The feline mouth: An enigma surrounded by mystery (Proceedings)

"The feline oral cavity is not a steroid deficient area."

The feline oral cavity has always been an enigma surrounded by mystery. Many of the problems have been defined and still others remain perplexing. The problems that are understood include the viral disease Caudal Stomatitis (Calici virus), Bartonella sp. Stomatitis, classic Adult Periodontitis, Plasmacytic/Lymphocytic Stomatitis and Neoplasia. The most significant area that remains a mystery is the feline resorptive lesion complex – the cause is unknown.

Resorptive lesions (Tooth Resorption) can be divided into three distinct clinical presentations – internal odontoclastic resorption, external odontoclastic resorption, and cervical line erosions. Internal resorptive lesions are most devastating in that they are not clinically evident until perforation through the enamel occurs. Internal resorptive lesions can start anywhere inside the tooth but usually start at the apical end in lining of the pulp canal. Resorptive lesions in lower canine teeth are classic examples. Clinical sighs of oral pain are absent until perforation occurs. Intraoral radiography will reveal early lesions and there teeth can be monitored until they ultimately perforate. Teeth with advanced lesions are extracted.

External resorptive lesions begin just below the cemental enamel junction and proceed inward. On rare occasion, these teeth can be restored using Copomers or Dentin Bloc but the overwhelming majority of these teeth are extracted.

Finally, cervical line erosions represent a small percentage of lesions found at or above the cemental enamel junction. These teeth appear to have tooth structure "scooped out" with healthy dentin or enamel in the lesion. The theory is that tooth flexion causes a state of abfraction with resultant mineral loss. In any event these teeth can be salvaged with Copomers. Intraoral radiography is mandatory if any attempt is made to restore the tooth.

The bottom line is that almost all the above teeth are extracted.

Inflammatory disease in the feline oral cavity is another matter. Caudal presents with a severe inflammatory response in the fossa area of the mouth extending rostrally. When opened, the back of the mouth and pharynx appear to be covered with raspberries. Many cats develop this disease following vaccination with Calici vaccine raising the question of cause and effect. In any event, therapy consists of posterior teeth extraction, interferon therapy, antibiotics, and NSAID – usually Metacam. Recently an injectable interferon hs been used that shows great promise for Calici driven disease. The prognosis is usually good as long as the cat is negative for Feline Leukemia and Immunodeficiency Virus. A few cats will experience flair's, and monthly pulse therapy with interferon usually controls the disease until the problem resolves.

Plasmacytic/Lymphocytic Stomatitis is nothing more than advanced severe periodontal disease – pure and simple. The cats present with severe inflammation around all teeth with palate and tongue ulcerations. Oral pain is usually severe. The domestic cat develops this problem at warp speed. Once plasma cells have been activated the line has been crossed and extraction of the premolars and molars is the treatment of choice. Steroid therapy merely prolongs the disease and is contraindicated. Following extraction, pain management and antibiotics will resolve the problem.

The good news is that another piece of the puzzle has been identified by Dr. Hardy at the National Veterinary Laboratory in New Jersey. Bartonella sp., the causative organism of cat scratch fever in humans has found to be a contributor to inflammatory diseases in cat mouths. Fortunately, Michigan had a low incidence, about 7%. However, cats have been identified in Michigan that test positive and thus require treatment. Of greater concern is the potential for human exposure. This is a potentially serious zoonotic disease that must be addressed by veterinarians. More information can be had by contacting Dr. Hardy's lab at www.natvetlab.com.

Squamous Cell Carcinoma is still the most common oral cancer. It is found in any age cat and must be ruled out when teeth appear mobile. Biopsy is essential and early treatment is a must. Great strides are being made in the management of this problem and while surgical removal is the treatment of choice, medical management with piroxicam has helped many cats. Telling a concerned pet owner "nothing can be done" is no longer good advice.