Intermediate/advanced

"Diagnosis of inflammatory diseases in the oral cavity of cats, and veterinary patients in general, can be complicated by the fact that there is a limit to the creativity of the oral tissues in their response to inflammatory disease. Not surprisingly, these inflammatory conditions create pain and discomfort for our veterinary patients and many of them suffer in silence due to the potentially subtle changes in their behaviors that may be missed by their caregivers and veterinary providers.

It is important to look at oral lesions in cats with a critical eye and work to obtain the most accurate diagnosis possible. Diagnostic follow-through is critical. Inflammatory and malignant lesions can overlap in their clinical appearance and care must be taken to avoid assumption and mis-identification. Inflammatory lesions may represent more of the lesions seen in our patients than previously recognized, and a diagnosis of a malignant lesion can have serious implications for the care a patient may be provided, impacting the length and quality of their life.

While there are many inflammatory oral conditions that can be seen in our feline patients, this presentation is focused on those commonly referred to specialty practice and those commonly seen in general veterinary practice. In this presentation we will review pattern recognition to narrow the differential list based on clinical findings which can help facilitate discussion with clients to develop a diagnostic plan to guide therapeutic planning."

The oral microbiome, the community of microorganisms (bacteria, fungi, viruses and archaea) residing in the mouth, plays a vital role in health. Distinct microbial profiles exist due to the unique biological properties of the various habitats which are constantly bathed in saliva. Under healthy conditions, the oral microbiome has a favourable commensal association with its environment. However, the build-up of dental plaque can trigger host-mediated inflammation leading to conditions such as gingivitis and periodontitis. Oral infection has been linked to systemic diseases and microbes are postulated to contribute via spread of infection due to transient bacteraemia, circulation of microbial toxins or systemic inflammation from an immune response.

Advances in sequencing and bioinformatics capabilities have led to numerous studies describing bacterial and fungal associations with periodontal health or disease. Crucially, several publications have indicated a lack of similarity (< 20%) between the microbial communities in dogs and cats with those in the human oral cavity. This knowledge creates new opportunities for tailored species-specific diagnostic and health monitoring solutions for cats and dogs. The main technological approaches deployed include sequencing of the entire bacterial community, quantification of individual species and measurement of bacterial biproducts. High throughput sequencing provides a comprehensive profile of the entire microbial community, but is resource-intensive, requires bioinformatics expertise and has a lengthy turnaround time. Quantification of individual species (e.g. qPCR) is cheap, fast and routinely used for diagnostics but can result in false negatives as some pets may not have the bacterial biomarker being screened for. Detection of bacterial biproducts involves measuring bacterial activity (e.g., volatile sulphur compound production or protease activity) and is rapid, cheap and applicable to point-of-care use. However, byproduct levels can fluctuate due to host and environmental factors and can lack specificity so may need to be combined with other measures.

Diet composition may impact the oral microbiome by providing a food source that enriches for certain bacterial species. For example, westernised human diets have led to an increase in acid-producing bacteria within the oral cavity which is likely the reason for the high prevalence of dental caries observed. In dogs and cats, the influence of diet is less well understood, however, molecular screening tools have shown that dry diets shift the bacterial population towards those associated with healthy gingiva and vice versa for wet diets. Dental chews have also been demonstrated to modulate the oral microbiome, increasing the relative abundance of taxa associated with oral health and decreasing the abundance of those associated with periodontal disease.

The oral microbiome plays a critical role in maintaining overall health. Advances in molecular methods and bioinformatics have significantly enhanced our understanding of the distinct microbial communities in the oral cavities of dogs and cats, enabling more precise and rapid diagnostic and monitoring tools. Oral care interventions have been shown to modulate the oral microbiome towards a healthier profile. Continued research integrating microbial profiling with clinical outcomes is required to optimise strategies for improving oral and systemic health in pets.

Immune related inflammatory disease in the oral cavity provides the clinician a diagnostic and treatment challenge. A tooth fracture is such and periodontal disease can be identified via Stages (1-4) with both probing and radiographic identification. However, immune oral pathology can mimic many processes. This lecture will review some of those processes and how to both identify and treat those conditions. I will be referencing three major pieces of literature (Frontiers in Veterinary Science, a lecture by Cindy Bell at the 2024 Veterinary Dental Forum and a recent article in JoVD regarding treatment of Canine Contact Ulcerative Stomatitis by Jamie Anderson)

Mandibular diseases in puppies include proliferative, inflammatory, and developmental conditions during rapid skeletal growth. Because clinical and radiographic features overlap, accurate recognition and differentiation are essential for prognosis and treatment.
Mandibular Periostitis Ossificans (MPO) occurs in immature large-breed dogs, typically 3–5 months old. Breeds such as Labradors, Great Danes, and Great Pyrenees are predisposed, with males and the left mandible more often affected. Signs include unilateral swelling, firm ventrally and fluctuant intraorally. Histopathology shows necrotic bone, sterile fluid, fibrin, granulation tissue, vascular proliferation, and acute inflammation. Odontogenic infection is thought to elevate the periosteum, stimulating new bone. Lesions are usually self-limiting, though enlargement may persist.
Craniomandibular Osteopathy (CMO), also called “lion jaw” or “Westie jaw,” is a developmental orthopedic disorder in terriers aged 3–8 months. Signs include pain opening the mouth, palpation discomfort, bilateral swellings, reduced jaw motion, drooling, fever, and sometimes muscle atrophy. Radiographs show bilateral spiculated hyperostotic bone, while histology confirms new bone formation. Though self-limiting, cases may need supportive care with nutrition, fluids, analgesia, and corticosteroids. Relapses are common if treatment stops early, and some dogs become malnourished due to trismus. A genetic link involves the SLC7A2 gene. In West Highland White Terriers, 36% were carriers, showing incomplete penetrance and variable expression.
Idiopathic Canine Juvenile Cranial Hyperostosis (ICH) affects dogs 3–8 months old in breeds including Boston Terriers, Pit Bulls, Dobermans, and Great Danes. Lesions can involve parietal and occipital bones, tympanic bullae, mandibular rami, and temporomandibular joints. This non-neoplastic proliferative condition has unclear cause, though trauma or inflammation may contribute.
Hypertrophic Osteodystrophy (HOD) affects large-breed puppies 2–6 months old and is heritable in Weimaraners. It presents with painful, bilateral metaphyseal swelling and fever. Radiographs show a “double physis” sign from periosteal bone proliferation. The disease is self-limiting but may recur, and supportive analgesia and nutrition are essential.
Hypertrophic Osteopathy (HO), though less common in puppies, causes distal periosteal bone proliferation, often secondary to thoracic disease. Mechanisms may involve vagal stimulation, vascular changes, or hormones.
Conclusion: Puppy mandibular diseases represent diverse disorders with overlapping features. Diagnosis requires history, clinical exam, imaging, and sometimes histopathology. Breed predispositions and genetics are key. While many conditions resolve, supportive care minimizes pain, prevents malnutrition, and preserves mandibular function. Advances in imaging and genetics will refine diagnostic accuracy and treatment planning.

Periodontal disease is staged based on the amount of bone loss surrounding a tooth root. Should one root of a multirooted tooth have more bone loss than the other, the PD classification is based on the worst root. It’s also essential to note that attachment loss (AL) rarely equates to periodontal pocket depth (PP). Any root exposure (RE) and/or gingival enlargement (GE) should be noted. In cases of root exposure, PP+RE = AL. For a video on the differences between curettes and scalers and their placement into the gingival sulcus, visit: https://tooth.vet/wvc-perio.
Keeping owner compliance and patient comorbidities in mind, along with tooth size variation, one can simplify PP measurements to guide treatment:
• PP depths 1–4 mm should receive closed root planing
• PP depths ≥5 mm are best served by open flap debridement surgery for an average patient (5 mm may be normal in large breeds, while 3 mm may be problematic in small teeth/breeds).
One reason to consider open root planing, which usually extends into some form of flap and oral surgery, is that despite meticulous closed cleaning, residual plaque and calculus are still found at depths greater than 5 mm. In other cases, practitioners may rely on perioceutic medication under the false impression that antimicrobials alone resolve disease. The advantages to open flap treatments include:
• Direct root cleaning with visualization
• Resection of diseased pocket lining and soft tissue treatment
• Primary intention healing
• Evaluation and treatment of bony defects if present
• Minimal alveolar bone resorption during healing
In pockets with vertical bone loss, common on palatal aspects of maxillary canines, intrabony defects provide potential for regenerative procedures. Guided tissue regeneration (GTR) removes irritants (calculus, bacteria, granulation tissue, debris) to encourage PDL, bone, and cementum by excluding gingival tissues with a barrier. Many barriers and graft products exist, with new options entering the veterinary market each year. Familiarity with their properties and sources aids in product selection. Available products are listed at https://tooth.vet/wvc-perio with the following summary:
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Grafts vary in source and features. The most basic feature is osteopromotive: promoting new bone. They may also have osteoconductive surfaces whose topography permits and encourages cellular attachment and migration. Both osteopromotive and osteoconductive surfaces act as scaffolds. Materials are often augmented to be osteoinductive, containing growth factors that induce stem cells. Osteogenic materials contain living mesenchymal cells capable of forming bone (from the patient’s marrow). Almost all graft materials do not function as barriers/membranes. Recall that a barrier is required for GTR to prevent soft tissue in-growth.

In recent veterinary dentistry, the concept of “saving natural teeth” has gained increasing attention. A 2025 study reported that periodontal disease is the primary cause of tooth extraction (82.05%) in small- to medium-sized dogs in Korea. Periodontal disease progresses from gingivitis, which is reversible, to periodontitis, which is irreversible and characterized by the destruction of normal periodontal structures. The concept of “saving natural teeth” includes guided tissue regeneration (GTR), a surgical approach that aims to restore these damaged tissues to a normal or near-normal state. Recently, Emdogain has been introduced as a biomaterial capable of simplifying conventional GTR procedures—traditionally involving bone grafts and barrier membranes—while potentially maximizing periodontal regeneration. This lecture will provide an in-depth analysis of Emdogain’s concept, application techniques, limitations, and anticipated clinical outcomes.
Emdogain is a porcine enamel matrix derivative extracted from developing premolars and molars of pigs less than six months old, with amelogenin comprising approximately 90% of its composition. Amelogenin exhibits high morphological conservation across mammalian evolution and can promote the formation of periodontal ligament, cementum, and alveolar bone through mechanisms similar to those involved in root development. Clinical application involves thorough root planing to debride the root surface, conditioning with 24% EDTA (PrefGel) to remove the smear layer, and applying Emdogain to the dried root surface.
However, Emdogain is not universally effective for all periodontal defects. Cases where favorable outcomes are unlikely include: (1) teeth with significant mobility, (2) periodontal pockets involving furcation exposure, and (3) sites with horizontal bone loss. Furthermore, Emdogain application must be performed with surgical access; its use following simple closed root planing is not recommended.
Human studies on Emdogain report varying conclusions, but consistently highlight its ability to accelerate early wound healing, stimulate gingival fibroblast proliferation, and promote partial regeneration of keratinized gingiva. Nonetheless, the sole use of Emdogain in periodontal pockets with extensive defects remains controversial, and its limitations are evident.
This lecture will review the biological mechanisms of Emdogain, detail its surgical application protocol, and discuss clinical case selection criteria. By understanding its mode of action and boundaries, veterinary practitioners can develop case-specific strategies for successful periodontal regeneration.

The purpose of this work was to develop a system that enables the acquisition of skills in using intraoral radiographic systems and methodologies through virtual reality (VR) and augmented reality (AR). Learning dental radiology techniques requires a multidisciplinary approach combining a solid theoretical foundation, practical skills, and technological sensitivity. To overcome these challenges, it is essential to integrate innovative teaching tools such as virtual and augmented reality simulations. The integration of AR and VR in dental radiology represents one of the most promising technological innovations of recent years, with a significant impact on diagnosis, planning, treatment, and education. VR creates immersive three-dimensional environments, ideal for detailed analysis of complex radiological data and simulation of radiographic techniques. It is widely used in dental education, offering realistic models for learning surgical techniques and improving understanding of anatomical and pathological structures. VR headsets and specific software allow clinicians to explore diagnostic images in 3D space, enhancing personalized treatment planning and fostering interdisciplinary collaboration.

Despite numerous advantages, large-scale adoption of AR and VR in dental radiology is still limited by challenges such as high equipment costs, the need for advanced staff training, and integration into existing clinical and diagnostic workflows. Further technological advancements and greater economic accessibility could overcome these barriers, making AR and VR indispensable tools for improving the quality of dental care. With this objective, we developed a system based on VR and AR that allows simulation of intraoral radiographic imaging. Students can perform radiographs by wearing specific headsets, enabling them to virtually position radiographic plates inside the patient’s oral cavity and place the X-ray device accordingly. The resulting virtual radiograph can then be compared with standardized images obtained at precise angles, allowing immediate feedback on whether the positioning was correct or errors occurred. In a recently published study, the average time required for students to feel comfortable with this technology was 60 minutes, demonstrating its ease of use and rapid learning curve. The virtually unlimited repeatability of the process, without radiation exposure, accelerates and enhances the acquisition of the skills required to produce high-quality images in a shorter time. As shown in Shanahan’s study, 95% of students identified repeatability as the main advantage of simulation, allowing them to practice until fully satisfied with the results. Traditionally, practical labs represented the only way to learn radiographic techniques, with high costs, the use of cadavers, and significant radiation safety issues. All these problems have been completely overcome by this methodology.

It is generally agreed that by graduation, new veterinarians should have acquired the needed knowledge and skills to meet both client demands and professional expectations. However, studies have shown that dental education is lacking in veterinary colleges. A 2017 article surveyed North American veterinary schools, achieving an 86% response rate. Among those schools, more than 50% of the colleges provided less than 5 hours of veterinary dental education.
In 2025, the American veterinary corporation Southern Veterinary Partners (SVP) launched a program for new graduates, titled Dental Fundamentals, which is offered to new graduates in their first two years of practice. A Diplomate of the AVDC designed this course. This is a 2-day wet lab offering 15 RACE-approved hours of CE that teaches equipment and instruments, how to create a flap, extraction techniques, a brief discussion on dental radiographs, and local blocks in canine cadavers. The goal is to fill the gap in veterinary dental education as the new graduates enter clinical practice. SVP wanted to determine if the return on investment was financially beneficial to the company; therefore, the company employed a data analyst to review multiple data points. Currently, the company has a robust dataset on the production of new graduates in their first few years of practice. Accounting for several variables, that data is being compared to the new graduates who have participated in a 2-day wet lab. Additionally, the data for each attendee, both before and after the lab, is being evaluated.
Dental Fundamentals is a new course, launched in 2025. Before this course, SVP had developed a CE course called Dental Principles. This is a 21-hour RACE-approved CE course on veterinary dentistry offered to veterinarians at any part of their career. We learned that participating in this course increased dental production by ~$6,000 per veterinarian. We also learned that there were predictable trends in production following the course that warrant further investigation. Through discussion with the participating veterinarians, we have also identified common roadblocks, outside of education, that limit further growth and likely production as well.
In 2025, Southern Veterinary Partners merged with Mission Veterinary Partners to become Mission Pet Health. The leadership of this new company remains committed to veterinary dental education. By 2026, we should have robust data on the financial impact of providing 2 days of veterinary dental education to new graduates. This presentation will present the data collected so far.

The presentation will focus on determining appropriate surgical margins in the treatment of oral tumors, highlighting their critical role in achieving optimal oncologic outcomes, ensuring adequate local disease control, and minimizing the risk of recurrence. In addition, it will address the evaluation and management of cervical lymph nodes in patients with oral tumors, with particular emphasis on accurate assessment of nodal involvement and the selection of the most appropriate therapeutic approach to improve prognosis and overall treatment success.