Feline Tooth Resorption

Feline Tooth Resorption – An Overview

  • Loss of varying amounts of substance of the tooth by a disease process (known as “dental resorptions”) affecting cats
  • “Odontoclastic” refers to “odontoclasts,” which are cells found around the teeth and are believed to lead to resorption (loss of substance) of the teeth
  • A relatively newly recognized syndrome
  • Previously known as “FORL,” for feline odontoclastic resorptive lesion
  • Feline tooth resorption is not the same problem as “cavities” found in people

Signalment/Description of Pet

Species

  • Cats

Breed Predilections

  • Asian shorthaired cats, Siamese, Persian, and Abyssinian may show breed susceptibilities

Mean Age and Range

  • Nearly 50% of cats older than 5 years old will have at least one tooth affected by resorption
  • Likelihood of tooth resorption increases as the cat ages

Signs/Observed Changes in the Pet

  • Most affected cats do not show clinical signs; some show excessive salivation/drooling (known as “hypersalivation”); bleeding from the mouth or difficulty chewing; some cats pick up and drop food (especially hard food) when eating; others hiss while chewing.
  • Some cats have behavior changes—they may hide or become aggressive
  • Pain, evidenced by jaw spasms
  • Tartar or calculus (mineralized plaque on the tooth surface) and excessive gum tissue (known as “hyperplastic gingival tissue”) may cover or hide the tooth resorptive lesion
  • Tooth resorption can be found on any tooth; the most common teeth affected are the mandibular (lower jaw) third premolar and molar teeth, followed by the maxillary (upper jaw) third and fourth premolar teeth
  • Tooth resorption is classified as Stage 1–5, based on its depth and amount of tooth destruction as follows:
  • Stage 1—minimal loss of hard tissue (enamel and cementum) of the tooth
  • Stage 2—moderate loss of hard tissue (enamel and cementum) of the tooth and penetrates the dentin (hard portion of the tooth, surrounding the pulp [blood vessels and nerves] and covered by enamel), but does not extend into the internal part of the tooth containing the blood vessels and nerves (known as the “pulp”)
  • Stage 3—deep loss of hard tissue (enamel, cementum, and dentin) of the tooth that extends into the pulp (internal part of the tooth containing the blood vessels and nerves); most of the tooth retains its structure
  • Stage 4—extensive loss of hard tissue (enamel, cementum, and dentin) of the tooth that extends into the pulp cavity; most of the tooth has lost its structure; various degrees of structural damage to roots (part of the tooth below the gum line) and crown (part of the tooth above the gum line)
  • Stage 5—the crown (part of the tooth above the gum line) is gone; the gum tissue covers the scant fragments of the roots; remaining hard tissue of the tooth is visible only on x-rays (radiographs) of the mouth

Causes

  • Unknown; likely many factors contribute to development of tooth resorption
  • Affected cats may have calcium-regulation problems; an improper ratio of dietary calcium, magnesium, and phosphorus; or parathyroid-gland malfunction, producing calcium imbalance
  • Hyperreactivity to inflammatory cells, dental plaque (the thin, “sticky” film that builds up on the teeth; composed of bacteria, white blood cells, food particles, and components of saliva), and/or tartar or calculus (mineralized plaque on the tooth surface); various compounds (endotoxins; prostaglandins, cytokines, and proteinases) also are under investigation as possible causes

Treatment

Diet

  • Add water to diet to soften food

Surgery

  • Stage 1—an enamel defect is noted; the lesion is minimally sensitive because it has not penetrated the dentin (hard portion of the tooth, surrounding the pulp [blood vessels and nerves] and covered by enamel); therapy includes thorough cleaning and polishing and possible surgical removal of some gum tissue (known as “gingivectomy”) and surgical contouring of the tooth surface (known as “odontoplasty”)
  • Stage 2—lesions penetrate the dentin (hard portion of the tooth, surrounding the pulp [blood vessels and nerves] and covered by enamel); often require either extraction or crown (part of the tooth above the gum line) reduction
  • Stage 3—lesions enter the pulp (internal part of the tooth containing the blood vessels and nerves); require either extraction or crown (part of the tooth above the gum line) reduction
  • Stage 4—the crown (part of the tooth above the gum line) is eroded or fractured with part of the crown remaining; gum tissue (gingiva) grows over the root fragments, yielding a sensitive bleeding lesion upon probing; additional extraction may be needed
  • Stage 5—the crown (part of the tooth above the gum line) is gone and scant root fragments remain; surgically remove any inflamed areas of tissue

Key Points

  • Loss of varying amounts of substance of the tooth by a disease process (known as “dental resorptions”) affecting cats
  • Nearly 50% of cats older than 5 years old will have at least one tooth resorption
  • Likelihood of tooth resorption increases as the cat ages
  • Daily home brushing may help control plaque (the thin, “sticky” film that builds up on the teeth; composed of bacteria, white blood cells, food particles, and components of saliva)

Feline Oral Inflammation

Inflammation of the Mouth and Throat in Cats – An Overview

  • inflammation affecting the gums, mouth, and throat in cats
  • Inflammation of the mouth is classified by its location, as follows:
  • Inflammation of the gums (known as “gingiva”)—gingivitis
  • Inflammation of the tissues that support the teeth—periodontitis; tissues that support the teeth include the periodontal ligament and the alveolar bone (the bone around the roots of the teeth)
  • Inflammation of the moist tissues around the teeth—alveolar mucositis
  • Inflammation of the moist tissues under the tongue on the floor of the mouth—sublingual mucositis
  • Inflammation of the moist tissues of the lip and cheek—labial and buccal mucositis
  • Inflammation of the moist tissues of the caudal areas of the mouth—caudal mucositis; “caudal” refers to the back or rear; in this condition, it describes the location in the mouth—the back portion of the mouth
  • Inflammation of the moist tissues of the tongue (top and underside)—glossitis
  • “Osteomyelitis” refers to inflammation of the jaw bone and bone marrow
  • “Stomatitis” is a general term to indicate inflammation of the moist tissues of the mouth in any location; frequently used when the inflammation is widespread in the mouth
  • Inflammation of the tonsils—tonsillitis
  • Inflammation of the throat (known as the “pharynx”)—pharyngitis

Signalment/Description of Pet

Species

  • Cats

Breed Predilections

  • Purebred cats more likely than other cats—Abyssinian, Persian, Himalayan, Burmese, Siamese, and Somali

Signs/Observed Changes in the Pet

  • Excessive salivation/drooling (known as “ptyalism”)
  • Bad breath (known as “halitosis”)
  • Difficulty swallowing (known as “dysphagia”)
  • Lack of appetite (known as “anorexia”)—prefers soft food
  • Weight loss
  • Scruffy hair coat from lack of grooming
  • Reddened, ulcerated lesions with rapidly growing tissue (known as “proliferative tissue”) affecting the gums (gingiva); the folds of moist tissue extending from the soft palate to the side of the tongue (known as the “glossopalatine arches”); tongue; lips; lining of the cheeks (known as “buccal mucosa”); and/or hard palate
  • Inflammation of the gums completely surrounds the tooth
  • May extend to the folds of moist tissue extending from the tongue to the wall of the throat or pharynx (known as the “glossopharyngeal arches”), as well as the palate

Causes

  • Unknown
  • Bacterial, viral, and immune-mediated causes are suspected
  • Feline calici virus
  • Decreased immune response (known as “immunosuppression”) from feline leukemia virus (FeLV) or feline immunodeficiency virus (FIV) also can lead to poorly responsive infections; however, most cats affected with inflammation of the mouth and throat (oropharyngeal inflammation) are negative for FeLV and FIV

Treatment

Health Care

  • Initial therapy for early inflammation of the moist tissues of the mouth (known as “mucositis”) involves professional teeth cleaning (above and below the gums [gingiva]), as well as strict home care; extraction of certain teeth may be necessary
  • Dental x-rays (radiographs) should be taken before and after surgery
  • Post-operative application of fluocinonide 0.05% (Lidex Gel) to the gum margin may help in the healing process

Surgery

  • Biopsy (especially for lesions involving only one side of the mouth) to rule out cancer—primarily squamous cell carcinoma
  • Extraction of the teeth in cats with inflammation of the moist tissues of the caudal areas of the mouth (caudal stomatitis) behind the canine teeth (that is, the premolar and molar teeth) resulted in resolution in 60% of the cases, without further need of medication; 20% of the remaining cases required medication
  • If the cat does not respond to extraction of the teeth behind the canine teeth (that is, the premolar and molar teeth), remove all remaining teeth; when extracting the teeth, pay meticulous attention to removing all tooth substance
  • CO2 laser may be used to decrease inflamed tissue

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive.

  • Medication and other therapies have been used with limited long-term success; lack of permanent response to conventional oral hygiene products, antibiotics, anti-inflammatory drugs, and drugs to decrease the immune response (known as “immunosuppressive drugs”) is typical
  • Medications should not be used as the primary method to control inflammation of the mouth and throat (oropharyngeal inflammation) in cats
  • Antibiotics—clindamycin, metronidazole, amoxicillin, ampicillin, enrofloxacin, tetracycline
  • Steroids—to decrease the immune response; such as prednisone; methylprednisolone also may help control inflammation
  • Gold salts—Solganal (Schering); used to treat serious immune-mediated diseases
  • Chlorambucil, a chemotherapy drug to decrease the immune response
  • Bovine lactoferrin is a protein found in cow’s milk that may have antibacterial activity and may have an effect on the immune system; it can be applied to the moist tissues (known as “mucous membranes”) of the mouth
  • Interferon is a protein produced by cells of the immune system; has a variety of effects in the body, including fighting viruses and cancer
  • Cyclosporine, to decrease the immune response

Follow-Up Care

Patient Monitoring

  • Monitor response to treatment; if the cat does not respond to extraction of the teeth behind the canine teeth (that is, the premolar and molar teeth), remove all remaining teeth
  • Monitor for potential side effects of medications used in treatment

Expected Course and Prognosis

  • Cases with extensive lesions of rapidly growing tissue (proliferative tissue) in the back part of the mouth and throat (pharynx) that respond poorly to treatment warrant a more guarded prognosis

Key Points

  • Inflammation affecting the gums, mouth, and throat in cats
  • Inflammation of the mouth and throat is classified by its location
  • Extraction of the teeth in cats with inflammation of the moist tissues of the caudal areas of the mouth (caudal stomatitis) behind the canine teeth (that is, the premolar and molar teeth) resulted in resolution in 60% of the cases, without further need of medication; 20% of the remaining cases required medication
  • If the cat does not respond to extraction of the teeth behind the canine teeth (that is, the premolar and molar teeth), remove all remaining teeth
  • Medications should not be used as the primary method to control inflammation of the mouth and throat (oropharyngeal inflammation) in cats.

Tooth Fractures

Tooth Fractures – An Overview

  • Trauma to the tooth may involve fracture of any part of the tooth.
  • May involve the crown and root of the affected tooth; the crown of the tooth is the portion of the tooth that is above the gum that is covered by enamel; the root of the tooth is the part of the tooth below the gum line that is covered by cementum to attach the tooth to the bone of the jaw.
  • Classified as “uncomplicated” if the fracture does not enter the internal part of the tooth containing the blood vessels and nerves (known as the “pulp”) and “complicated” if the fracture enters the pulp.
  • Both dogs and cats can fracture their teeth, although this is slightly more common in dogs.

Signs/Observed Changes in the Pet

Crown Fractures (Involving the Portion of the Tooth above the Gum Line)

  • Clinical loss of tooth-crown substance; may affect enamel only, or enamel and dentin; the enamel is the hard, shiny white material covering the crown of the tooth; the dentin makes up the bulk of the tooth structure.
  • Uncomplicated fractures with the fracture line close to the pulp (the internal part of the tooth, containing the blood vessels and nerves)—pale pink pulp is visible through the dentin; gentle exploring will not allow the explorer into the pulp cavity.
  • The recent or fresh complicated fracture is associated with bleeding from the pulp.
  • Older fractures may exhibit a dead pulp; clinically the pulp chamber is filled with dark material, and the tooth is often discolored.

Root Fractures (Involving the Portion of the Tooth below the Gum Line)

  • May occur at any point along the root surface; often in combination with fracture of the crown, although root fractures can occur without fracture of the crown.
  • Root segments may remain aligned or may be displaced.
  • Clinical signs indicating a possible root fracture include pain on closure of the mouth or during open-mouth breathing.
  • Abnormal horizontal or vertical mobility of a tooth may raise suspicion of a root fracture.

Causes

  • Generally the result of a traumatic incident (such as a road traffic accident, blunt blow to the face, chewing on hard objects).

Treatment

Dental Care

Uncomplicated Crown Fractures (Involving the Portion of the Tooth above the Gum Line without Entering the Pulp)

  • Dental procedure by the veterinarian in which sharp edges are removed with a bur and the exposed dentin tubules are sealed with a suitable liner or restorative material.

Complicated Crown Fractures (Involving the Portion of the Tooth above the Gum Line with Entering the Pulp)

  • Require treatment of the internal part of the tooth containing the blood vessels and nerves, known as the “pulp”; such treatment is known as “endodontic therapy” and includes root canals and pulpotomy—if the tooth is to be maintained; otherwise, extraction is preferable to no treatment at all.

Mature Tooth

  • Recent fracture in the mature tooth with the pulp still alive (vital)—two options exist, partial pulpectomy and direct pulp capping (vital pulpotomy) followed by restoration or conventional root-canal therapy and restoration.
  • For partial pulpectomy and direct pulp capping to succeed, the procedure should be carried out within hours of the injury; the initial procedure may not be the final treatment—the tooth may require standard root-canal treatment later, if the pulp tissue dies.
  • When the pulp already is inflamed chronically or is dead (known as “necrotic tissue”), standard root-canal therapy and restoration are the treatments of choice, if the tooth is periodontally sound.

Immature Tooth

  • A living (vital) pulp is required for continued root development; as long as the pulp is alive (vital), the treatment of choice is partial pulpectomy and direct pulp capping, followed by restoration.
  • If the pulp tissue is dead (necrotic), no further root development will occur; necrotic immature teeth need endodontic treatment to be maintained; remove the dead tissue and pack the root canal with calcium hydroxide paste; some continued root development and closure of the apex can be stimulated if this procedure is performed; change the calcium hydroxide every 6 months until the apex is closed at which time a standard root canal is performed.
  • Immature teeth may be present in the mature pet, if trauma to the developing teeth caused death of the pulp; such teeth should be treated as “immature teeth”.

Root Fractures (Involving the Portion of the Tooth below the Gum Line)

  • Treatment of crown and root fractures depends on how far below the gum line the fracture line extends.
  • If the fracture line does not involve the pulp (the internal part of the tooth, including the blood vessels and nerves) and does not extend more than 4–5 mm below the gum, restorative dentistry can be performed; if the fracture extends more than 5 mm below the gum and involves the pulp, the tooth usually should be extracted.
  • In some cases, the fractured tooth root may heal, if the tooth can be stabilized; in other cases, extraction of the tooth may be necessary.

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive:

  • A broad-spectrum antibiotic drug for 5–7 days may be indicated; for example, when long-standing infection is present.

Follow-Up Care

Patient Monitoring

  • Check a partial pulpectomy and direct pulp-capping procedure with dental x-rays (radiographs) 6 and 12 months post-operatively, or at intervals determined by clinical signs, to detect death of the internal tissues of the tooth, including the blood vessels and nerves (pulp) and subsequent changes in the bone around the tips of the root, indicating the need for root-canal treatment.
  • Check the outcome of conventional root-canal therapy by dental x-rays (radiographs) 6–12 months post-operatively; evidence of changes in the bone around the tips of the root at this time indicates the need for further treatment or extraction of the tooth; further treatment consists of redoing the root canal, often using surgical techniques.
  • Check root fractures with dental x-rays (radiographs) 6–12 months post-operatively.
  • Check uncomplicated fractures with dental x-rays (radiographs) at 4–6 months post-operatively.

Preventions and Avoidance

  • Avoid situations in which teeth are likely to be damaged; keep pet from chewing on hard objects, such as rocks.
  • To avoid complications, institute treatment within hours of injury.

Possible Complications

  • Untreated pulpal exposure invariably leads to inflammation of the pulp (known as “pulpitis”) and eventual death of the pulp tissue and subsequent changes in the bone around the tips of the root.
  • Immature teeth stop developing.

Expected Course and Prognosis

  • Vary with vitality of the pulp (the internal structure of the tooth, including the blood vessels and nerves), location of the fracture, and whether the tooth is mature or immature.

Key Points

  • Trauma to the tooth may involve fracture of any part of the tooth.
  • May involve the crown and root of the affected tooth; the crown of the tooth is the portion of the tooth that is above the gum that is covered by enamel; the root of the tooth is the part of the tooth below the gum line that is covered by cementum to attach the tooth to the bone of the jaw.
  • Avoid situations in which teeth are likely to be damaged; keep pet from chewing on hard objects, such as rocks.
  • To avoid complications, institute treatment within hours of injury.

Periodontal Disease

Periodontal Disease – An Overview

  • Inflammation of the tissues around and supporting the tooth; the tooth support structures include the gum tissue (known as “gingiva”); the cementum and periodontal ligament (the cementum and periodontal ligament attach the tooth to the bone); and the alveolar bone (the bone that surrounds the roots of the tooth); periodontitis (inflammation/infection of the tissues around and supporting the tooth) indicates some degree of periodontal attachment tissue loss (that is, some loss of the structures [cementum, periodontal ligament, alveolar bone] that attach the tooth to the bone).
  • Both dogs and cats get periodontal disease

Signs/Observed Changes in the Pet

  • Swelling of the gum tissue (known as “gingival tissue”)
  • Bad breath (known as “halitosis”)
  • Redness or fluid build-up (edema) of the gums
  • Variable amounts of plaque (the thin, “sticky” film that builds up on the teeth; composed of bacteria, white-blood cells, food particles, and components of saliva) and tartar or calculus (mineralized plaque on the tooth surface)
  • Gum surfaces bleed easily on contact (for example, during play or physical examination)
  • Loose teeth, missing teeth, and exposure of roots of the teeth

Causes

  • Plaque bacteria (bacteria found in the thin, “sticky” film that builds up on the teeth)

Treatment

Dental Care

  • Professional cleaning.
  • Periodontal surgery.
  • The ultimate goal of periodontal therapy is to control plaque and prevent attachment loss; a willing pet and a client who can provide home care are important considerations in creating a treatment plan.

Diet

  • Dry food or hard, biscuit-type foods are preferable to soft, sticky foods.
  • Dental diets, such as Hill’s Prescription Diet t/d—specifically indicated to control plaque (the thin, “sticky” film that builds up on the teeth; composed of bacteria, white-blood cells, food particles, and components of saliva) and tartar or calculus (mineralized plaque on the tooth surface) in dogs and cats.

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive:

  • Antibiotics—clindamycin and amoxicillin/clavulanic acid are approved for periodontal disease
  • Tetracycline

Follow-Up Care

Patient Monitoring

  • The degree of periodontal disease determines recall interval; some pets are checked monthly, while others can be evaluated every 3–6 months.

Preventions and Avoidance

  • Professional dental cleaning and home care are essential for prevention of periodontal disease.
  • Your pet’s veterinarian will discuss home care and available products and will provide instructions for their use.

Possible Complications

  • Loss of teeth; loss of bone structure in lower jaw (mandible), leading to shortened lower jaw; tongue protruding from mouth.
  • Generalized infection in the body.
  • Possible heart, liver and/or kidney disease.

Expected Course and Prognosis

  • The response of the individual pet and the expected course and prognosis are highly variable.
  • Early diagnosis and appropriate treatment can minimize the destructive effects of this disease.

Key Points

  • Periodontal disease is the most common infectious disease in dogs and cats.
  • Periodontal disease can lead to infection in other areas of the body and may cause heart, liver, and or kidney disease.
  • Professional dental cleaning and home care are essential for prevention of periodontal disease.
  • Our staff will discuss home care and available products and will provide instructions for their use.

Mouth Tumors

Tumors in the Mouth – An Overview

  • “Oral” refers to the mouth; “oral masses” are tumors or growths located in the mouth
  • Oral masses may be benign or malignant (that is, cancer)

Signalment/Description of Pet

Species

  • Dogs
  • Cats

Breed Predilections

  • Golden retrievers, German shorthaired pointers, Weimaraners, Saint Bernards, and cocker spaniels are more prone to tumors of the mouth than other breeds; dachshunds and beagles are less prone to tumors of the mouth than other breeds; boxers are more prone to have enlargement of the gums (known as “gingival hyperplasia”) than other breeds
  • Malignant melanoma—the most common cancer of the mouth in the dog; cocker spaniels, German shepherd dogs, chow chows, and dogs with heavily pigmented linings of the mouth (known as “mucous membranes”) are more likely to develop malignant melanoma than other dogs
  • Squamous cell carcinoma—the second most common cancer of the mouth in the dog; large-breed dogs are more likely to develop squamous cell carcinoma than other dogs

Mean Age and Range

  • Older pets are affected most often
  • Fibromatous epulis—the epulides (plural of epulis) are masses located on the gums; they are the most common benign tumor of the mouth; fibromatous epulis age range is 1–17 years; mean age is 7.5 years
  • Papillary squamous cell carcinoma—a rapidly growing cancer of young dogs (less than 1 year of age)
  • Fibrosarcomas—the third most common cancer of the mouth in dogs; seen in large, older male dogsOsteosarcoma—middle-aged medium- to large-breed dogs
  • Plasmacytoma—older dogs
  • Squamous cell carcinoma in the cat—type of cancer in the mouth; age range is 3–21 years; mean age is 12.5 years
  • Fibrosarcoma in the cat—the second most common cancer of the mouth; age range is 1–21 years; mean age is 10.3 years

Predominant Sex

  • Malignant melanoma—the most common cancer of the mouth in the dog; males more frequently affected than females
  • Fibrosarcomas—the third most common cancer of the mouth in dogs; seen in large, older male dogs
  • Osteosarcoma—females more commonly affected than males

Signs/Observed Changes in the Pet

  • May have no signs
  • May include bad breath (known as “halitosis”), tooth displacement, malocclusion (any deviation in the relationship or contact between the biting and chewing surfaces of the upper and lower teeth), bleeding in the mouth, and drooling
  • Weight loss
  • Lack of appetite (known as “anorexia”)
  • Reluctance to chew or can only eat soft food; chews only on one side of the mouth
  • Inability to open or close mouth
  • Abnormal facial appearance
  • Tooth loss

Causes

  • Unknown for most oral masses
  • Papilloma virus—papilloma, a benign tumor

Risk Factors

  • Squamous cell carcinoma of the tonsils occurs ten times more commonly in dogs from urban settings than in rural dogs
  • Squamous cell carcinoma—more common in white dogs in one study
  • Any long-term (chronic) irritation to the tissues of the mouth (such as inflammation/infection of the tissues surrounding and supporting the teeth [known as “periodontal disease”] or second-hand smoke) increases the risk of tumor development in the mouth
  • Feline leukemia virus (FeLV) or feline immunodeficiency virus (FIV) may play a role in squamous cell carcinoma development in cats
  • Some researchers showed that cats that wore flea collars had 5 times the risk of developing squamous cell carcinoma of the mouth than cats that did not wear flea collars
  • Second-hand smoke may be associated with squamous cell carcinoma in cats
  • Dogs and puppies that have an inability to develop a normal immune response (known as “immunosuppression”) are affected more commonly with papillomas (benign tumors) than dogs with normal immune responses

Treatment

Health Care

  • Depends on the tumor type
  • Benign tumors are treatable with long-term success via surgery and sometimes radiation treatment
  • Cancer (malignant tumors) is treated surgically with varying success, depending on tumor type, location, and if the cancer has spread to other tissues of the body (known as “metastasis”) at time of presentation to the pet’s veterinarian
  • In advanced cancer, combined therapy (surgery, chemotherapy, and radiation) may provide the best care
  • Pain control
  • Supportive care

Diet

  • Nutritional support is essential with any treatment
  • Gruel or liquefied diet may be necessary following surgery of the mouth
  • Tube feeding may be necessary

Surgery

  • Fibromatous epulis—surgical removal is the treatment of choice; freezing (known as “cryotherapy”); and radiation treatment also give long-term success
  • Peripheral odontogenic fibromas (ossifying epulis)—treat the same as fibromatous epulis
  • Acanthomatous ameloblastoma—surgical removal is usually curative; radiation also has been used successfully; the combination of surgery and radiation may be most effective (requiring less aggressive surgery), but if radiation is not readily available, surgery may be the only option; multiple injections of bleomycin at the tumor site have been effective in a small number of reported cases
  • Malignant melanoma—if surgery is chosen for therapy, it should be aggressive; typically involving surgical removal of the lower jaw or mandible (known as “mandibulectomy”) or the upper jaw or maxilla (known as “maxillectomy”)
  • Squamous cell carcinoma—may be removed surgically with wide margins or may be treated with radiation therapy in the dog, especially; surgical removal of the lower jaw or mandible (mandibulectomy) or the upper jaw or maxilla (maxillectomy) with a 2-cm clean surgical margin is the goal; dogs tolerate surgical removal of 40% to 60% of the tongue (known as “partial glossotomy”); surgery, radiation, and chemotherapy (mitoxantrone) may be the best options for tumors larger than 2 cm or those with incomplete surgical removal
  • Fibrosarcoma—usually requires surgical removal of the lower jaw or mandible (mandibulectomy) or the upper jaw or maxilla (maxillectomy)
  • Radiation therapy should be considered in pets where complete removal of the tumor is not possible or the location of the tumor makes surgical removal impossible

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive:

  • Chemotherapy may be indicated for some forms of cancer in the mouth; chemotherapeutic drugs may include mitoxantrone, bleomycin, or cisplatin
  • DNA-based vaccine for malignant melanoma may be used in certain cases after surgical treatment of the tumor in the mouth

Follow-Up Care

Patient Monitoring

  • Depends on type of tumor and the presence or absence of spread of cancer (metastasis)

Preventions and Avoidance

  • Remove or treat any source of irritation to the tissues of the mouth (such as inflammation/infection of the tissues surrounding and supporting the teeth [periodontal disease] or second-hand smoke)

Possible Complications

  • Surgical removal of part of the tongue may result in loss of blood supply to the remaining tongue, with death of tongue tissue
  • Postoperative complications of surgical removal of the lower jaw or mandible (mandibulectomy) include splitting open or bursting along the incision line (known as “wound dehiscence”), difficulty grasping food, tongue hanging out of the mouth, and excessive drooling
  • Surgical removal of the lower jaw or mandible (mandibulectomy) can be performed in cats, but mandibulectomy results in greater complications (such as tongue swelling) than in dogs
  • Within the first few weeks of low-dose radiation therapy, diarrhea, nausea, vomiting, and hair loss may occur (regrowth of hair is usually white); high-dose radiation therapy has these complications as well as superficial loss of tissue on the surface of the lining of the mouth, frequently with inflammation (known as “oral ulceration”) and/or death of tissues in the mouth (known as “oral necrosis”), cataracts (opacities in the normally clear lens), and radiation-induced tumors (mainly in young dogs that underwent radiation therapy)
  • Chemotherapy complications vary depending on the drug used

Expected Course and Prognosis

  • Early diagnosis and treatment offers the best chance for a successful outcome
  • Dogs with inadequate tumor-free surgical margins were 2.5 times more likely to die of the tumor than those with complete surgical removal of the tumor (as demonstrated by microscopic evaluation of tumor margins); some surgical patients need feeding tubes to facilitate nutritional supplementation during the treatment period
  • Dogs with tumors located behind the first premolar tooth had three times greater risk of dying from the disease than those with tumors located in front of the first premolar tooth
  • Malignant melanoma—prognosis improves if the tumor is small and located in the front part of the lower jaw or mandible; treatment of malignant melanoma involves surgical removal of the lower jaw or mandible (mandibulectomy) or the upper jaw or maxilla (maxillectomy)—median survival times average 8 months; combination of surgery, radiation, and chemotherapy (low-dose cisplatin) yielded a median survival of 14 months in one study; pigmentation does not affect the prognosis; this cancer of the mouth is relatively resistant to radiation therapy—one study showed a median survival time of 14 months after radiation only; the problem with melanoma is not local disease management, but spread of the cancer to other body tissues (metastasis)
  • Squamous cell carcinoma in dogs—better long-term prognosis than malignant melanoma or fibrosarcoma in the dog; the prognosis is better if the cancer is located toward the front of the mouth than if it is located toward the back of the mouth in dogs; radiation therapy alone delivers a median survival rate of 15–17 months; in dogs, prognosis for survival following treatment for squamous cell carcinoma of the tongue is poor
  • Squamous cell carcinoma in cats—mean survival time of 2 months; chemotherapy and/or radiation therapy can be used to control the cancer, but not to cure it (known as “palliative treatment”)
  • Fibrosarcoma—surgical removal of the cancer, with at least 2-cm margins, usually results in a 12-month median survival rate; surgical excision in combination with radiation therapy and chemotherapy offers the best prognosis; radiation or chemotherapy alone offered a poorer median survival rate than surgery alone; fibrosarcomas involving the roof of the mouth (palate) carry the poorest prognosis because of the inability to remove them adequately with surgery; radiation therapy can be useful following surgical removal of the mass
  • Osteosarcoma—wide surgical removal is ideal; recurrence can occur and the tumor can spread to other locations in the body (metastasis); radiation therapy can be used following surgery or can be used alone to control the cancer, without curing it (palliative treatment)

Key Points

  • Oral masses are tumors or growths located in the mouth
  • Oral masses may be benign or malignant (that is, cancer)
  • Benign tumors are treatable with long-term success via surgery and sometimes radiation treatment
  • Cancer (malignant tumors) is treated surgically with varying success, depending on tumor type, location, and if the cancer has spread to other tissues of the body (metastasis)
  • Nutritional support is essential with any treatment

Jaw Fractures and Malocclusion

Jaw Fractures – An Overview

  • Fractures of the upper jaw (known as the “maxilla”), the lower jaw (known as the “mandible”), and associated structures are classified as to location, severity (that is, tooth involvement, soft tissue tears, and type of bone fracture), and effects of the chewing muscles (known as “muscles of mastication”) on restoring the bones and teeth to their normal anatomic positions (known as “reduction”)
  • “Occlusion” is the relationship or contact between the biting (known as “incising”) and chewing (known as “masticatory”) surfaces of the upper and lower teeth; “malocclusion” is any deviation in the relationship or contact between the biting and chewing surfaces of the upper and lower teeth

Signalment/Description of Pet

Species

  • Dogs
  • Cats

Signs/Observed Changes in the Pet

  • Vary greatly according to the location, type, extent, cause of the fracture and underlying risk factors resulting in the injury
  • Facial deformity; deviation in the relationship or contact between the biting and chewing surfaces of the upper and lower teeth
  • (malocclusion); fractured teeth or teeth in abnormal positions; bleeding from the mouth or nose; and inability to properly close the mouth may be seen

Causes

  • Injury, trauma, and predisposing factors, such as infections of the mouth and cancer

Risk Factors

  • High-risk environment or temperament
  • Oral infections (such as infection of the gums and supporting tissues of the teeth [known as “periodontal disease”] or infection/inflammation of the bone [known as “osteomyelitis”]); tumors or cancer; and certain metabolic diseases—may result in weaker jaws that are more prone to injury
  • Traumatic injury affecting the jaws or teeth
  • Congenital (present at birth) or hereditary factors resulting in weakened or deformed jaw bone

Treatment

Health Care

  • Determined by the type of fracture, available equipment, supplies, and the veterinarian’s knowledge, experience, and comfort level
  • Treatment selection is based on four major points: (1) reduction of the fracture to restore the bones and teeth (if possible) to their normal anatomic positions and reasonable contact of fracture ends; (2) reestablishment of the natural relationship or contact between the biting (incising) and chewing (masticatory) surfaces of the upper and lower teeth (known as “occlusion”), if possible; (3) stabilization sufficient for proper healing; (4) salvage condition (that is, the fracture cannot be repaired or stabilized sufficiently to allow for proper healing; therefore, treatment is designed to allow the pet to be functional, without restoring the bones and teeth to their normal positions)

Home Care

  • Orthodontic wax—soft, pliable wax sent with owner to periodically cover any potentially irritating wires, which are used in repair of the fractured jaw
  • Oral irrigation/hygiene products—use twice daily for oral hygiene and to reduce bacteria; chlorhexidine solutions help reduce bacteria; zinc and ascorbic acid solutions (Maxi/Guard Gel, Addison Biological) help reduce bacteria and stimulate soft tissue healing

Activity

  • Avoid hard chew items during healing process

Diet

  • Soft food or gruel may be required during healing
  • Nutritional and fluid maintenance required

Surgery

  • Treatment may involve a variety of methods to repair and/or stabilize the fractures; examples include use of a tape muzzle; wiring the jaws (maxilla and mandible) together; use of surgical pins to hold the fractured bone together; use of acrylic or composite splint; wiring around or between teeth; use of bone plates and screws
  • Surgical procedures, such as removal of a portion of the jaw (examples are condylectomy and mandibulectomy), may be necessary for cases in which the fracture cannot be repaired or if massive injury is present—these are generally salvage procedures

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive:

Pain Management

  • Local anesthesia—nerve blocks to specific areas in the mouth (known as “intraoral local blocks”); regional nerve blocks: mental nerve, mandibular nerve, infraorbital nerve, palatine nerve, and maxillary nerve
  • Injectable pain relievers (analgesics)—butorphanol tartrate (Torbugesic, Pfizer Animal Health); buprenorphine; nalbuphine
  • Transdermal patches for pain relief—fentanyl (Duragesic, Janssen)
  • Oral pain relief medication (analgesics)—carprofen (Rimadyl, Pfizer Animal Health); butorphanol tartrate (Torbugesic); hydrocodone

Antibiotics

  • Broad spectrum based on history, health, and chemical profile

Follow-Up Care

Patient Monitoring

  • Physical examination—recheck 2 weeks after surgical repair
  • X-rays (radiographs)—recheck 4–6 weeks after surgical repair, then every 2 weeks until fracture is healed and/or stabilizing appliance is removed
  • Fracture site may temporarily (1–2 weeks) be more at risk to refracture after the support of the appliance is removed
  • Once the fracture line is stable, compromised teeth may need additional treatment (such as a root canal) or careful extraction
  • If the fracture healing process results in a deviation in the relationship or contact between the biting and chewing surfaces of the upper and lower teeth (malocclusion)—orthodontics, root canal or pulp capping, and/or selective extraction may be required
  • Other considerations—stability of fracture and appliance; oral hygiene; oral intake of food and water; maintenance of weight; appropriate urination and defecation; indications of pain or swelling

Preventions and Avoidance

  • Keep pet in an environment (such as a fenced yard, indoors) to minimize likelihood of trauma (such as being hit by a car)

Possible Complications

  • Deviation in the relationship or contact between the biting and chewing surfaces of the upper and lower teeth (malocclusion)
  • Disease involving the pulp, the tissue inside the hard portion of the tooth (known as “endodontic disease”)
  • Inflammation/infection of the bone (osteomyelitis)
  • Fractured bone does not heal (known as “nonunion” of the bone)
  • A piece of bone that has separated from healthy tissue or does not have blood supply and dies (known as a “sequestrum”)
  • Suture line splits open (known as a “dehiscence”)
  • Nerve defects
  • Facial pain
  • Impaired chewing (mastication)
  • Temporary weight loss
  • Trauma to the soft tissues of the mouth (such as gums, tongue), due to appliance or wires

Expected Course and Prognosis

  • Generally good; however, predisposing factors, initiating force, location, type of fracture, quality of home care, and selection of treatment affect the healing outcome
  • Usually takes 4–12 weeks to achieve bony union (that is, healing of the fracture)

Key Points

  • Fractures of the upper jaw (maxilla), the lower jaw (mandible), and associated structures are classified as to location, severity (that is, tooth involvement, soft tissue tears, and type of bone fracture), and effects of the chewing muscles (muscles of mastication) on restoring the bones and teeth to their normal anatomic positions (reduction)
  • Signs vary greatly according to the location, type, extent, cause of the fracture, and underlying risk factors resulting in the injury
  • Soft food or gruel may be required during healing
  • Avoid hard chew items during healing process

Halitosis or Bad Breath

Bad Breath (Brushing Your Pet’s Teeth) – An Overview

  • Offensive odor coming from the mouth; bad breath (Brushing Your Pet’s Teeth).
  • Both dogs and cats can have bad breath
  • Small breeds and short-nosed, flat-faced breeds (known as “brachycephalic breeds”) are more prone to disease involving the mouth, because their teeth are closer together, and their owners tend to feed softer foods.
  • Older pets are more likely to have bad breath (Brushing Your Pet’s Teeth) than are young pets.

Signs/Observed Changes in the Pet

  • Bad breath or Brushing Your Pet’s Teeth is a sign itself.
  • If due to oral disease, excessive salivation (known as “ptyalism”), with or without blood, may be seen; the pet may paw at the mouth; and lack of appetite (anorexia) may occur.
  • In most cases, no clinical signs other than actual odor are observed.

Causes

  • Disease of the mouth—infection of the gums and supporting tissues of the teeth (known as “periodontal disease”) and/or ulceration of the tissues of the mouth; inflammation of the throat or pharynx (known as “pharyngitis”); inflammation of the tonsils (known as “tonsillitis”); cancer; foreign bodies.
  • Metabolic—diabetes mellitus (“sugar diabetes”), uremia (excess levels of urea and other nitrogenous waste products in the blood).
  • Respiratory—inflammation of the nose or nasal passages (known as “rhinitis”); inflammation of the sinuses (known as “sinusitis”); cancer.
  • Gastrointestinal—enlargement of the esophagus (the tube going from the throat to the stomach; condition known as “megaesophagus”); cancer; foreign body.
  • Dermatologic—infection of the skin folds of the lips (known as “lip-fold pyoderma”)
  • Dietary—eating malodorous or offensive-smelling foodstuffs; eating feces or bowel movement (known as “coprophagy”).
  • Trauma—electric-cord injury, open fractures, caustic agents.
  • Infectious—bacterial, fungal, viral.
  • Autoimmune diseases.
  • Diseases characterized by one or more masses or nodular lesions in the mouth containing a type of white-blood cell, called an eosinophil (known as “eosinophilic granuloma complex”).

Treatment

Dental Care

  • Usually outpatient treatment.
  • Once the specific cause of the bad breath (Brushing Your Pet’s Teeth) is known, direct therapy at correcting the cause; it is possible that multiple causes may be involved (for example, the pet may have infection of the gums and supporting tissues of the teeth [periodontal disease] and have a foreign body or cancer present in the mouth).
  • Dental disease—assessment of the mouth, performed under general anesthesia, with x-rays of the mouth (known as “intraoral radiographs”) and treatment, including cleaning and polishing the teeth and extraction of teeth with greater than 50% loss of supporting tissues (gum and bone) around the teeth (often multiple teeth are extracted when advanced periodontal disease is the cause of the bad breath (Brushing Your Pet’s Teeth).
  • Cancer of the mouth—surgical debulking (removing as much of the tumor as possible) or removal; radiation therapy; other cancer therapies, based on type of cancer.
  • Foreign body—removal of foreign body (may require anesthesia).
  • Dermatologic causes—treatment for infection of the folds of the lips may include antibiotics, antibacterial shampoos, and possible surgery to remove some of the folded tissue.
  • Dietary causes—prevent pet from eating malodorous foodstuffs (for example, keep pet away from garbage); prevent pet from eating bowel movement (for example, block off litter box so dog cannot get to cat feces; clean yard frequently).

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive:

  • Medication is determined by the underlying cause of the bad breath (Brushing Your Pet’s Teeth).
  • Topical treatment with zinc-ascorbate cysteine gel usually reduces bad breath within 30 minutes of application, because of the effect of cysteine on sulfur compounds in the mouth.
  • Antibiotics are not indicated to treat bad breath (Brushing Your Pet’s Teeth); antibiotics are indicated in the treatment of infection of the lip folds and for cases of rhinitis and/or sinusitis, if bacterial infection is involved.
  • Controlling the bacteria that cause infection of the gums and supporting tissues of the teeth (periodontal disease) helps control dental infections and accompanying bad breath; Doxirobe Gel (Pfizer) may be used in dogs with periodontal disease.
  • Weekly application of OraVet (Merial), a plaque prevention gel has been shown to decrease plaque (the thin, “sticky” film that builds up on the teeth; composed of bacteria, white-blood cells, food particles, and components of saliva).
  • The use of oral home-care products that contain metal ions, especially zinc, inhibits odor formation due to the affinity of the metal (zinc) ion to sulfur; zinc complexes with hydrogen sulfide to form insoluble zinc sulfide, decreasing the odor.
  • Zinc ascorbate plus amino acid (Maxi/Guard Oral Cleansing Gel, Addison Biological Laboratory).
  • Chlorhexidine used as a rinse or paste also helps control plaque (the thin, “sticky” film that builds up on the teeth), decreasing eventual odor; many dental home-care products containing chlorhexidine are available commercially.

Follow-Up Care

Patient Monitoring

  • Periodic examinations to monitor results of dental professional and home care

Preventions and Avoidance

  • Varies with underlying cause
  • Daily brushing or friction wipes to remove plaque (the thin, “sticky” film that builds up on the teeth) and control dental disease and odor
  • Prevent pet from eating malodorous foodstuffs (for example, keep pet away from garbage); prevent pet from eating bowel movement (for example, block off litter box so dog cannot get to cat feces; clean yard frequently)

Possible Complications

  • Varies with underlying cause
  • Immature teeth stop developing.

Expected Course and Prognosis

  • Varies with underlying cause

Key Points

  • Bad breath or Brushing Your Pet’s Teeth is a sign; it is an offensive odor coming from the mouth.
  • Bad breath (Brushing Your Pet’s Teeth) generally indicates an unhealthy mouth.
  • Once the specific cause of the bad breath (Brushing Your Pet’s Teeth) is known, direct therapy at correcting the underlying cause.
  • Ensure good oral health by professional and home dental care (such as brushing teeth) to decrease bad breath (Brushing Your Pet’s Teeth).

Brush Your Pet’s Teeth

Brushing Your Pet’s Teeth

Dental care is an important part of your dog and cat’s health care. Pet dental issues are some of the most common problems seen at Tri-County Animal Hospital. Both dogs and cats need routine dental care, and a good dental program will provide comfort and longevity to your pet’s life as well as make them more pleasant to be around.

Dental disease is not just a cause of bad breath, but can lead to heart disease, kidney disease, liver disease and other problems.

We suggest that you start caring for your pets teeth while he or she is a puppy or kitten so that your pet will become accustomed to regular, at home brushing. During your pet’s physical exams, we will give your pet a dental exam and will recommend professional dental cleanings or other dental treatments as needed. We will also offer advice on home dental care and give you options on how to achieve the best results.

At-Home Pet Dental Care

Brushing your pet’s teeth every day will help to reduce or eliminate plaque buildup. Plaque, which is an accumulation of bacteria, will eventually loosen and destroy the tooth and possibly lead to bone loss if left untreated. The infection under the gum line can also spread to the liver, kidneys and heart.

Proper At-Home Pet Dental Care Supplies

    1. Proper Toothbrush

It’s important to spend some time finding the right toothbrush for your dog or cat. You can use a child’s toothbrush, but it is recommended that you buy a special toothbrush for your pet. It will make brushing easier and will be worth the money.

There are some rules for choosing the best brush for your dog or cat:

      • Be sure that the bristles are soft so they don’t damage the pet’s gums.
      • Please choose the right sized brush (just make sure it’s’ not too big or too small for your pet’s mouth).
      • Check that the handle is big enough for you to comfortably get a grip on the toothbrush.
      • Also available, is the “Finger Toothbrush”. This is an Ideal beginner toothbrush to help you and your pet become comfortable with the tooth brushing experience.
      • The staff at Tri-County Animal Hospital will be glad to help you select the best toothbrush for your pet.
    1. Proper Toothpaste

You cannot use human toothpaste on your dog. Rather, use a special high quality toothpaste with ingredients specially formulated for dogs. You need to spend some time choosing your toothpaste too. Cheaper brands might use ingredients that are harmful to your pet, and there are some common ingredients can make your pet sick. Read the labels carefully and check that the toothpaste does not contain salt, detergents or enzymes as these are dangerous for your pet. Feel free to stop by our office and we will be happy to recommend a pet toothpaste that is safe and effective for your pet’s proper dental hygiene.

How to Brush Your Pet’s Teeth

Brushing your pet’ teeth for the first time can be difficult; especially if they are not used to it. This can be avoided by starting when they are puppies or kittens – but if it’s too late for that don’t worry. The key is to be gentle, speak in a soft voice and do not force the pet. The key is to make it an enjoyable experience. Start from the back of the mouth and work your way forward in small circular motions.

If your pet really does not want to allow you to brush his teeth without a fight, you may want to try the finger brush with a beef or chicken flavored toothpaste. Try rubbing his teeth so he gets used to the sensation as well as your fingers in his mouth. Speak encouragingly and softly. After a few patient weeks the pet should allow you to brush his teeth without any hassles.

Start a Dental Routine

You should be brushing your pet’s teeth daily; but if you can’t manage that – once every second day should be fine. It’s important to stay consistent in order to avoid problems.

Please call us to schedule a dental exam with one of our veterinarians for your dog or cat, especially before starting a new dental care regime.