Feline odontoclastic resorptive lesions an unsolved enigma in veterinary dentistry

The in vitro effect of pH on osteoclasts and bone resorption in the cat: implications for the pathogenesis of FORL

Dental disease due to osteoclast over‐activity reaches epidemic proportions in older domestic cats and has also been reported in wild cats. Feline osteoclastic resorptive lesions (FORL) involve extensive resorption of the tooth leaving it liable to root fracture and subsequent tooth loss. The aetio‐pathogenesis of FORL is not known. Recent work has shown that systemic acidosis causes increased osteoclast activation and that loci of infection or inflammation in cat mouth are likely to be acidotic. To investigate this, we generated osteoclasts from cat blood and found that they formed in large numbers (∼400) in cultures on bovine cortical bone slices. Acidosis caused an increase in the size of cells—in cultures maintained up to 14 days at basal pH 7.25, mean osteoclast area was 0.01 ± 0.003 mm², whereas an 8.6‐fold increase was observed in cells cultured between 11 and 14 days at pH 7.15 (0.086 ± 0.004 mm²). Acidosis caused a modest increase in the number of osteoclasts. Exposure to pH 6.92 exhibited a 5‐fold increase in the area of bone slices covered by resorption lacunae (∼70% bone slice resorbed). In line with this finding, significant increases were observed in the expression of cathepsin K and proton pump enzymes (both approximately 3‐fold) that are key enzymes reflective of resorptive activity in osteoclasts. These results demonstrate that acidosis is a major regulator of osteoclast formation and functional activation in the cat, and suggest that local pH changes may play a significant role in the pathogenesis of FORL. J. Cell. Physiol. 213: 144–150, 2007. © 2007 Wiley‐Liss, Inc.

Analysis of the surface characteristics and mineralization status of feline teeth using scanning electron microscopy

External resorption of teeth by odontoclasts is a common condition of unknown origin affecting domestic cats. Odontoclastic resorptive lesions involve the enamel cementum junction (ECJ, cervix) and root surface, leading to extensive loss of enamel, dentine and cementum. This study was undertaken in order to determine whether features of the surface anatomy and mineralization of feline teeth could explain why odontoclastic resorptive lesions are so prevalent in this species. Backscattered electron scanning electron microscopy was used to study enamel, cementum and dentine in non-resorbed, undemineralized teeth from adult cats. Analysis of the ECJ revealed thin enamel and cementum and exposed dentine at this site. Furthermore, enamel mineralization decreased from the crown tip to the ECJ, and dentine mineralization was lowest at the ECJ and cervical root. Analysis of cementum revealed variations in the organization and composition of fibres between the cervical, mid- and apical root although no significant differences in mineralization of cementum were detected between different regions of the root. Reparative patches associated with resorption of cementum by odontoclasts and repair by cementoblasts were present on the root surface. In conclusion, results suggest that the ECJ and cervical dentine could be at a greater risk of destruction by odontoclasts compared with other regions of the tooth. The relationship of these features to the development and progression of resorption now requires further examination.

Hypoxia induces giant osteoclast formation and extensive bone resorption in the cat

Dental disease due to osteoclast (OC) overactivity reaches epidemic proportions in older domestic cats and has also been reported in wild cats. Feline odontoclastic resorptive lesions (FORL) involve extensive resorption of the tooth, leaving it liable to root fracture and subsequent loss. The etiopathogenesis of FORL remains unclear. Here, we explore the hypothesis that FORL is associated with hypoxia in the oral microenvironment, leading to increased OC activity. To investigate this, we developed a method of generating OCs from cat blood. Reducing O2 from 20% to 2% increased the mean area of OC eightfold from 0.01 to 0.08 mm2. In hypoxic cultures, very large OCs containing several hundred nuclei were evident (reaching a maximum size of approximately 14 mm2). Cultures exposed to 2% O2 exhibited an increase of approximately 13-fold in the area of bone slices covered by resorption lacunae. In line with this finding, there was a significant increase in cells differentiating under hypoxic conditions, reflected in increased expression of cathepsin K and proton pump enzymes. In conclusion, these results demonstrate that oxygen tension is a major regulator of OC formation in the cat. However, in this species, hypoxia induces the formation of "giant" OCs, which can be so large as to be visible with the naked eye and yet also actively resorb. This suggests that local hypoxia is likely to play a key role in the pathogenesis of FORL and other inflammatory conditions that are associated with bone resorption in cats.

Update on the etiology of tooth resorption in domestic cats

Based on recent findings of increased vitamin D activity in cats with feline odontoclastic resorptive lesions (FORL), the present article provides further clues on the possible etiology of FORL. Microscopic features of FORL and other peculiarities of feline permanent teeth are compared with pathologic findings obtained from experimental studies in other species. Administration of excess vitamin D or vitamin D metabolites in laboratory animals caused changes to dental and periodontal tissues that resemble histopathologic features of teeth from cats with FORL. Chronic excess dietary vitamin D may be the long-sought cause of multiple tooth resorption in domestic cats. It may also provide a basis for future research on idiopathic hypercalcemia and renal disease in the same species.

Evaluation of calciotropic hormones in cats with odontoclastic resorptive lesions

OBJECTIVE

To assess associations between epidemiologic and laboratory variables and calciotropic hormones in cats with odontoclastic resorptive lesions (ORLs).

ANIMALS

182 client-owned cats older than 1 year of age with oral disease.

PROCEDURE

Information on medical history, behavior, living environment, and feeding management was assessed by use of a questionnaire. After induction of general anesthesia, oral examination was performed following standardized protocols and included dental probing and full-mouth radiography. Laboratory analyses included evaluation of FeLV-FIV status, serum biochemical analyses, CBC, urinalysis, and serum concentrations of intact parathyroid hormone (iPTH), parathyroid hormone-related peptide (PTHrP), 25-hydroxyvitamin D (25-OHD), free thyroxine (fT4), and ionized calcium (iCa).

RESULTS

ORLs were identified in 72.5% of cats. Mandibular third premolars were the most commonly affected teeth. Cats with ORLs were significantly older (mean, 9.2 years) than cats without ORLs (mean, 6.6 years). Multivariate logistic regression analysis revealed that 25-OHD, urine specific gravity, jaw-opening reflex on probing, and missing teeth were significant variables, even after accounting for age. Cats with ORLs had significantly higher mean serum concentration of 25-OHD (112.4 nmol/L) and significantly lower mean urine specific gravity (1.0263), compared with cats without ORLs (89.8 nmol/L and 1.0366, respectively).

CONCLUSIONS AND CLINICAL RELEVANCE

Results did not indicate associations between iPTH, PTHrP, or fT4 and development of ORLs. In affected cats, the importance of high serum 25-OHD and low urine specific gravity has not been determined.

Local and systemic complications in a cat after poorly performed dental extractions

This case report describes a cat that was presented with infected oral tissues and signs of systemic inflammatory response. Incomplete dental extractions had been performed 10-days earlier During a second dental procedure, 22 tooth root remnants were removed. Diabetic ketoacidosis and possible thromboembolism complicated the cat's recovery period After 13-days of hospitalization, the patient was stable enough to be sent home. Postoperative examinations at 1, 3, 6, 12, 16, 24, and 52-weeks indicated continued improvement with moderate glycemic control and chronic but stable renal failure. The patient died from further complications of diabetic ketoacidosis 20-months following root remnant extractions.

A rapid screening technique for feline odontoclastic resorptive lesions

The feline odontoclastic resorptive lesion (FORL) status (presence or absence of odontoclastic resorptive lesions) of 423 clinically healthy cats was determined based on radiographic findings in a series of full mouth radiographs (eight views). This status was compared with the FORL status based on evaluation of only two views, namely the right and left mandibular premolar and molar views. Using the FORL status of the right and left third mandibular premolars (307 and 407) alone correctly predicted overall FORL status in 93.4 per cent of cats. The sensitivity of the new technique (FORL cases correctly diagnosed as positive by the test) was 78.5 per cent, while the negative predictive value (negative FORL cases correctly diagnosed by the test) was 91.3 per cent. Overall FORL status can therefore be confidently diagnosed in nine out of 10 cats by assessing FORL status in just two teeth (307 and 407) using two films, which has benefits for the cat (less anaesthetic time and reduced exposure to radiation) and the owner (reduced cost of screening).

A comparison of methods for measuring serum and urinary markers of bone metabolism in cats

Biochemical markers of bone cell activity have recently been shown to be useful for monitoring skeletal health in domestic animals, including dogs and horses. The aim of this study was to evaluate a number of biochemical assays, originally developed for use in humans, for their ability to measure indicators of bone cell activity in serum and urine of normal cats over a range of ages. Bone alkaline phosphatase (BAP), a marker of bone formation, was measured in serum using wheatgerm lectin precipitation (WGL) and by ELISA. The curve derived from serial dilution of feline serum was parallel with the ELISA standard curve, indicating species cross-reactivity, and there was a significant relationship between assays (rs = 0.97, P < 0.001). Deoxypyridinoline (DPD), a marker of bone resorption, was measured in its total form in urine by HPLC and ELISA, and in its free form in serum and urine by ELISA. The dilution curve for free DPD in urine showed parallelism with the assay standard curve; however, the curves for total DPD in urine and serum did not. A significant relationship was established between total urinary DPD (HPLC) with total serum DPD (rs = 0.69, P < 0.001), and with free urinary DPD (rs = 0.95, P < 0.001) concentrations. Carboxy-terminal telopeptide of type I collagen (CTX) concentration, another marker of bone resorption, was measured in serum and urine by ELISA, and there was a significant relationship between assays (rs = 0.82, P < 0.001). CTX could not be measured reliably using an auto-analysis method. A significant relationship was established between total urinary DPD (HPLC) with serum CTX (rs = 0.59, P < 0.05), and urinary CTX (rs = 0.65, P < 0.001) concentrations. BAP (ELISA and WGL), total urinary DPD (HPLC), urinary CTX (ELISA), and serum CTX (ELISA) concentrations were significantly inversely correlated with age (rs = -0.66, -0.88, -0.61, -0.70, and -0.51, P < 0.05 respectively). Cats under two years of age had significantly higher BAP, total urinary DPD (HPLC), and urinary CTX concentrations compared to older cats. In conclusion, this study has shown that a number of commercially available assays provide reliable methods for non-invasively monitoring bone cell activity in cats and has shown that bone turnover decreases within the first two years of life, until complete skeletal maturity is attained. Future studies can now be directed at evaluating the potential clinical application of these methods.

Mapping of the radiographic central point of feline dental resorptive lesions

Intraoral dental radiographs of 217 cats presented for dental treatment were examined. Radiographic signs of dental resorptive lesions were identified in 107 cats, and the apparent central point of each lesion was mapped on a diagram of the tooth. Mapping was only possible on maxillary and mandibular canine teeth and on mandibular third premolar, fourth premolar, and first molar teeth. Resorptive lesions were most common on the molar teeth (n = 103) and maxillary canine teeth (n = 96), and least common on fourth premolar teeth (n = 56). Resorptive lesions on premolar and molar teeth were widely scattered, noted more commonly in the coronal portions of the root. Resorptive lesions in canine teeth had a tendency to be located more apically on the roots.