Browsing tag: cat dental disease

Sometimes it’s not teeth – other causes of bad breath in pets.

mouth

What can cause bad breath?

Bad breath, or halitosis, is very common in dogs and cats; however, there are a wide range of possible causes. Some are simple to treat; others less  so – but bad breath is almost always symptoms of an underlying problem.

There is one, harmless cause of halitosis – eating something rotten or smelly (much more common in dogs than cats)! Some dogs love eating      faeces or rotting food; this may be habit, or greed – but in a small percentage of cases is due to a condition called pica. This is when the animal        will eat pretty much anything, whether or not it is actually food-like, and may be due to mineral or vitamin deficiencies or certain brain diseases. In  most cases, however, eating rotting or smelly things isn’t due to a disease condition (although it may well lead to a nasty episode of vomiting and  diarrhoea!).

Metabolic diseases can also cause bad breath – especially diabetes and kidney failure. These conditions are both associated with changes in urination and drinking, and often weight loss. If untreated, both are potentially fatal. In diabetes, the breath may smell sweet (because of the excess sugar in the bloodstream); sour (because of increased bacterial growth, as the bacteria feed on the sugar); or musty (as yeasts grow in the mouth). In kidney failure, the breath may smell metallic (due to a build-up of toxins and waste products that the kidneys aren’t filtering).

Diseases of the respiratory tract such as sinusitis, nasal infections, and nasal tumours may also lead to bad breath. This is caused by the production of pus (dead, dying and decomposing white blood cells, bacteria and blood) in the nose, which trickles down into the back of the throat.

Some diseases of the gastrointestinal system can also cause halitosis, particularly megaoesophagus (where the gullet becomes swollen and dilated so food pools in it) or persistent vomiting (e.g. due to a blockage of the bowel, gastritis, kidney or liver disease). Infections of the mouth or the lip folds (e.g. in spaniels) may also cause it.

However, by far the most common cause of bad breath in dogs and cats is dental disease. Unless we regularly brush their teeth, most (although not all) dogs and cats will develop tartar and plaque on their teeth. This material is a mixture of salts from the saliva and masses of bacteria, living off the food in the mouth. While this is on the ends of the teeth, it isn’t a major problem (although it may smell a little); however, once it reaches the gum line, it rapidly becomes dangerous. When these plaques of bacteria touch the gum, they cause inflammation and infection of the gum tissues (called gingivitis). If untreated, this will spread down into the sockets of the teeth (periodontal disease) and lead to damage to the ligaments of the teeth. In some cases, infection may even penetrate the bone causing a tooth root abscess (which may burst through into a sinus causing sinusitis) or even osteomyelitis (infection of the bone). Even simple gingivitis is a risk factor for heart disease and kidney failure as the bacteria can easily enter the bloodstream – in severe cases, they may even suffer from blood poisoning and septic shock. In addition, a dog with severe gingivitis or periodontal disease will be unwilling to eat, and may eventually starve to death. If untreated, gingivitis will almost inevitably progress (the speed is variable; the fact of progression is not). As you’ve found, in many cases by the time the problem is diagnosed, the affected teeth cannot be saved.

So how do we know what’s going on?

In bad breath cases, you really do need to find out what’s causing the problem! For that, you’ll need to get him seen by your vet. Kidney disease is easily detected on a blood test (elevated levels of urea and creatinine, two waste substances normally filtered by the kidneys); it can also be detected by certain tests on the urine (urine protein/creatinine ratio, or UPC; and specific gravity). Diabetes may be apparent on a single blood test (as a raised blood sugar level) – however, if the patient is very stressed (more of an issue in cats), you can get a false positive result. For a definitive diagnosis, it is often best to send away a blood sample for a fructosamine test (which will show the average blood sugar level over the last few weeks).

Respiratory disease is usually easy to recognise (snotty nose, sneezing, coughing, facial deformity in the case of some tumours or polyps), although actually working out what’s causing it often requires advanced imaging (X-rays and endoscopy). Similarly, it is very unusual for bad breath to be the only symptom of a dog or cat with a significant gastrointestinal problem – vomit or diarrhoea, or regurgitated food matter, is a more common finding. Lip fold dermatitis is easily recognised on examination, as when opened out, the lip folds are red, sore and often smell musty.

As I said above, dental disease is the most common cause. Often, a simple visual examination will reveal significant plaque and tartar; and gingivitis may be obvious just by looking at red or swollen gums. Occasionally, there is a tumour or other disorder of the gums, but again, this is usually clear to see. Your vet will be able to tell you what the chances are that dental problems are causing your pet’s bad breath.

So what can be done about it?

That, of course, depends what the underlying problem is… Diabetes cannot usually be cured (although some cats, if caught early enough, can go into full remission if treated appropriately and aggressively), but can be managed with appropriate, diet, insulin injections and good blood-sugar monitoring. The same applies to chronic kidney failure – this can be managed with appropriate diet, ad lib access to water, and sometimes medication (ACE inhibitors).

Respiratory and gastrointestinal disease does need diagnosis and treatment – if the underlying cause is treated, the halitosis will usually resolve at the same time.

If the dental disease is significant enough to cause bad breath, it does need treatment. It is important to remember, however, that old pets can, perfectly safely, undergo anaesthesia for a dental as long as there aren’t any underlying heath issues. Old age is not a risk factor for anaesthesia per se, it just means it’s more likely that they’ll have some medical problem that is! In older patients (cats and dogs) use of a fast, modern anaesthetic gas (e.g. sevofluorane), intravenous fluids and good, careful monitoring means that their risk isn’t that much greater than a young pet, assuming they are otherwise healthy (and if they aren’t, bad breath is the least of your worries).

Fortunately, however, in many cases the vet will be able to remove the worst of the tartar by hand without needing a full dental under anaesthesia. Often, the dental disease can also be controlled (not cured, but kept manageable) by regular and diligent tooth brushing and the use of appropriate mouth-washes.

David Harris BVSc MRCVS

“Please don’t tell me I have to brush my cat’s teeth, because I’d rather keep my fingers…”

Lucien's teethMy last article talked about a few of the dental problems most commonly seen in cats, and how easily they can be missed by both owners and vets. Remember, a cat with dental disease will probably act just like a healthy cat, but that doesn’t mean they’re not in pain! I’ll continue now by mentioning some of the preventative measures and treatments that can help keep your cat’s mouth healthy and pain-free.

What can I do to help prevent dental disease in cats?

Of the diseases mentioned previously, periodontal disease (gum disease) is by far the most common but fortunately the easiest to help prevent. Although genetics plays some role in whether or not a particular cat is going to have bad teeth, there are several things you can do to help keep the pain and inflammation to a minimum:

Brush the teeth – OK, this is admittedly not going to work for everybody. Or even most people. Or really even more than just a few people. But it’s worth giving it a try because if you are lucky enough to have one of the most chilled out cats on the planet, tooth brushing is the gold standard in preventative dental health care. By removing the bacteria before they are able to cause disease, the whole disease process is stopped in its tracks. Just use common sense and don’t get bit – if your cat doesn’t even like to be picked up or stroked, he probably won’t take too kindly to you shoving a toothbrush in his mouth.

Dental rinses or gels – These products work by killing off some of the bacteria in the mouth before they have a chance to cause disease. For cats (who let’s face it, probably won’t let you get anywhere near their mouths), one of the most sensible options is an antiseptic liquid (often containing chlorhexidine) that you put in their drinking water which can have the added benefit of freshening your cat’s breath. In most cases, if it sounds too good to be true, it probably is so although products like this can have some beneficial effect, they are not likely to solve all of your problems.

Special dental food – Some vets still say that plain old dry kibble helps keep your cat’s teeth clean. And many food manufacturers make similar claims to that effect. Although there is likely to be some truth to this, it is probably not as effective as we like to think. Most dry food is small and easy to swallow whole, so only a small percentage of it actually gets chewed. And I’ve seen plenty of cats who have seen nothing but dry food their whole lives with horrible teeth. If you want to help prevent dental disease with your choice of food, do your research and choose one that has been scientifically proven to decrease plaque formation. These foods tend to be more expensive, larger in size so they have to be chewed thoroughly before swallowing, and made in a special way such that they achieve maximum contact with the tooth surface. Ask your vet for their preferred dental health diet, which is often only available by prescription.

Regular dental cleanings at the vet – Unfortunately, even if you could train your cat to open her mouth and sit still on command, this would probably still require general anaesthesia. Vets use the same kinds of dental instruments on cats that dentists use on people (ultrasonic scalers, polishers, and drills) and the procedure itself varies from mild discomfort (with a simple scale and polish) to severe pain (with a surgical tooth extraction) and the use of local anaesthetics is not as reliable in cats because they can’t tell us what they feel. Also, dental cleanings require a lot of water and it is essential that an endotracheal tube (soft rubber tube inserted into the trachea or windpipe after they are asleep to aid breathing) is placed to prevent water from being breathed into the lungs. Although a general anaesthetic may sound like a risk that is greater than the benefit of clean teeth, most people both overestimate the risk and underestimate the benefit. When you consider that severe periodontal disease can have potentially fatal consequences, a dental cleaning can actually help save your cat’s life. Many people are (understandably) also concerned with the cost of having their cat’s teeth cleaned. I can assure you that if vets had figured out an easier, faster or less expensive way of cleaning animals’ teeth, we would all be doing it. And by having routine dental cleanings throughout an animal’s life, you can help prevent major vets’ bills down the road from complicated surgical tooth extractions or related systemic illness. As they say, an ounce of prevention is worth a pound of cure!

How can I tell if my cat has dental disease?

Signs of severe dental disease or pain in cats include bad breath, wobbly teeth, excessive salivation or drooling, teeth chattering or strange gnawing motions. Other symptoms can include lethargy, decreased appetite, depression or hiding/not wanting to be touched, although these can be seen with almost any illness! Another important yet subtle sign is whether or not your cat actually chews their food before swallowing it. Even some cats with no teeth at all will happily eat dry food by swallowing it whole, so instead of just assuming that everything is ok, try to notice how much crunching they do with each bite. If you’re particularly observant, you may even notice your cat chewing more on one side of the mouth (the healthier side) to avoid touching a painful tooth.

You may not ever notice them in pain, but more often than not owners remark after the painful teeth are removed that their cat is acting like a kitten again. This is further proof that they show such subtle signs of pain that they are often missed by owners and even vets, and although it is nice to be able to help them feel better, how much nicer would it be to prevent these problems from occurring in the first place! If you have noticed any of the symptoms listed above or are otherwise worried about your cat’s teeth, please speak to your vet. Because until your cat learns how to phone us herself, she’s relying on you to make sure that she doesn’t have to suffer with painful dental disease in silence.

More Useful Information

Examining your pet

Simple ways to check the health of your pet. Vets use these techniques as part of their clinical examiniation.

Medicating your pet

Arming you with the same simple techniques for stress free pill giving.

Worming & Flea Treatment

Information and advice in treating your pet for worms and fleas.