Animal Dental Clinic Treats Oral Inflammation in the Dog and Cat
Stomatitis is an inflammation of any of the soft tissue structures in the mouth, which may involve the cheeks, gums, tongue, lips, throat, and palate or sublingual areas. In the cat it is known as Chronic Ulcerative Gingivostomatitis (CUGS) and in the dogs as Chronic Ulcerative Paradental Stomatitis (CUPS). The cause for neither of these syndromes has been worked out and there are probably multiple etiologies for both conditions. The treatment for both of these conditions is similar and therefore they are discussed together.
Stomatitis is usually chronic, with a duration of months to years before treatment is sought. The tissue is ulcerative and bleeds very easily upon touch. Many cases diagnosed as CUGS are really other diseases such as periodontal disease, tooth resorption, retained root fragments and cheek chewer syndrome.
Why some cats will develop the painful condition that has also been termed Lymphocytic Plasmacytic Stomatitis (LPS) is not established. Opportunistic bacteria take advantage of this condition to invade the diseased tissue. In the process the patient’s normal tissues are destroyed.
Diagnosis begins with a history and a complete physical examination of the mouth, which, because of the amount of pain associated with this condition, usually requires general anesthesia. Routine CBC and biochemical analysis should be performed. FeLV and FIV testing is highly indicated. While the FELV and FIV tests often will be negative, they may yield an answer as to the cause of that particular patient’s stomatitis. Feline Bartonella has also been associated with stomatitis and therefore should be tested for. Occasionally the cause of the altered immune state is viral infections such as Calici virus.
The true cases of CUGS are the most difficult to successfully treat. Initial treatment may require extraction of all the teeth. Further treatment is often required and may be extensive and long term. Medical therapies have potentially dangerous side effects, and some drugs used have not been approved for use in cats. An important concept in the treatment of CUGS is that repeat treatment is often necessary.
Dental radiographs should also be taken to evaluate for loss of bone around the tooth. Internal (inside the root canal/pulp chamber) or external resorption of the root may be noted. The root tip and deeper socket regions of the teeth should be evaluated for endodontic disease. Diseased teeth must be treated, or sometimes extracted. Roots that are remaining after either spontaneous crown fractures from tooth resorption (formally called Feline Odontoclastic Resorptive Lesions (FORL)) should be completely extracted. This may require a gingival flap and removal of some bone, removal of the root and closure of the gingival flap.
Newer treatments that are undergoing clinical trail at the Animal Dental Clinic include Stem Cell Therapy whereby the patient’s own fat is collected and the stem cells are harvested and injected back into the patient. This is hoped to decrease the oral inflammation and promote tissue healing.
The equivalent to stomatitis in the dog is called Chronic Ulcerative Paradental Stomatitis (CUPS). The hallmark clinical sign in these cases is "kissing lesions” which are ulcers of the buccal mucosa over the teeth covered with a soft, pale yellow plaque. These lesions may create a perfect outline of the teeth. Most patients will continue to eat reluctantly, but some will stop eating altogether. Histopathology of the oral ulcerations usually reveals chronic active inflammation with mucosal ulceration.
The cause of this disease is not known. It seems to be a severe reaction to the bacteria and or bacterial byproducts on the teeth surfaces. Associated with this is extreme oral sensitivity, severe halitosis, and ulcerations on the sides of the tongue.
Workup for this condition includes dental radiographs of all teeth and biopsy. Initially, any teeth that show infection or bone loss should be extracted. Thorough dental cleaning should be performed. Early in the course of disease, keeping the teeth clean can be beneficial if the clients can brush the teeth. There is a window of 2 – 3 weeks whereby if plaque can be controlled, further extension of the disease can be prevented. However, if the ulceration returns, additional extractions and therapy may be necessary.