feline gingivostomatitis current thoughts

Re: feline gingivostomatitis current thoughts

Rosie_Skinner — Wed, 13 Oct 2010 20:15:33 GMT

That's my 'go-to' website for this condition, it's just getting motivated owners who are up for trying these treatments and management tips when there's quick fixes available. When I am no longer locuming I am hoping to train up just such clients!

Re: feline gingivostomatitis current thoughts

Catherine Williams — Wed, 13 Oct 2010 16:57:47 GMT

Had a couple of cases of Feline Chronic Gingivostomatitis and found a useful website which has an ebook for clients that can help them comprehend the problem - the cases I used it for were the motivated educated type owners but it definitely helped

http://www.dr-addie.com/stomatitis.html

Also has a useful section on FIP

Re: feline gingivostomatitis current thoughts

Martin Atkinson — Wed, 13 Oct 2010 16:39:55 GMT

[quote user="bob lehner"]

Very interesting and useful tip - do you use it at the normal recommended dose rate ?

[/quote]

Yes as same dose as cat and dog. I used to make up antibiotic impregnated beads but Convenia seems to work as well with less hassle and I've not killed one yet despite the warnings in he data sheets, best get off licence form signed though!!

Re: feline gingivostomatitis current thoughts

bob lehner — Wed, 13 Oct 2010 10:49:26 GMT

[quote user="Martin Atkinson"]Meanwhile, I use Convenia in rabbits routinely with no problems [/quote]

Very interesting and useful tip - do you use it at the normal recommended dose rate ?

Re: feline gingivostomatitis current thoughts

Martin Atkinson — Wed, 13 Oct 2010 10:40:38 GMT

I've found that in cats with severe chronic plasmocytic lymphocytic gingivo-stomatis the teeth invariably extract easily if they don't that is a sign to me that they will probably continue to respond to conservative treatment for a while. If in doubt do one side first and come back to the other in 3-6months if its no better.

Re: feline gingivostomatitis current thoughts

Julian Earl — Tue, 12 Oct 2010 18:21:33 GMT

[quote user="Bob Russell"]

I don't know if it is just me but I often find extractions in these cases relatively easy. I have always assumed this is because of chronic damage to the periodontal ligament.

[/quote]

Some are easy to extract but not always. Also I try and remove the teeth as soon as I see the condition so maybe that is why they are not always easy?

Re: feline gingivostomatitis current thoughts

Rosie_Skinner — Tue, 12 Oct 2010 17:28:42 GMT

I have found that too Bob, unless they have FORLs aswell, then it's a pain.

Re: feline gingivostomatitis current thoughts

Bob Russell — Tue, 12 Oct 2010 15:58:24 GMT

[quote user="Julian Earl"]

You have mentioned a lot of the options:

Steroids; antibiotics; oral hygiene; bloods as background information. The obnly reliable means of getting an improvement is via molar extractions, - all the upper ones, and any lower ones that are safe to remove (I'm always wary of mandibular teeth extractions in cats as the roots are usually rock-solid and I would hate to damage the jaw). In some the canines have to go as well.

On top of that, there are antiseptic mouth washes, brushing for the remaining teeth, and sensitivity diets to reduce the antigenic challenge but they are not as effective as removing the teeth in the first place.

As you mentioned there are steroids and I find exactly the same as you - depomedrone is easier than preds with these painful mouths but it comes back with a vengeance. Pred tablets though don't seem to have the same rebound but this may be due to on-going treatment whereas owners just tend to come back after three to four weeks with Depo-med when the condition has really flared again. Maybe use Dexafort or an equivalent and start with preds during the following week?

Re. antibiotics: I was told that Convenia is not suitable as it does not achieve therapeutic levels in the saliva but I have no data to back this up.

There is also the option of Virbagen omega that can be injected intra-orally but I am not totally convinced of the benfit and it is extremely expensive of course.

All in all, for me it has to be the extractions as about 10% completely clear with that and 80% imrove to a significant degree. The other 10% don't respond but leaving roots behind is a major risk factor for leading to a poor response to extractions.

Crucially, you have to tell the owners at the start that this is a very difficult condition to manage in many cases.

[/quote]

I don't know if it is just me but I often find extractions in these cases relatively easy. I have always assumed this is because of chronic damage to the periodontal ligament.

Surgery takes half as long as those poor cats with a nearly full set of resorptive lesions!!!

Re: feline gingivostomatitis current thoughts

Martin Atkinson — Tue, 12 Oct 2010 10:35:50 GMT

Hi Rosie. You didn't say if you did virus isolation for calici virus. If that is present (usually is) then Virbagen Omega may help but like the others, despite my extensive experience using it, I found it is of limited use in advanced cases. Total extraction is usually the only way but don't worry because when they're that bad the teeth normally shell out like peas. Once the teeth are out the way the mouth is usually comfortable enough for the cat to eat despite it sometimes still looking sore and they rarely need more depomed (as you know it is hidden in my practice anyway)! If you need some more info on the rationale of using interferon I can email it to you.

Meanwhile, I use Convenia in rabbits routinely with no problems and found that 'incurable' abcesses can be cured so long as you debulk them and its invaluble for those deep seated ones where you can't dig out every little last bit. I'm pretty sure that the perception that the infections involved were resistant to antibiotic treatment is due to the fact that previously the rabbits just weren't getting therapeutic doses via the drinking bottle or whatever. I just give a single dose and it seems to work whether or not it last the full 2 weeks. A bit of maluka honey helps too.

Re: feline gingivostomatitis current thoughts

Andre Escudeiro-Vieites — Tue, 12 Oct 2010 09:54:27 GMT

[quote user="alison howell"]Have had a couple of rabbits with horrible tooth related abscesses involving bone that thought would have to PTS but convenia seems to have cured![/quote]

I phoned the manufacturers of convenia to see if I could use it in rabbits. They said they knew of its use in this species but the duration of action was thought to be a lot less than in dogs and cats, definitely less than 2 weeks. In the end , because I wasn't sure how often the injections had to be repeated, I gave the rabbit daily injections of penicillin. It was a case of botriomycosis, that I had surgically debulked. Good response but kept flaring up 1-2 weeks after a course of injections. I am trying to control it,as it keeps flaring up, with pulse therapy. The owner is trained and injects the rabbit twice a week. This seems to have kept the lesion under control for the last few months. I am saying all this becouse I was wondering how often you repeat the convenia in rabbits, if you need a long course. I think that they thought the duration of action was only a couple of days;at least this was the impression I had from the above mentioned phone call

Re: feline gingivostomatitis current thoughts

Wren — Tue, 12 Oct 2010 09:00:37 GMT

[quote user="alison howell"]

Have had a couple of rabbits with horrible tooth related abscesses involving bone that thought would have to PTS but convenia seems to have cured!

[/quote]

Really? I hadn't even considered Convenia in rabbits. If that is the case it would make for much more reliable antibiotic dosing than Baytril in water and safer than sending owners home with syringes and needles to inject Baytril themselves. I would assume that it would be quite good for most skin/resp/UTI infections?

Re: feline gingivostomatitis current thoughts

Evelyn Barbour-Hill — Tue, 12 Oct 2010 01:19:25 GMT

Radical extraction competently performed is still the cornerstone of treatment. But it does not cure every case. After that, some people report good results with interferon but others don't. I'm pretty sceptical about the value of antibiotic treatment but Convenia could be worth a try. Stomorgyl is quite effective but of course almost impossible to give to a cat with a painful mouth.

Possibly a change to a raw meat diet (with or without "Vet Plus") can be curative. (Not much help if the cat's not eating).

Once all the factors are taken into account (owner's ability, owner's attitude, cat's attitude and so on) some cases do end up on frequent Depo-Medrone (a very safe drug) simply because there doesn't seem to be anything else to do.

To go back to the original question; maybe this cat could be syringe fed with Liquivite and then have Metacam added?

Re: feline gingivostomatitis current thoughts

vs0u — Mon, 11 Oct 2010 22:30:18 GMT

PS re. convenia - I think it is now licensed for periodontal infections, in dogs at least. I have had good results with it in mouth infections anyway - the inflammation in the mouth should lead to good blood supply, so is saliva concentration relevant? Have had a couple of rabbits with horrible tooth related abscesses involving bone that thought would have to PTS but convenia seems to have cured!

Re: feline gingivostomatitis current thoughts

vs0u — Mon, 11 Oct 2010 22:26:30 GMT

Once clients have had the easy option of steroids it's hard to get them keen on the more expensive/time consuming dental treatments! Also if you won't be there the next vet that sees the cat will probably just jab it again anyway. I find they are effective initially but tend to wear off quicker the more times they are given The main problem is that people tend to try to save money by leaving it an extra week after the mouth gets painful so the poor cat is off its food for a week in every 4.

The other thing I had heard in addition to the antibiotics, metacam, extractions mentioned above is diet - hypoallergenic or low allergen food is meant to help some cases. I have had some success with interferon - a couple of cats that were much better, even without major extractions, and a couple that were ok if maintained on short courses of oral interferon (and a couple that had no improvement whatsoever)

Re: feline gingivostomatitis current thoughts

Rosie_Skinner — Mon, 11 Oct 2010 21:32:28 GMT

Thanks Julian, that's what I thought! Alas I did not see the cat in the first instance and they were unaware of what a tricky disease their cat has, I have been through all of the options with them including radical extraction and interferon, and having agreed to try antibiotics and metacam, they now want depo again. Unfortunately pred tablets and antirobe would be impossible as these owners cannot pill the cat, possibly due to her very sore mouth, so I suppose that could change.

The blessing and the curse of locuming I suppose is that I won't be there in 3 weeks to explain everything again, and potentially do the radical extractions!

Rosie

Re: feline gingivostomatitis current thoughts

Julian Earl — Mon, 11 Oct 2010 20:44:20 GMT

You have mentioned a lot of the options:

Re. antibiotics: I was told that Convenia is not suitable as it does not achieve therapeutic levels in the saliva but I have no data to back this up.

There is also the option of Virbagen omega that can be injected intra-orally but I am not totally convinced of the benfit and it is extremely expensive of course.

Crucially, you have to tell the owners at the start that this is a very difficult condition to manage in many cases.