Page 568 - Clinical Small Animal Internal Medicine

536 Section 6 Gastrointestinal Disease

techniques, restoring a normal gingival contour via care­ Stomatitis
VetBooks.ir ful gingivectomy and gingivoplasty, extracting teeth with Stomatitis is a complex, chronic, and destructive inflam­
severe attachment loss, and instituting rigorous home
oral hygiene until elimination of potential causes of the
disease. matory process affecting the epithelium and lamina
propria, with frequent extension into the submucosal tis­
Medical management with antibiotic treatment may sues. This more widespread inflammation of the oral
occasionally be considered as an adjunct to definitive mucosa is estimated to affect 0.7% of cats presented to
treatment, in preparation for the procedure or in veterinary practices.
patients where anesthesia is not an option. Amoxicillin‐ The etiology of stomatitis is not fully understood, but
clavulanic acid (Clavamox®, Pfizer) has the highest in it is suspected to be multifactorial and a response to
vitro susceptibility against all isolates and all anaerobes chronic stimulation by a still unidentified antigen. This
isolated from the subgingival spaces of cats. Additionally, contrasts with the contact stomatitis or contact mucosal
enrofloxacin (Baytril®, Bayer) shows high in vitro sus­ ulceration that results from mucosal contact with an irri­
ceptibility for the anaerobes isolated in cats. In dogs, tant, allergen or antigen most often in areas of heavy
amoxicillin‐clavulanic acid has the highest in vitro sus­ plaque burden. This condition is known as canine
ceptibility against all isolates, all aerobes, and all anaer­ chronic ulcerative stomatitis and chronic ulcerative
obes. For dogs, enrofloxacin showed the highest in vitro paradental stomatitis. However, the lesions are com­
susceptibility for gram‐ negative aerobes. Anaerobic monly referred to as “kissing ulcers” or “contact ulcers.”
bacteria oral bacteria in dogs appear to be susceptible to Two cases of concurrent osteomyelitis and paradental
amoxicillin‐clavulanic acid, doxycycline, and erythro­ stomatitis have been reported. Epitheliotropic T cell
mycin, while aerobic bacteria are often also susceptible lymphoma and erythema multiforme have also been
to sulfa‐trimethoprim. reported as causes of an ulcerative stomatitis with minor
Despite the slight differences in susceptibility, no to no significant abnormalities in complete blood counts
major differences are found between the subgingival flo­ and blood biochemical profiles of affected dogs. Whereas
ras of dogs and cats with gingivitis. Evaluation of the cats are likely affected by the idiopathic form of this dis­
effects of systemic doxycycline use in dogs has shown a ease, in dogs the oral inflammation is often associated
significant improvement in gingival attachment and with a systemic disease. Vesiculobullous autoimmune
bleeding with oral subantimicrobial doses of 2 mg/kg per disease, although sometimes confined to dermal tissues,
day. A short‐term (42 days) study evaluating the efficacy can present as oral lesions in up to 90% of patients with
of control of gingivitis with use of cefovecin sodium pemphigus vulgaris and 50% of those with bullous
(Convenia®, Pfizer) after a professional dental cleaning pemphigoid.
showed no significant difference when compared to oral A similar type of lesion, called pyogenic granuloma,
administration of clindamycin. that is proliferative rather than ulcerative in nature devel­
In feline cases where professional dental cleaning and ops in the alveolar or buccal mucosa distobuccal to the
extraction of severely affected teeth do not resolve peri­ mandibular first molar tooth in cats (Figure 50.3). The
odontal inflammation, patients should be tested lesions may result from continued trauma secondary to a
for feline immunodeficiency virus ( FIV)/feline leukemia tight caudal occlusion between the maxillary fourth pre­
virus (FeLV) seropositivity. A greater prevalence and molar and the mandibular first molar, or due to contin­
increased severity of oral inflammation were noted in ued trauma from the maxillary fourth premolar on an
cats infected with FIV. The disease was worse in those area of inflammation on the distobuccal aspect of the
with co‐infection of FIV with feline calicivirus (FCV), or mandibular first molar. Surgical excision of the mass and
with FCV and FeLV. blunting or extraction of the involved tooth or teeth have
When evaluating the systemic effects of periodontal been reported to be 100% effective.
disease in dogs, a strong association has been found Some of the common bacterial isolates in cats with sto­
between increasing severity of attachment loss with matitis include Pasteurella pneumotropica, Pasteurella
changes in systemic inflammatory variables and renal multocida, and Capnocytophaga canimorsus. Prior expo­
indices. Additionally, in dogs with advanced periodontal sure to viral diseases such as FCV, feline herpesvirus
disease, increases in systemic nitric oxide levels two (FHV), FeLV, and FIV is thought to be a risk factor for
weeks after periodontal treatment have been reported, developing stomatitis. This is likely due to the progres­
but the response is idiosyncratic. In cats, the severity of sive decline in immune functions caused by infection
periodontitis has been associated with increases in glob­ with FIV and FeLV. On the other hand, FCV does seem
ulins, alanine aminotransferase, and IgG blood levels, to play a more direct role as shown by persistent shedding
suggesting that periodontal disease is not simply a local­ of this virus in all cats with chronic ulceroproliferative
ized disease but may also affect patients systemically. stomatitis compared to only about 20% in normal cats.