Oral Ulcerations

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Ulceration of a cat's pharynx
due to feline stomatitis

Definition - destruction of the oral epithelium exposing underlying connective tissue.

Pathophysiology - cell/cell and cell/matrix adhesion proteins are responsible for maintaining the integrity of the mucosal lining of the oral cavity. Disease processes that destroy keratinocytes or adversely affect their adhesion to one another or to the subjacent basement membrane will result in erosions, ulcerations, and desquamation. Immunologic processes that have a deleterious effect on the integrity of the epithelial/basement membrane submucosa complex may be involved in causing ulcers to form.

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Ulceration of the lower canine
incisors due to periodontal disease

Signalment

Species - canine and feline-Hard palate, buccal and tongue ulcers

Breed Predilections - Ulcerative eosinophilic stomatitis affecting three Cavalier King Charles spaniels have been described. The lesions are similar in gross appearance to palatine eosinophilic granulomas, but histologically they lack granuloma formation. Maltese are prone to oral ulceration caused by periodontal disease.

Mean Age and Range - N/A

Predominant Sex - N/A

Signs - ptyalism, anorexia, painful chewing

Causes - see differential diagnosis, below

Risk Factors - N/A

Differential Diagnosis - periodontal disease, uremia (tongue and buccal mucosa ulcers), lymphocytic plasmacytic stomatitis (feline), viral diseases (calicivirus, herpes virus) in the cat, autoimmune disease (pemphigus vulgaris, bullous disease, erythema multiforme, systemic lupus erythemaosus) gum chewers disease ( chronic chewing of the cheeks), malignancy, trauma, chemical injury, eosinophilic ulceration, and infection (bacterial, viral, and fungal).

Imaging - N/A

Diagnostic Procedures

Exfoliative Cytology - with the help of an applicator stick placed on the lesion then on a microscopic slide for examination.

Oral examination of adjacent teeth for various stages of periodontal disease.

Pathology Findings - depends on etiology

Treatment

Uremic ulcers: pepsid, clindamycin, Carafate...make suspension of 1/4 to 1/2 gm tab in water and give dose s-bid. Promotes oral epithelialization and is a phosphorus binder too. It's important to keep on antibiotics and minimize the azotemia.

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Ulceration on top of second premolar
due to periodontal disease
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Healed ulcers after premolar
extractions

Ulcers due to periodontal disease - initial therapy to clean and polish affected teeth. Extraction of advanced periodontal disease on affected teeth may be necessary.

Medications

Drugs of Choice - topical antimicrobial and antifunal agents, topical and systemic corticosteroids, carboxymethlycellulose preparations (Orabase). Zinc containing oral rinses are helpful in the healing process.

Contradictions - N/A

Follow-Up - weekly then monthly

Surgical Considerations - be careful to resuture gingiva without tension after extraction.

 


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Jan Bellows, DVM
All Pets Dental Clinic
17100 Royal Palm Blvd.
Weston, FL 33326
(954) 349-5800
dentalvet@aol.com