Practice Limited to Dentistry
This web log will review Dr. DeForge's hallmark surgery summarizing all aspects of the journey in the Cat Stomatitis Surgical Protocol. This life changing journey is detailed and reviewed from beginning to completion containing all steps which culminate in a pain free quality of life.!
Guided Bone Regeneration [GBR]
- Referring Doctor must fill out Doctor's Referral Form on SilverSandsVeterinary.com
- Please perform a Comprehensive Chemistry Profile and CBC with Urinalysis
- All cats, 5 years or older, must have a Thyroid Profile-including a Total T4 and a Free T4
- The following tests are sent to the National Veterinary Lab-William Hardy, VMD-Director; Feline Leukemia [FeLeuk IFA]; Western Blot FIV testing; Western Blot Bartonella Testing. [Call 201-891-2992 for a Test Supplies Order Form. All tests are directly mailed USPS to the National Veterinary Lab.] A test submission form may be downloaded as a PDF file at natvetlab.com. Click on the RED test submission form button.
- Chest Radiographs must be completed and read by a radiologist
- EKG/ECG and ECHOCARDIOGRAM are completed and reviewed by a cardiologist
- An Abdominal Ultrasound is completed to rule out lymphoma and other comorbidities. Many times an internist will need to complete a biopsy to scrutinize findings noted on ultrasonography for a definitive diagnosis
- Oral Biopsy is essential-including gingiva, oral mucosa, bone, and dental tissue. If uncomfortable with deep tissue biopsies, please ask Dr. DeForge to complete this procedure.
- Full mouth Oral Photography is completed
- Full mouth Oral Radiology is completed
- A Video Telemedicine Conference is initiated with Dr. DeForge and the Generalist referring the Cat Stomatitis patient
- A list must be provided from the Referring Doctor of any and all comorbidities, already diagnosed, in the stomatitis patient
- A history of any allergy to medicine[s]; or adverse reactions to any sedative; tranquilizer; analgesic; or other drug utilized in this patient in the past must be provided
- After all pre-anesthesia testing is completed, a Letter of Clearance for Anesthesia must be provided by the Referring LDVM or the Internal Medicine Doctor/and Cardiologist performing the pre-anesthesia assessment.
- If any of the above testing cannot be completed by the LDVM, the client must visit an Internal Medicine Doctor for testing. Local referrals can have all testing performed by Dr. DeForge if the LDVM is not able to complete the testing.
Feline Stomatitis [FS]No pet owner wants their cat in pain! Yet each day 1000's of cats wake up in pain thinking that a life of pain is normal.........believing that life is ONLY constant pain! As veterinary professionals and pet advocates, there now is a way to remove oral pain in stomatitis cats permanently.
Feline Stomatitis has been investigated by animal dentists for over thirty years.
Unfortunately, approximately only one-half of the cats with this type of extraction surgery reach full recovery. Depending on the author, 4-5 patients out of each 10 felines treated with whole mouth extraction revert to some degree of the oral inflammatory state within 6-18 months post-surgery. Full recovery is uncommon.
The Answer is here: Guided Bone Regeneration Surgery
The name of the disease is not as significant as the pain that is caused by this disease. Feline Stomatitis [FS] produces a chronic non-responsive generalized oral pain affecting the gingiva, mucosa, palate, lingual and lingual-sublingual areas; the glosso-pharyngeal arches; the commissures; and at times the entire pharynx. Depending on the feline, all mentioned above or site-specific pathology centers can be identified.
Historical medical treatments have been completely non-productive and useless to feline patients.. There is no successful medical treatment for this disease.
The inflammation can be hidden with glucocorticoids, immunosuppressants, herbs, gold salts, antibiotics, analgesics, vitamins, probiotics, local topical anesthetics, salicylate therapy, and multiple anti-inflammatory protocols. None are effective in the long term. Most, only, offer short term pain relief and discomfort quickly returns.
Three sub-groups of FS have been identified by this author. Juvenile [4 months to 18 months]; Adult onset 18 months to 10 years; and Geriatric or Late Onset [10 to 20+ years].
It must be emphasized that this author does not feel that Bartonella is the etiologic agent of FS. Azithromycin does definitely reverse some, oral inflammatory disease patients under twelve months of age that are Bartonella positive. In older Bartonella positive felines that have FS, confirmed with histopathology, treatment with Azithromycin does NOT reverse the pathology.
The main characteristics of all age groups are advanced oral inflammation and severe pain. No veterinarian should rely on corticosteroids and antibiotics as the treatment protocol for these felines. It is non-productive, does not help the patient in the long-term, and most importantly can predispose the patient to systemic pathology.
This author sees many cases of FS that have been treated for years with corticosteroid therapy with adrenal disease, liver disease, kidney disease, and transient diabetes. Others present with septic oral pathology that has been influenced by the immune system being suppressed by glucocorticoids.
Diagnosis of FS:
Diagnosis of FS is accomplished with biopsy and histopathology. The practitioner must never confuse FS with Squamous Cell Carcinoma [SCC] or any other oral neoplasia in the feline. Biopsy must be deep and representative of the pathology. Superficial biopsies are useless to the histopathologist. This author recommends soft tissue; dental; and bone biopsy specimens be sent to an oral histopathologist for examination. When referring a suspect stomatitis patient to Dr. DeForge, please include:
- Full mouth oral photography
- Full mouth dental imaging
- Histopathology reports.
Mixed pathology is found in the FS patient. Feline Eosinophilic Granuloma Complex, external and internal root resorption, root ankylosis, and bony changes can all be present. The soft tissue changes are the most extreme with ulcerated sites that bleed readily when being examined. In many FS patients, the attached gingiva, under general inhalation anesthesia, can be peeled back from the tooth and bone as easily as peeling a banana.
Dr. DeForge’s studies have confirmed that FS is not a disease of the dentition but is a disease of bone. A polymicrobial bone pathology is suspected. A grant for bone culture and tissue culture is being sought to identify FS etiology.
FS GBR Surgery utilizes oral digital radiology to identify areas of sclerosing osteomyelitis, condensing osteitis, sclerotic alveolar crestal bone loss, and hypertrophic bone reaction with resorption. Once the pathology is identified radiographically, osteoplasty techniques are utilized to removed petrological bone before initiating GBR techniques.
Pain control is paramount pre-operatory; intra-operatory; and post-operatory. There is no pain in any stomatitis cat from the moment Dr. DeForge meets your special friend until the stomatitis post-operative period is completed.
Pain control is accomplished with injectable opiates; Periodontal Ligament Blocks; and other safe pain medicines to be prescribed as part of a home treatment pain management plan after surgery.
Verification of Bone-Centered Etiology