Oral Pathology

Lectures 8 and 9

What is defined as inflammation of alveolar mucosa (i.e., mucosa overlying the alveolar process and extending from the mucogingival junction without obvious demarcation to the vestibulr sulcus and to the floor of the mouth)?

alveolar mucositis

What is defined as inflammation of mucosa on the floor of the mouth?

sublingual mucositis

What is defined as inflammation of lip/cheek mucosa?

labial/buccal mucositis

What is defined as inflammation of mucosa of the caudal oral cavity, bordered medially by the palatoglossal folds and fauces, dorsally by the hard and soft palate, and rostrally by alveolar and buccal mucosa?

caudal mucositis

What is defined as a condition in the cat characterized by inflammation of the oral mucosa, often affecting the area immediately lateral to the palatoglossal folds with or without inflammation of other oral mucosa; it commonly presents during the chronic stage, with or without inflammation extending into mucosa of the oropharynx?

Feline stomatitis

What is defined as lesions in susceptible individuals that are secondary to mucosal contact with a tooth surface bearing the responsible irritant, allergen, or antigen?

Contact mucositis and contact mucosal ulceration

What is defined as inflammation of mucosa covering the hard and/or soft palate?

Palatitis

What is defined as inflammation of mucosa of the dorsal and/or ventral tongue surface?

Glossitis

What is defined as inflammation of the lip?

Cheilitis

What is defined as inflammation of the palatine tonsil?

Tonsilitis

What is defined as inflammation of the pharynx?

Pharyngitis

What is the elevation of mucosa at the rostral end of the median line of junction of the halves of the palate, concealing the orifices of the incisive ducts?

incisive papilla

What are the transverse ridges of mucosa on the hard palate?

palatine rugae

List localized inflammatory diseases.

Feline Chronic Gingivostomatitis (FCGS)

Juvenile Periodontitis (Cats)

Canine Chronic Ulcerative Stomatitis (CCUS)

The term ____ is generally reserved for widespread oral inflammation that is beyond gingivitis and periodontal disease and may extend into submucosal tissues?

stomatitis

_____ is inflammation of the caudal oral mucosa lateral to the palatoglossal folds.

Caudal stomatitis

What is the etiology of feline chronic gingivostomatitis?

unknown but thought to be mutlifactorial involving viruses (Calicivirus), bacteria, individual immune response, and living conditions

List symptoms/exam findings of feline chronic gingivostomatitis.

dysphagia and pain —>will not eat

extensive oral inflammation and ulceration of the soft tissues

sublingual mucositis and contact mucositis can be present

severe, proliferative inflammation of the caudal oral mucosa, including the palatoglossal arches, is the most consistently affected region

vocalization when opening the mouth

hypersalivation

halitosis

How can we diagnose feline chronic gingivostomatitis?

awake oral exam findings partnered with dysphagia, anorexia, pain

hyperglobulinemia on chemistry profile

What is the treatment for feline chronic gingivostomatitis?

medical treatment in combination with or after surgical treatment including full or partial mouth dental extractions

recheck at 3-4 weeks then every month until improvement of lesions —> may take up to 6 months for lesions to resolve after surgery

What are the goals of medical management therapy for feline chronic gingivostomatitis for refractory cases or those unable to have anesthesia?

module inflammatory response and reduce pain

What is included in medical management of feline chronic gingivostomatitis?

glucocorticoids (or cyclosporine)

NSAIDs

adjunctive pain management (gabapentin, buprenorphine)

What is the role of antimicrobial therapy in feline chronic gingivostomatitis cases?

to control secondary infection and subsequent worsening or oral inflammatory lesions

typically Clavamox, Clindamycin, and Metronidazole

What is an alternative therapy that can be used in reffractory cases of feline chronic gingivostomatitis that cannot have glucocorticoids or under go anesthesia?

recombinant feline interferon-omega

What is seen in this image?

feline chronic gingivostomatitis

What age is juveline periodontitis typically seen in cats?

<9 months

List findings associated with juvenile periodontitis in cats.

rapid accumulation of plaque and calculus, with subsequent gingivitis

significantly early bone loss, periodontal pocket formation, gum recession, and furcation exposure

halitosis at time of adult dental eruption

NO caudal mucositis

non-painful

What is seen in this image?

juvenile periodontitis

What is the treatment for juvenile periodontitis?

extraction of significantly diseased teeth

daily homecare: 1-TDC capsule applied daily to gums

What is the severe inflammatory condition affecting the gingival and mucosa of the oral cavity characterized by contact mucositis consisting of inflammation and ulceration of the mucsosa in contact with the surface of the teeth; localized vestibular ulcers may also be present?

canine chronic ulcerative stomatitis

List symptoms of canine chronic ulcerative stomatitis.

depression

anorexia

inability to fully open mouth

restricted yawning

pain

drooling

severe halitosis

head shy

What is seen in this image?

canine chronic ulcerative stomatitis

What physical exam findings are associated with canine chronic ulcerative stomatitis?

severe streaking erythema on attached and unattached mucosal surfaces

uclerations on the labial and buccal mucosa

kissing lesions (localized vastibular contact ulcers)

intertrigo and dermatitis of the lower lip due to drooling

scarring of mucosal tissues at the lip commissures in chronic cases

How can we diagnose canine chronic ulcerative stomatitis?

clinical history and excluding other causes

histopathology of lesions can support diagnosis

What differential diagnoses must be considered in suspected canine chronic ulcerative stomatitis cases?

uremic ulcers

ulcers secondary to lepto

mucositis secondary to contact with irritants

adverse drug interactions

stomatitis secondary to chemo or radiation treatment

autoimmune disease

epitheliotropic lymphoma

eosinophilic granuloma

traumatic mucositis

thermal burn

What is the treatment for chronic canine ulcerative stomatitis?

diligent homecare

multimodal pain management (NSAID+gabapentin±opioid)

conservative: COHAT, application of plaque reducing agent. strategic extraction of teeth causing contact mucositis/kissing, repeat cleanings every 6mo

aggressive: extraction of all teeth

List differential diagnoses for ulceroproliferative diseases in dogs.

generalized gingivostomatitis / CCUS

autoimmune skin diseases (lupus, pemphigus vulgaris)

uremia

eosinophilic granuloma complex

mucosal drug reaction

chemical or thermal injury

infection

neoplasia (lymphoma, melanoma)

What is the vesiculobullous and.or ulcerative skin disease with uncommon oral involvement, but affected areas inlude intraoral and extraoral sites including the ventrum of the trunk, mucocutaneous junctions, footpads, pinnae, ulcerative stomatitis, and glossitis; nonspecific gingivitis and stomatitis can mimic this disease?

Erythema multiforme

What is the autoimmune disease characterized by autoantibodies against various cellular antigens that affects epithelial cells of the skin and mucosa?

Lupus erythematosus

What disease is seen in middle aged dogs, is caused by autoantibodies directed against desmoglein-3 in the basal cell layers of the epidermis and oral mucosa, and affects keratinized oral epithelium of the hard palate, gingiva, and dorsal tongue?

Pemphigus vulgaris

What disease is more commonly found in young animals 2-6 years old, lesions are typically linear, well circumscribed, raised, yellowish pink in color on the skin, paws, cheek, lip commissure, pinna of the ear, or oral cavity, and can be associated with insect bite allergies, food allergy, atopy, immunosuppression, and bacerial and viral (calicivirus) infections?

Eosinophilic granuloma complex (cats)

What disease is seen in young animals 1-7 years of age and is typically palatal lesions with no clinical signs?

Eosinophilic stomatitis (dogs)

How does oral eosinophilic granuloma typically present in Siberian Huskies?

hereditary or familial

usually on the tongue, can also be seen on palatal mucosa

lingual lesions = halitosis and oral discomfort

How does eosinophilic stomatitis present in Cavalier King Charles Spaniels?

presented for dysphagia, paroxysmal coughing, or anorexia

mucosal ulceration, plaque formation, and granulomatous lesions

familial

What is an uncommon canine autoimmune inflammatory disorder affecting the gingival, oral mucosa, and underlying alveolar bone that includes the complement system inhibition with C5a as important in pathogenesis, and clinically has gingival lesions that can be multifocal, bruised, and erythematous in appearance, expansile, and friable?

Wegner’s Granulomatosis

List differential diagnoses for suspected cases of Wegner’s granulomatosis.

traumatic granuloma

necrotizing ulcerative stomatitis

pyogenic granuloma

neoplasia

immune mediated conditions

What disease is caused by a low phosphorous or low calcium:phosphorous ratio, and can be caused by functional adenoma, chronic renal insufficiency or nutritional deficiency, or as a result of diets with low calcium to phosphorous ratio such as all meat?

hyperparathyroidism (rubber jaw, renal osteodystrophy)

What rare condition is related to dwarfism, with obstipation, megacolon, and delated dental eruption being primary presenting complaints leading to diagnosis, and treatment consisting of levothyroxine supplementation and gingivectomy?

Congenital hypothyroidism (cats)

What condition occurs in dogs and cats as a result of chronic renal disease causing multifocal oral ulceration, fibrinoid necrosis of aerterioles withint he oral mucosa, and necrotic (foul smelling) lesions along the ventral aspect of the tongue and buccal mucosa?

uremic ulcers

A 4yo FS DSH cat presents for oral pain and inflammation. FIV/FeLV negative, UTD on vaccines and preventative care. Pain when eating observed by the owner. No weight loss at time of presentation. Slower eating but not anorexic.

What do you see?

issues throughout the mouth, not just in one location

caudal mucositis

moderate to severe gingivitis

moderate calculus

A 4yo FS DSH cat presents for oral pain and inflammation. FIV/FeLV negative, UTD on vaccines and preventative care. Pain when eating observed by the owner. No weight loss at time of presentation. Slower eating but not anorexic. The patient was painful on awake oral exam.

You see the folllowing on oral exam:

• issues throughout the mouth, not just in one location

• caudal mucositis

• moderate to severe gingivitis

• moderate calculus

What is your diagnosis and how would you treat?

feline chronic gingivostomatitis (FCGS)

extract all remaining teeth