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“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.

Just because they’re still eating doesn’t mean their teeth don’t hurt! Dental Disease in Cats – Part 1

“ Sure his teeth are a little dirty but he’s still eating so they can’t be that bad, right?”  This is one of the biggest myths in veterinary medicine yet it is sadly repeated almost daily by my clients.  It’s certainly understandable though – if we have a toothache, we tend to alter our diet rapidly to find foods that are suitably easy to chew and then book ourselves in to see the dentist as soon as possible.  Cats (and dogs, but we’ll focus on cats in this article) would probably do the same, if they could, but I can’t recall the last time I saw Fluffy order her own meals or pick up the telephone!  Cats are still in many ways wild animals with natural instincts, and those instincts tell them that if they don’t eat, they’ll die.  For the same reasons, they are masters of hiding their pain, illnesses or anything that might make them seem vulnerable.  Therefore a cat with a toothache will probably act and eat very much like a cat without a toothache, suffering in silence.  Sure, there are some dental conditions that will cause a cat to stop eating, but by the time this happens they are usually so severe that they have become systemically ill (with infection and fever, for example) after weeks or months of living with the problem.  As responsible pet owners, it’s our job to make sure that our pets don’t have to quietly suffer with dental pain.

What kinds of dental disease do cats get?
  • Periodontal disease – Like us, cats’ teeth accumulate plaque (bacteria and debris that sticks to the outer surface of the tooth causing discolouration).  At this stage, the condition is reversible if treated with preventative home care.   But if left untreated, this plaque builds up over time into thick calculus that can only be removed using special tools under anaesthesia.  But the brown calculus is only the surface of the problem.  The gums surrounding the ‘dirty’ teeth become red and inflamed (a condition called gingivitis), and this inflammation hurts.  Over time, the inflammation eats away at the gums and the tissue that holds the tooth into the gums (the periodontal ligament), resulting in loose teeth that can hurt with every chew.  And as we’ll see later, this inflammation sometimes even eats away at the tooth itself.  Severe periodontal disease is not only painful and smelly, but dangerous too as it can lead to or exacerbate existing liver, kidney, and heart disease.
  • Feline Chronic Gingivostomatitis (FCGS) - Sometimes the gingivitis (inflammation of the gums) get so bad that all of the gum tissue around the teeth becomes bright red and swells, even to the point that the teeth become hidden under all the affected tissue.  Sometimes ulcers can form on the adjacent lip tissue or at the back of the mouth as well.  An extremely painful condition, FCGS is unfortunately not an uncommon disorder.  Despite much research, it is still unclear what actually causes this condition, although we do know that the bacteria in the plaque make it worse.  Many of these cats will test positive for Calicivirus (a virus commonly found in cats and often without causing any symptoms) but the significance of that is unknown.  It is thought to be in part due to an aberrant or inappropriate reaction by the cat’s immune system to something that would not normally cause a problem (normal mouth bacteria or even the most mild plaque buildup).  Treatment is difficult and frustrating and may include everything from antibiotics and steroids to the extraction of the majority of teeth in the mouth (as drastic as this sounds, this has proven to be the most successful treatment thus far), with varying degrees of success.  This is a very unfortunate condition for all parties involved – cat, owner and vet.
  • Feline Odontoclastic Resorptive Lesions (also called FORLs, resorptive lesions, or neck lesions) – These lesions affect more than a third of adult domestic cats, the second most common dental disorder after periodontal disease.  Resorptive lesions have been found in the skulls of cats dating back to the thirteenth century so the condition is far from new, however we have seen a dramatic rise in documented cases since the development of x-rays.  These lesions are particularly difficult for owners to pick up on because the disease process mostly occurs under the gumline, often with just a small area of redness or irregular shape to the gumline.  But underneath the gum, the tooth is being eaten away.  Sometimes the visible part of the tooth breaks off, leading us to believe that the tooth has simply fallen out (not that that isn’t also a problem!), leaving the fractured root to be re-absorbed or resorbed into the jaw bone.  Even if the tooth doesn’t break all the way off, it is still left with a big hole in it.  Anyone who has ever broken a tooth can testify to how unpleasant it feels!  Because it can be difficult to see resorptive lesions, the best and sometimes only way to diagnose them is with an x-ray.  The treatment for resorptive lesions is extraction of the affected tooth or teeth.
  • Broken teeth are another problem to look out for, in addition to the lesions mentioned above.  The long, sharp canine teeth are the ones that we see fractured most commonly, typically broken during a fight or if they get stuck somewhere, but any tooth can be affected especially if the cat has been in a road traffic accident or other trauma.  Broken teeth are often ignored, again assuming that because the cat is eating that it’s not a problem, but a fracture that exposes the pulp (living tissue which contains blood vessels and nerves) within the tooth can cause not only infection but a great deal of pain.  There may be a few cases when your vet may recommend that a fractured tooth be left alone (for example, if both the fracture and the cat are very old and/or it would be a high-risk anaesthesia), but in most cases they should be removed surgically.
  • Finally, malocclusion or the inability of the cat to close its mouth and chew properly, can have serious effects on its health.  This can occur when teeth fail to erupt correctly (for example, if the kitten teeth remain after the adult teeth come in) or with poor breeding in the case of brachycephalic breeds (such as Persians that have squished in faces).  If the teeth don’t fit together properly, they will sometimes dig into the opposing gum and cause painful ulcers.  Any baby teeth that are still present by the time the adult teeth have fully erupted should be removed surgically.  Severely brachycephalic cats also tend to have serious problems with their upper airway and sinuses resulting in breathing problems.   There is little that can be done to help these poor victims of bad breeding but we can help the situation as a whole by encouraging the breeding of only healthy, happy cats.
Up to 70% of cats will experience some degree of dental disease by the time they are 3 years old, and the odds get even worse with age.  But with a little bit of preventative care and awareness of the conditions above so that problems can be fixed quickly when they do arise, we can help make sure that our feline friends don’t have to suffer with dental pain in silence.  Part 2 of this article will discuss how to prevent and treat dental disease in cats.