PAIN SCORES, ANALGESIC REQUIREMENTS AND FOOD INTAKE IN CATS WITH ORAL DISEASE UNDERGOING DENTAL TREATMENT

WATANABE R, DOODNAUGHT G, PROULX C, MONTEIRO B, BEAUCHAMP G, DUMAIS Y, STEAGALL PDépartement de sciences cliniques, Faculté de médecine vétérinaire, Université de Montréal, Canada

1. Rolim VM et al. J Feline Med Surg. 2017; 19: 403-409.

2. Southerden P. In Pract 2010; 32: 2–7.

3. Reid J et al. Vet Rec. 2017; 180: 449.

4. Chandler ML et al. Vet Clin North Am Small Anim Pract. 2014; 44: 645-66.

5. Wegner K et al. Vet Anaesth Analg. 2007; 34: 132-138.

6. Lascelles BD et al. J Vet Intern Med. 2004; 18: 190-195.

7. Thrill DE et al. The skull In: Atlas of normal radiographic anatomy & anatomic variants in the dog and cat

2nd ed. Missouri: ELSEVIER; 2016. P. 20-48.

8. American Veterinary Dental College. Nomenclature. https://www.avdc.org/Nomenclature/Nomen-

Intro.html. Cited 2 September 2018.

l Periodontal disease (PD) is common and produces pain with potential impact

on nutritional status and quality of life of cats.1,2

l This study aimed to evaluate pain scores, analgesic requirements and food

intake between cats with minimal or severe PD before and after treatment.

l The hypotheses were: 1) cats with severe PD would have higher pain scores

and analgesic requirements than those with minimal PD, 2) pain scores

would correlate with dental parameters and 3) cats with severe PD would

have less food intake than those with minimal PD.

l Demographic data, prevalence and frequency of rescue analgesia and results

of CMPS-F are shown in Tables 1 and 2, and Figure 3, respectively.

l CMPS-F scores were positively correlated with number of tooth extractions,

gingival index, and calculus index (r = 0.80, 0.70 and 0.48, respectively).8

l The severe disease group had lower wet food intake during 3 minutes at 2

and 6 hours post-operative (day 1), evening of day 3 and morning and

evening of days 4 and 5 when compared to the minimal group (p ≤ 0.0004,

respectively). Wet food intake was higher in the minimal group at 6 hours

post-operative and lower in the severe group on the morning of day 4 (p =

0.001 and 0.0003, respectively) when compared with baseline.

l Results of wet food intake during 3 minutes and 2 hours/day and dry food

intake during 3 minutes and 2 hours are shown in Figure 4.

l Long-term analgesia is required after treatment of severe oral disease in cats.

This conditions impacts food intake before and after treatment.

RESULTS

ACKNOWLEDGEMENTS

REFERENCES

l Ethics committee: 17-Rech-1890

l Study design: Prospective, blinded clinical trial

l Animals: Twenty-four cats (11 males and 13 females) from local shelters were

divided into two groups (minimal or severe PD) based on a scoring system

(Figure 1).

l Treatment of oral disease: Cats were admitted on day 0. They underwent

general anesthesia (acepromazine, hydromorphone, propofol, isoflurane,

meloxicam and dental nerve blocks with bupivacaine) on day 1 for treatment

of oral disease. Cats were discharged on day 6; meloxicam was administered

up to day 4 (0.05 mg/kg PO at day 2-4).

l Pain assessment: Pain assessment was performed by an observed who was

blinded to disease severity using the Glasgow composite measure pain scale-

feline (CMPS-F)3 (Figure 2). Rescue analgesia was administered if scores ≥

5/20 using hydromorphone either at 0.05 mg/kg (IV) or 0.1 mg/kg (IM).

l Food intake evaluation: Cats were fed drya and wetb food according to Figure

2. Total amount (100%) of food/day was calculated based on the following

equation (kcal): 70� body weight (kg)0.75.4 Cats were offered 33.3% of their

daily total amount at each time point. Food intake (%) during 3 minutes and

2 hours were calculated for each time point and each day/cat. Any remaining

food was removed after 2 hours.

l Statistical analysis:

u CMPS-F scores were compared between baseline and each time point and

between groups at each time point using the Cochran-Mantel-Haenszel test for

repeated measures.

u Correlations between CMPS-F scores on the morning of day 2 and dental

parameters were evaluated using Spearman’s correlation.

u Prevalence and frequency of rescue analgesia were compared using the exact

chi-square test.

u Food intake was compared using a linear mixed model with Benjamini-Hochberg

sequential adjustment procedure for multiple comparisons (p < 0.05).

u CMPS-F scores and food intake obtained within 2 hours of IV and within 6 hours

of IM injection after rescue analgesia were excluded from the statistical

analysis.5,6

MATERIALS & METHODS

INTRODUCTION

CONCLUSIONS

l This study was funded by Hill’s Pet Nutrition and a

Discovery Grant by the Natural Sciences and Engineering

Research Council of Canada (RGPIN-2018-03831).

Variable Minimal disease (n = 12) Severe disease (n =12) p valueMedian (range) dental score 1 (0-4) 17 (8-28) < 0.0001

Mean (SD) Age (years) 3.6 (2) 8.5 (2.2) < 0.0001

Mean (SD) Body weight (Kg) 4.0 (0.6) 5.8 (1.9) 0.007

Median (range) Body condition score (1-9) 5 (5-6) 6 (4-6) 0.078

Table 1 – Demographic data for cats with minimal or severe oral disease undergoing treatment for oral disease

Figure 2 – Time points for pain assessment and food intake evaluation

(Atlas of normal radiographic anatomy & anatomic variants in the dog and cat)

Figure 1 – Dental scores based on number of dental extractions7

• If ≥ 7 incisive teeth

and/or first premolars

of the mandible were

extracted, they were

counted as 2 points,

otherwise if ≤ 6 teeth

were extracted, they

were counted as 1 point.

l Total score was

calculated.

l Cats were allocated to the minimal (Figure 1-a)

or severe (Figure 1-b)

oral disease group if dental scores were ≤ 7 or ≥ 8, respectively.

Day1Post-OP2.0h

Post-OP6.0h

Post-OP0.5h

Post-OP4.0h

Post-OP1.0h

Post-OP8.0h

Post-OP3.0hDentalprocedure

06:00 09:00 12:00 15:00 18:00 21:00

Day006:00 09:00 12:00 15:00 18:00 21:00

AdmissionDW

Day606:00 09:00 12:00 15:00 18:00 21:00

Discharge

Day2,3,4,5

06:00 09:00 12:00 15:00 18:00 21:00

Figure2-TimepointsforpainassessmentandfeedingevaluaGon

W W

W W W

D

W

CMPS-F DDryfooda WetfoodbCMPS-F+Feeding WaHill’sScienceDiet,AdultOpImalCare–Dry,

bHill’sPrescripIonDieta/d,

Hill’sPetNutriIonCanadaInc.,Mississauga,ON,Canada

GroupDay 1 (Postoperative)

Day 2 Day 3 Days4, 5, 6 Total p value

0.5h 1h 2h 3h 4h 6h 8hMinimal disease 0 0 0 0 0 0 0 0 0 0 0 (0%)

< 0.0001Severe disease 0 2 1 2 5 2 2 5 2 0 21 (91.7%)

Table 2 – Number of cats receiving rescue analgesia at each time point during the study

26 Atlas of Normal Radiographic Anatomy and Anatomic Variants in the Dog and Cat

Upper jaw

Left upperpermanent

2

Left upperdeciduous

6

Left

Left lowerpermanent

3

Left lowerdeciduous

7

Lower jaw

Right lowerdeciduous

8

Right lowerpermanent

4

Right upperdeciduous

5

Right upperpermanent

1

Right

A

Right lower

Right upper

Incisors

Incisors

Canine

Canine

B

Premolars

Premolars

Molars

Molars

101102

103

104

105

106

107

108

109

110

411

410

409

408

407

406405

404

403402

401

Left upper

Left lower

201202

203

204

205

206

207

208

209

210

311

310

309

308

307

306305

304

303302

301

Left upper

Left lowerRight lower

Right upper

Incisors

Incisors

Canine

Canine

C

Premolars

Premolars

Molar

Molar

101102

103104

106

107

108

109

201202

203204

206

207

208

209

409

408

407

404

403402

401

309

308

307

304

303302

301

Figure 2-7. The modified Triadan system of dental identification. In A, each quadrant of the mouth is designated by a number; this is the first digit in identification. With respect to permanent teeth, the right maxilla is designated 1, the left maxilla 2, the left mandible 3, and the right mandible 4. When describing deciduous teeth, the right maxilla is designated 5, the left maxilla 6, the left mandible 7, and the right mandible 8. B, Sche matic model of a canine jaw with each permanent tooth identified. The numbering always begins on midline; the central incisor is designated 01, the canine 04, and the first molar 09. C, Schematic model of a feline jaw, showing tooth identification.

3

3

2

1

21

Figure 1-a

Figure 1-b

Baselin

e

0.5h

1h

2h

3h

4h

6h

8h

Morning

Noo

n

Even

ing

Morning

Noo

n

Even

ing

Morning

Noo

n

Even

ing

Morning

Noo

n

Even

ing

Morning

0

1

2

3

4

5

Timepoint

CMPS-F

MinimaldiseaseSeveredisease

*†*†

*†

*†

*†

*†

*† *†

*†

*†*†

** *

**

*

** *

Day 1 (Postoperative) Day 2 Day 3 Day 4 Day 5 Day 6

Figure 3 and 4 - The bars and error bars represent least-squares means and standard errors, respectively.

* and † indicate a significant difference between groups and between baseline and each time point,

respectively (p < 0.05).

Figure 4 – Food intake (%) in cats with minimal and severe oral diseasebefore and after treatment

Figure 3 – CMPS-F scores in cats with minimal and severe oral diseasebefore and after treatment

Figure 4b – Dry food

Baseline Day60

20

40

60

80

100

Timepoint

Food

intake(%

)

*

*

*

*

Baseline Day1 Day2 Day3 Day4 Day50

20

40

60

80

100

Timepoint

Food

intake(%

)

Minimaldisease(3min)Severedisease(3min)Minimaldisease(2h)Severedisease(2h)

Figure 4a – Wet food

Baseline Day1 Day2 Day3 Day4 Day50

20

40

60

80

100

Timepoint

Food

intake(%

)

Minimaldisease(3min)Severedisease(3min)Minimaldisease(2h)Severedisease(2h)

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**