Taking care of your cat’s teeth is an important part of health care. With cats living longer lives, now it is more important than ever to make sure that your cat’s mouth is healthy and pain-free for the long haul.
Cats rarely stop eating from dental disease. Some painful conditions of the mouth, such as stomatitis and tumors, will affect eating, but the most common signs of dental disease are bad breath, not grooming, and general pain signs such as hiding or urinating outside the litter box. Cats with dental pain may be grouchy with other pets as well.
Cats have two sets of teeth: kitten (deciduous) teeth and adult (permanent) teeth. The adult canine teeth come in at six months of age and the rest follow. By three years of age, most cats with start to show some dental disease. Here are some common terms used to describe feline dental issues:
Plaque: the gooey film humans brush off their teeth. Eating dry food performs the same function for cats.
Tartar: If plaque is not removed, it hardens into a yellow-tan crust. The upper back teeth in cats get the most tartar.
Gingivitis: Bacteria sit on top of the tartar and infect the gums. You will see a thick red line at the gum line.
Periodontal Disease: Once the bacteria invade the gums, they move into the space between the jawbone and tooth roots. Over time, the infection destroys the tiny ligaments holding the tooth in place, leaving a wobbly tooth. Periodontal disease is painful, especially once the tooth starts to wobble. Periodontal disease has a grading system:
- Grade 1: gingivitis. Time for treatment.
- Grade 2: up to 25 % root exposure. Treatment is very effective.
- Grade 3: 25-50% root exposure. Treatment may still help.
- Grade 4: more than 50 % root exposure. Extraction is necessary.
Resorptive lesions: Also known as osteoclastic lesions, this painful dental condition is still being researched, but it appears to have a genetic component. The hard calcium structure within the tooth breaks down, leaving the tooth to crumble. It is like osteoporosis in humans, except it affects teeth instead of hips and spines. Pairs of teeth are typically affected. Some cats will only have 2 teeth become diseased while others will eventually lose all their teeth. Resorption of the roots is not painful. Crown resorption, however, will result in pain a lot like a cavity in a person. The crown is the part of the tooth that sticks up from the gums and can be seen. Teeth with crown resorption need to come out. Fillings don’t work because the tooth is crumbling from the inside-out. There are two treatments:
Crown Amputation: When dental x-rays show that the root is resorbed and the crown also has lesions, we can cut off the crown at the gum line, smooth out the bone, and sew the gum shut with absorbable suture.
Surgical extraction: After placing a local block, we pull the gum back. Working on the cheek side of the jaw, the over-lying bone is removed using a high-speed drill. Once the tooth roots are exposed, we cut the crown in half and carefully remove the bone around each root, severing the periodontal ligaments. This procedure allows us to lever each root out in one piece. We take a second x-ray to make sure we have completely removed the entire tooth, then smooth out the socket. In the final step, we carefully sew the gum back in place with tiny absorbable stitches and treat the area with our therapy laser to speed healing.
What can be done at home to prevent dental disease? When young, get your cat used to having his or her mouth handled by gently stroking the chin and lip area. Roll the upper lip back using your thumb behind the upper canine tooth. Do not stick your fingers inside the mouth. Most cats will instinctively gag and bite without any malice. Feeding half the diet as dry food will help limit tartar. If your cat is prone to excessive tartar, we may recommend a dental diet. It is not true that feeding canned or wet food causes tartar and we advise that most cats receive half their diet as wet or canned food. Some cats will tolerate having their teeth brushed. The key to introducing it is to be slow and gentle when starting. Do not start home dental care until 9 months old, when most kittens are done teething. There is no known prevention for resorptive lesions.
What about tumors and stomatitis?
Stomatitis is an autoimmune disease in cats currently under study. It causes painful eruption in the gums and soft tissues at the back of the mouth. The first step is a full oral exam under anesthesia with x-rays. Most cats already have advanced periodontal disease and resorptive lesions when their disease is diagnosed. Often all the premolars and molars are extracted in 1 or 2 sessions. While this treatment sounds extreme, this step is critical to control the severe pain these cats live with. Steroids are used to control the inflammation while the mouth heals. Sometimes other immunosuppressants such as cyclosporin (Atopic, Cyclovance) are added in.
Oral tumors in cats are very serious and most are due to aggressive cancers. Hospice care is usually our only option. In some cases, referral to an oncology service for chemotherapy and/or radiation treatment, is an option. Cigarette smoking in the home causes oral cancer in cats because the carcinogens in the smoke settle on the cat’s coat and then they lick it off.