Dental disease is commonly overlooked and under-treated in our cats. This is likely due to their ability to “hide” discomfort, pain, and the infection that occurs in the common oral conditions that affect cats. In fact the American Veterinary Dental Society estimates that 75% of cats over 5 years of age are in need of dental care. Subtle signs of a poor appetite, drooling, bad breath, weight loss, or changes in grooming habits may indicate a dental condition.
During your cat’s annual physical examination, we perform a thorough oral inspection. In many patients we will find tartar, red gums or gingivitis, fractured teeth, cavities, and even orthodontic abnormalities.
Dental conditions common to cats include: juvenile gingivitis, odontoclastic resorptive lesions, fractured teeth and plasmacytic/ lymphocytic stomatitis.
In a small number of cats it is not uncommon to see the development of red gums (gingivitis) at 6 to 9 months of age. Oftentimes, these cats have little or no calculus accumulation. The exact cause is unknown, however, some theories include: viral, breed disposition (purebred cats such as Persians, Siamese, Abyssinians), genetic and environmental influences, immune suppression, and of course, plaque and calculus build up.
Initially, gingivitis will appear as mild and localized, but it can progress to more severe inflammation of the gums. Treatment of juvenile gingivitis includes eliminating and preventing plaque and calculus formation by performing a thorough teeth cleaning, polishing, and oral rinsing with chlorohexidine solution. The final step is to perform dental home care that includes brushing at least three times weekly and the use of tartar preventative diets.
Feline Odontoclastic Resorptive Lesions
Feline odontoclastic resorptive lesions (FORLs) are painful- cavity like lesions seen in three out of every four cats over the age of 5. The most common teeth affected are the upper and lower premolar and molar teeth. The cause of these lesions is unknown. In the early stages they appear as small “pittings” in the enamel. As they progress it will become more painful and an area of red gum tissue will commonly develop. In time, the cavity will penetrate the pulp canal, the crown will fracture, and bacteria from the oral cavity will have access to the cat’s tooth, bone, and blood stream.
Cats that are “finicky” eaters should be examined for FORLs. By placing a cotton tipped applicator on the affected area, the cat will generally move away in pain with the jaw quivering. It is critical to take dental radiographs in cats to accurately diagnose this condition and to formulate a treatment plan to eliminate this painful condition. Treatment involves extraction or crown amputation therapy, followed by suturing of the gums, and appropriate pain medication.
The most commonly fractured tooth in cats is the canine tooth. Often, just the very tip of these teeth are fractured. Unfortunately the pulp (blood supply and nerve of the tooth) extends to the tip of the canine tooth. The wait & see approach to a fractured tooth is not acceptable in that cats are designed by nature to “hide” their discomfort. Nearly all of teeth with exposed pulp are painful and most will become infected. We recommend that these patients have dental x-rays, and either root canal therapy or extraction therapy.
Plasmacytic / Lymphocytic Stomatitis
Plasmacytic/lymphocytic stomatitis (PLS) is a chronic condition that involves the entire oral cavity. It appears as severe redness, inflammation, and bleeding of the gum tissues, lips, and even tongue. Signs vary from bad breath, loss of appetite, weight loss, difficulty in eating and swallowing, and general lethargy. The exact cause is unknown.
Treatment is challenging and pet owners need to be clearly aware that long term prognosis is guarded for a complete cure. The use of antibiotics and steroids will be a short term “fix”, but eventually the cats will become non-responsive. Full mouth dental radiographs should be taken to identify tooth abnormalities such as feline odontoclastic resorptive lesions, retained root fragments, and severe bone loss. The teeth involved in the affected (red) gums should be extracted. Depending on each individual case, the canine teeth may be salvaged during the initial extraction treatment session; however, the canine teeth may need to be extracted at a later date. Oral antibiotics and pain medications are used post extraction in all patients. Many cats go on to enjoy a happy, healthy life without many of their teeth. Some still eat dry food while others are on a canned diet.