calicivirus gingivitis.

Re: calicivirus gingivitis.

Charlie Lyon — Sat, 08 Mar 2014 14:27:26 GMT

No worries, we don't have dental xR unfortunately, only just made the upgrade to digital from an automatic chemical processor, it's something on the wish list (but one thing at a time!) Do admit it would be really really useful to assess cats mouths first rather than getting in there and having a nightmare with roots melding into the jaw

Re: calicivirus gingivitis.

Tiago Henriques — Sat, 08 Mar 2014 09:53:03 GMT

Hi!

Anyone have any opinion about the use of stem cells therapy in this disease?

Re: calicivirus gingivitis.

James Laidlaw — Fri, 07 Mar 2014 21:59:39 GMT

Sorry misread your post...!!! Do you have dental X-rays though? I've found they hugely changed my approach and now I'm in a clinic without them!!! It's amazing what you can find or miss when you have the opportunity to look...

Re: calicivirus gingivitis.

Charlie Lyon — Fri, 07 Mar 2014 20:21:41 GMT

[quote user="Charlotte Lusted"]but only if the roots are healthy, with resorption then yes hours[/quote]

Yes resorption definitely does make it more difficult!

Re: calicivirus gingivitis.

James Laidlaw — Fri, 07 Mar 2014 16:03:48 GMT

[quote user="Charlotte Lusted"]

[quote user="Rob Davis"]

Seriously?! You can extract all 14 premolars and molars (26 roots) in 30 minutes? I often do these in two stages as they can take me a long time to ensure ALL root remnants are removed.

[/quote]

...yes it has been known (is that odd) - admittedly it usually is more towards the 60 mins mark but in some cats the teeth come out really easily with roots intact... If I split all the roots that are easy to get to first and then steadily go round extracting then do any further splitting, really don't find it takes that long - but only if the roots are healthy, with resorption then yes hours, or if persian\exotics definitely hours! That doesn't include getting them under GA\scaling and polishing - only the extraction bit :)

[/quote] Radiographs? Honestly if there is resorption then extraction should be MORE difficult, not less. Mainly because you'd be losing the periodontal ligament and just be dealing with bone... Rotten periodontal diseased roots are a slightly different story.

Re: calicivirus gingivitis.

Evelyn Barbour-Hill — Fri, 07 Mar 2014 15:45:52 GMT

[quote user="Hannah Wynne Richards"]

And then owners phone around asking " What do you charge for a cat dental?" Answer : "I'll tell you the anaesthetic charge, and the hourly surgical charge, and it all depends on how long it takes."

Wynne

[/quote]

No, from me the answer would be composed from a selection of the following: "....... that depends what you mean by "a cat dental"....... there's no such single entity as "a cat dental"....... why do you ask?............ are you a client of ours already?......... have I seen the cat recently?......... have I seen the cat at all?.......... I must have a look at the cat and see what the situation is and if anything needs to be done at all, and if so what, and then I can give you a more realistic estimate......... "

And I'd like to add "if you're looking for the cheapest, there's no point phoning me"

Re: calicivirus gingivitis.

Charlie Lyon — Fri, 07 Mar 2014 15:19:39 GMT

[quote user="Rob Davis"]

Seriously?! You can extract all 14 premolars and molars (26 roots) in 30 minutes? I often do these in two stages as they can take me a long time to ensure ALL root remnants are removed.

[/quote]

Re: calicivirus gingivitis.

Hannah Wynne Richards — Fri, 07 Mar 2014 14:12:53 GMT

And then owners phone around asking " What do you charge for a cat dental?" Answer : "I'll tell you the anaesthetic charge, and the hourly surgical charge, and it all depends on how long it takes."

Wynne

Re: calicivirus gingivitis.

Rob Davis — Fri, 07 Mar 2014 14:01:34 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Rob Davis"]I'd be interested to know how long Evelyn would usually allow for a total caudal extraction?[/quote]

I wouldn't start if I had less than two hours clear before the next commitment.

But these days I'd often do it in two stages.

[/quote]

Thank you, that makes me feel a bit better!

Re: calicivirus gingivitis.

Evelyn Barbour-Hill — Fri, 07 Mar 2014 12:58:00 GMT

[quote user="Rob Davis"]I'd be interested to know how long Evelyn would usually allow for a total caudal extraction?[/quote]

I wouldn't start if I had less than two hours clear before the next commitment.

But these days I'd often do it in two stages.

Re: calicivirus gingivitis.

Anthony Todd — Fri, 07 Mar 2014 09:43:27 GMT

[quote user="Rob Davis"]OK, I'll take the bite.....[/quote]

All I was trying to get across is the concept that symptomatic relief combined with, or before, the obligatory prolonged diagnostic endeavour, is important, but increasingly forgotten, in this zealous pursuit of "gold standard" or "state-of-the-art" veterinary medicine.

Elizabethan collars on really itchy animals is another good example and biopsy of masseter muscles when the only treatment is going to be pred is another.

I saw a lot of these gingivitis cats, in enormous discomfit to the extent of total drooling inappetance and jumping back from food even when really hungry, and I get so frustrated, on welfare grounds, when some vets faff around seeking the elusive and immaterial diagnosis without giving the animal concurrent symptomatic relief.

This almost always involves steroids, finally, and my patients managed to cope very well without a diagnosis or histo and thanked me for my approach which is increasingly rare these days.

Depo did need to be repeated on occasion [usually when root fragment "appeared"] but never for long, and never with any apparent bad effects.

Re: calicivirus gingivitis.

Rob Davis — Fri, 07 Mar 2014 09:06:27 GMT

[quote user="Anthony Todd"]

[quote user="Evelyn Barbour-Hill"]Brushing would rarely be acceptable [/quote]

Especially in these cases where the gingiva bleeds if you look at it and the cats scream when you open their mouths....

Depo, on it's own always reduced the inflammation without antibiotics, giving almost total relief in a few days. And the chances of getting oral A/Bs into a really painful mouth are virtually nil anyway.

I guess I was more interested in giving the cat some relief rather than worrying about the mythical side effects of judicious steroids.

As everyone has said, a full extraction is curative.

[/quote]

OK, I'll take the bite.....

I agree that depomedrone often gives good (temporary) relief of the symptoms as does oral prednisolone if you can give it. The problem is that the beneficial effects of glucocorticoids appear to decrease with time and repeated administration. There is also some evidence (admittedly fairly weak) that administration of glucocorticoids can reduce the efficacy of other subsequent treatments (eg interferon or cyclosporine). As others have said, TOTAL caudal extraction is the key in most cases.

[quote user="Charlotte Lusted"]plus if no resorptive lesions can do a premolar\molar extraction fairly quickly as well (30-60 mins)[/quote]

Seriously?! You can extract all 14 premolars and molars (26 roots) in 30 minutes? I often do these in two stages as they can take me a long time to ensure ALL root remnants are removed.

I'd be interested to know how long Evelyn would usually allow for a total caudal extraction?

Re: calicivirus gingivitis.

Anthony Todd — Fri, 07 Mar 2014 08:48:56 GMT

[quote user="Evelyn Barbour-Hill"]Brushing would rarely be acceptable [/quote]

Especially in these cases where the gingiva bleeds if you look at it and the cats scream when you open their mouths....

I guess I was more interested in giving the cat some relief rather than worrying about the mythical side effects of judicious steroids.

As everyone has said, a full extraction is curative.

Re: calicivirus gingivitis.

Evelyn Barbour-Hill — Thu, 06 Mar 2014 23:49:23 GMT

[quote user="Busybee"] Do you find these cats are comfortable enough to allow tooth brushing or is it just a matter of dentisept/hexarinse? [/quote]

[quote user="Charlotte Lusted"]Has anyone tried dentisept after scaling? I find O compliance with dental care and cats a real issue[/quote]

Brushing would rarely be acceptable and most cats detest anything being squirtedinto the mouth so Hexarinse is no good. I like to use Virbac enzymatic fish flavour "toothpaste" (it's actually a clear gel, not a paste) or else Pet Dent oral gel (chlorhexidine the active ingredient), applied quite gently with a finger (not a gauze swab, that must be like sandpaper!), applied very generously and lightly rubbed around if possible. Applied generously so that the excess swills around in the mouth.

Warn the owner about avoiding getting bitten.

Gels flavoured with aniseed or peppermint are pretty useless.

Re: calicivirus gingivitis.

Charlie Lyon — Thu, 06 Mar 2014 21:27:43 GMT

I like the full mouth extractions - find that it resolves the problem in most cases apart from intermittent flare ups, plus if no resorptive lesions can do a premolar\molar extraction fairly quickly as well (30-60 mins). Depo/clindamycin makes it go away but don't like repeated injections, although often takes some persuading owners to go for the dental!

Has anyone tried dentisept after scaling? I find O compliance with dental care and cats a real issue

Re: calicivirus gingivitis.

shanley barber — Thu, 06 Mar 2014 21:19:04 GMT

Hi Claire, my cat also suffers from FCGS, he was so poorly I had to hospitalize and put him on fluids! He has since had a staged total extraction caudal to the canines and is much much better! I did notice, however, that he seemed to worsen after vaccination, so I am wondering if there is a concensus re: vaccinating these cats. I will not be vaccinating him again, as he now doing so well. I would caution that , if the roots are ankylosed, it is a difficult surgery. I bottled and had a colleague (who adores dentals) do it for me. Good luck!

Re: calicivirus gingivitis.

Busybee — Thu, 06 Mar 2014 20:12:43 GMT

Thanks all!

[quote user="Evelyn Barbour-Hill"]Try NSAID by all means. Combined with oral hygiene measures[/quote]

At the moment, the owner isn't keen on full extractions so this is probably what we'll try first. Do you find these cats are comfortable enough to allow tooth brushing or is it just a matter of dentisept/hexarinse?

Re: calicivirus gingivitis.

Evelyn Barbour-Hill — Thu, 06 Mar 2014 14:04:08 GMT

[quote user="Busybee"]Sorry to revive an old topic but wondered if there was any new information on these cases?[/quote]

Basically, as they say............... no.

Norman Johnston's article still sums it up well.

Gosh, 16 months is very young for a feline chronic gingivostomatitis though. It does look very much as if the calicivirus is responsible, but bear in mind that the causative relationship has never been really proved.

Try NSAID by all means. Combined with oral hygiene measures – this is the bit that often gets forgotten (sometimes on purpose )

Otherwise, yes, extraction of everything caudal to the canine teeth.

[quote user="Glenn Hodgson"]Get the teeth out sharpish prior to ankylosis. [/quote]

With respect, ankylosis results from resorptive lesions, not from FCGS.

[quote user="Glenn Hodgson"]Also get good kit! And hide it from everyone else[/quote]

Very good advice.

Re: calicivirus gingivitis.

Alex Allen — Thu, 06 Mar 2014 09:10:14 GMT

Further to Evelyn's reply here is a link to the review article by Norman Johnson that will help with these cases generally.

http://www.vetsurgeon.org/blogs/veterinary_practice/archive/2012/06/21/july-2012-edition.aspx

As stated previously the use of Interferon without premolar/molar extractions rarely produces satisfactory results so I would recommend revisiting previous treatments used once the extractions have been performed as you may find they have a different response second time round.

If you need more advice on the off label use of Virbagen Omega give our tech dept a call on 01359 243 243

Re: calicivirus gingivitis.

Miriam Lodewyks — Wed, 05 Mar 2014 21:34:28 GMT

+3. I have also found full mouth extraction (always raise a flap and do partial alveolectomy) to be the most effective. You know they don't need em, so just get on with it. Admittedly it's harder to convince owners of a 16m old to let you pull all it's teeth....

Re: calicivirus gingivitis.

Glenn Hodgson — Wed, 05 Mar 2014 20:14:30 GMT

Get the teeth out sharpish prior to ankylosis. I do in 2 stages so arm doesn't get tired. Also get good kit! And hide it from everyone else so it's not used tovjimmy out st Bernard carnasials !

Re: calicivirus gingivitis.

Anthony Todd — Wed, 05 Mar 2014 19:53:39 GMT

[quote user="Anon MRCVS"]Take the plunge and go with Evelyn's advice...[/quote]

+1, guaranteed "cure" in a remarkably short time. The maligned depomed [shock horror ]reduces the pain and restores appetite and can be given before extraction at least making the cat eat and be comfortable before complete the op.

Dmed gives relief in the fauces inflammation often seen with the gingivitis.

Re: calicivirus gingivitis.

Busybee — Wed, 05 Mar 2014 19:02:36 GMT

Sorry to revive an old topic but wondered if there was any new information on these cases?

I have a case of a 16mo old cat, mother was feral, had primary vacc course (Purevax RCP + FeLV) at 3mo of age. In Jan of this year, presented with what was described as marked gingivitis. Blood taken for FeLV and FIV came back negative. Cat given meloxicam and amoxy-clav which the owner reported did help.

Re-presented to see me last week. On exam, moderate stomatitis evident, the gingival margins being worse affected than the pharynx or tongue. No tartar evident. I took a swab from the oropharynx which came back calici +ve (herpes -ve). Assuming this is a true clinical case of FCV, what is the best way to proceed bearing in mind the cat's age? Long term meloxicam? Try interferon? Full mouth extractions? Full blood profile not done yet, but will be the next point of call. Also, do we keep vaccinating as usual?

Re: calicivirus gingivitis.

Laurence Webb — Tue, 30 Dec 2008 10:05:04 GMT

I've not encoutered any problems personally, but it is prudent to check for Toxo before starting on ciclosporin as there have been cases of subclinical infection rearing up after starting treatment. Fructosamine measurement may also be prudent if the cat is a bit of a fatty as it can antagonise insulin.

Re: calicivirus gingivitis.

Evelyn Barbour-Hill — Tue, 23 Dec 2008 18:32:56 GMT

Karl Zetner did a trial with cyclosporin, must be twenty years or so ago; my memory is a bit hazy but the results were not brilliant, and gingival hyperplasia is a common side effect of cyclosporin...... in man, enough to be a big problem.

I'm still looking for an opportunity to try it again, in a case that's not calicivirus, if the owner will accept it.