In the practice of medicine, names change constantly. Diseases, body parts, organisms. Usually it is a result of new information research has made available.
Such is the case with Feline Oropharyngeal Inflammation, which takes the place of Feline Stomatitis, Gingivostomatitis, Plasma Cell Gingivitis, Faucitis and Pharyngitis. There are even subcategories for use when specific areas of the mouth are involved.
Gingivitis, inflammation of the gums, is a common condition in dogs and cats. If we (humans) didn’t brush our teeth every day we, too, would suffer a similar rate of inflamed gums as our pets. The word comes from the Latin, gingiva, meaning “gums,” and itis, meaning “inflammation.”
Gingivitis is a broad term referring to any form of gum inflammation: bacterial, viral, chemical or even traumatic. The most common form is a result of gingivitis starts as plaque. If plaque is not brushed away it hardens and becomes calculus, which must be scaled away by your pet’s doctor.
Today, however, we are examining a more aggressive form of gingivitis which affects only cats and, fortunately, only a small percentage of our feline best friends. The condition is Feline Oropharyngeal Inflammation.
Feline Oropharyngeal Inflammation can look very similar to other inflammation conditions of cats’ mouths. However, accurate diagnosis is crucial because the treatment is much different and much more aggressive than that of other syndromes.
Affected cats will have extreme redness of the gums all the way around the affected teeth (which can sometimes be all teeth). They may cease eating and be selective of soft food over hard, resulting in weight loss. Self-grooming may be painful, and less grooming may result in a dull, dry haircoat and mats. “Bad breath” hardly begins to describe the odor.
Everyone knows that the mouth is not a particularly clean place. Bacteria normally live there and the immune system is expected to tolerate the good ones and kill off the bad ones. In addition, when pathogenic (disease-causing) bacteria or viruses enter the mouth, the immune system is called upon to kill them before they advance further into the body.
In Feline Oropharyngeal Inflammation it is believed that the immune system fails to tolerate any plaque. Thus, the two most effective forms of treatment, twice-daily home plaque removal and total dental extraction are the techniques that can virtually eliminate plaque buildup.
Other possible causes that are still being further investigated include genetic predisposition (including breed predilection, as Oriental breeds are over-represented), environmental stress, diet, viral and bacterial infection. While both feline calicivirus and Bartonella species of bacteria have been implicated, researchers know that these, alone, are not the answer they seek.
Histopathology does not provide a definitive diagnosis, but is effective in ruling out neoplasia (cancer) in those patients for whom this differential is included.
WHAT TREATMENT IS AVAILABLE?
There is little surprise among clinicians and researchers that aggressive home care of these patients contributes little to long-term success. Who has the time, energy and stamina to attend to his cat’s teeth twice daily for a lifetime? It is simply impractical.
Likewise, medical treatment has significant limitations. Of all of the medications that have been used in an attempt to control this condition, only one, the corticosteroid family, has offered significant long-term relief. However, corticosteroids, too, fail to be a viable solution because of their drawbacks: predisposing patients to diabetes mellitus and reducing the immune system’s ability to control inflammation and infection throughout the body.
Thus, the only approach with any promise has been total extraction of all teeth. Most board-certified veterinary dentists recommend a single surgical session, not repeated episodes of extracting a few teeth at a time. Some allow canine teeth that are normal on radiographs (X-ray) to remain.
Ten years ago we knew little to do for kitties with this horrible disease. Unfortunately, it isn’t going away, rather we are seeing more of it. We are fortunate to finally have a successful treatment modality.
See you next week, Dr. Randolph.
Our extreme gratitude to Dr. Jan Bellows, double-boarded veterinarian of All Pets Dental, Weston, FL.