Diet and feline gingivo-stomatitis complex

Re: Diet and feline gingivo-stomatitis complex

Evelyn Barbour-Hill — Thu, 11 Aug 2011 01:36:32 GMT

I think I see plenty of cats with FCGS where the periodontal disease has not largely broken down the attachment apparatus. It's always been my feeling that the great pain is coming from the areas of stomatitis over the commissures of the jaws, the palate and the "fauces" (It's considered very nit-picking to point out that they aren't strictly the fauces).

"Ankylosed" is when a tooth root has been suffering from resorption and the resorbed tooth has been partly repaced by bone, thus firmly ankylosing tooth to bone. Even if you didn't Xray them and so find out in advance, you can tell as you attempt the extraction because they give the impression of being rock-solid rather than yielding slightly to the luxator pressure.

If it gives the impression of tenuous attachment but doesn't avulse easily, I'd guess you had a root with a bulbous apex.

I don't have any magic answer to extracting teeth severely affected by FORL. Good instruments, care, patience and sensitivity in your approach, of course. Be ready to do flap surgery and remove bone. An ankylosed tooth is ankylosed: it cannot be "extracted" in the usual sense of the word. And if you are left with a root tip that's snapped off, but it's well below alveolar bone level with no spiky bits sticking up, and it was already part resorbed, then leave it buried: in fact bury it by suturing the gingiva over it. It was resorbing already, so it will go on resorbing. This is a better solution than risking damage by attempting to bur it away.

Re: Diet and feline gingivo-stomatitis complex

Martin Atkinson — Wed, 10 Aug 2011 15:54:32 GMT

Here's the point that Evelyn shoots me down in flames even though he accepted my article on the subject for the BVDA journal albeit it was from a virology stance rather than a dental one.

My understanding is that chronic gingivostomatitis only goes critical in cats in terms of intractible pain when the periodontitis is so severe that periodontal disease has also lead to loss of alveolar integrity thus facilitating easy extraction. Certainly there are times when some roots which appear as though their alveolar attachment is tenuous stiil dont evulse easily - I presume that is what you mean by ankylosed. If after a reasonable attempt to remove these roots they remain stubbornly attached I tend to make sure they are below the alveolar margin and leave them because I think you can end up doing more harm than good trying to chisel them out.. Not had a complication from doing that yet.

Re: Diet and feline gingivo-stomatitis complex

Bob Russell — Wed, 10 Aug 2011 15:26:46 GMT

Are there any real tricks to removing these nightmare 'ankylosed' teeth? I find them hideous to remove and end up wondering if I have done more harm than good.

Re: Diet and feline gingivo-stomatitis complex

Evelyn Barbour-Hill — Wed, 10 Aug 2011 13:53:42 GMT

[quote user="Martin Atkinson"] If I'm struggling to extract this tells me that periodontal and alveolar integrity remains intact[/quote]

Yeeeaaahhh............. (assuming the teeth are not "ankylosed" by resorptive lesions, another reason why someone might struggle to extract)...but I'm not sure that "periodontal and alveolar integrity" are relevant to FCGS.

Re: Diet and feline gingivo-stomatitis complex

Martin Atkinson — Wed, 10 Aug 2011 10:00:45 GMT

[quote user="Simon Neuhoff"]

With regards to full mouth extractions - do you "stage" this - ie extact all the caudal teeth but retain the canines initially and monitor response, with canine extraction as the next step? I tend to vary my approach depending on the client and whether they are amenable to two procedures but curois to know what other's approaches are.

[/quote]

I concur with Evelyn, however I sometimes stage the extractions with doing one side at a time. My criteria for this is that if I start on one side and the teeth extract easily which they inevitably do in severe intractible cases, the chances are all teeth will need to come out sometimes including the canines. If I'm struggling to extract this tells me that periodontal and alveolar integrity remains intact and there is still some mileage in medical treatment so I will delay further extractions.

Re: Diet and feline gingivo-stomatitis complex

Evelyn Barbour-Hill — Tue, 09 Aug 2011 19:37:56 GMT

[quote user="Simon Neuhoff"] do you "stage" this - ie extact all the caudal teeth but retain the canines initially and monitor response, with canine extraction as the next step?[/quote]

Yes, unless the canine teeth are clearly diseased (generally they are not).

Re: Diet and feline gingivo-stomatitis complex

Simon Neuhoff — Tue, 09 Aug 2011 13:26:06 GMT

Re: Diet and feline gingivo-stomatitis complex

Martin Atkinson — Mon, 01 Aug 2011 09:54:41 GMT

[quote user="ruthgloster1"]

I've treated a few cases with interferons and had good success. Interferons are usually reserved for post extraction cases that are not responding greatly but I have used them in cases where owners would not consider full mouth extractions. 1 vial of intererfons into a 100ml saline bag, divide into 10 x 10mls alliqouts, placed in freezer, defrost one at a time, will keep for 21 days in fridge and squirt 1ml into mouth daily. I've had some good response to this and seen cases that colleagues have treated similarly and responded well.

[/quote]

I had hoped that interferons (I assume you're using Virbagen Omega Ruth) were the holy grail for treatment of feline gingivo-stomatitis and no-one was more enthusiastic about their use to start with 7 years ago. This enthusiasm has been tempered with experience and I found that the results were disappointing in cats with advanced lymphocytic-plasmocytic-gingivo-stomatits even with combinations of oral administration with injections both sub cut and into the lesions themselves to the point I feel I can no longer justify it in terms of cost/aggravation/benefit ratios. This is undoubtedly because the condition is multi-factorial and the FCV is only a part of it although part of the effect they have may be immuno-modulatory rather than anti-viral. I now only use interferon in young cats with proven FCV gingivitis post eruption in the hope that this will stop the progression of disease to the horrible end-point we so often see and that seems to work quite well but it is early days and most are lost to follow-up. I still think that total extraction is the only solution once they are really bad. A lot of cats retain obvious inflammation post extraction but usually don't seem to be in discomfort - maybe it's just relative to the agony they were probably in before. Given that you have to continue indefinitely with the interferon if you don't find a more permanent solution I feel it is a bit like banging your head against a wall.

Re: Diet and feline gingivo-stomatitis complex

ruthgloster1 — Sat, 30 Jul 2011 20:44:24 GMT

Lappin gave a talk at the London vet show 2010 and it was also referred to in another talk by Lisa Milella at that years vet show, both advised that 80-83% of cats cure with extractions. I have been to many talks on dentistry and that seems to be the trend, I dont have the reference with me at the moment but can definitely get it. Based on these talks I offer meloxicam/oral vetergesic, antirobe and dental treatment with scale/polish and extract as necssary and if no response i then advise full mouth extractions. Norman Johnston is doing some interesting work with interferons with these cases and based on information from him and his notes, I've treated a few cases with interferons and had good success. Interferons are usually reserved for post extraction cases that are not responding greatly but I have used them in cases where owners would not consider full mouth extractions. 1 vial of intererfons into a 100ml saline bag, divide into 10 x 10mls alliqouts, placed in freezer, defrost one at a time, will keep for 21 days in fridge and squirt 1ml into mouth daily. I've had some good response to this and seen cases that colleagues have treated similarly and responded well.

Re: Diet and feline gingivo-stomatitis complex

Martin Atkinson — Tue, 26 Jul 2011 18:37:53 GMT

[quote user="Emily Nightingale"]

[quote user="bob lehner"]

In the interests of science I opened a casule and put a small dab on my tongue. I can confirm it tastes vile. Of course we can't presume that cats' taste buds work just like ours - but I'd be surprised if they found it very palatable.

[/quote]

A previous colleague of mine advocated putting the capsules in the freezer for storage before use which apparently took away some of the nasty taste.

[/quote]

I have long laboured under the perceived knowledge that cats have very few bitter taste buds, hence anti-lick stuff on their skin doesn't work well, so they can't taste the Antirobe. Whether this is true or not I rarely have any problem with cats taking the contents sprinkled on their food unless all my clients are lying to save face for not complying with their pet's medication.

Re: Diet and feline gingivo-stomatitis complex

Emily Nightingale — Tue, 26 Jul 2011 17:42:19 GMT

[quote user="bob lehner"]

[/quote]

A previous colleague of mine advocated putting the capsules in the freezer for storage before use which apparently took away some of the nasty taste.

Re: Diet and feline gingivo-stomatitis complex

Laurence Webb — Mon, 25 Jul 2011 21:45:03 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Laurence Webb"]Normal Johnson's webinar[/quote]

Did you watch it in Unseen University?

[/quote]He prefers to be known as Normal, so as not to confuse him with his brother Bergholt Stuttley.

Re: Diet and feline gingivo-stomatitis complex

Evelyn Barbour-Hill — Mon, 25 Jul 2011 19:33:27 GMT

[quote user="Laurence Webb"]Normal Johnson's webinar[/quote]

Did you watch it in Unseen University?

Re: Diet and feline gingivo-stomatitis complex

Evelyn Barbour-Hill — Mon, 25 Jul 2011 18:59:10 GMT

[quote user="Anthony Todd"]

[quote user="Hannah Wynne Richards"]I think some of her beliefs are wrong, or over-simplistic but I am certain that they are her genuine beliefs[/quote]

That's the sort of logic and justification that get folk into trouble and countries into wars, just ask Tony Blair.

[/quote]

The "Right Honourable" () Tony Blair has neither integrity nor sincerity. So what's the connection?

Re: Diet and feline gingivo-stomatitis complex

Anthony Todd — Mon, 25 Jul 2011 17:01:10 GMT

[quote user="Hannah Wynne Richards"]I think some of her beliefs are wrong, or over-simplistic but I am certain that they are her genuine beliefs[/quote]

That's the sort of logic and justification that get folk into trouble and countries into wars, just ask Tony Blair.

Re: Diet and feline gingivo-stomatitis complex

David Mills — Mon, 25 Jul 2011 16:42:47 GMT

[quote user="Bob Partridge"]

Sable started Pet Plus immediately after surgery and made a sustained improvement, the pharyngeal ulceration having largely healed after a year.

[/quote]

A year? Bloody hell. Anyone else fancy having an oral ulcer for 4-5 years? This is simply unethical.

[quote user="Bob Partridge"]

Ginger was in the control group and her gingivae returned to their original state a month after surgery, steroids and antibiotics. The owner requested that Ginger be given Pet Plus. Her gingivae showed marked improvement after only 6 weeks.

[/quote]

'surgery, steroids and antibiotics'. Blow me down with a feather - it improved. Much more quickly than poor Sable.

integrity's a funny thing. No doubt she's sincere. Fundamentalists generally are. Integrity is a far, far cry from sincerity; bang goes hers. This woman simply has no idea what she is on about, all in pursuit of commercial gain. Total madness.

Re: Diet and feline gingivo-stomatitis complex

Bob Partridge — Mon, 25 Jul 2011 16:20:45 GMT

Correspondence you probably won't see on the PetPLUS WEBSITE

-----------------------------------------------------------------------------------------------

Unfortunately you really don't seem to get the "openness and transparency" thing.

Simply amending the article doesn't actually admit that it has been corrected and what the original stated (incorrectly). It is basically the same concept as fiddling your past clinical notes to fit the facts as you later find them.

An honest, open and transparent approach is to leave the statement as it was with the incorrect text highlighted and a correction added.

Re the paper. You are now stating that there were two cats affected by FCGS. This is not what is stated in your paper - it clearly says only one cat & that was in the treated group. Perhaps you have "misread" your own paper.

Perhaps this illustrates why there is so little faith in the nutritionalist papers as quoted in the Daily Mail & the like.

If you have not read "Bad Science" you really, really should.

As far as "saving me embarrassment" - no you are not - you are simply censoring your website to ensure that correct meaningful challenges are withheld. Is this really 100% integrity? I repeat I am happy to have this correspondence on your website - why aren't you?

"shouting down a speaker" no recollection of that event - nor has anyone else I have spoken to. I may have challenged a speaker by asking the question at the end as to the scientific basis of drawing conclusions from n=1 type study, but nothing more.

Best Wishes

Bob Partridge

T +44 (0) 1423-561414

From: Suzi McIntyre [mailto:suzi.mcintyre@gmail.com]
Sent: 25 July 2011 08:18
To: Bob Partridge
Subject: Pet Plus

Hi Bob,

Thanks for your comments.

I have ammended the comment on my web site and emailed the vet concerned. Thank you for pointing out my error.

This is what I changed:-

The Pilot Study was published in the British Veterinary Dental Association Journal, a peer reviewed specialist journal, in 2000, after presenting it as a lecture to the BVDA at the Annual Scientific Meeting and subsequently as a poster presentation. The BVDA J did not have an official peer reviewing body at that time. A letter providing an update was published in BVDAJ in 2009. Professor Iain Chapple delivered an exceptional Key Note lecture at the last BVDA Annual Scientific Meeting (30 March 2011) on the first of the specialist days preceding the BSAVA Conference in Birmingham. I wrote a synopsis of his talk, with his help, which has just been published in the current BVDA Journal, 2011. You can read it in the Veterinary Dental section of this web site.

I would never do anything without 100% integrity. I have nothing to hide. I sent all the details of my Pet Plus web site with my letter, but Vet Times chose not to publish that. I guess they had to decide if this would constitute advertising, which they certainly don't want to do in their letters page. There is no lack of transparency anywhere. Many people have looked at my web site, just as you have. I really don't think there is anything hidden anywhere.

When we did the Pilot Study in 1996-1997, we bought the Pet Plus from a supplier just the same as you could have. We had no vested interest in the results apart from an honest desire to see if there was a different way of helping animals with periodontal disease.

I am sorry that you misunderstood the situation regarding the cats with FCGS in the Pilot study. There were 2 cats with FCGS. Sable was more severe than Ginger. Sable started Pet Plus immediately after surgery and made a sustained improvement, the pharyngeal ulceration having largely healed after a year. Ginger was in the control group and her gingivae returned to their original state a month after surgery, steroids and antibiotics. The owner requested that Ginger be given Pet Plus. Her gingivae showed marked improvement after only 6 weeks.

There is no ambiguity at all. You simply misread the paper.

I am shocked at your aggression Bob, although from the way you shouted down one of our speakers on this subject, I suppose I shouldn't be! I honestly thought everyone would be delighted to have a way of treating periodontal disease that works for life, without recurrence of the disease and that is easy and cost effective.

I shall save you the embarrassment of having this on my web site, so will just leave it as a personal communication.

I do hope you have a go at taking on the 'new' ways of treating periodontal disease in the light of the 3 presentations we have had so far.

With best wishes,

Suzi

Dear Suzi
I have to say I was disappointed by your lack of integrity in not declaring your interests in your letter to Vet Times.
Your supplement may or may not have a beneficial role - however your lack of transparency is more than a little concerning and does bring into question your professionalism.
Having lifted out the BVDA Journal from 2000 - your original paper was NOT peer reviewed (the then editor has confirmed this), nor was your follow up long letter in 2009. Perhaps you could make the appropriate corrections to your website and email those that have been misinformed?
You also state that "Ginger" the one and olnly cat in your study affected by FCGS was in the control group - however your paper reported him as being in the treated group. This level of ambiguity also does not play well when seeking to trust a paper's findings.
I also wondered whether you have read Dr Ben Goldacre's book "Bad Science" - there are perhaps some lessons to be learnt.
For my own DoI - please see www.rcvs.org.uk
All the best
Bob

Re: Diet and feline gingivo-stomatitis complex

Martin Atkinson — Mon, 25 Jul 2011 15:46:44 GMT

[quote user="Hannah Wynne Richards"]

Like Evelyn,I know Sue personally-we are both Bristol,year of 1980 grads. I don't agree with many of her clinical views-put bluntly, I'm orthodox, she's alternative, but I greatly respect her integrity. I think some of her beliefs are wrong, or over-simplistic but I am certain that they are her genuine beliefs

Wynne

[/quote]

Once again: no-one is discrediting her beliefs right or wrong, it is her modus operendi on this occasion that is in question.

Re: Diet and feline gingivo-stomatitis complex

Hannah Wynne Richards — Mon, 25 Jul 2011 15:08:50 GMT

Wynne

Re: Diet and feline gingivo-stomatitis complex

Martin Atkinson — Mon, 25 Jul 2011 15:05:17 GMT

[quote user="Evelyn Barbour-Hill"]

Vet Times is renowned for the loony letters, it's what you read the thing for. Are you going to write a rebuttal of David Coffey every time he sends a rant?

If you take it all too seriously, the joke's on you.

[/quote]

I am a veteran of writing loony letters so I know one when I see one! No I wouldn't reply to the likes of David Coffey but this was not a loony letter, a loony diet maybe, this was an attempt by someone to blatantly promote their own product and discredit widely accepted therapies for their own gain. Loonies can be forgiven and forgotten this was unforgiveable.

Re: Diet and feline gingivo-stomatitis complex

Evelyn Barbour-Hill — Mon, 25 Jul 2011 13:52:32 GMT

Vet Times is renowned for the loony letters, it's what you read the thing for. Are you going to write a rebuttal of David Coffey every time he sends a rant?

If you take it all too seriously, the joke's on you.

Re: Diet and feline gingivo-stomatitis complex

James Allsop — Mon, 25 Jul 2011 10:50:40 GMT

I stand corrected - still quite like using it though - may have to be more questioning of clients to see if they still find it easy. Clavaseptin on the other hand when first launched used to be very difficult to get out of the foil without splitting the tablets (foil was stronger than the tablets) - i have been told by the rep that this was corrected though.

Re: Diet and feline gingivo-stomatitis complex

Martin Atkinson — Mon, 25 Jul 2011 10:36:32 GMT

[quote user="David Mills"]

I think it's abundantly clear that the letter was nothing more than cynical free advertisement.

[/quote]

Absolutely and I have written a letter to Vet TImes suggesting thus. Despite Evelyn's defence of Ms McIntyre, this is the crux of the matter. She may well be sincere in her beliefs and who knows ultimately she may be proved correct, although I doubt there is such a simple answer, if only there was. She was rather less sincere in her condemnation of other accepted practices that didn't involve using her product and in not disclosing she had a vested interest.

Re: Diet and feline gingivo-stomatitis complex

Rob Loxley — Sun, 24 Jul 2011 23:33:21 GMT

A quick look at http://www.fabcats.org/press/easy_to_give/index.php says Antirobe never received such an award, but Clavaseptin (amox/clav) did. But this is an aside.

Re: Diet and feline gingivo-stomatitis complex

James Allsop — Sun, 24 Jul 2011 20:55:15 GMT

Ive not tried antirobe personally but always found good success with hiding it in food - tried it in my own cats when necessary. There may not be a current FAB award but im sure they used it in their advertising a few years ago if memory serves