Feline odontoclastic resorptive lesion

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Feline odontoclastic resorptive lesions on a molar. FORL-Molar.jpg
Feline odontoclastic resorptive lesions on a molar.

Feline odontoclastic resorption lesion (FORL) is a syndrome in cats characterized by resorption of the tooth by odontoclasts, cells similar to osteoclasts. FORL has also been called Feline tooth resorption (TR), neck lesion, cervical neck lesion, cervical line erosion, feline subgingival resorptive lesion, feline caries, or feline cavity. It is one of the most common diseases of domestic cats, affecting up to two-thirds. [1] FORLs have been seen more recently in the history of feline medicine due to the advancing ages of cats, [2] but 800-year-old cat skeletons have shown evidence of this disease. [3] Purebred cats, especially Siamese and Persians, may be more susceptible. [4]

Contents

Dental anatomy Tooth Section.svg
Dental anatomy

FORLs clinically appear as erosions of the surface of the tooth at the gingival border. They are often covered with calculus or gingival tissue. It is a progressive disease, usually starting with loss of cementum and dentin and leading to penetration of the pulp cavity. Resorption continues up the dentinal tubules into the tooth crown. The enamel is also resorbed or undermined to the point of tooth fracture. Resorbed cementum and dentin is replaced with bone-like tissue.

Clinical signs

FORL of the lower third premolar FORL 1.JPG
FORL of the lower third premolar

Clinical signs of FORLs are often minimal since the discomfort can be minor. However, there may be subtle signs of discomfort while chewing, as well as anorexia, dehydration, weight loss, and tooth fracture. The lower third premolar is the most commonly affected tooth. [2]

Cause

There are two types of FORL. "Type 1" lesions are focal defects often caused by local inflammation. "Type 2" lesions are characterized by a generalized loss of root radiopacity on a dental radiograph. The definitive cause of type 2 FORLs is unknown, but histologically destruction of the cementum and other mineralized tissue of the tooth root by odontoclasts is seen. It occurs secondary to the loss of the protective covering of the root (the periodontal ligaments) and possibly to a stimulus such as periodontal disease and the release of cytokines, leading to odontoclast migration. [5] However, FORLs can develop in the absence of inflammation. [2] The natural inhibition to root resorption provided by the lining of the root may be altered by increased amounts of Vitamin D, in cats supplied by their diet. [3]

Treatment

Treatment for FORLs is limited to tooth extraction because the lesion is progressive. Amputation of the tooth crown without root removal has also been advocated in cases demonstrated on a radiograph to be type 2 resorption without associated periodontal or endodontic disease because the roots are being replaced by bone. [6] However, X-rays are recommended prior to this treatment to document root resorption and lack of the periodontal ligament. [7]

Tooth restoration is not recommended because resorption of the tooth will continue underneath the restoration. Use of alendronate has been studied to decrease progression of existing lesions. [8]

Differential diagnosis: dental caries

True dental caries are uncommon among companion animals. [9] Although it has not been accurately documented in cats, the incidence of caries in dogs has been estimated at 5%. [10] The term feline cavities is commonly used to refer to FORLs; however, saccharolytic acid-producing bacteria are not involved in this condition.

Related Research Articles

<span class="mw-page-title-main">Human tooth</span> Calcified whitish structure in humans mouths used to break down food

Human teeth function to mechanically break down items of food by cutting and crushing them in preparation for swallowing and digesting. As such, they are considered part of the human digestive system. Humans have four types of teeth: incisors, canines, premolars, and molars, which each have a specific function. The incisors cut the food, the canines tear the food and the molars and premolars crush the food. The roots of teeth are embedded in the maxilla or the mandible and are covered by gums. Teeth are made of multiple tissues of varying density and hardness.

<span class="mw-page-title-main">Cementum</span> Specialized calcified substance covering the root of a tooth

Cementum is a specialized calcified substance covering the root of a tooth. The cementum is the part of the periodontium that attaches the teeth to the alveolar bone by anchoring the periodontal ligament.

<span class="mw-page-title-main">Tooth decay</span> Deformation of teeth due to acids produced by bacteria

Tooth decay, also known as cavities or caries, is the breakdown of teeth due to acids produced by bacteria. The cavities may be a number of different colors from yellow to black. Symptoms may include pain and difficulty with eating. Complications may include inflammation of the tissue around the tooth, tooth loss and infection or abscess formation.

<span class="mw-page-title-main">Toothache</span> Medical condition of the teeth

Toothache, also known as dental pain or tooth pain, is pain in the teeth or their supporting structures, caused by dental diseases or pain referred to the teeth by non-dental diseases. When severe it may impact sleep, eating, and other daily activities.

<span class="mw-page-title-main">Cementoenamel junction</span>

Cementoenamel junction (CEJ) is defined as the area of the union of cementum and enamel at the cervical region of the tooth. It is a slightly visible anatomical border identified on a tooth. It is the location where the enamel, which covers the anatomical crown of a tooth, and the cementum, which covers the anatomical root of a tooth, meet. Informally it is known as the neck of the tooth. The border created by these two dental tissues has much significance as it is usually the location where the gingiva attaches to a healthy tooth by fibers called the gingival fibers.

<span class="mw-page-title-main">Periodontal fiber</span> Group of specialized connective tissue fibers

The periodontal ligament, commonly abbreviated as the PDL, is a group of specialized connective tissue fibers that essentially attach a tooth to the alveolar bone within which it sits. It inserts into root cementum on one side and onto alveolar bone on the other.

<span class="mw-page-title-main">Human tooth development</span> Process by which teeth form

Tooth development or odontogenesis is the complex process by which teeth form from embryonic cells, grow, and erupt into the mouth. For human teeth to have a healthy oral environment, all parts of the tooth must develop during appropriate stages of fetal development. Primary (baby) teeth start to form between the sixth and eighth week of prenatal development, and permanent teeth begin to form in the twentieth week. If teeth do not start to develop at or near these times, they will not develop at all, resulting in hypodontia or anodontia.

Periodontology or periodontics is the specialty of dentistry that studies supporting structures of teeth, as well as diseases and conditions that affect them. The supporting tissues are known as the periodontium, which includes the gingiva (gums), alveolar bone, cementum, and the periodontal ligament. A periodontist is a dentist that specializes in the prevention, diagnosis and treatment of periodontal disease and in the placement of dental implants.

<span class="mw-page-title-main">Veterinary dentistry</span> Branch of veterinary medicine

Veterinary dentistry is the field of dentistry applied to the care of animals. It is the art and science of prevention, diagnosis, and treatment of conditions, diseases, and disorders of the oral cavity, the maxillofacial region, and its associated structures as it relates to animals.

<span class="mw-page-title-main">Veterinary surgery</span> Surgery performed on non-human animals

Veterinary surgery is surgery performed on non-human animals by veterinarians, whereby the procedures fall into three broad categories: orthopaedics, soft tissue surgery, and neurosurgery. Advanced surgical procedures such as joint replacement, fracture repair, stabilization of cranial cruciate ligament deficiency, oncologic (cancer) surgery, herniated disc treatment, complicated gastrointestinal or urogenital procedures, kidney transplant, skin grafts, complicated wound management, and minimally invasive procedures are performed by veterinary surgeons. Most general practice veterinarians perform routine surgeries such as neuters and minor mass excisions; some also perform additional procedures.

<span class="mw-page-title-main">Gingival recession</span>

Gingival recession, also known as gum recession and receding gums, is the exposure in the roots of the teeth caused by a loss of gum tissue and/or retraction of the gingival margin from the crown of the teeth. Gum recession is a common problem in adults over the age of 40, but it may also occur starting in adolescence, or around the age of 10. It may exist with or without concomitant decrease in crown-to-root ratio.

<span class="mw-page-title-main">Periapical cyst</span> Medical condition

Commonly known as a dental cyst, the periapical cyst is the most common odontogenic cyst. It may develop rapidly from a periapical granuloma, as a consequence of untreated chronic periapical periodontitis.

<span class="mw-page-title-main">Dental caries (non-human)</span>

Dental caries, also known as tooth decay, is uncommon among companion animals. The bacteria Streptococcus mutans and Streptococcus sanguis cause dental caries by metabolising sugars. Prehistoric primates eating fruit suffer from cavities.

<span class="mw-page-title-main">Gingival sulcus</span> Space between tooth and gums

The gingival sulcus is an area of potential space between a tooth and the surrounding gingival tissue and is lined by sulcular epithelium. The depth of the sulcus is bounded by two entities: apically by the gingival fibers of the connective tissue attachment and coronally by the free gingival margin. A healthy sulcular depth is three millimeters or less, which is readily self-cleansable with a properly used toothbrush or the supplemental use of other oral hygiene aids.

<span class="mw-page-title-main">Scaling and root planing</span> Dental procedure

Scaling and root planing, also known as conventional periodontal therapy, non-surgical periodontal therapy or deep cleaning, is a procedure involving removal of dental plaque and calculus and then smoothing, or planing, of the (exposed) surfaces of the roots, removing cementum or dentine that is impregnated with calculus, toxins, or microorganisms, the agents that cause inflammation. It is a part of non-surgical periodontal therapy. This helps to establish a periodontium that is in remission of periodontal disease. Periodontal scalers and periodontal curettes are some of the tools involved.

The junctional epithelium (JE) is that epithelium which lies at, and in health also defines, the base of the gingival sulcus. The probing depth of the gingival sulcus is measured by a calibrated periodontal probe. In a healthy-case scenario, the probe is gently inserted, slides by the sulcular epithelium (SE), and is stopped by the epithelial attachment (EA). However, the probing depth of the gingival sulcus may be considerably different from the true histological gingival sulcus depth.

Dental pertains to the teeth, including dentistry. Topics related to the dentistry, the human mouth and teeth include:

<span class="mw-page-title-main">Gingivitis</span> Inflammation of the gums

Gingivitis is a non-destructive disease that causes inflammation of the gums; ulitis is an alternative term. The most common form of gingivitis, and the most common form of periodontal disease overall, is in response to bacterial biofilms that are attached to tooth surfaces, termed plaque-induced gingivitis. Most forms of gingivitis are plaque-induced.

<span class="mw-page-title-main">Tooth resorption</span> Medical condition

Resorption of the root of the tooth, or root resorption, is the progressive loss of dentin and cementum by the action of odontoclasts. Root resorption is a normal physiological process that occurs in the exfoliation of the primary dentition. However, pathological root resorption occurs in the permanent or secondary dentition and sometimes in the primary dentition.

References

  1. van Wessum, R; Harvey, CE; Hennet, P (November 1992). "Feline dental resorptive lesions. Prevalence patterns". Vet Clin North Am Small Anim Pract. 22 (6): 1405–1416. doi:10.1016/s0195-5616(92)50134-6. PMID   1455579.
  2. 1 2 3 Gorrel, Cecilia (2003). "Feline Odontoclastic Resorptive Lesions". Proceedings of the 28th World Congress of the World Small Animal Veterinary Association. Retrieved 22 October 2006.
  3. 1 2 Lyon, Kenneth F. (2005). "Odontoclastic Resorptive Lesions". In August, John R. (ed.). Consultations in Feline Internal Medicine. Vol. 5. Elsevier Saunders. ISBN   0-7216-0423-4.
  4. Dodd, Johnathon R. "Feline Odontoclastic Resorptive Lesions". Small Animal Dental Service. Texas A&M University Veterinary Medical Teaching Hospital. Archived from the original on 3 September 2006. Retrieved 22 October 2006.
  5. Bar-am, Yoav. "Ethiopathogenesis of feline odontoclastic resorption lesions". Koret School of Veterinary Medicine. Retrieved 22 October 2006.
  6. Carmichael, Daniel T. (February 2005). "Dental Corner: How to detect and treat feline odontoclastic resorptive lesions". Veterinary Medicine. Archived from the original on 5 May 2006. Retrieved 22 October 2006.
  7. Beckman, Brett (1 March 2007). "Off with the crown?". DVM360.com. Advanstar Communications. Retrieved 11 December 2023.
  8. Mohn, Kenneth; Jacks, Thomas; Schleim, Klaus Dieter; Harvey, Colin; Miller, Bonnie; Halley, Bruce; Feeney, William; Hill, Susan; Hickey, Gerry. "Alendronate binds to tooth root surfaces and inhibits progression of feline tooth resorption: a pilot proof-of-concept study". Journal of Veterinary Dentistry. 26 (2): 74–81. doi:10.1177/089875640902600201. PMID   19718970 . Retrieved 3 June 2021.
  9. "Cavities". American Veterinary Dental Society. Archived from the original on 13 October 2006. Retrieved 23 October 2006.
  10. Hale, FA (June 1998). "Dental caries in the dog". J Vet Dent. 15 (2): 79–83. doi:10.1177/089875649801500203. PMID   10597155.