Chronic gingivitis in a young cat

RE: Chronic gingivitis in a young cat

Anthony Todd — Sat, 12 Jan 2019 16:58:04 GMT

[quote user="Thomas Johnson"]There aren't any molars in that photograph[/quote]

[sorry for the delay; No internet as phone cut off while I changed provider and not restored by new provider who insisted they'd checked and evrything was fine....]

Thanks for pointing that out, I suppose that's because they aren't in the photograph, they used to be further towards the back of the mouth??

Glen had multiple extractions for his mouth condition and, within 24-48 hours had a new happy personality !!!

I, and dinovets of my acquintance, sort of recognised the various conditions we were faced with and seemed to treat them successfully without ever bothering to name them.

We always thought that if we/I knew how to fix them it really didn't matter what they were called as relief in whatever was the most expedient seemed the obvious way to progress.

The "tartar" I am talking about was often 5mm thick in a cat, more in a dog, covering a purulent eroded "gum" with actually often fairly sound teeth below. This resolved nicely, but of course, over time recurred. some used to flick the tartar off when doing an exam prior to a booster and this seemed to work well.

All changed now of course...............

RE: Chronic gingivitis in a young cat

Evelyn Barbour-Hill — Thu, 03 Jan 2019 19:59:48 GMT

[quote user="Anthony Todd"]

[quote user="Evelyn Barbour-Hill"]periodontal disease or FCGS[/quote]

AFAIK BITD we never made the distinction

[/quote]

But you started to discuss the apparent harm or otherwise from retained roots, and in that context it's very important to know which you are referring to.

And now you seem to have moved on to something else again.

[quote user="Anthony Todd"]frank and massive tartar biuild up with associated pus and erosion[/quote]

In my weak and feeble experience it's pretty uncommon to find any pus in periodontal disease (and never in FCGS) – sometimes there's an abscess discharging though a hole in the gingiva, but not often.

RE: Chronic gingivitis in a young cat

Anthony Todd — Thu, 03 Jan 2019 10:52:48 GMT

[quote user="Evelyn Barbour-Hill"]periodontal disease or FCGS[/quote]

AFAIK BITD we never made the distinction but i suppose there were two presentations: frank and massive tartar biuild up with associated pus and erosion and just red gums with no apparent tartar.

The tartar build up seemed to respond just to removal and cleaning while the other only resolved with extraction.

RE: Chronic gingivitis in a young cat

Anthony Todd — Thu, 03 Jan 2019 10:47:44 GMT

[quote user="Kate Richardson"]I progressively end up extracting the teeth[/quote]

So did I but usually the sooner the better and as many as seemed involved.

RE: Chronic gingivitis in a young cat

Kate Richardson — Thu, 03 Jan 2019 10:35:29 GMT

[quote user="robloxley"]

Of these young juvenile cats with advanced periodontal disease, how many do people see coming under control and how many just seem to advance in the face of management/treatment - often ending in time with most/all teeth coming out?

[/quote]

Depends on how far advanced the periodontal disease is and the level of home care the owner is able and willing to do plus or minus how often you need to repeat subgingival cleaning under GA, but in most cases, I progressively end up extracting the teeth

RE: Chronic gingivitis in a young cat

Rob Loxley — Thu, 03 Jan 2019 08:39:17 GMT

RE: Chronic gingivitis in a young cat

Evelyn Barbour-Hill — Thu, 03 Jan 2019 01:43:45 GMT

[quote user="Anthony Todd"]Makes sense to me but IMHE [not by me he hastens a bit too quickly] some roots, even when a picket fence down both rami, don't always cause any problems at all except some difficulty when the mouth is examined by the next vet....[/quote]

Anthony, are you discussing periodontal disease or FCGS? Because, without knowing that, I really don't know how to answer in a way that will move the discussion forward.

RE: Chronic gingivitis in a young cat

Anthony Todd — Wed, 02 Jan 2019 17:56:01 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Anthony Todd"]Still can't reason why removing the teeth,a molars or premolars, and anyone else works so well when nothing else does? [/quote]

Are you referring to FCGS or to periodontal disease? Since the answer would be self-evident when referring to periodontal disease, I presume you are referring to FCGS. The answer generally given for the past twenty years has been that the FCGS cat is somehow hypersensitive to plaque, and no teeth means no plaque. If you were to comment that this answer seems just a little glib and does not quite explain, for instance, why the procedure is likely to fail if any root remnants are left buried, you would be quite justified in your comment. [/quote]

Makes sense to me but IMHE [not by me he hastens a bit too quickly] some roots, even when a picket fence down both rami, don't always cause any problems at all except some difficulty when the mouth is examined by the next vet....

It always amazed me how quickly cats' demeanour and appetite improved whilst the gums and sockets were recovering from extractions etc.

RE: Chronic gingivitis in a young cat

Bob Russell — Wed, 02 Jan 2019 17:48:05 GMT

It would be very 'unlucky' to leave any roots in a cat with a mouth like this. The teeth usually move very easily because of the severity of the periodontal disease therefore a bit of patience and the teeth usually come out cleanly. Rarely the nightmare extractions that resorptive lesions can be for the un X-rayed!!!

(I doubt there is such a term as un X-rayed but it does have a certain ring to it!)

RE: Chronic gingivitis in a young cat

Evelyn Barbour-Hill — Wed, 02 Jan 2019 16:56:35 GMT

[quote user="Anthony Todd"]Still can't reason why removing the teeth,a molars or premolars, and anyone else works so well when nothing else does? [/quote]

RE: Chronic gingivitis in a young cat

Evelyn Barbour-Hill — Wed, 02 Jan 2019 16:46:39 GMT

[quote user="robloxley"] I'd wonder whether the cat's problem is more periodontal disease with secondary gingivitis,[/quote]

Umm.... gingivitis is not secondary to periodontal disease. Gingivitis is the first stage of periodontal disease.

Anyway, looking at the photographs, the cat probably has plain old advanced periodontitis and it needs, with some urgency, proper oral examination and treatment under GA (which would certainly include extraction of 207 and 208). Why mess around giving a dose of a corticosteroid to make him feel better for a very short while? No antibiotic drug is indicated, of course.

[quote user="Anthony Todd"]The vet wants to send a sample to Glasgow, at a cost of £150.00 for this, and do a dental etc.[/quote]

Ummm... This might have been good advice at the time it was given – I don't know, i wasn't there – but I'd want to know what laboratory test this refers to, and I'd want to know what's meant by "a dental" (was that your description Anthony, or was it the veterinary surgeon's own phrase?)

Depending upon the whole clinical picture, retrovirus testing could be a wise thing to do. And in a case of Feline Chronic Gingivo-Stomatitis (which this isn't,I think), calicivirus testing is useful. But, a positive calicivirus result in a case of FCGS does not necessarily mean that calicivirus is the pathogen (sorry, Marie).

RE: Chronic gingivitis in a young cat

Anthony Todd — Wed, 02 Jan 2019 16:25:54 GMT

[quote user="Kate Richardson"]What I mean is, corticosteroids aren't indicated to manage this cat's dental disease long term; if they are needed as a quick fix ie as an anti-inflammatory to get the cat eating and feeling more comfortable, then that's different. [/quote]

Exactly,and at last the tide is turning, so how do you defuse the "contraindicated"?

Still can't reason why removing the teeth,a molars or premolars, and anyone else works so well when nothing else does? Must some how change the mileau

RE: Chronic gingivitis in a young cat

Kate Richardson — Wed, 02 Jan 2019 16:00:19 GMT

What I mean is, corticosteroids aren't indicated to manage this cat's dental disease long term; if they are needed as a quick fix ie as an anti-inflammatory to get the cat eating and feeling more comfortable, then that's different.

RE: Chronic gingivitis in a young cat

Anthony Todd — Wed, 02 Jan 2019 15:21:40 GMT

[quote user="Kate Richardson"]Corticosteroids are not indicated.[/quote]

Well they always gave all cats with mouths/gums looking like that relief and back to normal appetite within 24 hours which was good enough for me and my peers, and I'm sure that the cats agreed.

I wonder if someone, just for once, would provide actual evidence, not theoretical, for their contraindication. Case notes would help too.

This continual denigration of sensible Csteroids is continuous but never justified with horror stories nor evidence except via gross overdose for long periods.

Many years of sensible Csteroid use in many similar cases probably by most dinovets is always disregarded so the patients now suffer on unnecessarily.

RE: Chronic gingivitis in a young cat

Anthony Todd — Wed, 02 Jan 2019 15:05:15 GMT

[quote user="Robin Grimmer"]There aren't any molars in that photograph...[/quote]

Sorry, but the pictures do give you an idea...............

RE: Chronic gingivitis in a young cat

Anthony Todd — Wed, 02 Jan 2019 15:03:15 GMT

[quote user="robloxley"]The pictures look like there is a fair amount of periodontal disease; that upper premolar with most of the caudal root exposed and sitting at a funny angle, for example. I'd wonder whether the cat's problem is more periodontal disease with secondary gingivitis,[/quote]

Pictures sent after my first post. [i phones take great closeups!!!]

Too true! I hadn't seen him for about a year and the change is dramatic!

No argument at all with the removal of the molars etc!

RE: Chronic gingivitis in a young cat

Robin Grimmer — Wed, 02 Jan 2019 14:50:16 GMT

[quote user="Thomas Johnson"]

[quote user="Anthony Todd"]Er, much worse than i thought, looks like the molars will have to go......[/quote]

There aren't any molars in that photograph...

[/quote]

RE: Chronic gingivitis in a young cat

Thomas Johnson — Wed, 02 Jan 2019 14:44:35 GMT

[quote user="Kate Richardson"]Those teeth are far from fine- they have advanced periodontal disease. If the vet who saw the cat said the teeth were fine, then they need to go to specsavers. Personally I wouldn't waste money testing for calicivirus, whether it is positive or negative (which could be false anyway) it's not going to change your treatment which is a full mouth assessment (including xrays of course) and extractions. FIV testing is a good shout from Rob Loxley, but it also wouldn't change the treatment, more the long term management, however, it's not the death sentence it was once thought to be. [/quote]

I agree, those teeth look like they need to come out, and it looks more like a juvenile periodontitis than a typical gingivostomatitis to me (are we supposed to call it caudal stomatitis now?) I tend to swab less and less as time goes on, I'm not convinced a positive or negative calicivirus result changes what I do, FIV might be useful though.

[quote user="Anthony Todd"]Er, much worse than i thought, looks like the molars will have to go......[/quote]

There aren't any molars in that photograph...

RE: Chronic gingivitis in a young cat

Kate Richardson — Wed, 02 Jan 2019 13:54:58 GMT

Those teeth are far from fine- they have advanced periodontal disease. If the vet who saw the cat said the teeth were fine, then they need to go to specsavers. Personally I wouldn't waste money testing for calicivirus, whether it is positive or negative (which could be false anyway) it's not going to change your treatment which is a full mouth assessment (including xrays of course) and extractions. FIV testing is a good shout from Rob Loxley, but it also wouldn't change the treatment, more the long term management, however, it's not the death sentence it was once thought to be.

Corticosteroids are not indicated.

And this isn't gingivostomatitis.

RE: Chronic gingivitis in a young cat

Rob Loxley — Wed, 02 Jan 2019 13:36:06 GMT

[quote user="Anthony Todd"]My son''s very laid back cat, "Glen" 3yo-ish has been to the vet and has a chronic gingivitis. [photos to follow]. Teeth are fine.[/quote]

The pictures look like there is a fair amount of periodontal disease; that upper premolar with most of the caudal root exposed and sitting at a funny angle, for example. I'd wonder whether the cat's problem is more periodontal disease with secondary gingivitis, than the typical feline chronic ginigivostomatitis syndrome?

I suspect that extraction will be the most useful therapy. Regarding viral testing, I'd also consider FIV; I'm not sure how much calici virus result affects how we treat feline chronic gingivostomatitis?

RE: Chronic gingivitis in a young cat

Anthony Todd — Wed, 02 Jan 2019 11:55:00 GMT

[quote user="Marie Kubiak"] I also then knew that steroids were not ideal to induce immunosuppression in the face of a viral infection. Interferon was ineffective and I then could make an informed decision to do multiple extractions without second guessing whether that was the right thing and other treatments might be possible.[/quote]

Thanks Marie, I know that the 'roids are contraindicated, but they always gave my cats symptomatic relief until an almost always permanent resolution after removing the involved molars, and, if involved, all other teeth.

I never seemed to see any negative effects of intermittent pred and the cats certainly seemed happier [until extractions

Is there any other relevant information that the samples may give ?

I always thought the Glasgow results were invariably positive and didn't help therapeutics?

RE: Chronic gingivitis in a young cat

Marie Kubiak — Wed, 02 Jan 2019 11:26:53 GMT

I'm no feline vet, but from being an owner of two chronic gingivostomatitis cats I opted for viral testing in both (I'm presuming this is what you mean by Glasgow testing?). Then I knew the pathogen (calicivirus), prognosis and course of infection, treatment options etc. I also then knew that steroids were not ideal to induce immunosuppression in the face of a viral infection. Interferon was ineffective and I then could make an informed decision to do multiple extractions without second guessing whether that was the right thing and other treatments might be possible.

Marie

RE: Chronic gingivitis in a young cat

Anthony Todd — Wed, 02 Jan 2019 11:21:52 GMT

Er, much worse than i thought, looks like the molars will have to go......