11. Diseases of the lips. Mouth diseases. Gingivitis. Tartar. Neoplasia of the soft and hard tissue in mouth. Cleft palate. Oronasal fistula. Surgical diseases of the nose.

What are examples of diseases of the lips?

1. Lip fold dermatitis

2. Eosinophilic granuloma complex

3. Feline eosinophilic granuloma complex

What is lip fold dermatitis?

Chronic skin inflammation of drooping upper lips and lower lip folds.

What causes lip fold dermatitis?

Accumulation of moisture in the lip folds, leading to irritation, inflammation, and a good environment for bacterial growth. Worsens with bad oral hygiene

What are the clinical signs of lip fold dermatitis?

Redness, inflammation, bad smell, swelling, and pain on palpation.

How is lip fold dermatitis treated?

• Conservative: Clipping hair, cleaning folds with mild skin cleansers/chlorhexidine, keeping the area dry

• Surgical correction of droopy lips.

In which animals can eosinophilic granuloma complexes be found?

1. Dogs, horses (rare)

2. Cats (common)

What are the three forms of skin lesions in the feline eosinophilic granuloma complex?

Eosinophilic plaque, eosinophilic granuloma, and indolent ulcers.

What is the aetiology of eosinophilic granuloma complex?

A type IV hypersensitivity reaction

Which breed of dog is predisposed to eosinophilic granuloma complex?

Siberian Husky

What are the clinical signs of eosinophilic granuloma complex regarding lips?

Ulcers on the lips (especially the upper lip), clearly demarcated ulcers with raised borders and swelling, ptyalism, halitosis, oral bleeding, reluctance to eat hard food, dysphagia, anorexia, and weight loss.

How is eosinophilic granuloma complex diagnosed?

History (ruling out other causes of stomatitis), physical exam, and biopsy.

How is eosinophilic granuloma complex treated?

Dental prophylaxis, fluids, nutritional support, antibiotics (amoxicillin), and corticosteroids (prednisone: 0.5-1 mg/kg PO for 7 days, taper off).

What are examples of mouth diseases?

1. Stomatitis

2. Gingivitis

3. Periodontitis

4. Feline odontoclastic resorptive lesions

What is stomatitis?

Inflammation of the oral mucosa, including gingivitis and glossitis.

What are some causes of stomatitis?

1. Trauma and periodontal disease/gingivitis (Ulcers where the lip touches tartar (upper lip next to P4 or canines)

2. Heavy metal poisoning

3. Oral neoplasia

4. Chemical injury – strong acid or alkali

5. Metabolic – renal failure, DM, hypothyroidism

6. Idiopathic – eosinophilic granuloma complex

7. Infectious – Herpes, Calici, Candida, spirochaetes

8. Auto-immune – SLE, pemphigus, idiopathic vasculitis, toxic epidermal necrosis

9. Immune-deficiency – FeLV, FIV

What are the clinical signs of stomatitis?

Halitosis, ptyalism, dysphagia, inappetence, and weight loss.

How is stomatitis diagnosed?

History, physical exam, and histopathology.

How is stomatitis treated?

Depends on the cause.

What is gingivitis?

Inflammation of the gingiva.

What are causes of gingivitis?

1. Plaque: microorganisms form in a matrix of salivary glycoproteins and extracellular polysaccharides, adhere to tooth covering

2. Complicated by bacteria: Actinomyces, Streptococcus, Porphyromonas gingivalis, Fusobacterium, Prevotella

3. Tartar: mineralised plaque >2 weeks in duration

   1. Forms in layers, separated by organic cuticle, mineralised plaque forms from saliva and sulcular fluid

What is periodontitis?

Loss of attachment of the gingiva to the alveolar bone, leading to increased depth of the gingival sulcus.

What is plaque?

Microorganisms in a matrix of salivary glycoproteins and extracellular polysaccharides that adhere to the tooth surface.

Which bacteria are commonly involved in gingivitis?

Actinomyces, Streptococcus, Porphyromonas gingivalis, Fusobacterium, and Prevotella.

What is tartar?

Mineralised plaque (older than 2 weeks).

What are the clinical signs of gingivitis?

Halitosis, gingival swelling, and horizontal and vertical periodontal pockets.

What is the normal gingival sulcus depth in cats and dogs?

Cats: 0.5-1mm; Dogs: 2-3mm.

What are the stages of gingivitis/periodontitis?

• Stage 0: Normal

• Stage 1: Mild gingivitis (reversible)

• Stage 2: Moderate gingivitis (reversible)

• Stage 3: Periodontitis (irreversible)

• Stage 4: Severe periodontitis (irreversible).

What are the characteristics of stage 1 gingivitis?

Mild plaque and inflammation of the gingival margin.

What are the characteristics of stage 2 gingivitis?

Moderate sub-gingival plaque and supra-gingival calculus, moderate gingivitis.

What are the characteristics of stage 3 periodontitis?

Increasing plaque and calculus (including sub-gingival), established gingivitis, pocket formation, and radiographic changes.

What are the characteristics of stage 4 periodontitis?

Severe gingival inflammation, deep pocket formation, bone loss, and tooth mobility.

What is periodontitis?

Inflammation of the periodontium (gingiva, periodontal ligament, and alveolar bone).

What is the progression from gingivitis to periodontitis?

Bacteria grow and adhere to teeth → plaque progresses under the gingiva → loss of connective tissue → deep pockets. Plaque then mineralises into tartar → swelling, bleeding, pus formation, bone loss, gingival recession, root exposure, and loose teeth.

What are the clinical signs of periodontitis?

Red gingival margins, periodontal pockets, pain on gum palpation, halitosis, reluctance to eat hard food, gingival recession, black calcified material on teeth, root mobility, root exposure, and purulent discharge.

How is periodontitis diagnosed?

Clinical signs, X-rays of roots, and probing for pockets (deep pockets are > 3mm).

How is periodontitis treated?

Mechanical plaque removal with a scaler, gingivectomy, antibiotics, NSAIDs, Stomodine gel, gingival flap procedure, and tooth extraction.

How is periodontitis prevented?

Daily tooth brushing with dog toothpaste, chewing toys/bones, and Stomodine gel.

What are complications of periodontitis if not treated?

Deep periodontal pockets → anaerobic environment for virulent strains → pneumonia, endocarditis, micro-abscessation in liver or kidneys

What are feline odontoclastic resorptive lesions?

Resorption of teeth by odontoclasts.

What percentage of cats over 4 years old are affected by feline odontoclastic resorptive lesions?

At least 30%.

What is the progression of feline odontoclastic resorptive lesions?

Resorption of dentine from inside out, loss of cementum and dentine, penetration of the pulp cavity, resorption up to the crown, and replacement of resorbed tissue with bone-like tissue.

What are the clinical signs of feline odontoclastic resorptive lesions?

Severe pain, erosions of the tooth surface at the gingival border (often covered with calculus or gingival tissue).

How are feline odontoclastic resorptive lesions treated?

Extraction of affected teeth.

What are some types of oral neoplasia?

1. Squamous cell carcinoma

2. Melanoma

3. Fibrosarcoma

4. Reticulo-endothelial cell tumours

5. Rhabdomyosarcoma

6. Leiomyoma (often infiltrative and ulcerative).

What are the clinical signs of oral neoplasia?

Halitosis, dysphagia, ptyalism, haemorrhagic-purulent stained saliva, oral bleeding, tooth deviation, and facial swelling.

How is oral neoplasia diagnosed?

Clinical exam, biopsy, cytology, histopathology, and radiography (to assess infiltration).

How is oral neoplasia treated?

Complete surgical excision, potentially including tongue resection.

Tongue resection is a bloody procedure, can be controlled by electro-cautery or temporary occlusion of carotid arteries

What are some complications of oral neoplasia?

Anaemia, metastasis, and recurrence due to incomplete excision.

What is cleft palate?

A congenital condition (or acquired due to trauma) where there is an opening in the palate.

What are the two main types of cleft palate?

1. Primary (harelip – affecting the upper lip and maxilla)

2. Secondary (affecting the hard or soft palate or both).

What are some potential causes of cleft palate?

Inherited factors, nutritional deficiencies, hormonal imbalances, mechanical factors, and toxins.

What is the most common cause of cleft palate in cats?

Traumatic after falling from great heights.

Which breeds are predisposed to cleft palate?

Brachycephalic breeds (Boston Terrier, Pekingese, Bulldog, Boxer, Westie, Cocker Spaniel) and Siamese cats.

What are the clinical signs of cleft palate?

Vary depending on severity.

In young animals: starvation, poor growth, milk drainage from nostrils, coughing, gagging, sneezing while eating, respiratory tract infections (aspiration pneumonia), and nasal cavity infections.

How is cleft palate diagnosed?

Primary cleft palate is obvious at birth.

Secondary cleft palate requires examination of the oral cavity.

How is cleft palate treated?

1. Euthanasia (in severe cases)

2. Removal of affected parents from breeding

3. Pre-operative care (feeding tube, antibiotics)

4. Conservative management (orogastric tube feeding, palate guard)

5. Surgical correction (after 12 weeks of age, potentially requiring multiple surgeries as animal grows).

What are some surgical techniques for cleft palate repair?

1. Separate the oral and nasal cavities by reconstructing the nasal floor – Suture together airtight.

2. Close opening with an overlapping flap technique or Sliding bipedicle flap repair.

3. Soft palate: suture together or use overlapping flap technique

What are some complications of cleft palate surgery?

Swelling and long-term dehiscence (fistula formation).

What is the post-operative care after surgical repair of cleft palate?

Adequate nutrition - gastric tube, soft food.

Do NOT feed dry food for at least 6 weeks post-op

What is an acquired oronasal fistula?

An abnormal communication between the nasal and oral cavities caused by trauma or disease (e.g., canine tooth extraction, periodontal disease).

What are the clinical signs of an oronasal fistula?

Chronic rhinitis, sneezing, chronic unilateral serous or mucopurulent nasal discharge, drainage of water/feed from nostrils, cough, aspiration pneumonia.

How is an oronasal fistula diagnosed?

History of dental disease/trauma, probing of periodontal pockets, and X-rays.

How is an oronasal fistula treated?

1. Conservative management (antibiotics for rhinitis, tube feeding)

2. Surgical correction (simple suturing for small fistulas, flap techniques for larger ones).

What is the flap technique for operating on an acquired oronasal fisula?

Create a flap from surrounding tissue to cover the fistula. Mucosal, single/double layer, hard palate, soft palate flaps

What are some surgical diseases of the nose?

1. Nasal tumors: Removal of neoplastic growths from nasal structures (e.g., squamous cell carcinoma). - Rhinotomy

2. Nasal foreign bodies: Surgical removal of lodged foreign materials (e.g., grass awns). - Rhinotomy/endoscope

3. Chronic rhinitis/sinusitis: Inflammation of the nasal passages - Sinusotomy

4. Nasal fractures: Surgical correction of traumatic nasal fractures. Open reduction internal fixation (ORIF) or closed reduction

What is the main problem caused by soft palate surgery?

Swelling

How often should dogs be checked for dental care?

Small dogs: every 6 months

What can cause acquired cleft palate?

Trauma in cats after falling

What can untreated oronasal fistulas cause?

Aspiration pneumona, panophthalmitis (severe, purulent inflammation of all layers and structures of the eye)