Oral pathology & dental charting: Part 2 (Proceedings)
In the previous lecture, the importance of being able to identify periodontal indices was discussed as well as the importance of correctly recording that pathology on dental charts. The indices most commonly evaluated are gingivitis, probe depth, gingival recession, furcation involvement, mobility and periodontal attachment. These indices are the factors along with radiographs that are involved in grading periodontal disease.
As important as the periodontal indices are in the diagnosis and grading of periodontal disease, there are many other pathologies that may be encountered during a thorough oral examination. It is important to be able to recognize these anomalies and bring them to the attention of the veterinarian.
StomatitisLymphoplasmacytic Stomatitis (LPS) is a chronic, painful condition that can be very difficult to diagnose and treat. Multiple tests are needed to rule out other problems. Make sure the animal is FeLV/FIV negative, you may want to consider Bartonella testing. Most treatments are ineffective; to date the best treatment is a complete dental extraction including the removal of all dentin. This treatment is usually effective in about 80% of the cases.
Feline Odontoclastic Resorptive Lesions (FORL)
FORL's can be difficult to classify. There are five stages of FORL's that are determined by the amount of crown involved n the lesion.
• Stage 1
o Lesions extend only into the cementum. This stage occurs only subgingivally. – Very difficult to detect
• Stage 2
o Lesions progress through the cementum into the dentin of the root or crown but the pulp is not exposed. Hyperplastic gingiva may cover these defects.
• Stage 3
o Lesions progress into the pulp chamber. Bleeding on probing and spontaneous fractures of the crown may occur.
• Stage 4
o Lesions destroy a significant amount of the crown.
• Stage 5
o Lesions have significant root replacement resorption with healing of the gingiva. There will not be any clinically apparent tooth tissue.
In addition to the stages of FORL's, they can be classified based on radiographic appearance of the periodontal ligament space:
• Type 1 – Lesions are caused by inflammation. The root appears normal, and the periodontal ligament space is still observable.
• Type 2 – The affected tooth is ankylosed to the alveolus. This type of lesion is not associated with periodontal disease
Chronic Alveolar Osteitis
This condition commonly is associated the maxillary canines of cats. It produces a pronounced bulging appearance of the osseous tissue at the upper canines. Suspicious tissue should be biopsied, but in most cases this condition is the result of chronic inflammation. Periodontal pockets may be present and the teeth should be treated appropriately. There may be sufficient inflammation and loss of attachment to warrant extraction.
Maxillary Canine Extrusion
In conjunction with chronic alveolar osteitis, cats can have a unique response where the maxillary canine teeth appear to extrude. The teeth appear longer than normal and have an increased amount of gingival extrusion. The extruded teeth may also cause trauma to the lower lip. If the tooth is not mobile, does not have periodontal pockets or radiographic signs of excessive bone loss they can be saved. It may be necessary to blunt the tips of these canines to minimize lip trauma.
Discolored teeth should be thoroughly evaluated to determine if the discoloration is due to extrinsic or intrinsic staining. Extrinsic staining comes from accumulations on the surface. Intrinsic stains are secondary to endogenous factors that discolor the underlying dentin. Transillumination with a fiberoptic light can assist in distinguishing between vital and necrotic pulp. Radiographs of affected teeth can be very useful in identifying pathology associated with discolored teeth.