Small - intermediate cell alimentary lymphoma cat requiring a dental.

RE: Small - intermediate cell alimentary lymphoma cat requiring a dental.

Evelyn Barbour-Hill — Tue, 22 Mar 2016 14:48:05 GMT

[quote user="Martin Atkinson"][quote user="Evelyn Barbour-Hill"]Personally I'd put at least as much emphasis on copious, vigorous and repeated irrigation of the mouth with chlorhexidine.[/quote]You clearly have greater faith in your clients managing this than I do Evelyn.[/quote]

I meant, of course, during the dental procedure. Come to think of it, though, if I have a client dedicated enough to embark on immunosuppressive chemotherapy, I'll put a bit of faith in their willingness to irrigate the mouth.

[quote user="Martin Atkinson"] The majority of my patients that come in for a dental procedure have gingivitis/periodontitis and IMO require antibiotics, the occasions when I don't give them usually result in prolonged recovery of the gingiva.[/quote]

You are entitled to your opinion.

[quote user="Martin Atkinson"] I rarely convince owners that prevention is better than cure when there is just a bit of calculus.[/quote]

Seeing as calculus is not pathogenic..............

RE: Small - intermediate cell alimentary lymphoma cat requiring a dental.

Martin Atkinson — Tue, 22 Mar 2016 08:49:05 GMT

[quote user="Evelyn Barbour-Hill"]Personally I'd put at least as much emphasis on copious, vigorous and repeated irrigation of the mouth with chlorhexidine.[/quote]You clearly have greater faith in your clients managing this than I do Evelyn.

[quote user="Evelyn Barbour-Hill"]It is of course completely pointless to give a course of antibiotic after a dental procedure in a normal patient.[/quote]At what point does an animal that needs a dental become abnormal? The majority of my patients that come in for a dental procedure have gingivitis/periodontitis and IMO require antibiotics, the occasions when I don't give them usually result in prolonged recovery of the gingiva. Of course the odd preventative prophylactic procedure just to scale and polish doesn't need them but I rarely convince owners that prevention is better than cure when there is just a bit of calculus.

RE: Small - intermediate cell alimentary lymphoma cat requiring a dental.

Evelyn Barbour-Hill — Mon, 21 Mar 2016 20:06:31 GMT

[quote user="Anthony Dennison"] If they're not too bad I shouldn't think you would need too long a course of antibiotics either side, maybe 5 days max?[/quote]

While I'd be pleased to be corrected by someone who really knows, I don't see the point of giving an antibiotic before the dental procedure.... if it does anything that is just going to put selection pressure on the oral flora so that the bacteria present at the time of the procedure are more likely to be resistant. But a short course (just long enough to deal with the bacteraemia and maybe seek out bacteria lurking in lymph nodes) of antibiotic after the procedure (to be exact, first administration a couple of hours in advance, to get adequate blood levels) seems a good idea (but are there any actual data on the occurrence of bloodborne infections after dental procedures in the immunocompromised?). And if you are going to do it, it would seem to be one of the rare occasions when it would be sensible to combine two, even three, antibacterial drugs; and include metronidazole.

Personally I'd put at least as much emphasis on copious, vigorous and repeated irrigation of the mouth with chlorhexidine.

It is of course completely pointless to give a course of antibiotic after a dental procedure in a normal patient.

RE: Small - intermediate cell alimentary lymphoma cat requiring a dental.

Martin Atkinson — Mon, 21 Mar 2016 17:53:08 GMT

[quote user="Anthony Dennison"] Martin Atkinson may be the person to help.[/quote]I'm flattered but I'm not quite sure how I've suddenly become the expert. However logically a mouth full of infected teeth is going to be more of an issue to an animal on immuno-suppressive drugs than an anaesthetic so I would crack on and I always give antibiotics after a dental anyway unless its just a scale and polish with minimal gingivitis. I normally give 10 days clindamycin.

RE: Small - intermediate cell alimentary lymphoma cat requiring a dental.

Stephen Courtney — Fri, 18 Mar 2016 22:27:23 GMT

I would just do the dental procedure, but would provide antibiotics in such a case - IV to start, and continue with systemic cover till the mouth had healed. Expect healing to take longer, but not that much longer.

If the current medication hasn't turned the mouth into a cesspit of uncontrolled infection, i doubt that removing the cause of the problem is likely to come back and bite me in the ass either, but i would not feel comfortable if I didn't provide antibiosis.

RE: Small - intermediate cell alimentary lymphoma cat requiring a dental.

Danny cazabon — Fri, 18 Mar 2016 17:57:36 GMT

Yes, thanks for your advice.

Danielle

RE: Small - intermediate cell alimentary lymphoma cat requiring a dental.

Gerry Polton — Fri, 18 Mar 2016 17:24:31 GMT

Got to get those teeth out if they are a constant source of pain/inflammation. I hate toothache!

RE: Small - intermediate cell alimentary lymphoma cat requiring a dental.

Danny cazabon — Fri, 18 Mar 2016 17:22:59 GMT

Ok, thanks for getting back to me.

Moderate - severe periodontal disease, probable extractions, discomfort noticed eating, salivation and halitosis all apparent.

RE: Small - intermediate cell alimentary lymphoma cat requiring a dental.

Gerry Polton — Fri, 18 Mar 2016 17:14:53 GMT

I agree with Anthony

Gerry

RE: Small - intermediate cell alimentary lymphoma cat requiring a dental.

Anthony Dennison — Fri, 18 Mar 2016 17:12:50 GMT

Someone more experienced than me will come along I'm sure, but I wouldn't mess with the chemotherapy dose. Tapering it down and then re-increasing it may risk recurrence of control.

How bad are the teeth? If they're not too bad I shouldn't think you would need too long a course of antibiotics either side, maybe 5 days max? Martin Atkinson may be the person to help.