Dental Disease (Feline)

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Feline periodontal or dental disease results from gingivitis, or inflammation of the gums, which is caused by accumulation of dental plaque and inflammation of the tissues associated with it. Routine dental care is required to maintain proper dental health.

Common name: Feline dental disease, Feline gum disease, Inflammation of the mouth.
Scientific name: Feline periodontal disease, Feline gingivitis, Feline odontoclastic resorptive lesions (FORLs), Feline chronic gingivostomatitis.

Diagnosis

Signalment
For most periodontal diseases, there is no apparent association with gender or breed. Onset of feline odontoclastic resorptive lesions is usually around 4 to 6 years of age or older. There may be a predisposition for feline gingivostomatitis in younger purebred cats and in cats in multicat households.

Incidence/prevalence
Incidence of most periodontal diseases increases with age. Feline odontoclastic resorptive lesions are the most common disease of permanent teeth in domestic cats. Thirty to seventy-five percent of domestic cats develop this disease. Feline gingivostomatitis occurs in approximately 3 percent of domestic cats with oral disease.

Geographic distribution
There is no known geographic distribution.

Clinical signs (primary, most to least frequent, scientific term, synonyms)
Anorexia (not eating) or may show interest in food but be reluctant to eat, Ptyalism (drooling, salivation), Halitosis (bad breath).

Clinical signs (secondary, most to least frequent, scientific term, synonyms)
Pawing at face, Weight loss, Ulceration on lips, Many cats with FORLs have no clinical signs.

Causes (scientific, common term)
Dental plaque formation, Cause of feline odontoclastic resorptive lesions is unknown. Increased vitamin D levels may play a role. Cause of feline gingivostomatitis is unknown.

Organ systems affected (most to least affected)
Gingiva (gums), Oral tissue below the gums, Teeth, bones in jaw, Distant organs (kidney, liver) due to bacterial spread through bloodstream.

Diagnostic tests
Oral exam, Dental radiographs (X-rays), Blood work (test for FIV, FeLV, blood count and chemistry), particularly for cats with chronic stomatitis.

Differential Diagnosis
Oral abscess, Oral neoplasia (cancer), Halitosis secondary to systemic disease (such as kidney disease), Oral lesions secondary to systemic infections (such as kidney disease or calicivirus).

Overview

Feline periodontal or dental disease results from gingivitis (the inflammation of the gums), which is caused by the accumulation of dental plaque and the inflammation of the tissues associated with it. Plaque is deposited on the tooth, which causes the immune system to respond, leading to local inflammation. When the gingiva (gums) becomes inflamed, various enzymes that lead to the degradation of connective tissue are released.

This loss of connective tissue around the tooth may then result in destruction of the tooth, recession and loss of the gingiva, and bacterial release into the bloodstream. Bacterial release into the bloodstream may affect distant organs, which has the potential to lead to various diseases, such as kidney and liver disease.

Feline odontoclastic resorptive lesions (FORLs) are painful lesions that are the result of a progressive process of tooth destruction. They commonly affect middle-aged cats, and incidence increases with age. FORLs may occur at the gum line or away from the gum line. FORLs at the gum line are typically involved in an inflammatory process where plaque and oral fluids lead to an inflammatory reaction followed by excessive tissue formation, and the tooth gets resorbed (destroyed) along with the bone. FORLs away from the gum line are seen more frequently.

Feline gingivostomatitis is a syndrome that involves persistent chronic inflammation of many tissues of the mouth (not only the gums). The cause is unknown, but it may be immune-mediated (the cat's immune system may play a role in perpetuating the disease) and may be associated with feline calicivirus and/or feline herpesvirus-1. Although some of the teeth surrounding the inflamed tissue may be healthy, the teeth serve as a medium for plaque accumulation, bacterial proliferation and subsequent inflammatory response that causes stomatitis.

Treatment

Home Care
The prevention of plaque formation and the removal of dental plaque are key to oral health. Mechanical plaque removal (brushing teeth) combined with an anti-plaque agent daily is ideal. However, not all cats will allow pet parents to brush their teeth.

Professional Care
An oral exam should be performed annually by a veterinarian. If a dental cleaning (scaling and polishing) is needed, it will be performed under general anesthesia. Diagnosis of FORLs may be made by oral examination, depending on the amount of visible damage. However, affected teeth may appear clinically healthy, and dental X-rays are the only way to visualize root loss.

Several treatments for FORLs have been proposed, such as restoration, fluoride therapy and laser therapy. Although there may be ways to halt the destructive resorption process in the future, extraction of affected teeth is currently the best therapeutic option because the source of pain is removed. Cats with gingivostomatitis may be managed by performing multiple tooth extractions and treatment with antibiotics and immunosuppressive therapy. Some cats with chronic gingivostomatitis may require partial or full mouth extractions for resolution of signs.

Action
Cats with signs of periodontal disease should be seen by a veterinarian. Regular visits to a veterinarian and dental cleanings under general anesthesia as needed will help control periodontal disease. Veterinary dentists can provide specialized care when indicated.

Outcome
With proper medical care by a veterinary professional and continued care at home, the prognosis for most cats with periodontal disease is good.

References/Additional Readings

Gorrel, C. Periodontal and Oral Inflammatory Disease. In Slatter, Douglas, ed. Textbook of Small Animal Surgery. Philadelphia: Saunders, 2003; 2652-2681.

Reiter, A.M. Feline Odontoclastic Resorptive Lesions. ACVS Symposium Equine and Small Animal Proceedings, October 9, 2003.

Reiter, A.M. Treatment of the Stomatitis Patient. ACVS Symposium Equine and Small Animal Proceedings, October 9, 2003.

Author

Michelle Kazdin, VMD

Editor

Steven Hansen, DVM, MS, MBA

DABVT, DABT

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