Page 362 - Problem-Based Feline Medicine

354 PART 6 CAT WITH WEIGHT LOSS OR CHRONIC ILLNESS

Continuum of disease from mild gingivitis to ● Perform a full oral examination under general anes-
chronic, severe, intractable oral inflammation. thesia to assess for periodontal disease and feline
● Most cases are due to lymphoplasmacytic gin- odontoclastic resorptive lesions, including a full
givitis/stomatitis. mouth radiographic dental survey.
The condition may be waxing and waning in nature but Biopsy and histopathological examination of
in some cases is progressive. affected areas is required for definitive diagnosis of the
lymphoplasmacytic nature of the lesions.
Oral examination reveals erythema, swelling, ulcera-
tion and proliferative lesions (giving a cobblestone
appearance) of varying severity. The tissue is friable
Differential diagnosis
and therefore tends to bleed easily.
● These lesions may involve the gingiva, glos- Other diseases that may appear clinically similar on
sopalatine arches (fauces), pharynx, buccal examination include neoplasia (squamous cell carci-
mucosa and less commonly the tongue, hard palate noma and fibrosarcoma), eosinophilic granuloma com-
and lips. plex and autoimmune disease (pemphigus vulgaris and
● Many cats have significant dental disease but it is systemic lupus erythematosus).
not clear whether the inflammation precedes, con-
FIV, FeLV and the respiratory tract viruses, particularly
tributes to, or results from this.
feline calicivirus, may be associated with oral ulcera-
Submandibular lymphadenopathy is also common. tion or stomatitis.
A poor hair coat may be noted due to decreased groom- Stomatitis may be found in association with severe
ing. It is usually accompanied by varying degrees of uremia.
dental disease.
Dental disease may be associated with oral inflamma-
A particular form of oral inflammatory disease is feline tory lesions. If the oral inflammation does not resolve
juvenile hyperplastic gingivitis. with treatment of the dental disease, lymphoplasma-
● This condition affects young cats at the time of cytic gingivitis/stomatitis should be considered.
eruption of adult teeth. Abyssinian and Persian cats
may be predisposed.
● There is a tendency for spontaneous remission with Treatment
maturity.
Initial management involves removing or treating
● Lesions consist of a very proliferative, hyperemic
any underlying etiology identified.
gingivitis.
Attention should be given to the nutritional status of the
cat, including other forms of feeding, if the severity of
Diagnosis
the lesions is preventing the oral intake of food.
The identification of this condition is usually obvious ● A dietary trial of a novel protein source should also
on oral examination. be considered to exclude hypersensitivity as a
● A complete history and clinical examination is cause.
essential to ensure evidence of concurrent disease
Pivotal to management is thorough dental manage-
or additional lesions are not overlooked.
ment. The aim is to improve the overall oral hygiene
The investigation should aim to identify any possible by scaling and polishing, followed by extraction of
predisposing causes of oral inflammation. any anatomically compromised teeth which may be
● Perform routine hematology, biochemistry and uri- acting as foci of inflammation.
nalysis to assess for systemic predisposing disease. ● Repeated dental prophylaxis may be required to
– Approximately half the cats have a polyclonal maintain oral hygiene.
gammopathy. ● In a number of cases the condition resolves or can
● Test for FeLV, FIV and respiratory tract viruses. be more effectively managed after extraction of all