Gingivitis in a 5 month old cat

Re: Gingivitis in a 5 month old cat

Martin Atkinson — Fri, 10 Oct 2014 09:30:36 GMT

[quote user="Rob Davis"]As I recall Martin believes that FCGS is a progression of periodontal disease. This is, I believe, an incorrect interpretation of the aetiology.[/quote] I concede that juvenile eruption periodontitis/gingivitis isn't necessarily going to progress to chronic FCGS without the various components in place: being a FCV carrier and with poor dental health it is a primed bomb waiting to explode.

What is open to debate is whether the OP's case is purely an excessive tooth eruption reaction or there are other factors at play. It is impossible to tell from one photograph which isn't even of the cat in question I may add!!

Re: Gingivitis in a 5 month old cat

Rob Davis — Fri, 10 Oct 2014 08:59:59 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Martin Atkinson"][quote user="Evelyn Barbour-Hill"]That's gingivostomatitis, though, not juvenile periodontitis.[/quote]I think we are treading a very fine line between one and the other.[/quote]

Sorry, I don't remotely agree.

[/quote]

We've been here before. As I recall Martin believes that FCGS is a progression of periodontal disease. This is, I believe, an incorrect interpretation of the aetiology.

Re: Gingivitis in a 5 month old cat

Evelyn Barbour-Hill — Fri, 10 Oct 2014 00:18:50 GMT

Sorry, I don't remotely agree.

Re: Gingivitis in a 5 month old cat

Martin Atkinson — Thu, 09 Oct 2014 18:39:27 GMT

[quote user="Evelyn Barbour-Hill"]That's gingivostomatitis, though, not juvenile periodontitis.[/quote]I think we are treading a very fine line between one and the other.

Re: Gingivitis in a 5 month old cat

Evelyn Barbour-Hill — Thu, 09 Oct 2014 18:22:36 GMT

[quote user="Martin Atkinson"]I've just taken over a case of a 2 year old cat as a second opinion from another vet with grade 3 gingivo-stomatitis.[/quote]

That's gingivostomatitis, though, not juvenile periodontitis.

Re: Gingivitis in a 5 month old cat

Martin Atkinson — Thu, 09 Oct 2014 18:16:35 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Martin Atkinson"]there will almost inevitably be a secondary bacterial infection.[/quote]

Don't agree, sorry.

[quote user="Martin Atkinson"]Giving it some Antirobe will improve the symptoms at least although it is not the long term answer obviously. I don't understand why you would be so resistant to their use in the short term.[/quote]

Not resistant, just don't follow.

Never mind.

[/quote]I've just taken over a case of a 2 year old cat as a second opinion from another vet with grade 3 gingivo-stomatitis. It was given a dental scale and polish by the previous vet and has been miserable and dysphagic since (as it was before as well). Do you agree that should have been given some antibiotics? They didn't because I presume a similar logic to yours. It has improved exponentially with a course of Antirobe while waiting for the result of the FCV PCR test and the client has thanked me for 'giving her cat it's life back'!

The test has come back positive for FCV so we are going to try it on a course of oral Virbagen Omega for 2-3 months. I'm not expecting a miracle cure but I will keep you posted.

Re: Gingivitis in a 5 month old cat

Evelyn Barbour-Hill — Thu, 09 Oct 2014 14:47:51 GMT

[quote user="Martin Atkinson"]there will almost inevitably be a secondary bacterial infection.[/quote]

Don't agree, sorry.

Not resistant, just don't follow.

Never mind.

Re: Gingivitis in a 5 month old cat

Martin Atkinson — Thu, 09 Oct 2014 10:32:20 GMT

[quote user="Evelyn Barbour-Hill"]But what's the rationale for use of antibiotic drugs?[/quote]The cat has gingivitis which we both agree is likely to be multi-factorial but there will almost inevitably be a secondary bacterial infection. Giving it some Antirobe will improve the symptoms at least although it is not the long term answer obviously. I don't understand why you would be so resistant to their use in the short term.

Re: Gingivitis in a 5 month old cat

Evelyn Barbour-Hill — Thu, 09 Oct 2014 01:34:15 GMT

[quote user="Martin Atkinson"]

[quote user="Evelyn Barbour-Hill"]What's the rationale of "aggressive" use of antibiotic drugs, Martin? [/quote] Eats shoots and leaves!!

This is just how the punctuation makes it read but it was meant to say: aggressive treatment which may include antibiotics, interferon and gingivectomy.

[/quote]

OK, sorry.

But what's the rationale for use of antibiotic drugs?

Re: Gingivitis in a 5 month old cat

Martin Atkinson — Wed, 08 Oct 2014 19:17:10 GMT

[quote user="Evelyn Barbour-Hill"]There's no hyperplasia to be seen in the picture Starling has posted.[/quote] I would disagree with that but there is no substitute for seeing the real thing and probing.

[quote user="Evelyn Barbour-Hill"]What's the rationale of "aggressive" use of antibiotic drugs, Martin? [/quote] Eats shoots and leaves!!

This is just how the punctuation makes it read but it was meant to say: aggressive treatment which may include antibiotics, interferon and gingivectomy.

Re: Gingivitis in a 5 month old cat

Evelyn Barbour-Hill — Wed, 08 Oct 2014 18:53:50 GMT

Excision of gingival hyperplasia in a selective and cautious manner (you certainly don't want to take too much off) can be an important part of treatment.

There's no hyperplasia to be seen in the picture Starling has posted.

Just occasionally, gingivectomy in the form of excision of the inflamed gum margin can be indicated, in a very cautious and selective manner, but I'd very rarely do that in a cat.

I don't know of (gotta be careful here ) any published work showing any link with feline chronic gingivostomatitis in later life. Not sure how you'd establish that, I admit, without life monitoring of every cat with juvenile periodontitis.

What's the rationale of "aggressive" use of antibiotic drugs, Martin? I confess I can't see it, unless you are sure that juvenile periodontitis is due to a particular bacterium and that you know you can eliminate that bacterium by drug treatment.

Re: Gingivitis in a 5 month old cat

Martin Atkinson — Wed, 08 Oct 2014 16:17:07 GMT

[quote user="Rob Davis"]Do you have any evidence to back up this approach, Martin?[/quote] Well yes and no in that it is not documented in a way I could present statistical proof. You just have to take my word for it and try it if you want. Without having a large number of cats under treatment with a control group and many follow visits years on, and given anyway that this condition is multi-factorial so any number in each group could respond differently, it is not going to be possible let alone ethical to produce compelling evidence.

[quote user="Rob Davis"]My guess would be that a large proportion of your cats treated as described above recovered spontaneously rather than as a result of treatment, but I am genuinely interested if you have any evidence to the contrary.[/quote] You may well be right but given the number of cats that do present with horrible chronic lymphocytic-plasmocytic gingivo-stomatitis later in life associated with FCV infection, anything that I can do to prevent them reaching this irreversible state is worth a try. Not many clients will actually plump for the interferon therapy anyway and I cannot given them total confidence that it will make the difference. However I do try and perform a gingivectomy in cats with severe gingival hyperplasia (that is where it is far worse than I would normally expect for simple eruption gingivitis) when they are neutered.

Re: Gingivitis in a 5 month old cat

Starling — Wed, 08 Oct 2014 13:16:52 GMT

Unfortunately I don't have a picture of the real cat but I've found this one that is very very similar. It is an homogeneous thick hyperemic line. No stomatitis and not involving fauces, etc.

Re: Gingivitis in a 5 month old cat

Rob Davis — Wed, 08 Oct 2014 13:12:35 GMT

[quote user="Starling"]

And what kind of oral hygiene would you recommend in this case? are you referring to tooth brushing? mouthwashes?

By the way thank you for your responses, all your comments are very helpful.

[/quote]

Brushing is obviously the best, but it's a cat.... Chlorhexidine rinses (I use hexarinse) SID, while not as effective as brushing, will reduce plaque bacteria. I am sceptical of the benefits of the various water additives, but some people feel they help.

Re: Gingivitis in a 5 month old cat

Starling — Wed, 08 Oct 2014 13:06:18 GMT

And what kind of oral hygiene would you recommend in this case? are you referring to tooth brushing? mouthwashes?

By the way thank you for your responses, all your comments are very helpful.

Re: Gingivitis in a 5 month old cat

Rob Davis — Wed, 08 Oct 2014 11:34:35 GMT

[quote user="Martin Atkinson"]I have found that if these are treated aggressively with antibiotics, Virbagen Omega (inteferon) orally until a month post eruption and if necessary a gingivectomy to treat the exuberant gingival hyperplasia they settle well and may avoid some of the worst ravages of chronic gingivo-stomatitis which otherwise becomes inevitable. [/quote]

Do you have any evidence to back up this approach, Martin? The OP describes gingivitis with no apparent element of stomatitis (I assume that "generalized gingivitis (periodontal zone)" means that the inflammation does not extend beyond the muco-gingival line. At this age I would suspect it's most likely to be associated with tooth eruption, and would be concentrating on hygiene measures, and would expect a lot of these to resolve once the permanent dentition has fully erupted. I would not feel that chronic gingivo-stomatitis is inevitable at this stage (though as neither of us have actually seen the cat it's a difficult to be categorical). My guess would be that a large proportion of your cats treated as described above recovered spontaneously rather than as a result of treatment, but I am genuinely interested if you have any evidence to the contrary.

Re: Gingivitis in a 5 month old cat

Martin Atkinson — Tue, 07 Oct 2014 10:35:59 GMT

At 5 months this may be as much an exaggerated tooth eruption gingivitis but with its history FCV is likely to be a factor. I would also eliminate (or rule in) retro-viruses from the list of possibilities. Do a gingival swab and send it to Bristol for FCV PCR test.

I have found that if these are treated aggressively with antibiotics, Virbagen Omega (inteferon) orally until a month post eruption and if necessary a gingivectomy to treat the exuberant gingival hyperplasia they settle well and may avoid some of the worst ravages of chronic gingivo-stomatitis which otherwise becomes inevitable.

Re: Gingivitis in a 5 month old cat

Hannah Wynne Richards — Tue, 07 Oct 2014 10:06:40 GMT

Viruses viruses viruses

Wynne

Re: Gingivitis in a 5 month old cat

Evelyn Barbour-Hill — Tue, 07 Oct 2014 01:03:38 GMT

[quote user="Starling"]Have you ever seen this presentation? Which would be your approach?[/quote]

The same as yours.

And try to start some energetic oral hygiene – not easy, I know, in a kitten.

Interferon is/was favoured by some.