Cat with strange oral ulcer/swelling one month post dental

RE: Cat with strange oral ulcer/swelling one month post dental

Anthony Todd — Sun, 29 Jul 2018 12:51:39 GMT

[quote user="robloxley"]from one to more than four weeks".[/quote]

True, so you need to have a look at, say, weekly intervals, as you do with the possible variability of any therapy, which is what we always did, and where megestrol was a godsend in rodent ulcers.....

RE: Cat with strange oral ulcer/swelling one month post dental

Rob Loxley — Sun, 29 Jul 2018 12:31:16 GMT

[quote user="Anthony Todd"]

[quote user="robloxley"]will respond to some pred[/quote]

A time to use Depomed by injection, IMHE, apart from the difficulty of oral dosing with an oral condition, it works well and gives prolonged certain action which is what is needed.

[/quote]

Depomed has its place but the clients seem able to administer tablet (managed course of antibiotics) and what I don't like about depomed is the variability in duration of action so when to repeat injection, given most of these seem to need a good while of treatment. From the SPC "Relief from clinical signs is usually sustained for up to three weeks but may range from one to more than four weeks".

RE: Cat with strange oral ulcer/swelling one month post dental

Anthony Todd — Sun, 29 Jul 2018 11:27:59 GMT

[quote user="robloxley"]will respond to some pred[/quote]

A time to use Depomed by injection, IMHE, apart from the difficulty of oral dosing with an oral condition, it works well and gives prolonged certain action which is what is needed.

If response is disappointing megestrol is a reliable alternative and weekly dosing with a palatable tablet [used to be?]

RE: Cat with strange oral ulcer/swelling one month post dental

Rob Loxley — Sun, 29 Jul 2018 10:00:58 GMT

[quote user="Busybee"]biopsied the site which came back as 'eosinophilic grnauloma complex'[/quote]

We had one of these last week, should have taken some photos as it looked horrible, but hopefully will respond to some pred

RE: Cat with strange oral ulcer/swelling one month post dental

Busybee — Sat, 28 Jul 2018 18:58:43 GMT

Back to the original question!

I had something similar in my own cat. Admittedly, it didn't look quite as angry as this but I was also worried so biopsied the site which came back as 'eosinophilic grnauloma complex'.

I think biopsy will tell you what you need to know.

RE: Cat with strange oral ulcer/swelling one month post dental

Kathryn Burton — Fri, 27 Jul 2018 20:17:26 GMT

I believe that most flap break downs (for want of a better phrase!) are due to tension rather than infection, so not using antibiotics is unlikely to contribute to problems healing.

RE: Cat with strange oral ulcer/swelling one month post dental

Rob Davis — Fri, 27 Jul 2018 19:39:36 GMT

[quote user="robloxley"] Convenia sometimes seems to have become the new Antirobe as far as pushing the antibiotics https://file.scirp.org/pdf/OJVM20120300004_84267326.pdf [/quote]

Curious paper: I haven't read it in detail yet, but it seems to confirm that gingivitis improves after professional dental treatment. I'm not sure it can say anything about either antibiotic investigated without at negative control group.

RE: Cat with strange oral ulcer/swelling one month post dental

Jill Butterworth — Fri, 27 Jul 2018 17:28:49 GMT

[quote user="Aisling McGrath"]I am really worried about an oral tumour of some kind, but find it impossible to believe that I would have missed it completely during her original dental procedure, and it's only a few weeks ago.[/quote]

My neighbour's cat had a painful mouth, and had a dental, but didn't recover as expected and on the second GA about 2 weeks later a tumour was biopsied. I felt sorry for the first vet, but I think it is likely that something was there, albeit very small, and the dental stirred things up. There but for the Grace of God go I...

RE: Cat with strange oral ulcer/swelling one month post dental

Anthony Todd — Fri, 27 Jul 2018 16:23:22 GMT

If anyone doesn't give A/Bs and gets a post-dental infection etc then post it here.

In a year of -> 1000 ??+ dentals we should know?

RE: Cat with strange oral ulcer/swelling one month post dental

Aisling McGrath — Fri, 27 Jul 2018 16:19:04 GMT

Did a cat dental today, one extraction, no antibiotics given! I have changed my standard protocol based on our discussion.

RE: Cat with strange oral ulcer/swelling one month post dental

David Mills — Thu, 26 Jul 2018 20:58:56 GMT

[quote user="Anthony Todd"]

[quote user="Richard Carter"]Had drummed into me I would definitely cause an endocarditis if I didn't!![/quote]

Yes, me too 1961 Qld......

[/quote]

I was talking about this to my dentist recently after he yanked out a molar (3 rooted, no drilling, in less than 60s)

In humans, the chances of a reaction to amox (the previously normal prophylactic for humans with a murmur undergoing dental tx) outweighs the chances of endocarditis by more than 50 to 1.

RE: Cat with strange oral ulcer/swelling one month post dental

Anthony Todd — Thu, 26 Jul 2018 19:51:32 GMT

[quote user="Richard Carter"]Had drummed into me I would definitely cause an endocarditis if I didn't!![/quote]

Yes, me too 1961 Qld......

RE: Cat with strange oral ulcer/swelling one month post dental

Rob Loxley — Thu, 26 Jul 2018 19:50:27 GMT

[quote user="Richard Carter"]Must admit if I have done extractions, then I tend to give antibiotics - probably clindamyin. Had drummed into me I would definitely cause an endocarditis if I didn't!![/quote]

Pfizer did a very effective marketing campaign on Antirobe way back when. I'm sure there are still some giving the 'recommended' 1 week of preop Antirobe... Convenia sometimes seems to have become the new Antirobe as far as pushing the antibiotics https://file.scirp.org/pdf/OJVM20120300004_84267326.pdf
I use little antibiotics in dentistry, if needed I tend to go more for amoxyclav than clindamycin.

RE: Cat with strange oral ulcer/swelling one month post dental

Charlotte Marshall — Thu, 26 Jul 2018 19:42:53 GMT

Over the last few years we have really cut back on antibiotics in dentals (and other procedures). I vary rarely give them now and am not seeing any issues even with multiple extractions. There has been the very occasional animal I have given some to at post op check but not many.

RE: Cat with strange oral ulcer/swelling one month post dental

Evelyn Barbour-Hill — Thu, 26 Jul 2018 19:14:40 GMT

[quote user="Martin McDowell"] I was told that in cases of periodontal disease where there is gingivitis that ABs should be used. Sorry can't remember the lecturer who told me that. [/quote]

Just as well you can't remember. It's nonsense. (Gingivitis being the first stage of periodontal disease, there is no periodontal disease where there is not gingivitis).

[quote user="Richard Carter"] Thinking classic yorkie, shake the dog and catch the teeth dental?[/quote]

I doubt if there is any osteomyelitis in the case such as that, which is just advanced periodontitis. The bone level has been much reduced, yes, but not by osteomyelitis. Definitely there is no antibiotic drug required.

Drum it out again. It won't.

RE: Cat with strange oral ulcer/swelling one month post dental

Richard Carter — Thu, 26 Jul 2018 18:58:42 GMT

and where the bone is already spongy with osteomyelitis? Thinking classic yorkie, shake the dog and catch the teeth dental?

Must admit if I have done extractions, then I tend to give antibiotics - probably clindamyin. Had drummed into me I would definitely cause an endocarditis if I didn't!!

RE: Cat with strange oral ulcer/swelling one month post dental

Rob Davis — Thu, 26 Jul 2018 18:13:36 GMT

[quote user="Martin McDowell"]I was told that in cases of periodontal disease where there is gingivitis that ABs should be used. Sorry can't remember the lecturer who told me that.[/quote]

But the majority of patients who walk through the door have some degree of gingivitis....

RE: Cat with strange oral ulcer/swelling one month post dental

Martin McDowell — Thu, 26 Jul 2018 17:38:21 GMT

This is interesting. I was told that in cases of periodontal disease where there is gingivitis that ABs should be used. Sorry can't remember the lecturer who told me that.

I do agree that ABs should be avoided when at all possible. I do not give it for routine ops but for dentals was told it depends on the mouth.

RE: Cat with strange oral ulcer/swelling one month post dental

Anthony Todd — Thu, 26 Jul 2018 16:11:51 GMT

[quote user="robloxley"]

[quote user="Anthony Todd"]not so long ago [90s][/quote]

I was doing my GSCEs in the 90s (and I qualified as a vet over 14 years ago), so I think you may need to accept this is maybe some number of veterinary generations ago...

[/quote]

Yes sorry, it would have been around 2010- 2013. Your point being??

I'll bet some on here still have seen the practice of routine A/Bs after routine surgery, even today??

[Although a tube of intra-mammary or Aureo powder intra C/S wound may have declined.....]

RE: Cat with strange oral ulcer/swelling one month post dental

Anthony Todd — Thu, 26 Jul 2018 16:04:57 GMT

[quote user="Evelyn Barbour-Hill"]Commissure.[/quote]

RE: Cat with strange oral ulcer/swelling one month post dental

Evelyn Barbour-Hill — Thu, 26 Jul 2018 15:52:38 GMT

[quote user="Anthony Todd"]where the lips meet [what's the word?][/quote]

Commissure.

RE: Cat with strange oral ulcer/swelling one month post dental

Rob Loxley — Thu, 26 Jul 2018 15:49:25 GMT

[quote user="Anthony Todd"]not so long ago [90s][/quote]

I was doing my GSCEs in the 90s (and I qualified as a vet over 14 years ago), so I think you may need to accept this is maybe some number of veterinary generations ago...

RE: Cat with strange oral ulcer/swelling one month post dental

Anthony Todd — Thu, 26 Jul 2018 15:21:26 GMT

[quote user="Anthony Todd"]Nor do I, but if anything screams "biopsy" even to me this does,and I'm thinking of something very sinister too.[/quote]

Or, looking at the eroded area where the lips meet [what's the word?] an opened mouth picture centred on the top/bottom junction might be helpful??

The lips are a long way from the teeth after all.

RE: Cat with strange oral ulcer/swelling one month post dental

Anthony Todd — Thu, 26 Jul 2018 15:17:18 GMT

[quote user="Evelyn Barbour-Hill"]So what criteria would you use to determine if ABs are needed[/quote]

Yes we went through this and not so long ago [90s] so some of my vets still gave A/Bs to routine surgery, just didn't record it in the notes......

RE: Cat with strange oral ulcer/swelling one month post dental

Evelyn Barbour-Hill — Thu, 26 Jul 2018 14:58:58 GMT

[quote user="Aisling McGrath"]

So what criteria would you use to determine if ABs are needed?

[/quote]

Well, first of all abandon the ingrained unconscious attitude ("mindset" if you must) that's common to much of small animal practice, that an antibiotic treatment is probably required and we only need to look for reasons to do it, even if it's only "just in case". ( I remember, as will Anthony Todd, when to not give some antibiotic to a bitch spey was negligent; and I remember the first time when i thought "this is silly" and withheld the antibiotic to see what happened. Of course nothing happened.)

So, I might administer an antibiotic drug –

– in a known immune-suppressed patient

– if there are comparatively recent implants elsewhere (but not when a femur was pinned uneventfully ten years ago).

– if there has been excessive trauma in the procedure leaving possibly devitalised portions of tissue

– if there was definitely dirty contamination that I could not be sure I had debrided away, as in a road accident for instance

– in an endodontic case when there was obvious acute infection around the apex, or in the odd case where there was good reason to suspect osteomyelitis.

Sorry, Aisling, I didn't mean to lecture you. This is for everyone else.