Gingivitis in 6mth Kitten

RE: Gingivitis in 6mth Kitten

Charlotte Furnell — Wed, 10 Feb 2021 21:06:18 GMT

Thankyou for your advice and taking the time to respond.

We have started an oral care routine at home and shall reassess in a few weeks - we are currently waiting for dental X-rays to be set up in our practice so as soon as these are ( which should be soon) we’ll get those done.

RE: Gingivitis in 6mth Kitten

Rachel Perry — Wed, 10 Feb 2021 11:36:55 GMT

It's worth revising how calicivirus infections present. An acute infection is responsible for upper respiratory signs- sneezing, oculonasal discharge, lethargy, pyrexia, inappetence, conjunctivitis, and oral ulceration- typically palate and/or lingual ulceration.If there are these signs, then knowing it's calicivirus may well help with manage and mitigate spread. However, from your description this sounds like gingivitis- and as kate suggests, this sounds like juvenile gingivitis. It's worth remembering that calicivirus carriers exist, and from memory 30% or so of healthy cats will test positive if you swab them, especially cats from multi-cat households.

Gingivitis is caused by the host's immune response to plaque bacteria. There is no evidence that calicivirus contributes to periodontal disease. So in this case there's no reason to swab for calicivirus.

Gingivostomatitis is a completely different disease, in that we don't really understand it. Most cats who have this disease will carry the calicivirus, but carrying it does not mean it causes it. Cats with this disease typically have defined stomatitis as well as gingivitis, especially caudal stomatitis, and alveolar and buccal mucositis. These cats are miserable, don't eat, lose weight, don't groom, and are often (not always a bit older). Even with these cats, is it worth testing for calicivirus if we know they're likely to be positive?

Coming back to juvenile periodontal disease- you will need radiographs to prove there is no periodontitis, as these cats can quickly progress to periodontitis (and resorption), in which case extractions do become necessary. The "good' thing about this- if it is juvenile periodontitis compared to chronic gingivostomatitis, is that extractions are far more likely to result in cure, whereas with gingivostomatitis extraction will only significantly help about 66% cases.

The aggressive/ rapidly progressive periodontal diseases are the one time you MIGHT reach for antibiotics in periodontal disease, but if we're at the gingivitis stage then treatments as described above, warning the client without adequate homecare things might progress.

RE: Gingivitis in 6mth Kitten

Evelyn Barbour-Hill — Sun, 07 Feb 2021 22:50:37 GMT

Juvenile periodontal disease – a bit of a b****r to be honest. Do you really mean only the upper molars are affected? The cat only has one upper molar each side and it's right at the back . If it is just those teeth, I'd take 'em out, problem solved. But I'm assuming you mean all the upper cheek teeth, premolars as well.

Some eventually resolve, some progress to severe periodontitis.

There's no question of extractions right now. I'd start oral hygiene straight away. Don't attempt brushing: smear Stomodine around generously with a finger tip and generally do as Kate has suggested.

After a few weeks, if the owner will permit, have a GA session. Do a radiographic survey if you can. Examine tonsils, pharynx, fauces, general oral mucosa. Use the ultrasonic scaler very gently, on its lowest setting, under the gum margins. I doubt there will be anything to de-scale, but the scaler is excellent at removing plaque too. Only use a scaler that is truly safe to use under the gum – many are not. Either the type where the irrigant comes through a hollow tip, or the iM3/Odontoson. Excise tryly hyperplastic tissue if it's making a false pocket, but don't mistake swollen tissue for hyperplastic. Don't extract anything unless there's obvious bone loss or deep pocketing. (Most likely there is isn't, but not long ago I had such a case where many of the cheek teeth did already have severe support loss.). Apply Sanos.

Then go on with oral hygiene for at least a couple of months. Don't make any further decisions until you've done that.

Don't even think about glucocorticoid or antibiotic.

Some people consider this is caused by calicivirus. Personally I doubt it. By all means try interferon – it can't do any harm except to the owner's wallet. There are various protocols published.

RE: Gingivitis in 6mth Kitten

Kate Richardson — Thu, 04 Feb 2021 11:48:14 GMT

I tend to use Stomodine gel, rather than a mouth rinse as I find cats tolerate it better, but you could use hexarinse or similar- the gel just needs to get into mouth and cat's tongue moves it around, so they can either lick it directly from tube or smeared on their lips. I wouldn't start brushing until assessed further as you're right, they might be a bit sore, and if long term cleaning is going to be neeeded, then the last thing I want to do at this stage is piss the cat off, but I would start them doing just some basic oral handling, lifting the lips, touching the teeth and get the kitten used to this followed by a treat and move onto brushing later (if willing and able!)

RE: Gingivitis in 6mth Kitten

Charlotte Furnell — Thu, 04 Feb 2021 11:18:52 GMT

Thanks for your reply. I don't have any photos but I can try and get some definitely.

We are currently in the process of getting dental Xray fitted so I'm hoping we'll be able to use that soon. I didn't notice any hyperplastic areas but your right I would need to assess under GA I think.

Yeah I didn't know whether finding out if something like Calicivirus was involved would change our plan or not.

Do you find that brushing the teeth would exacerbate the gums? As they look sore?

Is the Chlorhex rinse something the O can do at home? Or mainly just brushing the teeth?

Thanks :)

RE: Gingivitis in 6mth Kitten

Kate Richardson — Thu, 04 Feb 2021 10:53:37 GMT

Hi Charlotte, I expect Evelyn Barbour-Hill will chip in, but here's my 2p's worth. Sounds like juvenile gingivitis. Can you get photos? Always helpful. Is the gingiva hyperplastic? I would advise examining the mouth under GA including xrays if you have facilities to do so, subgingival descaling and rinsing with chlorhex solution and if the gingiva is hyperplastic, a gingivectomy to remove the excess to stop plaque getting trapped underneath. Calicivirus may play a role, but usefulness of swabbing is debatable in my opinion. Could check for FIV if you want to tick all the boxes. But priority is exam under ga and clean +/- gingivectomy. Implement oral hygiene measures asap and continue post ga/exam/treat. My experience is that these usually settle down with these measures, but if you don't properly assess/perform gingivectomy, the likelihood of tooth loss at an early age due to periodontal disease is high.