{"id":1176,"date":"2013-11-01T17:17:31","date_gmt":"2013-11-01T17:17:31","guid":{"rendered":"http:\/\/phosdev.com\/todaysveterinarypractice\/?p=1176"},"modified":"2022-10-06T13:48:37","modified_gmt":"2022-10-06T13:48:37","slug":"dental-diagnosis-cat-with-calculus-gingivitis-missing-teeth","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/dentistry\/dental-diagnosis-cat-with-calculus-gingivitis-missing-teeth\/","title":{"rendered":"Cat with Calculus, Gingivitis, &amp; Missing Teeth"},"content":{"rendered":"<p><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2016\/09\/T1311C02.pdf\"><img decoding=\"async\" class=\"alignnone size-full wp-image-9886\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2011\/07\/pdf_button.png\" alt=\"pdf_button\" width=\"110\" height=\"27\" \/><\/a><\/p>\n<p>A 7-year-old, neutered male cat presented for a routine dental cleaning. Significant calculus and gingivitis were present throughout the mouth; halitosis and several missing teeth were also noted. The rest of the physical examination was unremarkable and the pre-operative workup was within normal limits.<\/p>\n<p>Based on the level of oral inflammation, dental prophylaxis and examination, with likely extractions, were planned for the patient.<\/p>\n<p>Following induction of anesthesia, a complete oral examination was performed, which confirmed moderate to significant calculus and gingivitis throughout the mouth. Oral examination also revealed a mobile right maxillary fourth premolar (108), with a 12-mm periodontal pocket (<strong>Figure 1<\/strong>).<\/p>\n<div class=\"orange-box\">\n<h2 class=\"blue\"><strong><span class=\"redheader\">Clinical Signs<\/span><\/strong><\/h2>\n<ul>\n<li>Halitosis<\/li>\n<li>Calculus and gingivitis<\/li>\n<li>Missing teeth<\/li>\n<li>Mobile maxillary premolar with periodontal pocket<\/li>\n<\/ul>\n<\/div>\n<h2 class=\"blue\">QUESTIONS<\/h2>\n<p class=\"blue\">Based on this patient&#8217;s history and oral examination:<\/p>\n<ol>\n<li>What is your diagnosis?<\/li>\n<li>What treatment options would you recommend?<\/li>\n<\/ol>\n<div id=\"attachment_2293\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/11\/Figure-111.jpg\"><img fetchpriority=\"high\" decoding=\"async\" aria-describedby=\"caption-attachment-2293\" class=\"wp-image-2293 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/11\/Figure-111-300x265.jpg\" alt=\"Figure 1(1)\" width=\"300\" height=\"265\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/11\/Figure-111-300x265.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/11\/Figure-111.jpg 339w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-2293\" class=\"wp-caption-text\">Figure 1<\/p><\/div>\n<h2>ANSWERS<\/h2>\n<ol>\n<li>The most likely diagnosis for a patient with heavy calculus and gingivitis, along with a mobile tooth, is advanced periodontal disease.<sup>1<\/sup><\/li>\n<li>The best treatment option is extraction of the diseased (mobile) tooth.<\/li>\n<\/ol>\n<p>However, dental radiography should be performed prior to all extractions, and full-mouth dental radiographs should be taken during every dental procedure, especially in patients with advanced periodontal disease.<sup>2-4<\/sup><br \/>\nPrior to pursuing tooth extraction, a dental radiograph was exposed of the affected area in the patient&#8217;s mouth (<strong>Figure 2<\/strong>).<\/p>\n<div id=\"attachment_2294\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/11\/Figure-211.jpg\"><img decoding=\"async\" aria-describedby=\"caption-attachment-2294\" class=\"wp-image-2294 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/11\/Figure-211-300x225.jpg\" alt=\"Figure 2(1)\" width=\"300\" height=\"225\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/11\/Figure-211-300x225.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/11\/Figure-211.jpg 400w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-2294\" class=\"wp-caption-text\">Figure 2<\/p><\/div>\n<h2 class=\"blue\">QUESTIONS<\/h2>\n<p>Based on this radiograph:<\/p>\n<ol>\n<li>Is advanced periodontal disease still the most likely diagnosis?<\/li>\n<li>Would you pursue tooth extraction or choose another treatment option?<\/li>\n<\/ol>\n<p>The dental radiograph (<strong>Figure 3<\/strong>) reveals:<\/p>\n<ul>\n<li>Significant lysis of bone and a moth-eaten appearance (red arrows) surrounding the right maxillary premolar (108) (rather than bony destruction, which would be seen with advanced periodontal disease)<\/li>\n<li>Irregular, productive coronal radiation (lower red arrow) of the marginal bone that extends slightly mesial to #108 at the level of 2 tooth roots, most likely those of #106 and\/or #107<\/li>\n<li>Tooth resorption evident on all 3 roots of #108.<\/li>\n<\/ul>\n<div id=\"attachment_2295\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/11\/Figure-311.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-2295\" class=\"wp-image-2295 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/11\/Figure-311-300x225.jpg\" alt=\"Figure 3(1)\" width=\"300\" height=\"225\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/11\/Figure-311-300x225.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/11\/Figure-311.jpg 400w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-2295\" class=\"wp-caption-text\">Figure 3<\/p><\/div>\n<h2 class=\"redtimesbold\">ANSWERS<\/h2>\n<ol>\n<li>The significant bone lysis is consistent with a more aggressive process, most likely neoplasia.<sup>5<\/sup><\/li>\n<li>In addition to extraction, treatment should include harvesting a section of bone and soft tissue from the affected area for histopathologic evaluation.<\/li>\n<\/ol>\n<div class=\"orange-box\">\n<p>The biopsy revealed high-level squamous cell carcinoma (SCC).<\/p>\n<\/div>\n<hr \/>\n<h2><span class=\"redtimesbold\">CASE DISCUSSION<\/span><\/h2>\n<p>Neoplasia is defined as\u00a0<em>abnormal growth of cells that is not responsive to normal growth control<\/em>.<sup>6<\/sup>\u00a0Neoplasms can be further classified by their biologic behavior as benign or malignant.<sup>7,8<\/sup><\/p>\n<h3><strong><span class=\"blue\">Malignant Neoplasia<\/span><\/strong><\/h3>\n<ul>\n<li>Malignant oral neoplasms typically invade bone early in the course of disease, resulting in irregular bone destruction, which will have a mottled, moth-eaten appearance.<\/li>\n<li>Late in the course of disease, radiographs reveal a complete loss of bone (teeth will appear to float in space).<\/li>\n<li>If the cortex is involved, an irregular periosteal reaction may be seen as well as lysis of the cortical bone.<\/li>\n<li>In my experience, as many as 50% of oral SCCs are not characterized by the presence of a mass lesion and, instead, cause bone destruction (as was the case in this cat).<\/li>\n<\/ul>\n<h3><strong><span class=\"blue\">Benign Masses<\/span><\/strong><\/h3>\n<ul>\n<li>Most benign neoplastic growths show no bone involvement on dental radiographs.<\/li>\n<li>If bone involvement does occur, it is expansive:<\/li>\n<\/ul>\n<ol>\n<li>The bone &#8220;pulls away&#8221; from the advancing tumor.<\/li>\n<li>This space fills with decalcified soft tissue.<\/li>\n<li>Tooth movement typically results due to this process.<\/li>\n<\/ol>\n<p>Both malignant and benign neoplasms may have bone involvement, but benign masses usually have distinct bone margins (<strong>Figure 4<\/strong>), while the bone affected by malignant neoplasms has a moth-eaten appearance.<\/p>\n<div id=\"attachment_5023\" style=\"width: 409px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/11\/Figure-43.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-5023\" class=\"wp-image-5023 size-full\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/11\/Figure-43.jpg\" alt=\"Figure 4\" width=\"399\" height=\"300\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/11\/Figure-43.jpg 399w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/11\/Figure-43-300x226.jpg 300w\" sizes=\"(max-width: 399px) 100vw, 399px\" \/><\/a><p id=\"caption-attachment-5023\" class=\"wp-caption-text\">Figure 4. Smooth areas of complete bone loss (red arrows) compared with normal bone height (blue arrows).<\/p><\/div>\n<h3><strong><span class=\"blue\">Histopathologic Testing<\/span><\/strong><\/h3>\n<p>If oral masses or suspicious bone changes are noted on radiographs, histopathologic testing of biopsy samples is always necessary. Accurate diagnosis of oral masses is critical because a variety of benign and malignant tumors appear radiographically similar. SCC can be destructive (no mass) and\/or productive (mass is present); as noted earlier, no mass was present in this cat.<\/p>\n<p>In addition, osteomyelitis can create similar radiographic findings to those found in neoplasia. If bone lysis is seen on radiographs, or any other suspicious clinical findings are present, histopathology should be pursued.<br \/>\nTo aid the pathologist, the practitioner should:<\/p>\n<ul>\n<li>Note the type and extent of bony involvement (if any) on the histopathology request form<\/li>\n<li>Include copies of the radiographs and intraoral pictures with the form.<br \/>\nHistopathology results must be interpreted in light of (and should agree with) the radiographic findings. For example, in this case, the radiographic evidence indicates malignancy; if the biopsy result had indicated a benign process, I would have questioned the result and investigated further.<\/li>\n<\/ul>\n<h3><strong><span class=\"blue\">Tooth Mobility<\/span><\/strong><\/h3>\n<p>As stated previously, the most common cause of tooth mobility is advanced periodontal disease. However, neoplasia also causes bone resorption and can create tooth mobility. Additional clues that mobility may be related to neoplasia rather than periodontal disease include:<\/p>\n<ul>\n<li>One quadrant having several diseased teeth while the remainder of the mouth is relatively healthy.<\/li>\n<li>The mobile tooth often lacks deep periodontal pockets; however, in this case, a periodontal pocket was present.<\/li>\n<li>Lack of calculus when the mobile tooth is extracted, indicating a quick loss of bone in the affected area and its lack of exposure to the oral cavity (exposure would result in calculus production).<\/li>\n<\/ul>\n<h3><strong><span class=\"blue\">Treatment<\/span><\/strong><\/h3>\n<p>Early and aggressive therapy is the key to successful management of oral neoplasia in the dog and cat. Unfortunately, treatment of feline oral SCC is very challenging, especially when SCC is advanced:<\/p>\n<ul>\n<li>The minimum 2-cm margins typically recommended for removal of malignant masses are difficult to achieve in feline patients.<\/li>\n<li>These tumors in feline patients are poorly responsive to other modalities, such as chemotherapy and radiation therapy.<sup>9<\/sup><\/li>\n<\/ul>\n<p>Referral to a veterinary dentist, surgeon, or oncologist is recommended for optimal therapy.<\/p>\n<div class=\"orange-box\">\n<h2><strong><span class=\"redtimesbold\">AAHA&#8217;s Guidelines Highlight Importance of Dental Radiography<\/span><\/strong><\/h2>\n<p>The 2013 AAHA Dental Care Guidelines for Dogs and Cats clearly outline the importance of dental radiography in all patients, regardless of whether visible pathology is present, stating that full-mouth radiography is &#8220;necessary for accurate evaluation and diagnosis.&#8221; It is also essential for proper treatment; the guidelines specify, &#8220;It is not until the oral radiographs have been evaluated that a full treatment plan&#8230;can be successfully made with any degree of accuracy.&#8221; Read the guidelines at <a href=\"http:\/\/aahanet.org\/PublicDocuments\/Dental_Guidelines.pdf\">aahanet.org\/PublicDocuments\/Dental_Guidelines.pdf<\/a>.<\/p>\n<\/div>\n<p>AAHA = American Animal Hospital Association; SCC = squamous cell carcinoma<\/p>\n","protected":false},"excerpt":{"rendered":"<p>A 7-year-old cat is admitted for routine dental cleaning; however, it has significant calculus and gingivitis, several missing teeth, and a mobile tooth.<\/p>\n","protected":false},"author":187,"featured_media":2813,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"iawp_total_views":188,"footnotes":""},"categories":[371],"tags":[13],"class_list":["post-1176","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-november-december-2013","tag-peer-reviewed","clinical_topics-dentistry"],"acf":{"hide_sidebar":false,"hide_sidebar_ad":false,"hide_all_ads":false},"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v24.7 (Yoast SEO v27.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Cat with Calculus, Gingivitis, &amp; 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