FIND OUT WHY
Figure 1 Significant inflammation without hyperplasia is suggestive of Feline Juvenile-Onset Periodontitis (See Figure 2)
This syndrome is differentiated from feline juvenile gingivitis by the presence of periodontal attachment loss that can start shortly after tooth eruption. (Figures 1 and 2) Dental radiographs will demonstrate alveolar bone loss especially adjacent to the incisors and mandibular molars. Concurrent tooth resorption is common. Other anatomic changes include gingival dehiscence, periodontal pocketing, and furcation exposure.
Figure 2 – A radiograph of the same patient in Figure 1 confirms the diagnosis of Feline Juvenile-Onset Periodontitis in this young cat by demonstrating bone loss and tooth resorption. Dental radiographs will demonstrate alveolar bone loss especially adjacent to the incisors. Other anatomic changes include gingival dehiscence, periodontal pocketing, and furcation exposure. Juvenile periodontitis starts in cats less than 9-months of age. Certain pure breeds seem predisposed (e.g., Siamese, Abyssinian, Burmese, Himalayan, Persian) but any cat could be affected.
Typically, periodontal changes, including alveolar bone loss, gingival resorption, pocket formation, or root exposure that affect older cats are seen but at this early age.
Confusion arises with the differentiation of feline juvenile-onset periodontitis with hyperplastic feline juvenile gingivitis. In juvenile gingivitis, periodontal changes are generally absent until the condition is allowed to progress untreated until 12-18 months of age. The determining factor is the hyperplasic nature of the gingiva that often covers the crown of affected teeth. This is not a sign expected in juvenile periodontitis.
Both conditions are mistaken for chronic feline gingivostomatitis. Neither, however, show clinical changes consistent with inflammation of the caudal oral mucosa, a hallmark of gingivostomatitis.
Radiographic evidence of bone loss adjacent to teeth. Tooth resorption is common. The incisors and mandibular first molars may be affected earlier in the progression.
Figure 3 Caudal mucositis seen in cases of chronic feline gingivostomatitis is not seen in cases of feline juvenile-onset periodontitis unless both are present concurrently.
A visual exam combined with dental radiographs is generally diagnostic. Significant oral inflammation in a young patient 6 to 18 months of age WITHOUT THE PRESENCE OF CAUDAL MUCOSITIS (Figure 3) AND WITHOUT HYPERPLASTIC GINGIVAL OVERGROWTH (Figure 4) are hallmark signs. The dental radiographs consistently confirm the advanced periodontal loss and often associated tooth resorption.
Figure 4 Hyperplastic feline juvenile gingivitis shown here displays the classic overgrowth of hyperplastic tissue covering the crown of the maxillary 4th premolar. Gingival inflammation is significant in feline juvenile periodontitis but not hyperplastic as shown here.
The treatment approach selected depends on many factors including the severity of and refractory nature of initial professional care along with the commitment of the pet parent. Initial cleaning, periodontal treatment if possible and extractions are performed. The patient returns in 3-4 months to monitor the success of the treatment and home care regimen. If no changes are present a longer interval for professional care can be adopted. The longest interval where significant changes are kept under control is established for each patient.
Full mouth extractions can be a consideration if the pet parent is unwilling to return for frequent professional care and home care in predictably progressive cases. (Figures 5 and 6)
Figure 5 This more advanced case feline juvenile-onset periodontitis shows marked plaque, calculus, inflammation, and gingival recession.
Diligent home plaque control will significantly influence the outcome as it does with hyperplastic feline juvenile gingivitis. Brushing is the best at accomplishing plaque control however this is rarely performed due to the lack of owner and/or patient compliance. More likely treatments include dental formulated diets, chlorhexidine rinses, gels, and dental treats, Water additives allow total mouth immersion each time a patient drinks and may provide the best option. Home care options that have achieved the Veterinary Oral Health Council (VOHC) seal of approval are recommended. This list of all approved home care products for dogs and cats can be accessed here: www.vohc.org
Figure 8 This is the radiograph of the same patient in figure 5 showing tooth resorption and vestibular bone expansion surrounding the canine tooth.
This discussion should help the veterinarian in general practice recognize feline juvenile-onset periodontitis and differentiate it from hyperplastic feline juvenile gingivitis and/or feline chronic gingivostomatitis (feline stomatitis). Lifelong care for this condition is imminent requiring frequent professional and home care if progression is to be controlled.