Intraoral Radiographic Interpretation Agreement Between Veterinary Students, Veterinary Dental Residents and Veterinary Dental Specialists.

This study evaluated observer variations in the interpretation of radiographic evidence for periodontal disease, tooth resorption, and endodontic disease in dogs. Forty dental radiographs were evaluated for 12 different parameters (periapical destruction of bone, wider than expected root canal, narrower than expected root canal, apical root resorption, loss of alveolar bone, external surface resorption, external replacement resorption, external inflammatory resorption, external cervical root resorption, internal surface resorption, internal replacement resorption, internal inflammatory resorption). Interpretations by 20 veterinary dentists, 10 veterinary dental residents, and 10 veterinary students were analyzed for consistency within groups and between groups by intraclass correlation coefficients (ICCs [95% CI]). Additionally, the agreement rate between groups compared to histopathological diagnosis, when available, and to a consensus group were evaluated. The results showed fair to good interobserver agreement for all participants when looking at all questions simultaneously (0.578 [0.515-0.635]) and with the consensus group (0.483 [0.451-0.517]). However, questions pertaining to various types of tooth resorption scored the lowest ICCs ranging from 0.005 (-0.311 to 0.321) to 0.189 (-0.105 to 0.402) across individual groups. Students had the lowest agreement compared to the consensus group for all questions (0.383 [0.347-0.421]) with fair to good agreement involving groups of residents (0.501 [0.465-0.538]), recently boarded diplomates (0.541 [0.506-0.578]), and more experienced diplomates (0.545 [0.510-0.582]). While dental radiographs are essential for clinical decision making, this study shows that interpretation of radiographs is highly subjective.

Prevalence of feline calicivirus in cats with odontoclastic resorptive lesions and chronic gingivostomatitis.

Feline odontoclastic resorptive lesion (FORL) and feline chronic gingivostomatitis (FCGS) are two of the most common diseases of the feline oral cavity. While evidence is emerging that FCGS is caused by gingival inflammation initiated and perpetuated by the oral microbiota, little is known in this regard for FORL. Feline calicivirus (FCV) has been associated with the presence of FCGS and is thought to play a role in the initiation of this disease. In this study, the incidence of FCV was investigated in cats with FORL and FCGS, and compared to unaffected controls. FCV was detected by viral culture. The incidence of FCV was as follows: 6 (24.0%) of 24 control cats, 9 (22.5%) of 40 cats with FORL and 15 (60.0%) of 25 cats with FCGS were positive for FCV. There was a significant difference in FCV incidence between all the groups (p=0.003) but none between the control group and the FORL group. However, significant differences were observed in the incidence of FCV between control and FCGS (p=0.010) and between FORL and FCGS (p=0.006). It is concluded that although FCV may be associated with FCGS, it appears unlikely to play a role in FORL.

Dental radiographic findings in cats with chronic gingivostomatitis (2002-2012).

OBJECTIVE: To compare dental radiographic findings in cats with and without feline chronic gingivostomatitis (FCGS). DESIGN: Retrospective case-control study. ANIMALS: 101 cats with FCGS (cases) and 101 cats with other oral diseases (controls). PROCEDURES: Controls were age- and treatment date-matched with cases. Conventional full-mouth dental radiographic views were evaluated for distribution, pattern, and severity of alveolar bone loss (periodontitis), tooth resorption, buccal bone expansion, tooth fractures, and retained roots. RESULTS: All cases and 77 (76%) controls had periodontitis; differences in extent and severity of periodontitis were significant, with semigeneralized or generalized and moderate or severe periodontitis in 78 (77%) and 93 (92%) cases, respectively, and 28 (28%) and 38 (38%) controls, respectively. The pattern of alveolar bone loss in cases was dominated by horizontal bone loss, with a nonsignificant increase in vertical bone loss, compared with that of controls. Cases were more likely than controls to have external inflammatory root resorption (49 [49%] vs 25 [25%]) and retained roots (57 [56%] vs 28 [28%]). Fewer dental fractures occurred in cases (14 [14%]) than in controls (35 [35%]). There were no differences between cases and controls in breed, sex, or presence of feline resorptive lesions or buccal bone expansion. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that FCGS was associated with more widely distributed and severe periodontitis, with a higher prevalence of external inflammatory root resorption and retained roots than other oral diseases. Full-mouth radiographic views are indicated for cats with FCGS to diagnose the extent of associated periodontitis, reveal external inflammatory root resorption, and identify retained roots.

Radiographic changes associated with tooth resorption type 2 in cats.

The aim of this retrospective study was to follow the progression of radiographic changes in intentionally retained roots of teeth affected with tooth resorption type 2 in cats. Emphasis was placed on assessment of degree of resorption as well as the occurrence of inflammatory changes in tooth roots. The results confirm that crown amputation is an adequate treatment in cats for teeth affected by type 2 resorption.

[Multiple tooth resorption in an Italian greyhound]. / Résorptions Dentaries Multiples Chez un Lévrier Italien.

An Italian greyhound was presented three times during a two-year period for dental prophylaxis due to periodontal disease. Clinical examination revealed lesions on several teeth. Radiographs revealed extensive resorptive root lesions. On histological examination, the presence of odontoclasts and signs of boney remodeling of the roots confirmed the resorptive nature of the lesions. Given the extent of the lesions, and poor prognosis with conservative treatment alone, teeth affected by the most severe resorption were extracted at each visit using a flap technique combined with alveolar vestibular osteotomy. Dental resorptive lesions are rarely detected in the dog but may be more frequent than previously thought. The routine use of dental radiographs can be used to reveal these lesions in the dog.

Human and feline invasive cervical resorptions: the missing link?--Presentation of four cases.

This report describes 4 patients presenting with multiple teeth affected by invasive cervical resorption (ICR). The cases came to our attention between 2006 and 2008; previously, no cases of multiple ICR (mICR) had been reported in Switzerland. Characteristics common to all 4 cases included progression of disease over time, similar clinical and radiographic appearance of lesions, and obscure etiology. The histologically assessed teeth showed a similar pattern of tooth destruction, with resorptive lesions being confined to the cervical region. Howship's lacunae and multinucleated, tartrate-resistant acid phosphatase-positive odontoclasts were detected. None of the teeth presented with internal resorption. The positive pulp sensitivity corresponded to the histologic findings, indicating that the pulp tissue resisted degradation even in advanced stages of resorptive lesions. Although mICR is rare in humans, a similar disease known as feline odontoclastic resorptive lesions (FORL) is common in domestic, captive, and wild cats. The etiology of FORL, like that of mICR, remains largely unknown. Because FORL has been associated with feline viruses, we asked our mICR patients whether they had had contact with cats, and interestingly, all patients reported having had direct (2 cases) or indirect (2 cases) contact. In addition, blood samples were taken from all patients for neutralization testing of feline herpes virus type 1 (FeHV-1). Indeed, the sera obtained were able to neutralize (2 cases) or partly inhibit (2 cases) replication of FeHV-1, indicating transmission of feline viruses to humans. Future studies on mICR (and FORL) should evaluate the possible role of a (feline) virus as an etiologic (co-)factor in this disease.

Oral examination and radiographic evaluation of the dentition in wild cats from Namibia.

Feline tooth resorption has been widely reported in domestic cats and sporadically described in other felidae. The goal of the present study was to determine the prevalence of tooth resorption and to report other dental problems in a population of wild felidae. Observations of dental disorders and anomalies were made in skulls from 73 wild felidae (cheetahs, leopards, caracals, African wildcats, and lions) originating from Namibia. In addition, radiographs were taken in 43 cases to determine signs of bone and root pathology. Radiographs showed varying stages of tooth resorption in 16.0% of the specimens. Other dental anomalies found included fused teeth, supernumerary roots, or missing teeth. The prevalence of dental resorption in wild felidae was lower than reported in the domestic cat.

A scanning electron microscopy study of idiopathic external tooth resorption in the cat.

BACKGROUND: Multiple idiopathic root resorption (MIRR) is a rare condition in man characterized by cervical resorption leading to significant tooth loss. A similar condition, feline osteoclastic resorptive lesions (FORL), affects up to 70% of domestic cats and thus provides a valuable model for investigating the etiopathogenesis of MIRR. The aim of the present study was to establish changes in the surface microanatomy of the tooth in late stage FORL and to identify whether its location has a surface bias. METHODS: Scanning electron microscopy (SEM) was used to analyze the surface features of enamel and cementum of feline teeth affected with advanced FORL. RESULTS: Resorption involved the coronal root at the cementoenamel junction (CEJ) in 95% of teeth and focal resorption of intact enamel was observed in 14% of teeth. In 55% of teeth, the main lesion was on the buccal surface and a distinct circumferential resorption "front" was present at the apical margin of resorption. The root surfaces of most affected teeth either lacked extrinsic fibers or cellular lacunae or featured evidence of cementum remodeling. Woven bone-like tissue was found within lesions, on resorbed dentin, or on the root surface in 27% of teeth. CONCLUSIONS: This study demonstrates that most FORL involve the CEJ, and the presence of focal lesions at this site suggests that this is where resorption is initiated. This implies that local factors in the oral microenvironment play a role in the etiopathogenesis of this condition. The study also shows that FORL are more likely to occur on buccal surfaces and are associated with changes in the microarchitecture of the root surface consistent with destruction of the normal periodontal attachment and stimulation of a reparative response. These findings may be relevant to understanding the etiopathogenesis of multiple idiopathic resorption areas in man.

A rapid screening technique for feline odontoclastic resorptive lesions.

The feline odontoclastic resorptive lesion (FORL) status (presence or absence of odontoclastic resorptive lesions) of 423 clinically healthy cats was determined based on radiographic findings in a series of full mouth radiographs (eight views). This status was compared with the FORL status based on evaluation of only two views, namely the right and left mandibular premolar and molar views. Using the FORL status of the right and left third mandibular premolars (307 and 407) alone correctly predicted overall FORL status in 93.4 per cent of cats. The sensitivity of the new technique (FORL cases correctly diagnosed as positive by the test) was 78.5 per cent, while the negative predictive value (negative FORL cases correctly diagnosed by the test) was 91.3 per cent. Overall FORL status can therefore be confidently diagnosed in nine out of 10 cats by assessing FORL status in just two teeth (307 and 407) using two films, which has benefits for the cat (less anaesthetic time and reduced exposure to radiation) and the owner (reduced cost of screening).

Scanning electron microscopy of root resorption of feline teeth.

Scanning electron microscopy was carried out on 10 feline extracted permanent teeth from 3 cases with root resorption. Various-sized resorption lacunae were well defined, showing an etched pattern and configuration as shown in human deciduous teeth. In cats, regardless of the shape and depth of lacunae, the resorption lacunae showed opening dentinal tubules in the wall with or without cement matrix apperring only in the deep and round lacunae of human cases. Some specific process of mineralization for repairing dental root resorption was suggested in cats.

Comparison of periodontitis and root replacement in cat teeth with resorptive lesions.

Cat teeth with resorptive lesions and periodontitis may have a distinctly different clinical and radiographic appearance compared with teeth that have focal, lesion-associated gingivitis. A retrospective, case-controlled study was performed to determine the occurrence of root replacement in cats with resorptive lesions and associated periodontitis. Of 543 teeth evaluated with resorptive lesions, radiographic and/or clinical signs of periodontitis were identified in 236 (43.5%) teeth. Periodontitis was present in 43 of 275 (15.6%) teeth with root replacement and 193 of 268 (72.0%) teeth that had normal radiodensity and maintenance of the periodontal ligament. There was a significantly lower occurrence of root replacement in cat teeth with resorptive lesions and periodontitis.

Risk factors for odontoclastic resorptive lesions in cats.

A cross-sectional study evaluating potential risk factors for odontoclastic resorptive lesions (ORL) in feline teeth was conducted. Owners of 32 cats with ORL and 27 cats without ORL were interviewed regarding their respective cat's demographic characteristics, diet, and medical and dental histories. Four factors were identified as significantly associated with ORL using unconditional logistic regression. A history of dental disease (gingivitis, calculus, or periodontal disease; odds ratio [OR], 4.5); city residence (OR, 4.4); and being an exclusively indoor cat (OR, 4.5) were associated with an increased risk for ORL. Consumption of commercial treats (OR, 0.3) appeared protective for ORL.

Feline immunodeficiency virus (FIV) infection leads to increased incidence of feline odontoclastic resorptive lesions (FORL).

Feline odontoclastic resorptive lesions (FORL), previously known as 'neck lesions,' are commonly known in domestic, but also in non-domestic cats. They are characterized by odontoclastic resorptive processes, which take place at the dental root and at the periodontium. Chronic inflammation of gingiva and periodontium is believed to be an important etiological factor in the development of FORL. In this context, various feline viruses have been discussed to play a relevant role in the pathogenesis of these lesions. The aim of this project was to determine in a blinded study the incidence of FORL in 10 cats which were infected for several years with feline immunodeficiency virus (FIV), but were otherwise free of feline viral infections (feline leukemia virus, feline calicivirus, feline herpesvirus, feline parvovirus, feline coronavirus, feline syncytium-forming virus). Nine age-matched controls were kept under identical conditions, but free of FIV. Subgingival resorptive lesions were found in six of 10 FIV-positive cats, but in three of nine controls only. FIV-positive cats had significantly more often gingivae with an increased tendency for bleeding upon probing than FIV-negative cats (p=0.0055), and they had slightly more often hyperplastic gingivae (p=0.0867). In conclusion, signs characteristic of FORL such as subgingival lesions, granulomatous or hyperplastic gingivae with a tendency for bleeding, were found significantly more often in FIV-positive cats than in the controls (p=0.0198). Therefore, it was concluded that FIV infection is an important factor for the occurrence of FORL, possibly through immune suppression or changes of the (sub)gingival micro-environment. However, non-infected control cats also showed some evidence of FORL in the absence of all tested viral infections. Therefore, factors other than viral infections must also play a role in the development of FORL in cats.

Feline "odontolysis" in the 1920's: the forgotten histopathological study of feline odontoclastic resorptive lesions (FORL).

This article reviews an historic description of feline odontoclastic resorptive lesions (FORL) from the 1920's. Hopewell-Smith describes the complete resorption process of feline permanent premolar teeth in remarkable detail, using 14 excellent photomicrographs. Resorptive lesions in cats were seen in the early part of this century, however the prevalence of this condition in domestic cats appears to have increased concurrently with certain aspects of domestication since the 1960's.

Treatment of asymptomatic internal resorption of a maxillary premolar tooth in a military working dog.

An asymptomatic pink discoloration of a maxillary right fourth premolar tooth was discovered during a routine oral examination on a 9 year-old Belgian Malinois dog. A radiolucent lesion was seen in the pulpal chamber on radiographic examination. The lesion had perforated the mesiobuccal root of the tooth. The primary differential diagnosis was idiopathic internal resorption. The tooth was treated by partial resection (removal of the mesiobuccal root and associated crown). A vital pulpotomy and amalgam restoration was performed on the remaining tooth structure. A follow-up 1 year later demonstrated a successful treatment outcome. The animal was asymptomatic and able to perform military duties. Clinical and radiographic signs of healing were evident and the tooth was functional.