Pawsitive Veterinary Dentistry “The podcast for veterinary dental teams—hosted by Benita Altier, LVT, VTS (Dentistry).”
Hosted by Benita Altier, LVT, VTS (Dentistry), Pawsitive Veterinary Dentistry brings real-world insight to the challenges faced by today’s veterinary dental teams. Each episode features in-depth conversations with Diplomates of the American Veterinary Dental College and Veterinary Technician Specialists in Dentistry, exploring common clinical conditions, dental pathologies, surgical techniques, anesthesia considerations, and patient-care safety. Using a case-report approach, Benita guides focused discussions that help practitioners connect evidence-based knowledge to everyday clinical practice—so teams can deliver safer, smarter, and more effective dental care.
Pawsitive Veterinary Dentistry “The podcast for veterinary dental teams—hosted by Benita Altier, LVT, VTS (Dentistry).”
Full Mouth Extractions for FCGS: Is It the Only Option? with Dr. Maria Soltero Rivera
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Chronic Feline Gingivostomatitis (FCGS) is one of the most painful and frustrating oral diseases encountered in feline patients. Cats with FCGS often suffer from severe oral inflammation, difficulty eating, weight loss, and chronic pain — leaving veterinary teams and cat caregivers searching for answers.
For many patients, full-mouth or near full-mouth extractions remain the gold standard treatment. But is surgery always the answer? And why do some cats continue to struggle even after extractions?
In this episode of the Pawsitive Veterinary Dentistry Podcast, host Benita Altier, LVT, VTS (Dentistry) is joined by Dr. Maria Soltero Rivera to discuss the evolving science behind feline chronic gingivostomatitis and what current research reveals about this complex disease.
Together they explore:
• What FCGS actually is and why it develops
• The immune-mediated nature of the disease
• The possible role of chronic viral infection and the oral microbiome
• Why full-mouth extractions are often recommended
• What veterinary teams should expect after surgery
• How to communicate extraction recommendations to cat owners
• Treatment options for refractory cases
• Emerging therapies including mesenchymal stromal cell therapy
• The future of personalized treatment approaches for FCGS patients
This episode provides practical clinical insight for veterinarians, veterinary technicians, students, and anyone involved in the care of feline dental patients.
If you’ve ever struggled with an FCGS case — or helped guide a client through the difficult decision of full-mouth extractions — this is an episode you won’t want to miss.
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Show Resources:
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Welcome everyone to the Positive Veterinary Dentistry Podcast, a podcast dedicated to helping veterinary professionals like you elevate patient care to better dentistry, better diagnostics, and better dyssions. I'm your host, Benita Altheer, licensed veteran, tech specialist in dentistry, and the creator and founder of Positive Dental Education. Whether you're listening in a general practice setting, specialty academia as a student, or just beginning your career in veterinary medicine, this podcast is intended for you to give you practical real-world insights. Today's episode focuses on a disease that many of us in practice find both heartbreaking and challenging to manage, chronic feline gendivostomatitis, or FCGS. This is a debilitating and painful condition for cats, and it can be equally frustrating for veterinary teams and cat caregivers who are trying to help these pets find relief. For many years, FCGS was thought to be simply a severe response to plaque or dental disease, but more recent research has shown that this condition is far more complex, involving an immune-mediated response, possibly chronic viral infection, and even changes in the oral microbiome. To help us better understand this disease and how we can help these patients, I'm excited today to be joined by Dr. Maria Soltera Rivera. Dr. Soltera Rivera has been involved in advancing our understanding of feline chronic gendivostomatitis through both clinical work and research. She is also the co-author of a review article that explores the current science behind this disease, including its immune-mediated nature, the role of the oral microbiome, and emerging treatment options for refractory cases. This article, published in the Journal of Feline Medicine and Surgery in 2023 by Dr. Soltero Riveras, Dr. Stephanie Goldschmidt, and Dr. Boaz Arzey, will be referenced in this podcast today. All three are professors at the University of California at Davis and work together on these types of research projects. In this episode, we're going to talk about what we currently know about FCGS, why full mouth extractions are still considered the mainstay of treatment, and what new therapies may be on the horizon for our patients who don't respond to surgery alone. Before we jump into this podcast, I want to welcome you, my guest, Dr. Maria. I really appreciate you being here. Thank you for allowing me. Yes, I have really enjoyed working with you, teaching DVMs around the country. Your level of expertise and scientific understanding has just really impressed me because knowing the why behind what we do, I feel is so important. And I know as I've been out in the world going to lectures on this particular topic, we're all looking for new information and what the research is telling us so that we can make better clinical decisions for these animals. So I'm really excited that you're here today and that you can help us with understanding this a little bit more thoroughly. Before we dive into this episode, my last guest, Dr. Chris Bannon, left you a question. Yeah. And that question wasn't specifically directed at you, but it's a good one. And I think it does apply somewhat to this episode. Okay. So her question was if you have a nickel for every time a client says to you, Oh my gosh, you have to extract how many teeth and how will my pet ever eat again? How rich would you be?
SPEAKER_03I would be a billionaire by now. One nickel at a time. Absolutely. It's such a common question that we get. And it and it's very nice to see then their reaction on the other side once their animal feels better, has recovered. And then that's when we get the typical comment of they're acting like a puppy and a kitten again, despite their age.
SPEAKER_01And they might eat you out of house and home, actually. They're going to eat way better because they've been struggling. So this definitely applies a lot to these types of patients where we are seeing them losing body weight and not thriving because they literally are struggling to get the nutrition that they need.
SPEAKER_03Even their relationship with the owner struggles, right? Because they're so painful, it's hard to pet them. They don't receive the interaction as well as they would if they were comfortable.
SPEAKER_01Exactly. And we could talk about that because the human-animal bond is so important. And when something significant like this could interrupt that human-animal bond where the pet's not wanting to be interactive with their owner, that can really affect their quality of life, both human and animal, right? So let's start with the big picture. So many of us were taught early on in our careers that feline gendivostomatitis was essentially an extreme response to plaque or potentially related to severe periodontal disease. But your research and other recent work in the field suggests that this disease is far more complex. Can you help us understand what we currently know about the pathophysiology of chronic feline gendivostomatitis and what's actually happening in these patients?
SPEAKER_03You are correct. And that was the previous knowledge. And that's not entirely wrong. It's just that there's a more complex picture than just that happening. So what we know so far is that this seems to be an immune-mediated disease where the not only the oral cavity is affected, but this is the whole system is showing signs of this happening, and that it's driven by chronic antigenic stimulation where the plaque plays a role. Definitely the bacteria, the oral cavity, play a role. But there's also other things that happen in these cats very commonly that could serve as a chronic antigenic stimulation, like for example, viral infections. A lot of them have prinker and chaleci virus infection, FIV or FELV. And so that plays a role too. So what we know from targeted studies is that C D8 positive T cells, meaning the lymphocytes that are cytotoxic, play a big role in this disease, and that there is a mixture of cytokine profiles that don't necessarily fit the hypersensitivity reaction alone. There's a mix there. That's why we don't necessarily think it's an allergy anymore. And lymphocytes are raining here, like they are the ones that drive everything, but neutrophils can be in there too, depending on if there's ulceration or how acute this is. Definitely the bacteria in the oral cavity in FCGS is different than what you typically see in health. And it's different in multiple locations in the oral cavity, not just the areas that are inflamed, it's everywhere in the different specific locations that you can see. If you compare the dorsal tongue microbiome in health versus FCGS, it's going to be different. And then if you compare the microbiome and the dorsal tongue within a cat with FCGS to the cheek pouch, they're going to be different. So there's a dysbiosis that's happening that's part of this process. But also there's a host response that seems to be uncontrolled. And so untargeted studies that have come out recently support the fact that there could be a genetic component in these patients that is making them respond in this exaggerated way, and has been an interesting finding with the upregulation of these cytokines, especially IL6 and 17A, and the fact that we're talking about lymphocytes, but really this study also showed that those cells that usually take care of the immediate immune response could also be playing a role in the disease. So it involves the immune system acutely and chronically, the innate and the adaptive immune system. It involves bacterial and viral infections. It's it's a very complex disease. And I think that the more we learn about it, we think we're gonna find the one thing to blame, and that's not happening.
SPEAKER_01Yeah, it seems like we learn more and it becomes more complicated and makes that even more challenging for a general practitioner to figure out how do we actually combat this besides just aggressive treatment. With the research, can you explain a little bit more how this research was conducted to come to some of these conclusions so that we can better understand how this was investigated thus far to get us better information?
SPEAKER_03Yeah, I think you can think about it as layers. The first layer was that first retrospective study that reported on the clinical findings of these cats and what it looked like on oral examination. And then we started digging deeper and said, okay, what do biopsies from these cats look like? And then there was the explanation of what these biopsies look like in histopathology, but then there was also the explanation of how cats responded to certain treatments, including antibiotics and maybe like steroids. Then there was also, and these happen in different timelines, the explanation of what do we see on the dental radiarest of these cats. And so that kind of helped come complete the picture of yes, it's not only the soft tissues that are affected, the heart tissues are also affected, the teeth are affected, because we see that these cats, all of them have periodontal disease, usually more moderate or severe, and 50% of them will have tooth restoration or root tips. So now we're better understanding what's happening at the soft tissue level, at the heart tissue level. How do we go about the treatment and what the clinical behavior of the disease is? And then people started taking it further, saying, okay, now we take the biopsy and now we're going to look for specific things. We're going to look at CD4 positive cells, CDA positive cells, what are the cytokines that are there? What are the tall-like receptors? And then somebody said, Oh, wait, but what happens in the blood? And so then the blood was looked at. And then we found out that they are, and this was some of the early work, but the hyperglobulinemia that we typically see on these cases, it was confirmed. And then people said, Oh, but wait, there's molecular studies that we can do that are untargeted, meaning we don't choose to look for certain things. We let all the genetic information in there tell us the story. And so that's when we started looking at DNA sequencing and RNA sequencing for these patients, trying to figure out what's their and infectious disease is in terms of infectious diseases, which has had been done before with targeted studies with BCR and things like that. But those are inevitably, they will have false positives or false negatives. Whereas when you're getting all this genetic data and processing it, you're gonna be able to have a more holistic view of what's happening. And so you look at it and you can remove all the genetic data from the cats and only look at infectious diseases. And we've done that and looked at that only. And we have done the opposite where we remove all the infectious diseases and we look at the cat only. And that has been done at the RNA level. And so that tells you not only which genes are there, but which ones are actively playing a role there. And then we've looked at what does the saliva look like there? Well, how the how do the proteins change in the saliva when you have FCGS? And then as we learn more and more, then at the same time, the medications and their research increase. So then you're like, oh, this is happening. So maybe this medication can do a good job. So let's look at cyclosporin and a clinical trial was done for that. Or let's look at telign recombinant interferon omega and a clinical trial was done on that and see how that changes the other findings that we've seen as baseline for this disease. And so that's how the research has gone in this particular disease, which is pretty amazing. And I use it as a poster child of how we should go about researching anything really in oral medicine because we've done a pretty good job over the last three decades trying to figure out this disease and how to improve the quality of life of these patients.
SPEAKER_01Wow. Three decades of research, and it's brought us to this point and answered some questions that were really unanswered for years and years and years for these kitties, right? We were very confused about this. So when we think about gene expression or these specific cats, you talked a little bit about potentially familiar lines having higher incidence of this condition. What have we learned from that in regards to cats that are genetically related?
SPEAKER_03Good question. So, in order to determine that, we would need to do genetic studies and populations of cats of the same breed, affected and unaffected. And those studies are not out yet. We we've had suggestions of cat breeds that are typically seen more commonly in these studies of FCGS that could potentially then lead you to think that there's a familial predisposition. Usually, when you see common breeds being represented, you can't help but think there has to be some sort of genetic link. I think the strongest genetic suggestion that we have found so far is this last study looking at the host response at the RNA level with that upregulation of IL6 and 17A and the myeloid lineage cells. That was pretty strong evidence that we may have cats that are genetically predisposed to having these dysregulated immune responses in response to chronic antigenic stimulation, which could be viral or it could just be anything that's in the oral cavity microbiome-wise. So um, so I think that's a pretty those two things are pretty strong suggestions. And I think the next step would be to do genome studies where again you compare the population of interest with and without the disease and see if there's any genetic variations that are picked up and that could explain the biology behind the disease, too, because it could be something random, right? And it might not be related to the biology of the disease. So you have to make sense of that in the context of what we know about the disease already.
SPEAKER_01Right. Is there specific breeds that we know of now that we feel could potentially be on that list of genetically predisposed to this condition?
SPEAKER_03Well, I don't I don't think that we can necessarily say particular breeds, but I do think that in general we tend to see more severe disease, dental disease, and pure breeds of cats. Um, so I wouldn't hang my hat on any specific breed being more affected with FCGS or not, but to say that when the studies are done, the definitely the breeds will have to be considered as a covariate or a potentially confounding variable.
SPEAKER_01Okay. All right. What about the evidence when it comes to cats in the same household? Because they obviously are sharing their saliva with each other and viruses and they're on potentially similar foods. What have we learned about cats in the same household having a higher incidence, if that's true, of chronic feline gendomostomatitis?
SPEAKER_03Yeah, that's a great question. So we have learned from a study evaluating cohabiting cats that that does represent a risk factor for FCGS. And you do get an increased odds of having FCGS if you have, as compared to households with just a single cat. The study showed it's pretty remarkable that for each additional cat in the household, there's an increased odds of FCGS by more than 70%.
SPEAKER_01Wow.
SPEAKER_03That's tremendous.
SPEAKER_01Well, that's a real number. Yeah. Yeah. And that's what I understood as well, because we it's unusual, but when you have multi-cat households and then you find one where they seem to just be having a rash of this same condition amongst their cats, it just makes you wonder. And then we're having to consult with these clients about some pretty significant treatment to make these cats comfortable and in improve their quality of life. And if it's affecting more than one of their cats, that can be quite significant for them, especially financially, trying to deal with more than one having a similar issue. Does and we maybe don't know, but if they are a multicat household and they are related genetically, that could be even more increase in the incidence of it.
SPEAKER_03The increased risk in shared households brings up the question of could it be that there's enough stress that makes for opportunistic infections to happen, or is it like a shared infectious disease that everybody has left? Or is it that the antigen is there and the susceptibility depends on the cat, on the cat, but if you have enough of them, you're gonna find the susceptibility. So, anyway, those are things that that have come to mind when we talk about the results of these studies.
SPEAKER_01I've often wondered if a vaccine could be developed to prevent this condition.
SPEAKER_03Good question. I think in the context of the role of feline caleci virus and with disease, that could be something to be thought about. Also, in general, a vaccine for viral infections could go a long way, but we would need to see the clinical trials because I don't think we've been able to firmly say that those are a needed to elicit the disease or if they just have disease modifying properties and affect the prognosis of the patient. It's a standing, lingering question.
SPEAKER_01Okay, that would be amazing if that would be because we're always looking for the quick fix or the preventative, right? Because we never want them to get into this situation. Yeah, exactly. So if we can prevent it all together, that would be ideal. And that could be something in the future with cat breeding programs for these purebred kitties. If there was some sort of genetic marker, which forgive me for not understanding genetics, no dad, you're at the at the research. The right the right way, absolutely that we could you could check with yeah, right, prevent breeding ones that would be more likely to pass that genetic marker on to their offspring. Correct, correct.
SPEAKER_03That would be the goal, but even it's so that's super early on. If we take it a little bit later, what are the things that we need to look at in cats that could give us a clue that this is where they're trending? That's another question that we I've aimed to try and answer with some of my research is what comes before FCGS? Because it it's hard to believe that something that affects the heart tissues that way would be coming up acutely of acute onset, right? To have an effect on heart tissues, you have to be there for a little while. So, what comes before FCGS? And I think we've starting, we're starting to to figure out what that is. And in one study that we did here looking at aggressive periodontitis in young cats, we found that a certain percentage of them, um, minority nonetheless, but still will go on to develop FCGS like lesions. And so, so my question is do you have aggressive periodontitis before you have FCGS? And so that is, we have to do further studies on that to see, because then you are gonna want to be more proactive about the treatment of aggressive periodontitis and follow it up more closely and make sure that we don't get to that point of uncontrolled, more diffuse inflammation because aggressive periodontitis is only affecting the periodontal tissues. But if with FCGS, you have that extension of the inflammation beyond the muco gingival mind to affect the other non-kerotinized tissues of the oral cavity.
SPEAKER_01Right. That brings up two questions I have for you. One is that I think there's still a lot of confusion out there when a general practitioner is observing clinical signs in the mouth of a cat that they want to call it stomatitis or chronic feline gingivostomatitis when we're just dealing with something like gingivitis. Could you best define for us the how a general practitioner can discern the difference between what we would call gingivitis versus no, it's actually chronic feline gingivostomatitis and the things we need to look for. Oh, absolutely.
SPEAKER_03So I think the the thing to know is that gingivitis and periodontitis is confined to the periodontal tissues, right? So gingiva, alveolar bones, the periodontal ligament, those are the periodontal tissues. But in feline chronic gingival stomatitis, the term stomatitis is there because we're extending beyond the periodontrum, and now other soft tissues are affected. So you're thinking about inflammation that involves the periodontal tissues, but then extends beyond that mucogingival line to affect alveolar, buccal mucosa, caudal mucosa, sublingual tissues, linguomolar glands, the commissures of the lips, there's more diffuse inflammation. Interestingly, the heart palate doesn't seem to be affected in these cats. So, and we do sometimes see that the soft palate being affected, but it's not to be. So when we see that pattern of inflammation that's more diffuse, and there is that inflammation present in the back of the mouth, lateral to the palatoglossal arches, that anatomical structure that is a fold of tissue that connects the palate to the tongue, lateral to that, that inflammation extending to the front, affecting the areas around the teeth, that is pretty typical of these cases. And that can be ulcerative, proliferative, or both. So you can have where you can have patients in which the tissues look like they've running wild and proliferating, or you can have ones that look very ulcerated and not necessarily proliferative. And the proliferative ones are important because you want to make sure that you biopsy and rule out any sort of more assiduous process like a cancer, uh like squamous cellcastinal mind cats is a big concern. So that would be something to consider. So typically speaking, that's what we notice in these patients.
SPEAKER_01Yeah, and if it's strictly gendivitis or periodontitis, it's going to be confined to the attached genital tissues and the structures surrounding the teeth. And once it's outside of those defined areas, now we're dealing with something more sinister as we realize it's actually stomatitis. So the second question I had for you is how has your research shown, or I know you said it's not that common, but when we see these younger cats, they've just erupted their adult teeth. And they have inflammation of the genival tissues that does not extend beyond the mucogenival line. And we are defining that as juvenile onset gingivitis or juvenile onset periodontitis? How often are we finding that those cats, especially if left unchecked or unmitigated through anesthetized cleanings and strategic gingival surgery or extractions, even if we have loose teeth at that point? How often is it that they go on to progress to actual chronic feline gingivostomatitis?
SPEAKER_03Good question. So we're talking about those cases. So let me let's define this case, uh, typical case first. So typically these cases are presenting for early onset gingivitis, and they're less than two years of age, and they've already erupted their permanent teeth. So you know it's not inflammation related to the eruption process. Um, for those that are already beyond puberty, then we probably have a real problem. And I say that because you can have gingivitis and periodontitis that's hormonally mediated. And once you get done with that exposure to the hormones, it should resolve. So we're talking about the ones that persist. So the ones that persist, um, we've actually done some studies on this. It's those are animals that should be proactively treated. And by that I mean we should put them under anaesthesia and we should take radiogas because we have found that in retrospective studies here, there's moderate to severe periodontitis in those cases in about 78% of them. So now let's rethink about the nomenclature that we've been using for this forever. We've been calling it juvenile gingivitis. But if you see moderate to severe periodontitis in 78% of the cases, can we still just call it gingivitis? And so then you go back to the human literature and you say, How did humans deal with this? Because the same thing happens with humans. And what they've done is they've realized, oh, um, we're not dealing with only gingivitis. And oh, they're not typically speaking juvenile anymore because they're done with puberty. So really what we should be calling it is aggressive periodontitis. And so that is something that we have moved towards too, is adopting that terminology of aggressive periodontitis, first of all, because it more accurately defines the disease. Um, and second of all, because it it means it doesn't confine it to an age group because we're not talking about that age group anymore. And so if you post it to the on RS juvenile gene divitis, first of all, they're gonna think it's only the gum tissue affected, and second of all, they're gonna say, oh, they're growing, they'll grow out of it. And what we see is not necessarily that. We see that this is periodontitis like you and I will get, like everybody gets, but it goes faster. And so what we have found looking at those cases in this retrospective study and following them over time is that we looked at 27 cases, and of those, two of them develop FCGS like lesions, and about seven of them had progression of that aggressive periodontitis, despite the cure that was provided. And so when you have those cases, it's really important to have those conversations with the owners of if we were on Facebook, we would be going steady because this is not something that I can fix with just one procedure. We're gonna do our evaluation. Chances are that extractions might be needed, even at this early of an age. It's not wild, it has been described. It is a more rapidly progressing form of periodontitis, and we can only define it and call it by that when we've had two subsequent evaluations six months apart, and we see that there's more attachment loss over that time than what we would like to see. And you can extrapolate the definition in humans to cats, and it really doesn't take much from one measurement to the other to say, oh yeah, this is aggressive periodontitis. And so then you have to explain to the owners is we're gonna do everything that we can, but you're gonna have to come to see me more often than you would expect for a cat that doesn't have this, and the lifespan of those teeth is probably gonna be shorter. We'll do everything in our power to keep them for longer, but it's probably gonna be shorter. Or oh, by the way, the inflammation could extend to the rest of the mouth, so we're gonna keep a close eye on that, right?
SPEAKER_01So there definitely is a risk that it could progress on to chronic feeling and divostomatitis, so we have to keep a close eye on them. But because it is aggressive, it is a earlier onset type periodontitis.
SPEAKER_03We have to be aggressive in our interventions to try and control. We also have to be very proactive with home care, trying to brush. These are the cats that definitely you want to try and get them to be um compliant with brushing. And I think it also supports the fact of you know starting those evaluations in cats earlier early on, as soon as like six months of age to see that this pericoronitis that tends to happen with eruption resolves and it doesn't continue to be um something that is inflammation beyond the the eruption process.
SPEAKER_01Gotcha. Is there any correlation from the research that you know of in regards to Khaleesi virus with these cats and the aggressive periodontitis?
SPEAKER_03Good question. Not not currently, but there's somebody actually looking at that right now. So hopefully that will be something that will see the light of day here soon. Somebody in on the East Coast is actually looking at that right now.
SPEAKER_01So I'm we're working together on that. That's great. Good to know. Yeah, because I think there's still so much unmisunderstood about that specific condition. Um, there is a product which we can talk a little bit more about treatment here in a bit. But before I guess I before I talk about any treatment and that kind of thing, what would you say to a client who presents a cat that has chronic feline gendivistomatitis in regards to what they should expect? And we're gonna be talking more about what they need to do at home, what we might be doing procedurally, um, what would be a normal kind of spiel or something that you would talk to them about if you diagnosed this?
SPEAKER_03Yeah. Um, so most of them come to our practice already frustrated because they've tried so many different things. They've tried multiple anesthesias, some extractions, they may have already tried medical management. And so um they are desperate because their animal is still in pain. And at that point, sometimes even some of them don't even know or remember what their cat was like before they had the disease. Um, and so we have a conversation about how the knowledge about this disease of our time has progressed, and how unfortunately we're still at the point of the gold standard of treatment being near full mouth extractions to full mouth extractions. And I try to explain to them because this is a misconception that I think a lot of owners come in here with in it is that they think that we're extracting teeth just to extract them. And though it is true that we end up doing extractions of sometimes some healthy teeth, the reality is that there's so much dental disease in these patients that the extractions are needed just based on that for the tooth resorption that we see, for the root remnants that we find, for the moderate to severe parodontal disease that we find in these patients. Just that alone is justification for extractions in these patients. Now, having to go beyond that, that we still don't quite understand. Why do we need to go beyond that and end up extracting as many teeth? And I do have the conversation with the owner of I know if I had that disease and I went to the dentist and they said we got to extract everything, I'd be running away immediately. So I don't expect them to subscribe to that message immediately, but I do quote the information that we know from multiple studies on the surgical management of this disease that have repeatedly found that about 70% of patients will have a desirable outcome, whether it is complete resolution of the inflammation or at least improvement and improvement of their clinical signs. And we've seen that repeatedly from different institutions looking at this. That is to me convincing evidence. Could we be doing better? Oh, absolutely. And that's what I'm working towards, trying to get to the point where we don't have to extract the healthy teeth, but we're not there yet. So at the moment, that's the one solution that I can, or the one treatment that I can propose that will give us a good, a good chance of improving the quality of life of the patient. And so that's usually what I try to explain to the owners. And I to be fair, most of them by the time they come here, they've been they've heard about full mouth extractionists or partial mouth extractionists right.
SPEAKER_01So there is a risk that it could progress on to chronic feline gendivostomatitis, so we have to keep a close eye on them. But because it is aggressive, it is earlier onset type periodontitis, we have to be aggressive in our interventions to try to control.
SPEAKER_03We also have to be very proactive with home care, trying to brush. These are the cats that definitely you want to try and get them to be compliant with brushing. And I think it also supports the fact of starting those evaluations in cats earlier early on, as soon as like six months of age to see that this pericoronitis that tends to happen with eruption resolves and it doesn't continue to be something that is inflammation beyond the eruption process.
SPEAKER_01Gotcha. Is there any correlation from the research that you know of in regards to Khaleesi virus with these cats and the aggressive periodontitis?
SPEAKER_03Good question. Not not currently, but there's somebody actually looking at that right now. So hopefully that will be something that will see the light of day here soon. Somebody in on the East Coast is actually looking at that right now.
SPEAKER_01So um, we're working together on that. That's great. Good to know. Because I think there's still so much misunderstood about that specific condition. Before I talk about any treatment, what would you say to a client who presents a cat that has chronic feline gendivistomatitis in regards to what they should expect? And we're going to be talking more about what they need to do at home, what we might be doing procedurally, what would be a normal kind of spiel or something that you would talk to them about if you diagnosed it?
SPEAKER_03So most of them come to our practice already frustrated because they've tried so many different things. They've tried multiple anesthesias, some extractions, they may have already tried medical management. And so they are desperate because their animal is still in pain. And at that point, sometimes even some of them don't even know or remember what their cat was like before they had the disease. And so we have a conversation about how the knowledge about this disease of our time has progressed and how unfortunately we're still at the point of the gold standard of treatment being partial mouth to full mouth extractions. And I try to explain to them because this is a misconception that I think a lot of owners come in here with. It is that they think that we're extracting teeth just to extract them. And though it is true that we end up doing extractions of sometimes some healthy teeth, the reality is that there's so much dental disease in these patients that the extractions are needed just based on that for the tooth resorption that we see, for the root remnants that we find, for the moderate to severe periodontal disease that we find in these patients. Just that alone is justification for extractions in these patients. Now, having to go beyond that, that we still don't quite understand why do we need to go beyond that and end up extracting as many teeth? And and I do have the conversation with the owner of I know if I if I had that disease and I went to the dentist and they said we got to extract everything, I'd be running away immediately. So I don't expect them to subscribe to that message immediately, but I do, you know, quote the information that we know from multiple studies on the surgical management of this disease that have repeatedly found that about 70% of patients will have a desirable outcome, whether it is complete resolution of the inflammation or at least improvement and improvement of their clinical signs. And we've seen that repeatedly from different institutions looking at this. That is, to me, convincing evidence. Could we be doing better? Oh, absolutely. And that's what I'm working towards trying to get to the point where we don't have to extract the healthy teeth, but we're not there yet. So at the moment, that's the one solution that I can, or the one treatment that I can propose that will give us a good chance of improving the quality of life of the patient. And so that's usually what I try to explain to the owners. And I took most of them by the time they come here, they've been, they've heard about full mouth extractions or partial mouth extractions at least once before. So they're not completely adverse to it. I still give them the schve, as you say. So I just assume that they know everything. I kind of uh do the opposite. I say, let's pretend like you don't know anything about this disease and let's talk.
SPEAKER_01Uh right, just start from the beginning and explain.
SPEAKER_03Yeah. And then we talk about expectations too. If there's FELV, FIV in the history, we know that those tend to have more of a guarded prognosis. Probably the disease is modifying the prognosis. And so we talk about that too. And we talk about if we fall in that 30% of cases that don't respond to whatever we do, there are other options and and we can cross that bridge. Usually by then, their cognitive load has been reached. So I try not to overwhelm them with what happens if they're refractory, but I do mention it because 30% of refractory cases, that's a real number. That's not 5%. So I mention it to make sure that they keep it in mind. That's a possibility.
SPEAKER_01They're coming to you to be the miracle worker at UC Davis, thinking that you have more tools in your tool belt, or definitely you have more knowledge than most on this subject, but still it's hard to work miracles when we're still beyond the ability to have a simple cure. What would you want a general practitioner to know? Since you're at the referral end of things and you're getting cases that have been through potentially years of management, medical management, maybe some surgical management. What would you want general practitioners to know to help avoid potential years of things that aren't necessarily going to make that pet more comfortable?
SPEAKER_03Good question. Gosh, I take my hat off with general practitioners. Their primary care practitioner has such a tough job to do. First of all, kudos to them for all their work. I think they do a fantastic job in trying to manage such a complicated disease and such hard conversations with the owners, right? Because, you know, they come in for the first time with their animals not eating, and all of a sudden you basically wax them with this information of they have somatitis and the gold standard three minutes full mouth extraction, and that would surprise anybody. And yet that's the role, and they do it so well. So well that by the time owners come here, they're almost like, please take all teeth out, and you're like, wait, yes, we we will probably end up doing that, but let's have the conversation first. So, so I think that overall general practitioners doing a fantastic job at this. But I think that it's a conversation that I have very commonly with primary care practitioners is the fact that you have to treat the patient acutely, and then there's also the chronic treatment. Acutely, you have to get the patient to feel better. And so then pain medications are necessary. Sometimes antibiotics are necessary if there's secondary infection. We try to be very judicious with our use of antimicrobials, but the tissues are abnormal, they can get secondarily infected, and we know that a certain percentage of patients, roughly around 30%, will show some response to antimicrobials. It is a transient response, nonetheless, but it could help the patient wait until they can get to the extraction period. And then there could be a role of using anti-inflammatories even before extractions, again, to improve the quality of life of the patient before they get to the extractions. So consider that acute timeline of the disease and manage that, right? Um, other things to think about now with the current literature is the fact that a lot of them can have esophagitis. So maybe treating for that would be a good idea acutely to help them feel better. And then newer data suggests that maybe they also have tracheal bronchitis, but that study didn't look at viral infections in those cases. So I wonder if it's secondary to that, because we do see that those upper airway viruses uh in association with stomatitis, or I do typically see a lot of my stomatitis cases also having upper airway disease and things like that. So those are things to consider. Then um, you know, the workup to figure out that they can undergo anesthesia is very important. And, you know, most of my kids that come here are already, they've already done that. Checking FELV FIB status just to see if prognosis is going to be any different is important. And then planting the seed with the owners with the need of anesthesia and dental radiographs and charting to see how many teeth are already affected with paradontitis, tooth resorption, if there's any root remnants. Perhaps if the owner's very hesitant to take the chronic management approach of full mouth extractions, then biopsying might not be a bad idea, especially if it's proliferative and staging extractions by taking care of the teeth that are obviously beyond the point of return, doing a cleaning and the rest of the teeth, seeing how the patient does before you make any other recommendations. It's not a bad idea so long as you continue having that pain management dialed down across the entire timeline of the disease, from the acute to the chronic to post-extractions until the animal's doing better. I think that's very important. And just making sure they're keeping up their weight and managing their nutrition accordingly. And then also we have conversations about the reality of performing full mouth extractions and primary care practice. And my take on this is the following: I think that in an ideal world, full mouth extractions would be done in gosh, less than three hours, ideally, right? And that's a hard ask. That's a hard ask for somebody that's not doing this every day to get to the point that you're so proficient that you can do it so quickly. So I sometimes just say to priority care practitioners that you need to be realistic with what you can do. You self-evaluate and you say, Can I get to that point? If I get to that point, go for it. If you're not getting to that point, then refer them because in that period of time that you do that full mouth extraction, you can help so many more patients by seeing your regular appointments and doing your the work that you know you are proficient and efficient at, that you're better off doing that, to be quite honest. The other option is that, you know, if you know you're not going to be able to do it within a reasonable amount of time, stage them. If the patient's not systemically healthy, I wouldn't necessarily have that as my first option. I would try to get everything done at once with the appropriate monitoring and expertise. Maybe hopefully anesthesiologist could be involved. But staging should not be frowned upon. I think that if it's done with the appropriate communication handling with the owner and with the patient's best interest in mind, I think that's also that should be a valid option.
SPEAKER_01Wonderful. I know that in the past there have been some thoughts in regards to caudal mouth extractions versus extracting the canine teeth. If the gindival tissues are quiet around the canine teeth, or if they are not quiet and they are inflamed, do you think that that's a potentially appropriate treatment when we're talking about extractions for a general practitioner to start with caudal mouth extractions?
SPEAKER_03Yeah, that's a good question. And that's the that's our treatment approach here. If we see that the inflammation is limited to the premolars and molars, um, and the incisors and canines are otherwise healthy on radiographs and charting and not significantly impacted by inflammation, we can start with the caudal mouth extractions. We just haven't run the data to see how many of them return to complete the full mouth extractions. We should definitely do that. But anecdotally speaking, I feel like a lot of them do. So I do tell the owner if we can manage this financially and you can come back for the monitoring, I'm all for this attempt. But know that a lot of people do come back to finish the full mouth extractions. And some people are even happy with getting six more months out of the maxary canines and mandaveric canines as functionally important teeth. And I'm all for that too. I'm in the business of trying to save teeth. So with appropriate communication and management of expectations of the owners, if it's the right patient, I think it's um it's a good idea.
SPEAKER_01Right. And potentially would then set them up for that staging idea. When do you think it's inappropriate to not be aggressive and just go for full mouth extractions as soon as the disease is diagnosed?
SPEAKER_03Gosh, I'm I'm more of a gray stone kind of person with adequate communication with the owner. So um when would I think it's inappropriate to not go straight to full mouth extractions? I think in my case, I can I can tell you an example. In my case, it would be the cat that has been managed with steroids for two years. And I see open the mouth and I see obvious tooth resorption, feline resorptive lesions, or I see obvious gingival recession and root exposure. And I see obvious disease there that's present and the animal is hasn't had that handled yet. I think that that to me is a no-brainer.
SPEAKER_01Sure. And potentially if the animal's not eating well, right? If they are losing body weight and there's no other reason that we can contribute to body weight loss. And with cats specifically, I know how incredibly difficult it is to get them to lose weight on the case. Absolutely trying to control their calories and increase their exercise. If you have a win with losing weight in a cat because you're trying to, that's amazing. But usually if a cat presents that we see they've lost a pound in the last six months, we start to get really concerned about something else systemic in the body. But in cases where it's specifically obvious that the mouth is a problem and they want to eat, but they're just so painful they can't that it may become more urgent that they do more aggressive treatment, which could be full mouth extractions. Does that sound right? That sounds absolutely right. Okay. When we think about these kitties, what symptoms or signs do you think the owner might notice so that we could better educate the cat parents on how to look for signs?
SPEAKER_03Oh, absolutely. I think we already talked about the fact that it's typically a multi-cat household. Could be an indoor-outdoor cat. Maybe they don't want to go outdoors as much. At home, you may notice them running away from the food bowl, pawing at their mouth. I've had some that vocalize when they eat. Non-grooming, they could be hiding from the owner or other cats in the household. Salivation can be another sign, and it could be blood tinged, yellow, or green. And then you can see them shying away from you, trying to pet their face. And salivation may show as literally saliva coming up, but it could be also crusting around the face or on the front paws and the neck region. So it's also a good idea to look at that. Quality of their coat if they're not grooming is going to look poor. And weight loss could be also detected as a result of not eating if it's chronic enough.
SPEAKER_01Right. And potentially they may be sleeping more and hiding or just hiding, not interacting with the family. Like you said, that's a sad thing. They don't remember what their cat was like before they had this disease.
SPEAKER_03That's something that I brought up because I think that um part of monitoring how they do over time has to do with looking inside the mouth. But the other very vital part that sometimes we undermine is how they're doing at home. And so what I like to do with owners, and this is based on research that we've done with a collaborator that is working on stem cell treatment for these patients, is getting a good understanding of the behaviors that went away when the disease started. So we can look at those specifically over time and see if they will come back. And that will tell us that will make something that can be very subjective, become more objective, and really help us track their quality of life at home because sometimes that will improve before the oral cavity improves.
SPEAKER_01Interesting. And just seeing the improvement in the behaviors that they did have before the disease could really be an indicator that their quality of life is improving as well, right? Okay. So if full mouth extractions are done, and let's say a cat comes to you and that's where we're at with things, hoping for a cure, do you guys have any specific things that you do that are you feel new medicine, cutting edge, or something that you feel is important? I remember hearing that if any tooth root fragments are left behind, or if we don't curette out the alveolus to get all periodal ligament fibers out, that we could be dealing with refractory cases because there's some portion of the tooth that's still there and maybe misinformation regarding any of that. What do you have to tell us about specifically when the surgery is done technique-wise, that's important for these kids?
SPEAKER_03I think that you're spot on. I think that post-operative radiographs or imaging in general is absolutely necessary to make sure you don't leave any tooth material behind. And we don't have a good explanation for why that happens, but sometimes refractory cases come in, and the first thing we want to do is some form of imaging to assure that there's no tooth material left under the gum line because some of them will respond by just managing that. And so that's important. And again, I can't emphasize enough the need for pain management. Post ops are done and until the inflammation goes away, because this is a chronic enough disease where behaviors change at home and they're normalized and they're not picked up as pain, even though these are painful, painful animals. So, yeah, post-op rates are important. And then for those cases that look atypical where there could be proliferation or the inflammation is asymmetric biopsy, too, to make sure that you are dealing with lympoplasmacytic inflammation and not eosinophilic inflammation or not something like a squamous cell carcinoma, that would be important too.
SPEAKER_01So tell me more about the eosinophilic inflammation. Cats potentially with asthma, is there anything specific to those?
SPEAKER_03Yeah, you know, we talk about eosilic granuloma complex, and we when we hear about that, we think about the indolent ulcer and we think about the proliferative lesions that can happen in the oral cavity on the tongue or in other areas that look pretty typical with their pinpoint yellow to tan deposits on the top that are almost like pathonomonic for eusinophilic granulomas. But we've had some cases come in with more of a stomatitis presentation, and we're doing work on that now, but they don't all respond the same way that you would expect with a case that only has lipoplasmacytic inflammation and not ecinophils in there.
SPEAKER_01Okay. Okay. Now you mentioned cases where cats have maybe the trifecta, they have periodontitis leading to bone loss and tooth attachment loss of periodontal ligament. They may have stomatitis, which is the topic of the day, but also tooth resorption. We are just talking about not leaving any tooth remnants behind. But what if someone discerns that there's type two resorption on a tooth in a cat's mouth that also has chronic feline gendival stomatitis? Do you still recommend doing core amputations?
SPEAKER_03In these cases, typically what you see is type one resorption in general, because that's the resorption that we see in association with inflammation. But we have we see enough stomatitis here that we have seen cases with type two resorption, which is typically around the maxurate canines and non-inflammatory in nature. In those cases, I would say that sometimes you can do more harm trying to extract a tooth that is no longer a tooth. And so I think that it's not completely unjustified to continue taking the approach that we would for a tooth with type two feline resorption, where we follow the guideline of if the root no longer have a predontal ligament space and you can't see a root canal system, and the density of the root is more similar to bone in the area than teeth in the area, then you can consider crown amputation. But thinking about it, really it's very unusual to find that type of scenario in a cat with somatitis, but then healthy cat altogether. When we get to perform crown amputations for the right indications, it's like a reason to celebrate in dentistry. It's less, even less commonly seen in FCGS. Typically in FCGS, it's type one. And in those cases, you have to extract the entire tooth. Okay. But then those would be ones that I would follow up very closely and perhaps even do radiographs in three to six months to make sure that the tooth continues to go away and then explain to the owner hey, our data shows that typically if we're going to see an improvement, we're going to see it within two months. But maybe in this case, because we have this atypical type of resorption for these cases of type two, and we have to handle it this way, maybe we're going to give it a little bit more time and we want to see actually that tooth going away. That makes sense.
SPEAKER_01With these cats, when we think about their in surgery, maybe they have full mouth extractions, and we know that they have been malnutritioned, losing body weight. What percentage of cats do you place a feeding tube on if they're getting full mouth extractions?
SPEAKER_03Rarely ever do we have to do that. Um I think in my residency I did it once and I haven't knocked a wood had to do it again.
SPEAKER_01Okay. Well, that's good. That's less complicated. What if they do go home and they're still not doing well or they're still not eating? Would that be something that your primary care practitioner should consider getting them back in and doing a feeding tube placement? Yeah.
SPEAKER_03Oh my gosh, it it happens so infrequently that it's not the mainline conversation that I have. I think usually stronger pain management would be my first go-to before I recommend a feeding tube. But I do know that some practitioners are firm believers of bypassing the oral cavity with a feeding tube to help with the control of inflammation. I, to my knowledge, there are no studies to necessarily support that, but I remember a person saying this to me before in our college. They're firm believers of bypassing the oral cavity to promote the healing.
SPEAKER_01Right. I remember a cat in my general practice setting that had just horrible chronic feline genovistomatitis, and we did full math extractions, and it became just a refractory case that we were struggling with. And I think if I remember correctly, we may have tried some cyclosporin, but this cat was so head shy, mouth shy. It was also super thin, hadn't been eating well for a very long period of time leading up to the full mouth extraction surgery. And we did place a tube and was able to then give the cat better consistent nutrition, as well as the oral antibiotics and other medications. And I remember that cat specifically getting rapidly better when he got more consistent nutrition. Do you have any other suggestions given your experience with these cats on how to get them more consistent nutrition as they're recovering from something like full mouth extractions?
SPEAKER_03Yeah. So barring any other systemic diseases that would determine what they should be eating, I think I I've had better experience with well, softer foods for sure, high caloric diets, and small meals multiple times a day rather than trying to give them a whole lot of food. Then the other thing is I've had cats that cats are impressive. I've had cats that hate soft food. And even those abstractions, I've had to cross my fingers and hope that the hard food does not interfere with the healing, but they need to go back to hard food because that's the only thing they'll eat even without having tea. So I think the conversations with the owners are so important. There's always the you don't know those patients as well as the owners do. And so taking these cues that the owners give you is so important to bringing them back to their normal routine. Right. Even what type of medication? Is it a pill cat or is it a liquid cat? Or do we have to try transhermal? And yes, there's no real evidence that it works so well, but let's give it a try. If you're willing to try it, I'm willing to try it and we'll see how the cat does. And so just thinking outside the box with cats is so necessary.
SPEAKER_01Yes, they are their own little creatures, and each one is such an individual, and we have to cater to what the cat will accept and what we can do as pet parents. When we think about giving medications, you commonly suggest you mentioned potentially that we might be needing to use some antibiotics given certain microbiome populations, and then we need to talk about pain management as well. What kind of medical management acutely would you say you often do with these cats given chronic feline gendively stomatitis and potentially full mouth or near full mouth extraction cases?
SPEAKER_03Yeah, typically buprenorphine is the first one that we go to. Recent being there have been studies looking at the analgesic effects and absorption of buprenorphine after bucklined administration in these cats with stomatitis. And even though it had a lower bioavailability and shorter absorption half-life in that study, the animals did have an analgesic effect from it and was beneficial for them. So that's usually our go-to. But things like gabapentin could be another option in the chronic setting where you're trying to manage them for enough time, something like amantidine could be an option. So, and then you hear about the newer forms of pain medication available for cats that monoclonal antibodies that could be considered too. We don't personally use them, but we do see a lot of cases that come in on that medication, and they seem to have good, successful effects in pain management too. So then steroids will help to some degree. And ansets I try to stay away from just because eventually you may need to use steroids in these patients. And so you don't want to have to have a cat wait for a washout. Although even that washout period recently has become a little bit controversial. I still go by it, but some people now say that a washout is not even necessary. I find it uh I things to consider the things how how medicine changes over time from how you're trained to where we are now does never cease to surprise me.
SPEAKER_01But to be safe, let's do the washout, right? Yeah. When we think about while they're under anesthesia, I'm sure you are doing nerve blocks. Do you often do controlled rate infusions with these cats that are getting full mouth extractions under anesthesia?
SPEAKER_03Yeah, sometimes we have to because the local blocks will not work as well. There's an acidic environment because of all the inflammation, and local blocks are super dependent on the pH of the environment. And so sometimes the blocks won't work and you have to rely on CRIs and other forms of pain control for them.
SPEAKER_01Great. And I talk about that a lot when I talk about nerve blocks because people think that they work no matter what, but often under these chronic inflammatory states, we are up against a brick wall when it comes to having these types of drugs be our primary pain control. So having other tools in the tool belt or other ways of providing the pain control that these cats need while they're under anesthesia and beyond, I feel is something we need to educate ourselves about more. So very good to know. So when we think about preventing these cats from ever getting here, what is the future of research looking like that you know about?
SPEAKER_03Yeah, the goal in the future will be to be able to get something called biomarkers. Biomarkers are different types of substances, it could be genetic material, protein, or a metabolite, or it could be, and it could be from saliva, it could be from a buckle swab, it could be from the blood, but it would be a hint of something that is an intrinsic factor in the cat that could be associated with this disease. And so that's where I think we're going to go in the future. And that's linked to this concept of personalized medicine where you say we measure these things ahead of time, and they're not going to guarantee that you're going to get the disease in the future, but it may change the way we treat you, we monitor you for sure, so that we hopefully catch things at the very least earlier on.
SPEAKER_01Right. Before we have no other choice but to do full mouth extractions on these cats, or that they've been suffering for months to years with the most painful oral condition that we can probably imagine. Yeah. Absolutely. Well, there's so many avenues to think about when it comes to this specific condition. When we think about some of the other products that are out there and available, what do you know about using a laser in the mouth of these cats?
SPEAKER_03Yeah, good question. I think there's two types of lasers, right? There's a therapeutic laser and the ablative laser. In terms of the therapeutic laser, there's no real evidence out there to support since its use. The ablative laser has low quality evidence, and that there's only like a case report with a literature review on ablative laser used for a cat with stomatitis. And in my experience, I've used CO2 laser and a cat with stomatitis before, um, more than one, to be honest, because of proliferative lesions. And my experience with it is that they are more painful, they get worse before they get better. And so a feeding tube on those would be a good idea. And you need to do multiple treatments to promote that fibrosis that will resolve the inflammation. And so I use it as a means to debulk proliferative lesions or as a last resort because I feel that it is a tough sell to an owner to say, and now I'm gonna make your cat feel worse before they feel better, especially now in this environment where in Europe there's feline recombinant interferon, and then in the United States, there's gonna be hopefully stem cell therapy here available in the near future. It would be very hard to justify making a cat feel worse if you have something that doesn't do that and it's FDA approved here soon. So um I think that it's something to know that it's there and it may have a role intraoperatively if you have very exuberant tissue to make the exhumation process less risky. But as a means of treatment for refractory patients, perhaps I wouldn't, it wouldn't be my first choice.
SPEAKER_01Okay, perfect. What about sealants? There is a sealant out there that we have used for years and years in cats called Sanus, and we put that on as the last step of our dental cleaning procedure in all cats because we thought this lasts for six months and it could potentially prevent periodontitis or inflammation of the genival tissues. In specifically cases of aggressive periodontitis, which we had referred to as juvenile onset genivitis or periodontitis. This is happening earlier on in their life and is aggressive to the point that they're losing bone in attachment. I personally had seen some pretty remarkable differences between getting them anesthetized, getting their teeth cleaned, obviously taking full mouth dental radiographs, addressing any specific teeth that require extraction because of mobility, they're too far gone regarding bone loss even at a young age. And then putting that Xanos on, it seemed that the cats that we did that on, they quieted down pretty quickly. Do you have any thoughts or input or anything on specifically that particular sealant?
SPEAKER_03No, not really. It it is VOHC approved, but I have not necessarily used it in our clinics and not specifically for that population of patients for sure. I try to er more towards let's try to get the teeth brushed. I think that would that is my main priority.
SPEAKER_01Right. Which is, we will admit, difficult in cats, especially if they've had something really painful going on in their mouth. It seems like it would be a very hard sell to a cat just because they don't forget. They're like elephants and they remember if that dish of food caused them some sort of pain, like they never want to let a dish. And that's food again. Yes, definitely difficult. One of the products that we're talking about is a hot topic lately is hyaluronic acid. Do you have any thoughts or opinions in regards to hyaluronic acid when it comes to these chronic xeline genitalitis cats?
SPEAKER_03I think that I again haven't used it personally. I think the data on hyaluronic acid in general is pretty solid. I think that for this disease, still we're learning more and more about it. And I would see it as an adjunct rather than a single agent. I do think that there are things that we talked about the complexity of this disease. And I do think that we have other methods that literally act like a Swiss Army knife for this disease. With that, I'm talking about stem cells that tackle like basically every single aspect that we have seen and talked about briefly here in FCGS. So I think that if we want to take a multimodal approach, it's not a bad idea. But there seems to be, especially for these refractory cases, the one treatment that will give you the multimodal approach in one thing, which is pretty remarkable. And I am very excited about the future for these cats because of that possibility, that option.
SPEAKER_01Yeah, stem cell research is amazing and has really taken us a long way in finding some solution to many, many problems that we're dealing with with these patients and other patients. So that could be another episode that we talk about. Regenerative medicine and cuting edge of regenerative medicine. Yeah, so exciting. So we'll have to save that for another time. Sounds great. If there was one key message that you would like veterinary professionals to take away from this discussion about feline chronic gendivostomatitis, what would that be?
SPEAKER_03Yes. Gosh, I think the disease itself is complex. I think that we need to continue to work on it to hopefully find a solution where we don't have to attract teeth that are healthy anymore and we can do better by these cats. But this is when I talk to students here, this is the disease that lets me show them how important client communication is and managing client expectations is, and making sure that clients understand that pain can be missed in these patients and emphasizing the need for pain management across. The board through this disease from the very beginning until the information is resolved. Um, so those are I think key home take-home messages that are key for me with my students and my clients in general in relation to this disease. Yeah.
SPEAKER_01Really good advice and something that I think we can all use because when we are a patient advocate, one thing we're advocating for is that the patient has a not just good but exceptional quality of life. We want really good things for them, and that can then help with the human-animal bond. A cat that comes out and wants to interact with its people and is comfortable and healthy and happy is a really fun cat to have in your house and something that I think really enriches our lives as humans. So we want to be really educating them on what to watch for and then getting these cats in on a more routine basis. We found in my practice that a lot of cats weren't coming in on an annual basis because the owner was hesitant to try to get them in the crate and have to take them out of the cut. And it's yeah, the cat is so good at hiding and not being caught the day the vet appointment is and helping them with all those things by emphasizing how incredibly important it is, even more so in cats I feel than dogs, that we get in there and look in their mouth at least annually from looking for something like just gendivitis or doing a baseline full mouth dental radiographs and assessing things. But cats have such a high incidence of tooth resorption.
SPEAKER_03Yeah, they're just terrible at showing pain, right?
SPEAKER_01So you can't trust them to let you know what's happening. They're not gonna let us know, and they're suffering in silence. And so us as veterinary professionals really need to be proactive in a strong way to make sure that we are emphasizing how important it is that these cats get anesthetized on a frequent basis to investigate thoroughly and look for any signs of any other dental condition or squamous cell carcinoma, which we're gonna talk about with Dr. Goldschmidt at length because they're so good at hiding it, but it can really completely sabotage their quality of life and shorten their lifespan potentially if they were to get something significant like squamous cell carcinoma. Well, Dr. Robert, thank you so much for joining us today and for sharing your insights on this super challenging disease. It's your turn now, before we go, to leave a question for my next guest. Absolutely. So, what would your question be if you would like to ask an interesting question to someone like yourself or someone like myself? All right.
SPEAKER_03So, my question is looking back in time, what concepts in veterinary dentistry did we get most wrong early on? And what are we still getting wrong today? That's great.
SPEAKER_01I think that will be a perfect question for our next guest. Thank you so much for the question, and we will look forward to the answer. Thank you for being on Positive Veterinary Dentistry Podcast today. And to our listeners, thank you for tuning in to the podcast. If you found this episode helpful, we really are trying to grow our listenership. So please share it with your colleagues, anyone who is passionate about helping animals improve their dental care and to help advocate specifically for cats, given this episode focused on chronic delineostomatitis. Until next time, keep learning, keep growing, and keep doing cognitive dentistry making a difference for the patients that you care for.
