Dental radiographic findings in cats with chronic gingivostomatitis (2002�2012)

• Localización: JAVMA: Journal of the American Veterinary Medical Association, ISSN-e 0003-1488, Vol. 244, Nº. 3, 2014, págs. 339-345
• Idioma: inglés
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• Resumen

  • Objective�To compare dental radiographic findings in cats with and without feline chronic gingivostomatitis (FCGS).

    Design�Retrospective case-control study.

    Animals�101 cats with FCGS (cases) and 101 cats with other oral diseases (controls).

    Procedures�Controls were age- and treatment date�matched with cases. Conventional full-mouth dental radiographic views were evaluated for distribution, pattern, and severity of alveolar bone loss (periodontitis), tooth resorption, buccal bone expansion, tooth fractures, and retained roots.

    Results�All cases and 77 (76%) controls had periodontitis; differences in extent and severity of periodontitis were significant, with semigeneralized or generalized and moderate or severe periodontitis in 78 (77%) and 93 (92%) cases, respectively, and 28 (28%) and 38 (38%) controls, respectively. The pattern of alveolar bone loss in cases was dominated by horizontal bone loss, with a nonsignificant increase in vertical bone loss, compared with that of controls. Cases were more likely than controls to have external inflammatory root resorption (49 [49%] vs 25 [25%]) and retained roots (57 [56%] vs 28 [28%]). Fewer dental fractures occurred in cases (14 [14%]) than in controls (35 [35%]). There were no differences between cases and controls in breed, sex, or presence of feline resorptive lesions or buccal bone expansion.

    Conclusions and Clinical Relevance�Results suggested that FCGS was associated with more widely distributed and severe periodontitis, with a higher prevalence of external inflammatory root resorption and retained roots than other oral diseases. Full-mouth radiographic views are indicated for cats with FCGS to diagnose the extent of associated periodontitis, reveal external inflammatory root resorption, and identify retained roots.

    Feline chronic gingivostomatitis is characterized by chronic, severe inflammation of the gingiva, buccal mucosa, and caudal aspect of the oral mucosa; the palate, oropharynx, and tongue are also occasionally involved.1,2 Presence of caudal stomatitis (also called caudal mucositis; often incorrectly referred to as faucitis) differentiates FCGS from other inflammatory oral mucosal diseases.2 Hyperglobulinemia is reported in up to 50% of cases.3,4 Other clinical signs such as inappetence, weight loss,5,6 and unkempt hair7 may also be present, particularly at more advanced stages.

    Feline chronic gingivostomatitis is considered to have a multifactorial etiology, with viral,5,8 bacterial,6,9 and immune5 factors suggested as causal. Conditions such as periodontitis and FRLs have also been suggested to play a role in FCGS.2 Diagnosis can be made on the basis of clinical findings, but determining the full extent of the dental lesions requires probing and full-mouth dental radiography.10 The diagnosis of FCGS may be confirmed with histologic analysis of affected tissues, typically revealing a lymphoplasmacytic infiltrate in the mucosa and submucosa.5 Although the soft tissue aspects of FCGS are well characterized, limited data are available regarding the degree and extent of hard tissue involvement.

    The veterinary literature contains no systematic, controlled investigations that include evaluation of dental radiographs of a large number of cats with FCGS. It has been reported that only cats severely affected by FCGS have periodontal disease, whereas most have no dental disease11; there is no indication whether this claim was based on probing and dental radiography or solely on clinical appearance. Other investigators4 provide a vague description of the degree of dental disease in cats with FCGS and report that few patients studied required and underwent dental treatment.

    A limited number of reports of case series that include radiographic findings of cats with FCGS have been published.7,12,13 Periodontitis has been reported in certain subtypes of FCGS, whereas other subtypes were described as free of periodontal disease.7,12 Retained roots12 and FRL7,12 are also reported in association with FCGS. A common issue in these reports is that not all cats with FCGS are described as having caudal stomatitis,10,12 or the results are not reported separately for cats with and without caudal stomatitis.7 Other reports11 do not provide details of radiographic findings. One study13 of cats with caudal stomatitis reported radiographic findings consisting of horizontal bone loss with high prevalences of FRL and retained roots. An increased OR for retained roots has been reported in cats with FCGS.14 Dental radiography is used to evaluate the presence and extent of lesions involving the hard tissues of the dentoalveolar complex. The distance between the alveolar margin and the CEJ is the most widely used criterion to evaluate periodontal health,15,16 with a distance > 1 mm considered abnormal in cats.15,17 Alveolar bone loss in periodontal disease can be classified as horizontal or vertical. Horizontal bone loss is characterized by a reduction in alveolar margin height relative to the CEJ, with the alveolar margin remaining perpendicular to the long axis of the tooth roots.18 Vertical bone loss occurs in an oblique direction so that the base of the defect is located apical to the surrounding bone.18 In multirooted teeth, progression of either type of bone loss can result in involvement of the furcation area.18 Buccal bone expansion is an idiopathic condition in cats associated with vertical bone loss; this appears as an increase in the thickness (> 2 mm)15 of the alveolar bone and widening of the periodontal ligament space buccal to the canine teeth.

    In addition to alveolar bone loss, dental hard tissue abnormalities may include several types of tooth resorption. In humans and dogs, 7 types of tooth resorption, each with different radiologic characteristics, are known19; a similar evaluation has not been performed for cats. In addition, FRLs occur in cats and are characterized by idiopathic resorption of tooth substance,20 commonly starting at the CEJ,21 leading to tooth weakening and potentially fracture of the tooth and loss of the tooth crown. Retained roots are often a result of FRL and may contribute to persistent local inflammation.15,22 Of the 7 types of tooth resorption that occur in dogs, the 2 most common are external inflammatory root resorption and external replacement resorption.19 External inflammatory root resorption is a distinct entity occurring in response to periodontal ligament injury or inflammation.19 This appears radiographically as loss of root substance associated with evidence of periodontitis or periapical inflammation.19 External replacement resorption, in which the periodontal ligament is progressively replaced with alveolar bone, results in fusion of the cementum with the surrounding bone.19 The prevalences of external inflammatory root resorption and external replacement resorption in cats with FCGS have not been investigated. According to the American Veterinary Dental College's tooth resorption classification guidelines,23 type 1 resorption refers to a tooth with focal or multifocal radiolucency with an intact periodontal ligament, whereas type 2 resorption refers to a tooth with alteration of the periodontal ligament space and decreased radioopacity in part of the tooth. Feline resorption lesions may be classified as type 1 or 2, which to some extent overlaps with external inflammatory or external replacement resorption, respectively. Fracture of the crown of a tooth generally occurs because of trauma and can be classified as complicated (with pulp exposure) or uncomplicated (without pulp exposure).

    Periodontitis is a progressive disease characterized by cyclic activity and quiescence,24 which results in loss of periodontal attachment and, eventually, tooth loss. In addition, the inflammatory process in periodontitis can affect the integrity of tooth structure and may be seen radiographically as external inflammatory root resorption.19 Feline chronic gingivostomatitis, on the other hand, is a chronic inflammatory process considered to be clinically continuous and progressive in the absence of treatment. As such, it is reasonable to conclude that FCGS would contribute to the progression of periodontitis.

    The purposes of the study reported here were to determine the distribution, patterns, and severity of alveolar bone loss and prevalence of FRL, tooth fractures, retained roots, and external inflammatory root resorption or external replacement resorption in cats with FCGS, compared with cats with other oral diseases. Feline resporptive lesions have been reported in association with FCGS, and evaluation of these specific types of resorption lesions would allow comparison of prevalence of resorption of an inflammatory cause (external inflammatory root resorption) with that of a noninflammatory cause (external replacement resorption). A secondary aim was to determine whether age, sex, or breed was associated with FCGS.