Management of Severe Oral Inflammatory Conditions in Dogs and Cats.

Severe oral inflammatory disease is not uncommon in the mouths of canine and feline patients. An approach to oral diagnosis is offered. This article discusses a brief review of important points in the oral diagnosis and management of main canine (canine chronic ulcerative stomatitis (CCUS), eosinophilic stomatitis, and Wegener's granulomatosis (WG)) and feline diseases (feline gingivostomatitis/caudal stomatitis, oral eosinophilic lesions, pyogenic granuloma, and autoimmune diseases with oral manifestations), and-whereby possible-information about the current understanding of disease pathogenesis and treatment is offered.

Locoregional Flap Reconstruction Following Oromaxillofacial Oncologic Surgery in Dogs and Cats: A Review and Decisional Algorithm.

Primary treatment of most oromaxillofacial tumors in dogs and cats is resective surgery. Management of malignant tumors may be very challenging as wide/radical free-margin surgical removal must be achieved while preserving vital functions. Removal of orofacial tumors may result in large defects exposing the oral cavity or creating a communication with the nasal, pharyngeal, or orbital cavities. Such defects require orofacial reconstruction in order to restore respiratory and manducatory functions. The veterinary surgeon must be familiar with reconstructive techniques in order to prevent the inability of closing the defect, which could lead to an insufficient resection. Small oral defects exposing the nasal cavity are best closed with local random mucosal flaps. Closure of large oral defects may be better achieved with a facial or major palatine-based axial-pattern flap. Small to moderate facial defects can be closed with local advancement or transposition skin flaps. Reconstruction of large facial defects often requires the use of locoregional axial pattern flaps such as the caudal auricular, the superficial temporal, or the facial (angularis oris) myocutaneous axial pattern flaps. Recent publications have shown that the facial (angularis oris) flap is a very versatile and reliable flap in orofacial reconstructive surgery. A surgical decision algorithm based on the size, nature, and location of the defect is proposed.

Bilateral fibrodysplasia ossificans affecting the masticatory muscles and causing irreversible trismus in a domestic shorthair cat.

CASE SUMMARY: An 8-year-old spayed female domestic shorthair cat was referred for trismus of progressive onset, which had started at least 1 month previously. The patient presented with weakness, anorexia, chronic bilateral purulent nasal discharge and concurrent reduced nasal airflow. Upon physical examination, painful mouth opening, bilateral swelling of the temporal areas, with an inability to open and close the mouth completely, were apparent. A vertical mandibular range of motion (vmROM) of 22 mm was noted. Complete blood count, biochemistry, electrolytes and various serology tests were unremarkable. CT revealed multiple mineralised lesions within the masticatory muscles. Histopathological features were consistent with those seen in the human disease fibrodysplasia ossificans progressiva (FOP). Supportive treatment did not improve the vmROM, eventually resulting in a 13 mm open bite, and total inability to close and open the mouth. Cardiac arrest occurred at the induction of an anaesthesia procedure aiming to perform tracheostomy and nasal lavage. Despite emergency tracheotomy and cardiac resuscitation, humane euthanasia was elected by the owners. Post-mortem molecular investigations highlighted a heterozygous deletion, compatible with a splicing site mutation in ACVR1, which is also associated with FOP in humans. RELEVANCE AND NOVEL INFORMATION: This is the first report in the veterinary literature of FOP-like disease selectively affecting the masticatory muscles. This condition is associated with a poor prognosis, as no medical or surgical treatment has currently proven to be of any prophylactic or curative benefit. Although rare, FOP-like disease should be included in the differential diagnosis of trismus in the cat. Any further muscle injury should be avoided.

Relationship between Feline calicivirus Load, Oral Lesions, and Outcome in Feline Chronic Gingivostomatitis (Caudal Stomatitis): Retrospective Study in 104 Cats.

OBJECTIVE: This study was performed to assess the relationship between oral Feline calicivirus (FCV) load and severity of lesions at the time of presentation of cats suffering from feline chronic gingivostomatitis (FCGS) (part 1) and treatment outcome after dental extractions (part 2). We hypothesized that a higher FCV viral load would be positively correlated with the severity of lesions at presentation and negatively correlated with treatment outcome. In addition, the effect of dental extractions on outcome and the influence of preoperative severity of lesions on the outcome were investigated. MATERIALS AND METHODS: Cats with FCGS were included in the study if they had been diagnosed with caudal stomatitis, had been tested positive for FCV using a real-time reverse transcriptase-PCR test on oropharyngeal swab, and had dental extractions performed within the authors' department. General practitioners provided all previous medical treatments. Cats with recheck examinations were included in part 2 of the study. Multivariate statistical analysis was performed to assess the relationship between the different parameters. RESULTS: One hundred four cats met the requirements for part 1 and 56 cats for part 2 of the study. Data collected from patients' record included patient history, viral testing results, extent and severity of oral lesions, extent of teeth extraction. Signalment, history, preoperative treatment, and severity of caudal and alveolar stomatitis score were not associated with FCV load (P > 0.05). Presence of lingual ulcers was significantly correlated with FCV load (P = 0.0325). Clinical cure (32.1%) or very significant improvement (19.6%) was achieved in 51.8% of cats within 38 days. Concomitantly, 60.7% of the owners considered their cat cured (41.1%) or significantly improved (19.6%). Extent of teeth extraction was not found to influence the clinical outcome (P > 0.05). CONCLUSION: The results of this study did not support the hypothesis that FCV oral load is correlated with the severity of oral lesions or with the outcome following dental extractions. In addition, the severity of caudal inflammation was not correlated with healing time or achievement of cure.

Mandibular body fracture repair with wire-reinforced interdental composite splint in small dogs.

OBJECTIVE: To report the outcome of mandibular body fractures treated with a wire-reinforced interdental composite splint (WRICS) in small breed dogs. STUDY DESIGN: Retrospective case series. ANIMALS: Client-owned small breed dogs (n = 24). METHODS: Medical records (1998-2012) of small breed dogs (<10 kg) with mandibular body fractures treated by WRICS were reviewed for signalment, history, type of fracture, treatment, and clinical and radiological follow-up. The angle of the fracture line (ANG) was measured on dental radiographs. A mandibular injury severity score (MISS) and a dental injury score (DIS) were evaluated as potential prognostic factors. RESULTS: Fractures most commonly involved P4-M1 (56%), and healed in a mean time of 2.37 ± 0.7 months. Healing was slower (P = .012) if teeth were present in the fracture line and required extraction, hemisection, or root canal therapy prior to WRICS placement (2.39 ± 0.7 months) than if no dental treatment was required (1.46 ± 0.8 months). Contrary to the MISS, the DIS was associated with longer time to bone healing (P = .001; r = .63) and risk of complications (P = .004). Bone healing time was decreased (P = .003; r = .61) with increasing fracture angles. CONCLUSION: WRICS can be considered to treat mandibular body fractures in small breed dogs if the fracture is not severely comminuted, and if at least the canine and first molar tooth can be used for anchorage. More severe lesions, such as those with teeth in the fracture line and a shorter fracture surface, are associated with prolonged bone healing.

Piezoelectric Bone Surgery: A Review of the Literature and Potential Applications in Veterinary Oromaxillofacial Surgery.

Piezoelectric bone surgery is a recent and innovative technology, permitting a selective cut of mineralized tissue while sparing soft tissue. Similar to a dental scaler, a high frequency vibration, in the range of 25-35 kHz, is transmitted to a metallic tip. However, the power of the piezosurgical instrument is three to six times higher than that of a dental scaler. The major advantages of this technology include high precision, a design that increases ease of curvilinear osteotomy, less trauma to soft tissue, preservation of neurological and vascular structures, reduced hemorrhage, minimal thermal damage to the bone, as well as overall improvement of healing. The handpiece of the instrument is equipped with a sterile irrigation system and light-emitting diode (LED) light, which improves visibility and overall safety. Piezoelectric surgery is particularly useful when performing delicate bone procedures such as periodontal or endodontic surgery. It is also indicated when performing more invasive bone surgery such as maxillectomy, mandibulectomy, and condylectomy, where preservation of neurovascular structures is important. Piezoelectric instruments are different from rotary instrumentation or oscillating saws, they require light pressure with constant motion of the tip. Training is required to master the technique.

Maxillary osteomyelitis in two Scottish terrier dogs with chronic ulcerative paradental stomatitis.

Two Scottish terrier dogs were presented for recurrent oral problems. They were diagnosed with refractory chronic ulcerative paradental stomatitis and necrosis of the incisive and maxillary bones. Both dogs were treated with a combination of bilateral rostral maxillectomy and tooth extractions. The ostectomy was performed with a specific cutting device using piezoelectric bone surgery technology. These two cases show that a precise evaluation of dogs is essential for the diagnose of chronic ulcerative paradental stomatitis and its differentiation from mucocutaneous autoimmune diseases.

Comparative efficacy of a recombinant feline interferon omega in refractory cases of calicivirus-positive cats with caudal stomatitis: a randomised, multi-centre, controlled, double-blind study in 39 cats.

Chronic caudal stomatitis with alveolar/buccal mucositis in calicivirus-positive cats is the most severe presentation of feline chronic gingivostomatitis. Refractory cases are helped by antibiotic and anti-inflammatory treatments often including glucocorticoids. In order to evaluate the comparative efficacy of oromucosal administration of recombinant feline interferon omega (rFeIFN-ω) versus oral administration of glucocorticoids, a randomised, multi-centre, controlled, double-blind study was performed in 39 cats. The progression of behavioural, clinical and lesional scores was assessed over 90 days. Daily oromucosal treatment with 0.1 MU of rFeIFN-ω was associated with a significant improvement of clinical lesions (caudal stomatitis and alveolar/buccal mucositis) and a decrease of pain scores from D0 to D90. Although no such statistical improvement was noticed in the prednisolone group, there was, however, no significant difference between the two groups for most of the parameters, except pain at D60 and D90.

Tooth resorption and vitamin D3 status in cats fed premium dry diets.

It has been suggested that tooth resorption (TR) in cats is associated with vitamin D3 status. The purpose of this study was to evaluate any correlation between serum 25-OH-D concentrations and the prevalence of TR. The healthy adult domestic cats (n=64) of this study had been fed similar premium dry-expanded foods throughout their lives. Serum 25-OH-D was measured, and cats received a single, complete periodontal examination, with periodontal probing of each tooth and exploration of the tooth surface using a dental explorer A complete set of 10 dental radiographs was taken for each cat. There were 168 TRs diagnosed in 40 of 64 cats (85 were Type 1 TR and 83 were Type 2). The mean serum 25-OH-D concentration was 187.7 +/- 87.3 nmol/L. The mean serum 25-OH-D in cats with one or more TR was 164.2 +/- 78.8 nmol/L, compared with 226.8 +/- 88.2 nmol/L for those without TR (p = 0.14). The mean serum 25-OH-D in the 13 cats with >5 TR was 131.2 +/- 49.5 nmol/L, which was significantly less than in cats with no TR (p < 0.05). There was no relationship between TR type and serum 25-OH-D. There was no effect of age or sex on serum 25-OH-D. On the contrary, variations in serum 25-OH-D were observed according to the studied breeds. There was no relationship between TR type and serum 25-OH-D. TR prevalence was greater in cats with lower serum 25-OH-D concentrations. In conclusion, the hypothesis that higher serum 25-OH-D concentrations are associated with a higher prevalence of TR is not supported by this study.

Periodontal health status in a colony of 109 cats.

Periodontal disease has not been well characterized in the cat, and it is not known if feline tooth resorptions (TR) are equivalent to those observed in humans and dogs. The aim of this study was to investigate the different patterns of periodontal inflammation in cats, and to evaluate their prevalence in a standardized healthy population (n = 109). Particular emphasis was placed on the potential associations between TR and periodontal parameters, as well as the influence of potential risk factors (including breed, sex, and age). A single complete periodontal examination was performed, including periodontal probing of each tooth and exploration of the tooth surface using a dental explorer; at least 10 radiographs were taken for each cat. Missing teeth with radiographic evidence of root apices were present in 34.0% of cats. Periodontal disease was common, and 13.0% of cats had aggressive periodontitis. All of the cats had some form of periodontal inflammation, and only 4.0% of cats were free from gingival inflammation. Moderate to severe gingivitis was present in 13.0% of teeth. Dental furcation exposure was present in 18.0% of all multi-rooted teeth. Periodontal bone loss was observed in 31.2% of teeth, with the majority (98.2%) of all cats having some form of periodontal bone loss. Breed effects were identified for some variables. Eight of 14 periodontal variables were statistically correlated with Type 1 TR. Two of 14 variables (and age) were statistically correlated with Type 2 TR. In conclusion, the cats of this colony had a wide range of periodontal inflammation, including aggressive periodontitis. Type 1 TR and Type 2 TR were identified to be two significantly different manifestations of TR, with a strong association between Type 1 TR and periodontal disease.

Effectiveness of an oral hygiene chew to reduce dental deposits in small breed dogs.

Over a period of 4-months, feeding small breed dogs with a regular dry diet supplemented with a daily oral hygiene chew resulted in a significant reduction in plaque deposition (17.3%) and calculus accumulation (45.8%) compared with dogs fed the dry diet alone. Daily feeding of a specifically designed oral hygiene chew that reduces plaque and calculus accumulation may play a role in the severity of canine periodontal disease.

Evaluation of the Logan & Boyce plaque index for the study of dental plaque accumulation in dogs.

The objectives of this study were to assess intra-examiner (experienced examiner) and inter-examiner agreements (experienced versus non-experienced examiners) of scores assessed with the Logan & Boyce plaque index and to evaluate whether a modification of this index, where anatomical landmarks are used for horizontal division [mod L&B-AL] and dye references are used for assessing intensity of dye (plaque thickness) [mod L&B-DR], would improve repeatability. The Logan & Boyce index was found to be inaccurate when scoring plaque coverage as it underestimated the total crown surface. The contribution of the gingival part to the total tooth score was minimized by the Logan & Boyce index compared to the mod L&B-AL/DR. Precision of global plaque scorings was significantly improved by the mod L&B-AL/DR. Intra-examiner agreement of plaque thickness and plaque coverage scorings on the gingival part of the tooth was significantly improved by the mod L&B-AL/DR. Studies evaluating plaque accumulation in dogs should therefore use the mod L&B-AL/DR rather than the Logan & Boyce index.

Surgical endodontics in dogs: a review.

Surgical endodontic therapy (apical surgery) is a treatment alternative aimed at removing periapical inflammatory tissue followed by apical resection and retro-filling of the root canal. These procedures are performed through a trans-osseous approach. Terminology pertinent to this article include: apical (periapical) curettage--a surgical procedure to remove diseased tissue from the alveolar bone in the apical region of a pulpless tooth; apical cyst--a cyst in bone at the apex of a pulpless tooth. It is believed that such cysts arise after the death of the pulp from noxious physical, chemical, or bacterial stimulation of epithelial rests of Malassez; apicoectomy (apical resection) amputation of the apical portion of the root and removal of soft tissue in the bone; epithelial rests of Malassez--cords, strands, or clusters of ectodermal cells in the periodontal ligament (or sometimes alveolar bone) derived from remnants of Hertwigs epithelial root sheath. These cells frequently begin proliferating when inflammation occurs in the periodontal ligament and are believed to be responsible for the genesis of the epithelial lining of apical cysts.

Effectiveness of a dental gel to reduce plaque in beagle dogs.

Tooth brushing is considered a superior technique for reducing plaque accumulation. Chemical agents may be used to reduce plaque accumulation on tooth surfaces since many owners may not be willing or able to brush their dog's teeth. Following a professional teeth cleaning procedure, a dental gel containing chlorhexidine was applied in 11 dogs BID for 7-days, while 11 other dogs received a control dental gel applied in the same manner. Dogs in the treatment group had significantly less plaque accumulation during the trial period compared with dogs in the control group. The dental gel applied in the study reported here decreases plaque accumulation in the short-term and may be beneficial in reducing the severity of gingivitis and associated periodontal disease if provided on a long-term basis.