cleaning digital photos
• Anesthetic monitoring summary
• Dental report card
• Review of home care instructions

**Antibiotics are NOT included. The need for antibiotics is determined at the time of the oral health exam and may not apply to all pets**