Dental Corner: Feline gingivostomatitis: How to relieve the oral discomfort - Veterinary Medicine
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Dental Corner: Feline gingivostomatitis: How to relieve the oral discomfort


VETERINARY MEDICINE


TREATMENT

In rare cases, simply maintaining excellent oral hygiene will keep this condition under control. A home-care program may include daily tooth brushing and chlorhexidine (topical) application and long-term or long-term intermittent (pulse) antibiotic therapy. Antibiotics whose spectrum of activity includes gram-negative anaerobic bacteria are good empirical choices. Antibiotic therapy often produces favorable results initially; however, the benefits of antibiotic therapy seem to diminish over time. The Catch-22 of feline gingivostomatitis is that the cats that have had sore mouths for a long time are usually the poorest candidates to cooperate with a home-care regimen. When home care alone is not working or not possible, consider medical or surgical treatment.

Medical treatment

Unfortunately, the medical treatment options include either drugs with poor chances of success or drugs with serious side effects (e.g. corticosteroids). Many drugs have been used to treat feline gingivostomatitis with varying degrees of success. The most effective drug appears to be methylprednisolone acetate given at a dosage of 20 mg/cat injected subcutaneously every three weeks as needed. Other corticosteroids, such as oral prednisone, have also been used to successfully control feline gingivostomatitis. The goal is to find the lowest every-other-day oral dose that provides clinical control of the disease. Long-term corticosteroid treatment is not ideal because cats can develop serious side effects, including diabetes mellitus and iatrogenic hyperadrenocorticism. Avoiding corticosteroids is especially important when treating cats infected with feline leukemia virus or feline immunodeficiency virus.2

Nonsteroidal drugs that have been used to treat feline gingivostomatitis with limited success include interferon, cyclosporine, bovine lactoferrin, piroxicam, azathioprine, and gold salts. Many of these drugs are not labeled for use in cats and may have marked side effects.

Surgical treatment


Figure 3A & 3B. A cat before and immediately after surgical treatment for gingivostomatitis. Providing postoperative supportive care and proper analgesia is essential in these patients. The patient should remain in the hospital until it is stable and eating—usually one or two days.
Extracting all teeth (or sometimes just the teeth behind the canines) has cured feline gingivostomatitis. In one study, 60% of feline gingivostomatitis patients treated with extraction were clinically cured, and another 20% were significantly improved.3 This procedure is labor-intensive and will not be successful if any root fragments are left behind. In some patients, areas of abnormally appearing alveolar and perialveolar bone may also need to be removed. Having the proper dental radiography equipment and a high-speed drill before performing the extractions is highly recommended. Perioperative and postoperative patient monitoring and support, as well as appropriate analgesia, cannot be overemphasized. Patients with gingivostomatitis requiring surgical treatment are commonly referred to veterinary dental specialists (Figures 3A & 3B).

When extracting teeth to treat feline gingivostomatitis, the question arises whether to extract canine and incisor teeth. A suggested approach is to extract canine and incisor teeth if they are diseased or if the surrounding tissues are markedly inflamed. If canine and incisor teeth are sound and inflammation is limited to the caudal portion of the oral cavity, the canine and incisor teeth may be spared.

REFRACTORY STOMATITIS


Figure 4. Refractory stomatitis in a cat that previously had its caudal dentition extracted.
Even after having all teeth and roots removed, about 20% of patients with feline gingivostomatitis will continue to experience signs of oral inflammation (Figure 4).3 These cases are refractory, and the patients may require treatment for life. In refractory cases, no therapies work consistently, but several treatments can be used. The goal of treatment is to minimize corticosteroid use while markedly reducing or eliminating oral discomfort.

Perform a radiographic re-examination of the dental arches to rule out retained root fragments or reactive periodontal tissue. If a patient's canine or incisor teeth were initially spared, extract these teeth now.


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Source: VETERINARY MEDICINE,
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