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Tel: (856) 242-9253, Fax: (856) 394-2585
455 Old Baltimore Pike, Chadds Ford, PA 19317
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Feline Chronic Gingivostomatitis

Feline Chronic Gingivostomatitis (FCGS) is a painful and potentially debilitating condition of cats, characterized by widespread inflammation in the oral cavity. It is typically seen in cats ranging from 3-10 years of age but has been identified in older and younger animals as well. Unfortunately, this disease is challenging to treat and can be frustrating for pet owners and veterinarians alike.


Suspected Causes of FCGS
To date, no single cause for FCGS has been identified. The disease is currently believed to be a multifactorial process with infectious agents, host immune response, genetic predisposition, and concurrent periodontal disease each playing a role. In particular, FCGS is thought to be triggered by an exuberant host immune response to the chronic oral antigenic stimulation caused by dental plaque bacteria. This excessive response results in severe inflammation of the oral cavity.

While several infectious agents have been associated with FCGS, no specific agent has been identified as the inciting cause. Bacterial species Pasteurella and Prevotella appear to be more highly represented than other species in the dental plaque of cats with FCGS. Feline Calicivirus has also been implicated, with some studies showing up to 97% of cats with chronic oral inflammation carrying the virus. Feline Leukemia Virus (FeLV) and Feline Immunodeficiency Virus (FIV) have also been implicated as possibly predisposing cats to the development of FCGS. However, it is important to note that a true cause and effect relationship has not been established for any of these infectious agents.


Clinical Signs
Cats are stoic creatures, and many cats with periodontal disease will continue to eat and drink normally despite oral pain. Cats with FCGS are often severely painful and may exhibit signs such as:

  • Partial to complete loss of appetite
  • Preference for canned food and reluctance to eat hard food
  • Weight loss
  • Excessive salivation, blood-tinged saliva
  • Pawing or rubbing the face
  • Dropping food
  • Halitosis
  • Abnormal swallowing
  • Pain when chewing, yawning, or opening the mouth
  • Swollen, ulcerated, or bleeding gums
  • Unkempt appearance due to a decrease in self-grooming
  • Hiding, reclusive behavior


Diagnosis of FCGS
As with any dental condition, the diagnostic process first begins with a thorough history and an examination of the oral cavity. History should include discussion of the patient’s diet, concurrent medical conditions, clinical signs, and age at onset of the disease. The oral examination is best accomplished under general anesthesia and should include full mouth radiographs to evaluate disease beneath the surface. Practitioners should note that while routine gingivitis is typically confined to the gingival tissues, lesions in FCGS extend beyond the mucogingival line.

Blood work, urinalysis, and thyroid panel are also recommended for all cats with suspected FCGS to rule out underlying disease. Additional testing such as FIV/FeLV test, calicivirus PCR, and Bartonella screening may be useful in some cases.

Differential diagnoses for FCGS include other causes for extensive oral inflammation such as eosinophilic granuloma complex, food allergy, neoplasia, uremic stomatitis, and ingestion of caustic or irritating substances. These differentials should be ruled out prior to proceeding with treatment for FCGS.


Typical clinical appearance of a cat suffering from FCGS


Treatment
Due to the multifactorial etiology of FCGS, there is no single treatment that is effective in all cases. Unfortunately, treatment is often frustrating and can be unrewarding. Good client communication regarding costs, prognosis, and home care is essential in order to promote client compliance.

The gold standard treatment for FCGS is partial or full mouth extraction. This significantly decreases the oral antigen burden and removes the nidus for inflammation. In some cases, removal of the molars and pre-molars is sufficient. In others, full mouth extraction is necessary in order to adequately control inflammation. If extraction is to be performed, it is critical that all structures are completely removed and no tooth root remnants are left behind. Post- operative full mouth radiographs are also required in order to ensure all roots have been removed. Referral to a veterinary dentist is often recommended for this procedure.

If extraction is not possible, medical therapy may be used as a primary treatment, though this is often unrewarding. More commonly, medical therapy is used as an adjunctive treatment in cases where extraction alone does not achieve a clinical cure. Medical therapy is typically multimodal and the goal is to reduce pain, eliminate infection, and modulate the host’s immune response. Medical treatment for FCGS may include:

  • Antibiotics to reduce oral bacterial load
  • Anti-inflammatory medications such as corticosteroids
  • Immune-modulating drugs such as cyclosporine or interferon
  • Laser therapy
Supportive therapy such as vitamin and fatty acid supplementation, fluids, and critical care diets It is particularly important to note that antibiotic therapy should never be the sole method of treatment in cases of FCGS. While antibiotics can decrease bacterial load and provide some short term relief, they ultimately provide little benefit and predispose the cat to development of resistant infections. In cases where full mouth extraction is to be performed, most veterinary dentists feel that antibiotic therapy is unnecessary.


Outcomes
A study of the outcomes of 30 cats following full mouth extractions (Hennet, 1997) found that 60% of cats were cured and required no further treatment. Another 20% of the cats studied showed significant improvement, 13% showed only minor improvement, and 7% showed little to no improvement. Similarly, a more recent study (Girard, 2005) demonstrated that full mouth extraction resulted in a cure for 50% of the cats studied, while 37% improved but required adjuvant medical treatment, and the remaining 13% did not improve. Thus, while full mouth extraction provides the best chance at a clinical cure, it is important to prepare pet owners for the possibility that their individual cat may require further medical therapy following extraction.

Perhaps the most common question from pet owners is whether or not their cat will be able to eat solid food following the procedure. While it is best to transition to a canned food diet prior to surgery (and some cats may have already made this choice for themselves due to chronic oral pain), many cats are able to return to eating dry food and treats 2-3 weeks after the procedure. However, in refractory cases a soft diet may continue to be a lifelong necessity.


Summary
Feline Chronic Gingivostomatitis is a complex disease, the cause and treatment of which is still poorly understood. Currently, full mouth extractions are recommended as the primary therapy, but medical management may be necessary in refractory cases. In all cases, long term follow up is recommended to monitor for recurrence of oral inflammation.




Would You Know if Your Pet Was Suffering From Oral Pain?


Did you know dental problems in pets are very common? Approximately 80% of dogs and 70% of cats over 3 years of age have some form of oral disease. The pain associated with dental disease can range from discomfort to agonizing for your pet, and it’s progressive — so it’s important to get it addressed and schedule a pet dental checkup.

Because February is National Pet Dental Health Month, we would like to help pet owners understand how to recognize the signs that a pet may have dental disease. Many pet owners just assume that stinky breath goes with having a pet — but it doesn’t have to and it’s a sign of needed care.

Symptoms of pet dental problems that indicate treatment is needed:

  • Bad breath
  • Buildup of tartar
  • Eating difficulties
  • Excessive salivation
  • Facial swelling
  • General fatigue
  • Head shyness
  • Loose or broken teeth
  • Lumps or bumps in their mouth
  • Stained or dark teeth
  • Swollen/irritated gums
  • Weight loss

If your pet is displaying any of these symptoms, please make an appointment for an exam with your primary care veterinarian. If your pet does not receive treatment, it can lead to pain, tooth loss, sinus infections, organ toxicities, and periodontal disease. An evaluation may also reveal dangerous oral tumors that, if caught early, are treatable, and can save a life.

Preventive dental care in dogs and cats
Just like in humans, good oral care, including regular cleanings and checkups, will keep your pet’s mouth healthy, improve their quality of life—and can even prolong their lives. In addition to yearly dental examinations, an at home routine for dental upkeep should be established. This can be challenging for any pet owner, so the sooner a maintenance plan is established, the better. Brushing your pet’s teeth daily is ideal but may not be realistic as many pets don’t like this. In the event your pet will not allow you to brush their teeth, dental chews are a great option to help remove plaque and tartar.

Advanced dental care for dogs and cats
If your pet’s oral disease is advanced or your pet has suffered a facial/jaw injury, care by a dental specialist may be necessary. Talk to your veterinarian about a referral to our practice. VDS is the only practice in the nation dedicated to advanced dentistry and oral surgery for pets where a full-time board-certified veterinary dentist and board-certified veterinary anesthesiologist are on staff to ensure the safest and most comfortable experience and the best possible outcome.

While February is National Pet Dental Health Month, dental health should be a daily ritual for pet owners all year long. VDS is here for advanced care and we’re happy to help you get your pet’s smile back. Call 856.242.9253 to schedule an appointment or speak with one of our team members.




When Should My Pet See A Veterinary Dentist?


Although many Americans dislike visiting the dentist and make excuses to put off scheduling an exam and cleaning, deep down they understand why it’s important to have a doctor regularly check their teeth and perform preventative dental care. But what they don’t realize is that just like humans, dogs and cats should have regular checkups with a veterinary dentist as well. And for extreme cases including dental disease and oral surgery your primary care veterinarian might refer you to a board-certified specialist like at Veterinary Dentistry Specialists. 

Veterinary Dentists: Helping Keep Your Pet Healthy By Fighting Dental Disease

Many pet owners just assume that stinky breath goes with having a pet - but it doesn’t have to. Although periodontal disease is the most common medical condition found in dogs and cats, it can be prevented.

There are four stages of periodontal disease in pets:

Stage 4 periodontal disease, image from AVDC.org

Stage 1

In the first stage, a slight buildup of tartar may be evident on the teeth. Additionally, the gums may appear to be red and slightly swollen. If x-rays are taken, no bone loss will be evident. A dental cleaning can be performed to ensure that the dental disease does not progress to later stages.

Stage 2

In addition to tartar and swollen gums, x-rays may reveal up to 25% bone loss. At this time, a dental cleaning should take place in order to prevent further deterioration of the bone. 

Stage 3

At this point significant bone loss has taken place. Although this may not be evident by simply looking in the pet’s mouth and is typically only be discovered by taking dental x-rays.

When a pet is found to have stage three dental disease, a pet parent typically must choose between extraction and advanced procedures performed by a board-certified veterinary denistry specialist to save the affected tooth. Keep in mind that just like with humans, once a pet loses a tooth it will not grow back.

Stage 4

When this stage is reached, the bone loss is so severe that nothing can be done to save a tooth and the only option is extraction.

Dental disease can be quite painful for a pet, pain which could easily be avoided with regularexams with your primary care veterinarian and routine home dental care.

A VDS patient, Frankenstein (Frankie) the Greyhound had periodontal disease and as a result, needed to have several teeth extracted.

Veterinary Dentists Don’t Just Treat Dental Disease

There are many conditions other than dental disease which can impact a pet’s health. In the past, our dental specialists have helped patients impacted by:

  • Jaw Fracture
  • Jaw Malocclusion
  • Salivary Gland Issues
  • Cleft Palate Defects

An examination of the entire mouth may also reveal dangerous oral tumors such as:

  • Fibrosarcoma
  • Melanoma
  • Squamous Cell Carcinoma

If left unchecked, oral tumors, which are quite common and account for 12% of all cancers in cats and 6% of all cancers in dogs, can be life-threatening. However, if caught early enough, these cancers may be treatable, saving your pet’s life.

Additionally, regular visits to your veterinary dentist may also help prevent other life-threatening diseases.

VDS patient, Boots with veterinary technician (nurse) Tara. Boots had severe periodontal disease and tooth resorption (loss of tooth structure). We completed an oral exam, full mouth dental x-rays, and extracted four teeth.

Study Links Dental Disease To Heart Disease In Dogs

Although veterinary dentists focus on taking care of the mouth, the work that they do may also be helping to stave off other serious medical conditions. Recently, Larry Glickman, a professor of epidemiology at Purdue University published a study in the Journal of American Veterinary Medical Association which showed that dogs with untreated periodontal disease have an increased risk of developing heart disease.

This study is similar to one published in human medical journals performed by researchers at Harvard, the results of which suggest that bacteria from the mouth is moved to the heart through the bloodstream. How do bacteria enter the bloodstream? Through bleeding gums - caused by dental disease.

How Often Should My Pet See A Veterinary Dentist?

It’s never too early to see a veterinary dentist! At Veterinary Dental Specialists, we recommend that you make an appointment to see one of our experienced board-certified vetinary dentistry specialists. During a visit, we will examine your pet and then discuss preventative care and/or immediate treatment options with you. If your primary care veterinarian has diagnosed your dog or cat with dental disease, you can ask for a referral to our practice. Call 856.242.9253 to schedule an appointment today.

Why Choose VDS?

VDS is the only facility of its kind in the entire country. We are the only practice entirely dedicated to dentistry and oral surgery for pets and where a full-time board-certified veterinary dentist and full-time board-certified veterinary anesthesiologist are always on staff to ensure the best care and outcomes. For this reason there is no need to fear anesthesia. This ensures the safest, most comfortable experience for your pet.

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The VDS Experience

With two locations to choose from, you can count on VDS for Concierge Care—an exceptional level of service and genuine caring for you and your pet that sets a new standard in delivering veterinary dental care.

Because superior service is our standard of care, and you and your pet deserve it.

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