Feline dental care is perhaps the most overlooked and under-treated area in small animal medicine. Cats are affected by many of the same dental problems that affect dogs (periodontal disease, fractured teeth, and oral masses) in addition to special syndromes (tooth resorption, gingivostomatitis).
More than fifty percent of cats over three years old will be affected by tooth resorption (TR). These tooth defects have also been called cavities, neck lesions, external or internal root resorptions, or cervical line erosions. Teeth affected by lesions will erode and finally disappear when they are absorbed back into the cat's body. The root structure breaks down; then the enamel and most of the tooth become ruined, and bone replaces the tooth. This most commonly happens where the gum meets the tooth surface. Some molars are most commonly affected; however, tooth resorptions can be found on any tooth. The reason for the resorption is unknown, but theories supporting an autoimmune response have been proposed.
Cats affected with tooth resorption may show excessive salivation, bleeding in the mouth, or have difficulty eating. Tooth resorptions can be quite painful. A majority of affected cats do not show obvious clinical signs. Most times it is up to the clinician to diagnose the lesions upon oral examination. Diagnostic aids include a probe or cotton tipped applicator applied to the suspected resorption; when the probe touches the lesion, it causes pain and jaw spasms. Radiographs are helpful in making definitive diagnosis and treatment planning.
Tooth resorptions can be seen in many stages:
- Stage 1 (TR 1): Mild dental hard tissue loss.
- Stage 2 (TR 2): Moderate dental hard tissue loss.
- Stage 3 (TR 3): Deep dental hard tissue loss; most of the tooth retains its integrity.
- Stage 4 (TR 4): Extensive dental hard tissue loss; most of the tooth has lost its integrity
(a) Crown and root are equally affected;
(b) Crown is more severely affected than the root;
(c) Root is more severely affected than the crown.
- Stage 5 (TR 5): Remnants of dental hard tissue are visible only as irregular radiopacities, and has completely covered the gum.
Radiographic appearances of the resorptions vary. If the periodontal ligament is visible, the tooth should be extracted via flap exposure. If the periodontal ligament is not visible, crown reduction and gingival closure can be performed.
Cats can also be affected by gingivostomatitis, an inflammation. The cause of this disease has not been determined but an immune-related cause is suspected. Signs in an affected cat include difficulty swallowing, weight loss, and excessive saliva. An oral examination will show many abnormalities. Radiographs often reveal moderate to severe periodontal disease with bone loss.
All stages of tooth resorption can be seen by the veterinarian and on x-rays. Managing a case of gingivostomatitis can be challenging. Oftentimes attempts at conservative therapy are not affective, nor is medical care. Extracting specific teeth usually resolves the syndrome in sixty percent of the cases. Twenty percent require medication, typically prednisone. Twenty percent respond poorly. A carbon dioxide laser has also been used with some success.
Cats are also affected by cancer in their mouths. Squamous cell carcinoma (SCC) is the most common type of oral cancer. Less common feline oral malignancies include melanoma, fibrosarcoma, lymphosarcoma, and undifferentiated carcinomas.
Not all feline oral swellings are malignant. Cats are frequently affected by reactions to foreign bodies, problems from dental disease, tumor-like masses, infections, and growths in the nose or throat. Biopsies are essential for diagnosis.
Some cats have orthodontic problems. Commonly a lance or saber-like projection of canine teeth occurs, especially in Persians. Cats are also affected with wry bites that are uneven.
What to Expect if Your Cat Needs Dental Care
Root canals, dental x-rays, orthodontics, crowns, caps, implants, and periodontal surgery for pets? You must be kidding! Not at all. Dental procedures are performed daily in veterinary practices. How does a loving pet owner know if dental care is needed, and where can a pet owner go for advanced dental care?
Examination is the key to diagnosis and helps determine the type of treatment needed. You need to know what to look for. A pet owner can help by examining their pet's teeth and oral cavity at least monthly. First smell your cat's breath. If you sense a disagreeable odor, gum disease may present. Periodontal disease is the most common ailment of small animals. Gum problems begin when bacteria accumulates at the gumline around the tooth. Unless brushed away daily, these bacteria can destroy tooth supporting bone, cause bleeding, and if untreated, cause tooth loss. Usually the first sign is bad breath. Other signs you may notice are red swollen gums, tartar (a yellow or brown accumulation on the tooth surface), or loose teeth.
When examining your cat's mouth, look for chips or fractures on the tooth's surface. Many times small pieces of enamel chip off, which may cause no harm. Deeper chips may cause sensitivity in your pet if they are not treated. If the fracture is deep you may notice a red, brown, or black spot in the middle of the tooth's surface. The spot is the pulp or root canal, which may which be open inside the mouth, eventually leading to a tooth abscess.
When your home exam reveals dental problems or if you are still uncertain, a trip to the veterinarian is in order. The veterinary oral examination will begin with a complete visual examination of the face, mouth and each tooth. Frequently pet's mouths have several different problems that need care. The veterinarian may use a record chart similar to the one used by human dentists to identify and document such dental problems.
A more detailed exam then follows. Unfortunately cats cannot point to dental abnormalities with their paws so in order to determine the proper treatment plan, other tests are usually necessary. Sedation and anesthesia are essential for an adequate evaluation. Anesthesia allows the veterinarian or assistant to thoroughly examine each tooth individually. Proper dentistry can not be performed on an awake patient. Modern veterinary medicine offers a wide array of safe and effective anesthetics and monitoring equipment that allay previous concerns of anesthesia.
Expect your veterinarian or dental assistant to use a periodontal probe to measure gum pocket depths around each tooth. One or two millimeters of probe depth normally exists around each tooth. When cats are affected by periodontal disease, the depths may increase. If the probe depth is great, there may be periodontal disease that requires additional care to save the tooth. Unfortunately by the time some pets come in for dental care, it is too late to save all of the teeth. Preventative care and periodic check ups should help hinder the loss of additional teeth.
Your veterinarian may also take x-rays of some or all of the teeth. X-rays show the inside of the tooth and the root that lies below the gumline. Some veterinarians use human dental x-ray machines while others modify standard veterinary x-ray equipment. Many decisions are based on x-ray findings. Usually the veterinarian will visually examine the mouth, note any problems, take x-rays under anesthesia, and then tell you what needs to be done. X-rays can also be used to show the pet owner how home dental care should be improved in order to save teeth.
If your cat needs advanced dental care, where can it be found? Many veterinarians have taken post-graduate dental training in order to better serve their patients. Some veterinarians have passed advanced written and practical examinations given by the American Veterinary Medical Association, which certifies them as dental specialists. Veterinary dental specialists can consult with your veterinarian or see your cat directly without a veterinary referral. Here is a link to Dr. Brooke Neimeic, a specialist in San Diego that the veterinarians at our clinic commonly refer to Southern California Veterinary Dental Specialties
Pets do not have to suffer the pain and discomfort of untreated broken or loose teeth or infected gums. With the help of thorough examinations, x-rays, dental care, and daily brushing, your pet can keep its teeth in its mouth where they should be.