FELINE DENTISTRY Oral Assessment, Treatment, and Preventative Care FELINE DENTISTRY Oral Assessment, Treatment, and Preventative Care Jan Bellows A John Wiley & Sons, Inc., Publication Edition first published 2010 © 2010 Jan Bellows Blackwell Publishing was acquired by John Wiley & Sons in February 2007 Blackwell’s publishing program has been merged with Wiley’s global Scientific, Technical, and Medical business to form Wiley-Blackwell This publication is designed to provide accurate and authoritative information in regard to the subject matter covered It is sold on the understanding that the publisher is not engaged in rendering professional services If professional advice or other expert assistance is required, the services of a competent professional should be sought Library of Congress Cataloging-in-Publication Data Editorial Office 2121 State Avenue, Ames, Iowa 50014-8300, USA For details of our global editorial offices, for customer services, and for information about how to apply for permission to reuse the copyright material in this book, please see our website at www wiley.com/wiley-blackwell Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by Blackwell Publishing, provided that the base fee is paid directly to the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923 For those organizations that have been granted a photocopy license by CCC, a separate system of payments has been arranged The fee codes for users of the Transactional Reporting Service are ISBN-13: 978-0-8138-1613-5/2010 Designations used by companies to distinguish their products are often claimed as trademarks All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners The publisher is not associated with any product or vendor mentioned in this book Bellows, Jan Feline dentistry : oral assessment, treatment, and preventative care / Jan Bellows p ; cm Includes bibliographical references and index ISBN 978-0-8138-1613-5 (hardback : alk paper) Veterinary dentistry Cats–Diseases I Title [DNLM: Tooth Diseases–veterinary Cats Dental Care–veterinary Mouth Diseases–veterinary SF 867 B448f 2010] SF867.B447 2010 636.8′08976–dc22 2009031848 A catalog record for this book is available from the U.S Library of Congress Set in 9.5/12 pt Palatino by Toppan Best-set Premedia Limited Printed in Singapore 2010 Dedication This text is dedicated to Dr Colin E Harvey Throughout his professional life, Dr Colin Harvey has taught and mentored others while creating and maintaining the foundation of veterinary dentistry in the United States and around the world Dr Harvey graduated from the School of Veterinary Science at the University of Bristol, England, in 1966 He completed an internship and residency in small animal surgery at the University of Pennsylvania, receiving the Diploma of the American College of Veterinary Surgeons in 1972 Dr Harvey is a diplomate of the American College of Veterinary Surgeons (1972), member of the Organizing Committee and charter diplomate of the American Veterinary Dental College (AVDC, 1988) and the European Veterinary Dental College (1998), and also a charter diplomate of the European College of Veterinary Surgeons (1993) He was section chief of Small Animal Surgery (1974–80) and vice-chair of the Department of Clinical Studies (1996–2002) and was the founding head of the Dentistry and Oral Surgery Service at the University of Pennsylvania (the first dentistry and oral surgery service to be established at a veterinary school in North America) Dr Harvey has received numerous university, national, and international awards for excellence in teaching, research, and clinical work He was elected a fellow of the College of Physicians of Philadelphia in 1980 Dr Harvey has been a board member (1978–83) of the Comparative Respiratory Society, secretary (1985– 89) of the American Veterinary Dental Society, president (1990–92) and executive secretary (2002–present) of the American Veterinary Dental College, cofounder (1985) of the International Veterinary Ear Nose and Throat Association, charter fellow and secretary-treasurer (1987–89) of the Academy of Veterinary Dentistry, and director (1997–present) of the Veterinary Oral Health Council Dr Harvey was editor of the Journal of Veterinary Surgery from 1982 to 1987 and editor of the Journal of Veterinary Dentistry from 1994 to 2000 and has been a reviewer or review board member for numerous other journals His publications include approximately 70 chapters in textbooks, 130 papers in peer-reviewed journals, and over 100 abstracts and other papers on surgical and dental topics He has written, edited, or coedited five books on small animal surgery and dentistry Dr Harvey’s research interests include veterinary and comparative periodontal disease (including comparative microbiology, standardization of periodontal scoring, and prevention and treatment); the interaction of infectious oral diseases, particularly periodontal disease, with the rest of the body, specifically, distant organ and systemic effects; and the utility and effectiveness of antimicrobial drugs in the management of patients with oral diseases Feline dentistry has been of special interest to Dr Harvey Much of what we know about feline dentistry today is largely due to his and his mentees’ uncompromised research and discovery efforts v Contents Preface, viii Acknowledgments, ix Introduction, x Section I Oral Assessment, Chapter Anatomy, Chapter Oral Examination, 28 Chapter Radiology, 39 Chapter Charting, 84 Chapter Oral Pathology, 101 Section II Treatment, 149 Chapter Equipment, 151 Chapter Anesthesia, 169 Chapter Treatment of Periodontal Disease, 181 Chapter Treatment of Endodontic Disease, 196 Chapter 10 Treatment of Tooth Resorption, 222 Chapter 11 Treatment of Oropharyngeal Inflammation, 242 Chapter 12 Treatment of Occlusion Disorders, 269 Chapter 13 Oral Trauma Surgery, 280 Chapter 14 Treatment of Oral Swellings/Tumors, 290 Section III Prevention, 297 Chapter 15 Plaque Control, 299 Index, 305 vii Preface Ah, Cats What would veterinary dentistry be without them! For sure, a lot simpler and less frustrating Even for procedures so apparently “simple” as a tooth extraction, the cat often has the last word, when we as veterinary dentists hear that quiet but awful ‘snick’ that means that a tooth root has fractured, leaving a root tip somewhere down there … Since the first-reported mention of oral disease in cats in the 1920s, a lot of progress has been made, but some key knowledge is not yet available The immunological function of the cat does not seem to obey the same rules as rodents, dogs, and humans; and as a result, immunologically based conditions such as stomatitis continue to frustrate veterinary dentists Teeth in cats are attacked viii by the body’s own tissues for reasons that are still not clear, and our frustrations are heightened by the lack of success of restoring feline teeth undergoing resorption Squamous cell carcinoma is by far the most common feline oral neoplasm, benign or malignant; and it resists all standard treatments used in management of other malignancies When we add in that anesthesia is essential for all feline dental procedures (lest our fingers be impaled by the needle-like, plaque-coated canine teeth) and that cats have such a little mouth compared with dogs, it is not surprising that there is some love-hate aspect to the relationship of veterinary dentists to cats The challenge is one to rise to, and the companionship cats offer makes it all worthwhile A book dedicated to feline dentistry and related topics is overdue I am pleased that Dr Bellows has found the time to pull the material together in a coherent format, so that others may build upon the accumulated experience and knowledge that are described here Those delicate feline oral structures require all the skill and knowledge that we have and deserve our best efforts to ensure that we are not continuously restarting the steepslope part of the learning curve Colin E Harvey 134 Feline Dentistry a a b Figure 5.36 asymmetry b Figure 5.35 a and b Mandibular mesioclusion Dental Malocclusion Distoversion describes a tooth that is in its anatomically correct position in the dental arch but is abnormally angled in a distal direction Mesioversion describes a tooth that is in its anatomically correct position in the dental arch but is abnormally angled in a mesial direction This inherited defect may cause secondary maxillary lip lesions due to the abnormal canine tooth position (figs 5.37 a, b) a Maxillary/mandibular asymmetry b Mandibular Linguoversion describes a tooth that is in its anatomically correct position in the dental arch but is abnormally angled in a lingual direction (fig 5.38a) Labioversion describes an incisor or canine tooth that is in its anatomically correct position in the dental arch but is abnormally angled in a labial direction (fig 5.38b) Buccoversion describes a premolar or molar tooth that is in its anatomically correct position in the dental arch but is abnormally angled in a buccal direction Normally, cats replace their deciduous teeth starting with the first maxillary and mandibular incisors at fourteen weeks The permanent canines should erupt by six months Persistent deciduous mandibular canine teeth may fail to exfoliate because the permanent tooth buds were lingually malpositioned This malposition may result in lingual (base narrow) displacement of the permanent mandibular canine teeth, causing traumatic occlusion with the hard palate Maxillary fourth premolar impingement results in trauma to the soft tissue (gingiva and alveolar mucosa) Oral Pathology 135 a a b Figure 5.38 a Linguoversion of the maxillary canines b Labioversion of the right mandibular canine b Figure 5.37 a Maxillary canine tooth mesioversion b Mandibular canine tooth mesioversion surrounding the mandibular first molar buccally The repeated trauma frequently results in gingival ulceration, proliferation, recession, and exposure of the roots of the mandibular fourth premolar and/or first molar (figs 5.39 a, b; 5.40 a, b) Oral Swellings/Tumors Swellings and growths of the oral cavity are relatively common There are many etiologies of oral masses ranging from cyst, infection, and inflammation to benign and malignant tumors (fig 5.41) Osteomyelitis Bone infection and inflammation is often diagnosed as the cause of oral swellings in the cat These pathologies commonly occur from traumatically induced bone segments that act as sequestra or tooth root fragments Biopsy and culture are important for treatment planning and to help rule out neoplasia (figs 5.42 a–e) Eosinophilic Granuloma Complex This complex can manifest in three ways: • • • Eosinophilic (indolent or rodent) ulcer Eosinophilic plaque Eosinophilic granuloma Only the eosinophilic ulcer and eosinophilic granuloma apply to the oral cavity and adjacent haired areas Eosinophilic ulcers most commonly affect the upper lip at the philtrum but may occur anywhere in the oral cavity Ulcers on the upper lip usually have a carvedout, depressed appearance with a yellow-appearing a a b b Figure 5.39 a and b Right maxillary fourth premolar impingement Figure 5.40 Figure 5.41 136 Pharngyeal mucocele a and b Left maxillary fourth premolar impingement c a d b e Figure 5.42 a Marked facial swelling b Inflamed gingiva c Aspiration of swollen face d Inflammatory cytology (neutrophils, macrophages) e Radiograph revealing root fragments and left maxillary third premolar periodontal disease 137 138 Feline Dentistry a b c Figure 5.43 a Eosinophilic ulcer b Eosinophilic granuloma c Tongue eosinophilic granuloma center Clinically, the lesions can be mistaken for neoplasia (figs 5.43 a, b) Even though cats nine months to nine years of age can be affected, there is a higher incidence in middle- to older-aged cats with females predisposed There may be a genetic component with a predisposition in some inbred lines The major underlying diseases thought to cause the lip ulcers are flea and/or food allergy, Microsporum canis, and atopic dermatitis; when these underlying conditions are controlled, the lip lesion usually resolves Diagnosis of lip ulcer is confirmed by deep incisional biopsy Histopathology reveals hyperplastic, ulcerative, superficial, perivascular dermatitis with eosinophils, neutrophils, mononuclear cells, and fibrosis Eosinophilic granuloma occurs most commonly in the oral cavity and/or as a linear lesion on the back legs The etiology is unknown but suspected to be a hypersensitivity reaction The underlying cause is rarely identified Oral lesions may occur anywhere in the mouth including the gingiva, hard and/or soft palate, tongue, and oropharynx Typically, the lesions have a papular to nodular configuration and histologically show granulomas with multifocal areas of collagen Eosinophils are common in the biopsies from the face or oral cavity, and there may be a peripheral eosinophilia as well (fig 5.43c) Oral Neoplasia Oral tumors in the cat make up approximately 10% of feline neoplasms Nearly 90% of feline oral tumors are malignant When presented with an oral swelling, the practitioner needs to use available diagnostic aids, including radiography, fine-needle aspiration for cytology, and biopsy for histopathology to render a diagnosis and treatment plan Oral tumors may be classified as odontogenic or nonodontogenic, depending on origin, and as inductive or noninductive, based on the interaction of epithelial and mesenchymal tissues Benign Neoplasia Peripheral odontogenic fibroma (fibromatous epulis and ossifying epulis) An epulis is a nonspecific clinical descriptive term referring to a benign local growth of the oral mucosa Histologically, the overlying gingival epithelium is normal to Oral Pathology 139 Inductive fibroameloblastoma Inductive refers to the relationship between the ameloblastic epithelial cells and the dental pulp–like stroma Also known as inductive fibroameloblastoma, the feline inductive odontogenic tumor most commonly affects young cats Osteolytic involvement of the rostral maxilla is usually involved in this rather rare tumor Amyloid-producing odontogenic tumor Amyloid-producing odontogenic tumor, previously referred to as calcifying epithelial odontogenic tumor, may be locally invasive in both dogs and cats but has not been reported to metastasize Malignant Neoplasia Figure 5.44 Peripheral odontogenic fibromas A ten-year study of 371 neoplasms in the oral cavities of cats found that a majority (89%) were malignant Squamous cell carcinomas make up a vast majority (61%) of the oral malignant tumors diagnosed, with fibrosarcoma, adenocarcinoma, lymphoma, osteosarcoma, and melanoma occurring less often Squamous cell carcinoma Figure 5.45 Multiple peripheral odontogenic fibromas mildly hyperplastic in the sessile forms, but pedunculated epulides often have marked gingival and mucosal hyperplasia with prominent rete ridge formation A majority of the feline epulides are peripheral odontogenic fibromas Some have mature osteoid as their major component with only small islands of entrapped periodontal ligamentous stroma within the osteoid (fig 5.44) The majority of peripheral odontogenic fibromas occur as single oral swellings; however, multiple epulides have been reported In one study of thirteen cases, the biologic behavior of multiple fibromatous epulides differed from the single lesion in that after local surgical excision, eight of the eleven patients had tumor recurrence (fig 5.45) Squamous cell carcinoma (SCC) occurs primarily in the tongue and/or gingiva A small percentage of cases also involves the palate, pharynx, and one or both tonsils Metastasis to distant organs is not common Metastasis, if present, is usually confined to the ipsilateral regional lymph nodes Oral SCC in the cat displays a significant geographic, environmental, and dietary correlation Tonsillar SCC are rare in North America but more common in the United Kingdom, while lingual SCC is rare in Australia One study also found a significant correlation between oral SCC in cats and exposure to secondhand tobacco smoke Another study found that cats fed canned food were predisposed to oral SCC compared with those fed dry food The median age of cats with oral SCC is eleven to thirteen years; however, affected cats as young as three months and as old as twenty-one years have been reported The most common finding is a facial swelling or asymmetry recognized by the cat’s owner or veterinarian during a routine examination (fig 5.46) Other signs include excessive salivation, anorexia, weight loss, and halitosis On oral examination, a prominent hard mass will usually be noted on the maxilla or mandible (fig 5.47) Often the tumor affects the tongue root ventrally near the frenulum, which often appears thickened or ulcerated (figs 5.48 a, b) If the mass occurs on the gingiva, a Figure 5.46 Facial deformity secondary to squamous cell carcinoma b Figure 5.48 a Thickened tongue deformity secondary to squamous cell carcinoma b Squamous cell carcinoma tongue mass Figure 5.47 Mandibular firm swelling secondary to squamous cell carcinoma 140 Oral Pathology Figure 5.51 Figure 5.49 carcinoma Radiograph of a right mandible with squamous cell 141 Fibrosarcoma Although fine-needle aspiration with cytological evaluation can be used to tentatively evaluate suspected lesions, proper diagnosis of SCC requires an incisional biopsy and histopathological examination Fine-needle aspiration and cytology is performed if any local lymph nodes are palpable, asymmetric, or enlarged The typical histologic characteristics of oral SCC include irregular cords of pleomorphic epithelial cells with abundant eosinophilic cytoplasm, prominent intercellular bridges, and keratin pearls (fig 5.50) Fibrosarcoma Figure 5.50 Fine-needle aspiration cytology of squamous cell carcinoma with marked anisocytosis, anisokaryosisa, and prominent nucleoli Fibrosarcoma (FSA) is the second most common (although rare) tumor of the feline oral cavity Oral FSA generally occurs in older cats (average thirteen years); however, cats as young as one year of age and as old as twenty-two years have been reported There does not appear to be any gender predisposition or any oral cavity site predilection, though the lesions are usually located rostrally on the gingiva Most cats with oral FSA will present for the same problems as cats with oral SCC; however, cats with oral FSA invariably will have a mass at the primary tumor site The workup for the oral FSA patient is identical to that discussed above for oral SCC Procurement of a deep incisional biopsy is recommended to best ensure a correct histopathological diagnosis (fig 5.51) Staging of Oral Tumors there may be increased mobility of the adjacent teeth due to loss of support from bone destruction (fig 5.49) Abnormal laboratory results often show a neutrophilic leukocytosis, anemia, and azotemia There is also an increased incidence of feline immunodeficiency virus in those cats affected with oral SCC There is no apparent link to feline leukemia virus Thoracic radiographs usually not show evidence of metastasis Intraoral radiographs commonly reveal marked localized osteolysis with increased hard tissue formation on the affected lower jaw but not on the upper jaw In order to compare examination findings and treatment results, oral masses can be staged per the World Health Organization’s TNM system, based on the extent of the tumor, the extent of spread to the lymph nodes, and the presence of metastasis For staging, the tumor is: • • Inspected and palpated for the presence of ulceration or necrosis Examined for adjacent tooth mobility not related to fracture or periodontal disease 142 • • Feline Dentistry Evaluated for regional lymph node involvement; nodes are checked for size, shape, pain on palpation, and lack of mobility Radiographed for areas of bone resorption or new bone production; thoracic radiographs are taken for metastatic evaluation (depending on tumor type) Primary tumor T-1: Tumor less than cm in size T-2: Tumor between and cm in size T-3: Tumor greater than cm in size Bone invasion (determined radiographically) a: Absent b: Present Regional lymph nodes N-0: Non-palpable nodes, no metastasis expected N-1: Palpable, ipsilateral, nonfixed, no metastasis suspected N-2: Palpable, contralateral, nonfixed, node metastasis suspected N-3: Fixed nodes, metastasis suspected Distant metastasis M-0: No distant metastasis M-1: Evidence of metastasis to other than cervical nodes Generally, the ipsilateral mandibular lymph nodes are regarded as the ones to biopsy when striving to determine regional metastasis Consideration should also be given to examining the parotid and medial and lateral retropharangyeal lymph nodes to more precisely determine regional metastasis Tissue sampling can be accomplished by fine-needle aspiration, which is also helpful for lymph node sampling Incisional biopsy is indicated for large lesions and those with a more ominous malignant appearance not conducive to initial total removal Incisional biopsies can be performed with a scalpel blade, disposable biopsy punch, or a Tru-cut needle A Michelle trephine or Yamshidi needle can be used to biopsy masses that have bone involvement Biopsy of an orally visible mass should not be sampled through the skin but rather through an intraoral incision to prevent seeding of the tumor into the surrounding normal external tissues A pie-shaped or elliptical wedge of soft tissue is removed for incisional biopsy Incisions on either side of the ellipse should converge in a V shape to join in deeper sublesional tissues The ellipse length should be three times the width Lesions from fixed alveolar or palatal tissue not require the 3:1 ellipse shape because of the inability to close the surgical defect Normal tissue is not purposely incised to prevent opening previously unexposed tissue planes Once the cytologic or histopathologic diagnosis has been rendered, additional surgical excision, chemotherapy, and/or radiation therapy can be performed Ideally, the surgeon should provide clean surgical margins of at least cm for benign lesions and at least cm for malignant lesions Oral Trauma Maxillary and mandibular fractures occur often secondary to facial trauma and rarely from preexisting pathology Before focusing on the obvious orthopedic problem, the examiner must stabilize the patient If the cat will allow examination without causing further pain, the oral cavity is initially evaluated for additional pathology If the cat is uncomfortable, this examination can wait until the cat is anesthetized Oral examination should include evaluation of range of motion of the temporomandibular joints and palpation for crepitus and areas of discomfort The traumatized jaws may present in normal occlusion or with displacement toward or away from the side of fracture or dislocation The hard and soft palates separate the oral and nasal cavities When the palate has been injured, causing a communication between oral and nasal passages, the nasal cavity may fill with food or fluid during eating and drinking, and aspiration pneumonia may result Prompt treatment of acquired palate defects is required Fresh linear midline defects, which often result from falling from a height in cats, can be apposed by simple interrupted sutures and will usually heal readily Temporomandibular Joint Dislocation A traumatic rostrodorsal or less commonly caudoventral temporomandibular joint dislocation may be responsible for a cat that acutely presents with a “dropped jaw” or with the jaws in a non-occlusal position Due to a large retroarticular process that forms a caudal extension of the mandibular fossa, the condylar process usually displaces rostrodorsally (figs 5.52 a, b) The luxation may be unilateral or bilateral (fig 5.53) When unilateral, the lower jaw deviates to the side opposite the luxated joint Diagnosis of luxation alone or luxation with fracture can usually be confirmed with ventrodorsal closed-mouth radiographs Oral Pathology 143 a Figure 5.53 Right-sided temporomandibular joint dislocation computer 3-D reconstruction of CT study Open-Mouth Jaw Locking b Figure 5.52 a Right-sided rostrodorsal temporomandibular joint dislocation computer 3-D reconstruction of CT study b Clinical appearance of rightsided temporomandibular joint dislocation Temporomandibular dysplasia can cause joint laxity This may result in mandibular shift, causing the coronoid process of the mandible to lock on or ventrolateral to the zygomatic arch The affected cat presents with the mouth wide open and without contact between the maxillary and mandibular teeth Locking usually occurs opposite to the dysplastic joint Palpating the zygomatic arch may yield a prominent protrusion contralateral to the affected temporomandibular joint The open mouth resists closure until either the cat frees the locked coronoid or the veterinarian does so under sedation or anesthesia Jaw Fractures Occasionally, the fibrocartilaginous disc in the luxated joint will be torn and folded on itself, preventing the mandibular condyle from settling back in place or reluxating following reduction If the condyle does not properly reduce back into the fossa, condylectomy may be indicated to allow functional occlusion Temporomandibular Joint Ankylosis Temporomandibular joint ankylosis may occur secondary to zygomatic arch and mandibular condyle trauma leading to subsequent loss of effective joint function Clinically, the cat will be unable to open its mouth normally (figs 5.54 a, b, c) Maxillary and mandibular fractures occur most commonly from automobile trauma and falling from heights Mandibular symphyseal separations are most common, followed by fractures of the mandibular body, mandibular condyle, maxilla, and hard palate Mandibular symphysis separation The mandibles are connected to each other by means of a fibrous symphysis (not bone) Separation of the mandibular symphysis is a common condition in cats, typically as a result of falling from a height or other blunt force trauma Radiographs are exposed and examined to evaluate the symphysis and adjacent structures Radiographs must be exposed and examined before attempting care (figs 5.55 a, b) a a b b Figure 5.55 a Mandibular symphysis separation b Radiograph of mandibular symphysis separation c Figure 5.54 a Temporomandibular joint ankylosis (clinical appearance) b Radiograph with abnormal-appearing temporomandibular joints circled c Computed tomography scan confirming ankylosis 144 Oral Pathology 145 a Figure 5.57 b Figure 5.56 a Midline hard palate defect after motor vehicle trauma b Radiograph of traumatic hard palate trauma Maxillary fractures Midline maxillary fractures usually result from high-rise or hit-by-car trauma in the cat (figs 5.56 a,b) Mandibular fractures Mandibular fractures are the third most common fracture in cats (head of femur and pelvis fractures first and second in a study of 517 cats) (fig 5.57) Further Reading Berger M, Schawalder P, Stich H, Lussi A Feline dental resorptive lesions in captive and wild leopards and lions J Vet Dent 1996; 13: 13–21 Berger M, Schawalder P, Stich H, Lussi A “Neck lesion” bei Grosskatzen; Untersuchungen beim Leoparden (Panthera pardus) Kleintierpraxis 1995; 40: 537–549 Radiograph of mandibular fracture Berger M, Stich H, Huster H, Roux P, Schawalder P Feline dental resorptive lesions in the 13th to 14th centuries J Vet Dent 2004; 21: 206–213 Berger M, Stich H, Huster H, Roux P, Schawalder P Feline caries in two cats from a 13th century archeological excavation J Vet Dent 2006; 23: 13–17 Bertone ER, Snyder LA, Moore AS Environmental and lifestyle risk factors for oral squamous cell carcinoma in domestic cats J Vet Int Med 2003; 17: 557–562 Bonello D Feline inflammatory, infectious and other oral conditions In: Tutt C, Deeprose J, Crossley D (eds) BSAV A Manual of Canine and Feline Dentistry, 3rd ed BSAVA, Gloucester, 2007; 126–147 Brown TR Trismus secondary to squamous cell carcinoma in a cat J Vet Dent 2003; 20: 218–219 Clarke DE, Cameron A Relationship between diet, dental calculus and periodontal disease in domestic and feral cats in Australia Aust Vet J 1998; 76: 690–693 Colgin LM, Schulman FY, Dubielzig RR Multiple epulides in 13 cats Vet Pathol 2001; 38: 227–229 Colley PA, Verstraete FJ, Kass PH, Schiffman P Elemental composition of teeth with and without odontoclastic resorption lesions in cats Am J Vet Res 2002; 63: 546–550 Cotter SM Oral pharyngeal neoplasms in the cat J Am Anim Hosp Assoc 1981; 17: 917–918 DeBruijn ND, Kirpensteijn J, Neyens IJ, Van den Brand JM, van den Ingh TS A clinicopathlogical study of 52 feline epulides Vet Pathol 2007; 44: 161–169 DeLaurier A, Allen S, deFlandre C, Horton MA, Price JS Cytokine expression in feline osteoclastic resorptive lesions J Comp Pathol 2002; 127: 169–177 146 Feline Dentistry DeLaurier A, Boyde A, Horton MA, Price JS Analysis of the surface characteristics and mineralization status of feline teeth using scanning electron microscopy J Anat 2006; 209: 655–669 DeLaurier A, Boyde A, Horton MA, Price JS A scanning electron microscopy study of idiopathic external tooth resorption in the cat J Periodontol 2005; 76: 1106–1112 Diehl K, Rosychuk RA Feline gingivitis-stomatitis-pharyngitis Vet Clin North Am Small Anim Pract 1993; 23: 139–153 Dubielzig RR, Adams WM, Brodey RS Inductive fibroameloblastoma, an unusual dental tumor of young cats J Am Vet Med Assoc 1979; 174: 720–722 DuPont GA, DeBowes LJ Comparison of periodontitis and root replacement in cat teeth with resorptive lesions J Vet Dent 2002; 19: 71–75 Emily P Feline malocclusion Vet Clin North Am Small Anim Pract 1992; 22: 1453–1460 Frost P, Williams CA Feline dental disease Vet Clin North Am Small Anim Pract 1986; 16: 851–873 Gardner DG Ameloblastomas in cats: a critical evaluation of the literature and the addition of one example J Oral Pathol Med 1998; 27: 39–42 Gardner 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and serum immunoglobulin levels in cats with chronic gingivostomatitis Vet Rec 2003; 152: 125–129 Harley R, Helps CR, Harbour DA, Gruffydd-Jones TJ, Day MJ Intra-lesional cytokine mRNA expression in chronic gingivostomatitis in cats Clin Diag Lab Immunol 1999; 6: 471–478 Harvey CE Feline dental resorptive lesions Sem Vet Med Surg Small Anim 1993; 8: 187–196 Harvey CE, Orsini P, McLahan C, Schuster C Mapping of the radiographic central point of feline dental resorptive lesions J Vet Dent 2004; 21: 15–21 Harvey CE, Thornsberry C, Miller BR Subgingival bacteria— comparison of culture results in dogs and cats with gingivitis J Vet Dent 1995; 12: 147–150 Hayes A, Scase T, Miller J, Murphy S, Sparkes A, Adams V COX-1 and COX-2 expression in feline oral squamous cell carcinoma J Comp Pathol 2006; 135: 93–99 Healey KAE, Dawson S, Burrow R, Cripps P, Gaskell CJ, Hart CA, Pinchbeck GL, Radford AD, Gaskell RM Prevalence of feline chronic gingivostomatitis in first opinion veterinary practice J Feline Med Surg 2007; (5): 373–381 Heaton M, Wilkinson J, Gorrel C, Butterwick R A rapid screening technique for feline odontoclastic resorptive lesions J Small Anim Pract 2004; 45: 598–601 Herring ES, Smith MM, Robertson JL Lymph node staging of oral and maxillofacial neoplasms in 31 dogs and cats J Vet Dent 2002; 19: 122–126 Ingham KE, Gorrel C, Blackburn J, Farnsworth W Prevalence of odontoclastic resorptive lesions in a population of clinically healthy cats J Small Anim Pract 2001; 42: 439–443 Klein T Predisposing factors and gross examination findings in periodontal disease Clin Tech Small Anim Pract 2000; 15: 189–196 Lewis JR, Okuda A, Pachtinger G, Shofer FS, Pachtinger G, Harvey CE, Reiter AM Significant association between tooth extrusion and tooth resorption in domestic cats J Vet Dent 2008; 25: 86–95 Lewis JR, Tsugawa AJ Gingival hyperplasia and granulation tissue associated with a feline dental resorptive lesion J Vet Dent 2004; 21: 23–25 Lommer MJ, Verstraete FJ Concurrent 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Dentistry Diplomate, American Board of Veterinary Practitioners FELINE DENTISTRY Oral Assessment, Treatment, and Preventative Care Section I Oral Assessment Chapter Anatomy An understanding and. .. disease (gingivitis and periodontitis) Large dogs more commonly present with gingivitis, fractured teeth, and oral masses Feline Dentistry: Oral Assessment, Treatment, and Preventative Care was