Dental problems are very common in cats. It
is important to treat dental problems because they may damage the kidneys
and heart.
Cats often develop a condition not seen in
humans called FORL, which can be excruciatingly painful but which is often
not visible.
There are several treatments you can try,
and for some dental problems, certain treatments can be easily and cheaply
done at home.
if your cat does need to undergo dental
surgery, there are precautions your vet can take to reduce the risks.
Introduction
A cat with a full set of teeth has thirty teeth, consisting of canines
(the four long pointy teeth at the front, known as fangs in our house),
incisors (those tiny little teeth at the front), pre-molars and molars.
Animal Dentistry and Oral Surgery Specialists
explain more about feline teeth.
The Royal Veterinary College explains the
numbering system for feline teeth used by vets.
Unfortunately, cats are prone to dental problems, just as humans are, and
they can start surprisingly early in life.
Cornell University College of Veterinary Medicine
reports that between 50 and 90% of cats over the age of four have
some kind of dental disease. Therefore it is important to monitor your
cat's oral health.
Periodontal Disease: Ginigivitis and Periodontitis
Dental problems are not confined to the teeth. Many dental problems
actually begin in the gums (gingiva).
If teeth are not kept clean, plaque forms on them and causes problems,
particularly under the gum line (subgingival) where plaque cannot be seen.
Initially the gums may become red, sore and inflamed, which is known as
gingivitis. If the gums remain inflamed, over time it may lead to
periodontitis, which eventually can result in loose or damaged teeth.
The 2019 AAHA dental care guidelines for dogs and
cats (2019)
Bellows J, Berg ML, Dennis S, Harvey R, Lobprise HB, Snyder CJ,
Stone AES, Van de Wetering AG Journal of the American Animal Hospital
Association55(2) pp49-69 divide periodontal disease into four
stages, with treatment depending upon which stage is present.
Feline Odontoclastic Resorptive Lesions (FORL)
Cats are also prone to a dental condition called feline
odontoclastic resorptive lesions or FORL or tooth resorption (also known as neck lesions or
cat cavities). This
condition was previously only seen in cats, though apparently some dogs
are now trying to get in on the act.
Animal Dentistry and Oral Surgery Specialists
state that well over 50% of adult cats develop this problem.
Worryingly, FORLs can start quite early in life:
Prevalence of odontoclastic resorptive lesions in a
population of clinically healthy cats
(2001) Ingham KE, Gorrel C, Blackburn J & Farnsworth W Journal
of Small Animal Practice42 pp439-443 found the overall
prevalence of FORLs in this study was 29%, even though the mean age of the
cats in the study was only 4.92. FORLs may be seen in Siamese or Burmese
cats before they even reach one year old.
FORLs used to be known as cat cavities because they sometimes look a bit
like a cavity in human teeth. However, they are not actually cavities.
Cavities occur when bacteria attack the teeth from the outside and work
their way into the tooth; whereas with FORLs the problem occurs within the
tooth and gradually works its way out, often exposing roots.
FORLS are often divided into five classes:
FORL Class
Effects
Treatment
Class 1
Enamel affected but not
dentin.
Not overly sensitive.
A cleaning by your vet following by daily tooth brushing at home may
slow the progression of class 1 FORLs.
Class 2
Enamel and dentin affected.
More sensitive.
Some vets attempt restoration (fillings) for class 2 FORLs but success tends to
be limited and temporary. Extraction is advised.
Class 3
Enamel, dentin and pulp
affected.
Very painful.
Extraction is necessary.
Class 4
Enamel, dentin, pulp and
crown affected.
Extremely painful.
Extraction is necessary but may be difficult.
Class 5
The crown is completely
resorbed.
Extremely painful.
Extraction is necessary but is much harder to do because the tooth tends
to fragment as it is removed. Crown amputation (leaving the roots behind)
may be necessary but is not ideal.
You will note that there is no mention of antibiotics under possible
treatments. This is because antibiotics do not help with FORLs.
More advanced
FORLS are so painful that, as shown in a video from
Long Beach
Animal Hospital, even cats under anaesthesia may react
when an affected tooth is touched. Yet despite this, since FORLs start on
the inside of the teeth, they can be very hard to
detect because often there are no visible signs, especially in the early
stages; and it doesn't help that our stoical cats instinctively try to
hide the fact that they are in pain.
A trembling jaw: what resorptive tooth lesions mean for your cat
(2013) Schaible L The Water Bowl says
"If your vet suspects your cat may have a FORL, they may use a
cotton-tipped applicator to press against the suspected lesion. This
causes pain when the FORL is touched and the cat's jaw actually spasms.
The trembling is not subtle and is often alarming to the pet parent. While
this is clearly not pleasant for the patient, this is the best way I know
to demonstrate to the pet parent the pain their cat is in and likely has
been experiencing for some time."
Even this is not foolproof: Dr Schaible goes on to say
"In some cases, the FORL will be covered with inflamed gum tissue and is
only detected while the patient is under anesthesia having a dental
cleaning performed." Animal Dentistry and Oral Surgery Specialists
have photos of this, where it looks as if the gum is growing
over a part of the tooth near the gum.
The best
way to diagnose FORLS is via x-ray, which can detect class 1 and 2 FORLs
before pain is present. If your cat is to undergo a dental under
anaesthesia, always ask for x-rays of the entire mouth. Personally, if I
were putting a CKD cat through a dental, I would ask for any teeth affected
by FORLS to be removed.
Cats who have had a FORL are very likely to develop more in the future.
How to detect and treat feline odontoclastic
resorptive lesions (2005) Carmichael DT Veterinary Medicine
says "If a cat has an FORL in one
tooth, it is safe to assume that the cat is at a high risk for other teeth
to eventually become affected." You can help slow the
progression of class 1 FORLs by brushing your cat's teeth daily.
A trembling jaw: what resorptive tooth lesions mean for your cat
(2013) Schaible L The Water Bowl recommends pressing a Q-tip
against where a tooth meets the gum once a month, to check for a pain
response or bleeding. If either is present, take your cat to the vet.
For some strange reason, cats with FORLs may develop a low
urine
specific gravity (USG). This may improve once the FORLs have been
treated.
Feline Odontoclastic Resorptive
Lesions
(2003) Gorrel C Presentation to the28th World Congress
of the World Small Animal Veterinary Association explains more
about FORLs.
Update on the etiology of tooth resorption in
domestic cats (2005) Reiter AM, Lewis JR & Okuda A
Veterinary Clinics Small Animal Practice35 pp913-942 mentions
that cats with FORL tend to have higher levels of vitamin D and lower
urine
specific gravity and mentions that further studies are needed to
investigate the relationship between FORL, vitamin D and kidney
insufficiency.
The Importance of Dental Health
Dental problems
hurt. A lot. As if that were not enough, dental problems
appear to be linked to an increased risk of other health issues.
Although the precise mechanism is not known, scientists believe that in
humans there may be a link between heart disease and the oral bacteria associated with poor
dental hygiene.
Colgate
reports on this.
There is also increasing
evidence that dental disease is associated with both CKD and diabetes in humans.
states that "Dental disease doesn’t affect just the mouth. It can
lead to more serious health problems including heart, lung and kidney
disease."
Arizona Veterinary Dental Specialists
says "periodontal disease is usually under-treated, and may cause
multiple problems in the oral cavity and may be associated with damage to
internal organs in some patients as they age."
Veterinary Dental Specialties & Oral Surgery
says "The reason that a broken pet tooth with direct pulp exposure
presents a problem is that after the tooth is fractured, bacteria from the
mouth gain access to the root canal and infect the tooth. Eventually, the
tooth will die and become a bacterial haven. The bacteria then leak out
through the bottom of the tooth, and infect the bone in that area.
Eventually, the bacteria cause bone destruction around the tips of the
tooth root. Next, the blood vessels in the area pick up the bacteria and
spread it to other areas of the body, including the liver & kidneys which
filter the blood, and potentially to the heart valves, which damage these
vital organs."
Dental problems may also cause
pyelonephritis.
Veterinary
Partner
says
pyelonephritis is "caused
by a bacterial invasion. The kidney infection may have come from the
bladder through the ureters, the bloodstream, or have invaded via other
organs. Infection via the bladder/ureters is the most common route.
Urinary stasis, urethral obstruction, kidney stones, trauma, and depressed
immunity may predispose the pet to pyelonephritis. The bloodstream route
of infection may be caused by bacterial endocarditis, diskospondylitis,
abscesses, and dental disease."
Dental Health and CKD
There is increasing evidence that dental disease is associated with CKD in
humans, though further research is needed.
Periodontal disease and risks of kidney function
decline and mortality in older people: a community-based cohort study
(2015) Chen YT, Shih CJ, Ou SM, Hung SC, Lin CH,
Tarng DC American Journal of Kidney Disease66(2) pp223-30
looked at a group of people aged over 65 in Taiwan. The study concludes
"The results indicate that periodontal disease is a risk factor for
all-cause and cardiovascular mortality and
eGFR decline ≥ 30% over 2 to 3
years in older people."
There also appears to be a link in cats between dental problems and CKD.
Risk factors for development of chronic kidney
disease in cats (2016)
Finch NC, Syme HM & Elliott J Journal of Veterinary Internal Medicine30(2) pp602-10 states "It
is possible that oral inflammation may lead to kidneys damage through
unknown mechanisms" and concludes
"Our study suggests independent associations
between both vaccination frequency and severity of dental disease and
development of CKD" but states that further studies are necessary to
investigate why this might be the case.
Some cats with periodontal disease who need dental treatment under
anaesthesia may develop CKD shortly afterwards.
Risk factors associated with the development of
chronic kidney disease in cats evaluated at primary care veterinary
hospitals (2014) Greene JP, Lefebvre SL, Wang M,
Yang M, Lund EM & Polzin DJ Journal of the American Veterinary Medical Association244 pp320–327 found that "Risk
factors for CKD in cats included ... prior periodontal disease
or cystitis, anesthesia or documented dehydration in the preceding year."
A more recent study appeared to support these earlier findings.
Survival analysis to evaluate associations between
periodontal disease and the risk of development of chronic azotemic kidney
disease in cats evaluated at primary care veterinary hospitals
(2018)
Trevejo RT, Lefebvre SL, Yang M, Rhoads C, Goldstein G & Lund EM
Journal of the American Veterinary Medical Association252(6)
pp710-720 evaluated cats at 829 hospitals over a period of more
than eleven years, comparing cats with periodontal disease to cats without
periodontal disease. The study found that periodontal disease (PD) "was
associated with increased risk of CKD; risk was highest for cats with
stage 3 or 4 PD. Risk of CKD increased with age. Purebred cats had greater
risk of CKD than mixed-breed cats. General anesthesia within the year
before study exit and diagnosis of cystitis at any point prior to study
exit (including prior to study entry) were each associated with increased
CKD risk. Diagnosis of diabetes mellitus or hepatic lipidosis at any point
prior to study exit was associated with decreased CKD risk."
It cannot be proven that the CKD has been triggered by the dental disease,
and it is also possible that the anaesthetic played a role; but dental
procedures do appear to carry some degree of risk, although the risks can
be greatly minimised if precautions are taken (see below).
Certainly I
feel that it is important to keep a
close eye on your cat's dental health, as indicated by our own small
survey of two CKD cats — Tanya was very healthy apart from
the occasional dental abscess, and when we trapped Thomas, he had three
badly abscessed teeth. I have heard from a number of people whose cats'
kidney values improved when their dental problems were addressed.
Symptoms
Common symptoms of dental problems include:
teeth grinding
not eating
dropping food out of the mouth
tilting the head when eating
eating on one side of the mouth only
pawing at
the mouth. This may also be a sign of a rare condition called Feline
Orofacial Pain Syndrome (FOPS), which is a pain disorder predominantly
seen in Burmese cats.
Feline orofacial pain (FOPS)
(2009) Rusbridge C has some information about this condition.
lipsmacking
drooling
not chewing food
approaching food, then walking away
being a little subdued
Performing a complete oral examination
(2012) Rawlinson J
Presentation to the 73rd SCIVAC International Congress 2012 pp389-390
discusses some possible symptoms of dental problems in cats.
Not every cat will exhibit symptoms according to
Arizona Veterinary Dental Specialists,
which says "Unfortunately, other than bad breath, there are few signs of
the disease process evident to the owner, and professional dental cleaning
and periodontal therapy often comes too late to prevent extensive disease
or to save teeth."
Some of the above symptoms may have other causes (for example, lipsmacking
may be a sign of nausea). See
Index of
Symptoms and Treatments for more information.
Treatments
There are a number of possible treatments available, and your vet can
decide which you need to use based on your cat's particular problems and the severity of
those problems.
The treatments below are listed in order of invasiveness. The treatments
you can do at home may help prevent or delay the need for more invasive
treatments.
The 2019 AAHA dental care guidelines for dogs and
cats (2019)
Bellows J, Berg ML, Dennis S, Harvey R, Lobprise HB, Snyder CJ,
Stone AES, Van de Wetering AG Journal of the American Animal Hospital
Association55(2) pp49-69
have a good overview of dental care requirements in cats..
Just like humans, cats benefit from having their teeth cleaned regularly
at home with a toothbrush. This may help slow the progression of both
periodontal disease and
FORLs.
You can buy special small toothbrushes for cats
and also special toothpastes in various flavours. My cats hated the vanilla
flavour but seemed to quite like the poultry flavour.
Do not use human toothpaste or baking soda to clean your cat's teeth.
According to
Camillus Animal Clinic, some human
toothpastes contain ingredients that are inappropriate for cats, while
baking soda is too alkaline and may upset the acid balance in the stomach
if swallowed.
Start off gradually, and let your cat get used to the toothbrush first,
and then to the toothpaste, before you put them both together. Some people
find their cats prefer a cloth to a toothbrush. And take your time, it
doesn't matter if it takes several weeks to get your cat into a routine.
Toothpastes and toothbrushes are also widely available including from most
vets.
Diet
It used to be thought that dry foods were better for dental health than
canned foods, but this is now thought unlikely to be the case.
The Cat Doctor
says "most dry food diets do not keep the teeth clean, as many
people have been led to believe."
However, there are some therapeutic foods available for dental health, e.g.Hill's t/d.
Dr Milinda Lommer, a
veterinary dentist, explains that these are designed so that the
cat's teeth must penetrate the kibble, which removes plaque. The kibble
size also helps.
Some members of Tanya's CKD Support
Group do find this type of food makes a difference to their cats' dental
health.
Essential fatty acids (EFAs) are polyunsaturated fats (sometimes
abbreviated as PUFA). They are essential because the cat's body cannot
synthesise them in sufficient amounts, so they have to be obtained from
food.
The two main types of EFAs are omega-3 and omega-6.
Since cats as obligate carnivores benefit from
animal-based products, the most appropriate form of essential fatty acid
supplement is fish oil. Fish oil contains omega-3 fatty acids in the form
of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).
Omega 3 fatty acids and periodontitis in US adults
(2010) Naqvi AZ, Buettner C, Phillips RS, Davis RB & Mukamal KJ Journal
of the American Dietary Association110(11) pp1669–1675 states
"In summary, we found that n-3 intake, particularly DHA and EPA, are
inversely associated with periodontitis in the US population. To date, the
treatment of periodontitis has primarily involved mechanical cleaning and
local antibiotic application. Thus, a dietary therapy, if effective, might
be a less expensive and safer method for the prevention and treatment of
periodontitis. Given the evidence indicating a role for n-3s in other
chronic inflammatory conditions, it is possible that treating
periodontitis with n-3s could have the added benefit of preventing other
chronic diseases associated with inflammation, including ischemic
cerebrovascular disease, as well. Both of these questions warrant further
investigation in prospective cohort and randomized clinical trials."
Earlier research found that the use of a product called 1-TDC improved
periodontal disease in rabbits.
Topical oral 1-tetradecanol complex in the treatment
of periodontal diseases in cats (2019) Kubitza FML & Anthony
JMG Journal of Feline Medicine and Surgery21(12)
pp1141-1148 looked at the use of this product in cats and found that cats
receiving one 1-TDC capsule (525mg) a day for six weeks had "significant
reductions in all parameters of clinical periodontal disease except tooth
mobility at 6 weeks. The 1-TDC group exhibited a statistically significant
reduction in pocket depth, clinical attachment loss, gingival index and
bleeding on probing." (Interestingly, the control group received olive oil
(0.25 ml per gel capsule a day) and although these cats had no improvement
in their periodontal health, it did not get worse).
1-TDC is made by Elite Science and it is "a proprietary blend of fatty
acids derived from beef tallow." It also contains a small amount of fish
oil . It is available from
Amazon or
Heartland Veterinary Supply.
Antioxidants
mop up free radicals in the body, which are associated with aging and
disease.
Co-enzyme Q10
(CoQ10), also known as ubiquinone or ubiquinol, is
an antioxidant that is used by the body in energy production. Human
research indicates that it may be helpful in the treatment of periodontal
disease.
There were similar findings in research by Nihon University
School of Dentistry presented to The 63rd Meeting of the Vitamin Society of
Japan, Hiroshima, Japan on 4th and 5th June 2011.
I am not aware
of any more recent research, and I don't know
anybody who has tried this in a cat, but I cannot think it would be
sufficient to help you avoid dental surgery. if you want to try it, check with
your vet first. More information on CoQ10 can be found
here.
to try to
dampen down dental problems which are not too advanced; or
if your vet is
reluctant to perform a dental under anaesthesia because of your cat's
other health issues
Using
antibiotics to stop bacteria reproducing is bacteriostatic, whereas using
antibiotics to kill the bacteria is known as bacteriocidal.
Using
antibiotics in this way is not ideal because they will not resolve the
problem if it is periodontal disease.
Cats with oral
infections often do need antibiotics, however, they are unlikely to be
sufficient in isolation.
Position statement: the use of antibiotics in
veterinary dentistry
(2019)
American Veterinary Dental College states "Antibiotics should
never be considered a monotherapy for treatment of oral infections, and
should not be used as preventive management of oral conditions."
Antibiotics should
ideally not be given repeatedly
because this may lead to antibiotic resistance.
Antibiotics may
also be prescribed if your cat undergoes a dental under anaesthesia,
in which case
antibiotics should be given for a couple of
days in advance, and continued for 5-7 days afterwards. Some
vets seem to be reluctant to prescribe antibiotics before dentals,
however,
Position statement: the use of antibiotics in
veterinary dentistry
(2019)
American Veterinary Dental College states "Patients that are scheduled for an oral procedure may benefit from
pre-treatment with an appropriate antibiotic to improve the health of
infected oral tissues, however a full course treatment is always
recommended. Bacteremia is a recognized sequela to dental
scaling and other oral procedures. Healthy animals are able to overcome
this bacteremia without the use of systemic antibiotics. However, use of a
systemically administered antibiotic is recommended to reduce bacteremia
for animals that are immune compromised, have underlying systemic disease
(such as clinically-evident cardiac, hepatic, and renal diseases) and/or
when severe oral infection is present."
Clindamycin (Antirobe) is the best choice of antibiotic
in most cases, because this is particularly good at killing anaerobic
bacteria which are often found in the mouth. When my PKD
cat had a dental, this was the antibiotic which both the veterinary dentist and
kidney specialist recommended for him.
Cleanings
While Conscious (Anaesthesia-Free Dentistry)
Some vets and
groomers offer teeth cleanings performed while the cat is awake.
Unfortunately it is not possible to perform a proper dental cleaning on a
conscious cat. Therefore this sort of procedure is largely cosmetic (it
may be of some use for cats who have had a dental performed recently,
though
tooth brushing might
suffice).
Problems with this approach include:
this is a largely cosmetic procedure, because
the problem area is under the gumline, which can only be reached if the
cat is unconscious.
nevertheless, it can be traumatic and painful for the cat.
it is not possible to see any problems that need treating, such as
FORLs.
it is not possible to take x-rays to look for such problems.
if you pay for these procedures regularly, you will probably end up
spending as much as or more than you would have spent on proper cleanings.
Companion animal dental scaling without
anesthesia
(2004) American Veterinary Dental College says "Removal of dental tartar
on the visible surfaces of the teeth has little effect on a pet’s health,
and provides a false sense of accomplishment. The effect is purely
cosmetic." It also explains the other risks of dental scaling performed
without anaesthesia.
The 2019 AAHA dental care guidelines for dogs and
cats (2019)
Bellows J, Berg ML, Dennis S, Harvey R, Lobprise HB, Snyder CJ,
Stone AES, Van de Wetering AG Journal of the American Animal Hospital
Association55(2) pp49-69 say "Without general anesthesia, an
accurate diagnosis cannot be made, patient pain cannot be addressed, the
patient’s airway cannot be protected from aspiration, and disease cannot
be appropriately treated."
Dr Milinda Lommer, a
veterinary dentist, explains why cosmetic cleaning of the teeth is no
substitute for a thorough medical cleaning.
Eventually you may find that your cat needs dental surgery under
anaesthesia. This enables your vet to clean under the gumline to help
fight periodontal disease and/or to remove unhealthy teeth, perhaps
because of FORLs or abscesses.
Many people are terrified of having their cat undergo a dental, but if
your cat is suffering severe dental problems, you probably have little
choice because it becomes a quality of life issue. Dental
problems can be extremely painful! And since cats instinctively try to
hide pain, your cat could be suffering chronic pain without you realising
it.
Americans are famous
for their standards of dental care so probably don't know how bad
toothache can be; but I'm English, so, as night follows day, I have bad
teeth (though in my defence I would like to point out that they are
naturally beautifully straight — no orthodontist necessary for me!). Therefore, yes,
I have had toothache, and I can tell you it is absolutely horrible,
and a dental abscess is unbelievably painful. If your cat has advanced FORLs, it is so painful that even cats under
general anaesthesia may react when an affected tooth is touched.
You should always have a physical exam and bloodwork performed and blood
pressure checked before surgery, so any problems can be addressed. If your
cat has heart issues,
you may also wish to see a veterinary cardiologist prior to surgery.
Consider a
chest x-ray to check the lungs are clear.
If your cat is on blood pressure medication such
as amlodipine (Norvasc) or benazepril (Fortekor), ask your vet if you
need to stop the medication before the surgery (since anaesthetics may reduce
blood
pressure).
AAHA Anesthesia and Monitoring Guidelines for
Dogs and Cats (2020) Grubb T, Sager J, Gaynor JS, Montgomery E, Parker
JA, Shafford H & Tearney C Journal of the American Animal Hospital
Association56(2) pp59-82 advises stopping benazepril and
has a list of which medications can normally be given and which not.
Antibiotics should be given to the cat, ideally starting a day or two
before the procedure and continuing for 5-7 days afterwards. I
often hear from people whose vets are reluctant to give antibiotics to
cats before surgery. I would refer such vets to
Position statement: the use of antibiotics in
veterinary dentistry (2019) American Veterinary Dental
College, which says "Patients that are
scheduled for an oral procedure may benefit from pre-treatment with an
appropriate antibiotic to improve the health of infected oral tissues,
however a full course treatment is always recommended. Bacteremia is a
recognized sequela to dental scaling and other oral procedures.
Healthy animals are able to overcome this bacteremia without the use
of systemic antibiotics. However, use of a systemically administered
antibiotic is recommended to reduce bacteremia for animals that are
immune compromised, have underlying systemic disease (such as
clinically-evident cardiac, hepatic, and renal diseases) and/or when
severe oral infection is present."
CKD cats
should be placed on
IV fluids for a few hours before, during and after
any dental procedures. All cats should be placed on IV fluids during and after any dental
procedures. This is to avoid reduced blood flow and falls in blood pressure during the
procedure, which may damage the kidneys.
It is very important to fast your cat before
anaesthesia. This will usually be done for several hours before
surgery, often overnight, but a shorter period may be possible in some
cases, so be guided by your vet. Your cat may be allowed to drink
water until a couple of hours before surgery, which can be helpful for
a CKD cat, but your vet will decide what is the best approach for your
cat.
Ensure all
members of the team caring for your cat are aware of your cat's needs.
One member of Tanya's Support Group pinned a reminder list to her
cat's carrying basket when dropping him off for his dental.
During Surgery
Read up on
anaesthesia and discuss
with your vet which
anaesthetic agents
to use. Some vets use nerve blocks (local anaesthetic) during dental
surgery to reduce the amount of inhaled anaesthesia needed and to
provide pain control.
The 2019 AAHA dental care guidelines for dogs and
cats (2019)
Bellows J, Berg ML, Dennis S, Harvey R, Lobprise HB, Snyder CJ,
Stone AES, Van de Wetering AG Journal of the American Animal Hospital
Association55(2) pp49-69 say "The use of local anesthetics as
dental blocks dramatically decreases the depth of general anesthesia
needed, and thereby helps support blood pressure, decreases
ventilatory depression, provides analgesia, and generally increases
safety."
Skills laboratory: how to perform four oral
regional nerve blocks in dogs and cats (2012) Beckman B Veterinary Medicine explains more about
the use of nerve blocks (this article is rather technical).
Blood pressure should be monitored throughout the procedure.
A cat
should always be given intravenous fluids during the procedure, and a
CKD cat should also receive IV fluids before and after the surgery
(see
Anaesthesia).
Always ask for X-rays to be performed so that the condition of the
teeth can be examined properly and any teeth affected by
FORLs
can be
identified and removed.
Why should you do whole-mouth intra-oral dental
radiographs? (2013) Hale F The Canadian Veterinary
Journal54(9) pp889–890 says "If you have a live patient
with an oral cavity under general anesthesia, you should do
whole-mouth intra-oral dental radiographs." Amongst other reasons it
states "tooth resorption is so common in cats, you
should assume every cat has some tooth resorption until proven
otherwise (by detailed clinical and radiographic evaluation."
Ask that a
mouth gag (used to hold the mouth open during surgery) is not used.
Their use has been associated with blindness in cats.
Open wide: Blindness in cats after the use of
mouth gags (2014) Reiter AM
The Veterinary Journal201 pp5-6 explains more about this.
Your cat should be monitored closely after surgery.
AAFP feline anesthesia guidelines
(2018) Robertson SA, Gogolski SM,
Pascoe P, Shafford HL, Sager J & Griffenhagen GM Journal of Feline
Medicine and Surgery 20(7) pp602-634 state that
"Sixty percent of all anesthetic-related cat deaths occur during the
recovery period, especially the first 3 h."
Some cats
develop a low temperature following anaesthesia.
Anaesthesia for the geriatric dog and cat
(2008) Hughes JML Irish Veterinary Journal61(6)
pp380–387 states "the elderly patient is at
increased risk of developing hypothermia. Shivering increases oxygen demand in the recovery
period; if this demand is not met, arrhythmias often develop. Duration
of anaesthesia should be kept to a minimum and all efforts taken to
keep elderly patients warm". Therefore you should ensure that your cat
is kept warm and his/her temperature monitored afterwards.
The American Association of Feline Practitioners
Senior Care Guidelines
(2009) Pittari J, Rodan I, Beekman G, Gunn-Moore D, Polzin D, Taboada J,
Tuzio H & Zoran D Journal of Feline Medicine & Surgery11
pp763-778 states "Since hypothermia is
common, evaluate body temperature every 15 mins, continuing
postoperatively until the cat is ambulatory or normothermic. Support body
temperature by using tools such as a heated cage, hot air blankets,
water-circulating heating pad, and/or booties." If your
vet
uses a heat
pad,
this should only be used once the cat is able to move off the pad
of his/her own volition should they start to feel too hot.
Anaesthesia for the geriatric dog and cat
(2008) Hughes JML Irish Veterinary Journal61(6)
pp380–387
also states "All recovering geriatric patients should receive oxygen
supplementation and be monitored closely until their protective
pharyngeal reflexes have returned."
If inhaled
anaesthesia has been used, your cat will have a tube down the throat
during surgery (intubation), which can cause the throat to feel a
little sore (possibly causing hoarseness) for a day or two afterwards.
Blood pressure should also be monitored for a week or so afterwards because
surgery and anaesthesia may cause increases in blood pressure
following the procedure.
Painkillers are usually necessary after dental surgery.
WSAVA guidelines for recognition, assessment and
treatment of pain (2014) Mathews K, Kronen PW, Lascelles D,
Nolan A, Robertson S, Steagall PVM, Wright B & Yamashita K Journal of
Small Animal Practice55(6) ppE10–E68 points out that "pain
associated with surgery is 100% predictable."
My Indie (non-CKD) had
extensive extractions, and was given a
Fentanyl patch on her back leg
to help her oral pain.
Buprenorphine
is also used for many cats following dentals with few problems.
Your cat
may be able to come home a few hours after surgery, or may have to
stay in the hospital overnight or for a day or so. If you bring him or
her home soon after surgery, keep him/her in a warm, quiet place. Your
cat may be a little wobbly at first, but this should soon improve. If
you have any concerns, contact your vet.
Most cats do cope with dental surgery; but it is still surgery, and problems
may occur in some cases. Some cats will start
eating immediately following a dental, but may then worsen a day or two
later as the painkillers wear off. Many cats take a while to
regain their appetite. Our Indie, non-CKD, was given a dental at the age
of nine because she simply stopped eating because of dental pain. Although
she recovered relatively quickly from the surgery, she still went through an extended
period of not eating afterwards, which had me at my wit's end.
If your cat
does not resume eating and also seems to be gaining weight following a
dental, check with your vet because occasionally more serious problems can
arise, as
happened to Harpsie (who developed a torn trachea), even though we followed all the
above guidelines.
Success Stories
Immediately above I describe some of the problems I have encountered
during dentals in my cats. However, I would say there are many, many more
success stories than problems.
You have to understand that dental problems can cause a lot of pain, but
your cat may well not show it. Veterinary Dental Specialties & Oral Surgery,
talking about broken teeth, say ""Pet teeth with direct root canal
exposure are excruciatingly painful to a dog or cat. Unfortunately, only
very rarely will animals show discomfort, as they are evolutionarily
conditioned to mask pain fairly well, preferring to suffer in silence.
This allows owners (and veterinarians) to ignore the problem, as “it
doesn’t seem to bother the pet”. But we now know that these animals are
suffering with consequences both locally in the mouth as well as
systemically throughout the body. This means that in today’s current age
of veterinary medicine, it is no longer appropriate or acceptable to
ignore broken teeth in our patients."
Dental pain sucks, big time. What is the point of your cat living a
longer life if that life is filled with pain?
Many members of Tanya's CKD Support Group have had dentals performed on
their cats with great reluctance, only to find their cats not only come
through very well, they actually look and act much better than before the
dental.
Veterinary Dental Specialties & Oral Surgery says "We have had numerous
clients who have told us that their pet is not bothered by its broken
tooth when it is discovered, that later tell us joyfully that their pet is
acting “5 years younger” just two weeks after the problem is fixed."
As a bonus, many cats' kidney bloodwork improves following a dental.
Veterinary Dental Specialties & Oral Surgery
says "infected teeth (and periodontal disease) can so greatly affect the
rest of the body and its vital organs that we have had numerous patients
with elevated liver and kidney enzymes found on the pre-op blood which
then improve or return to normal levels within two weeks of the dental
procedure."
One 13 year old cat on Tanya's Support Group had BUN of 107 mg/dl and creatinine
of 10.1 mg/dl back in November 2011. His caregiver was told he had
severe dental problems and was offered either a dental or euthanasia, so
she opted for the dental. Following the dental, her cat's creatinine fell
to 1.9 mg/dl and he has remained stable to date, with his numbers only
recently (2017) worsening.
Another cat had creatinine of 3.4 mg/dl before her dental. After the
dental her creatinine fell to 1.9 mg/dl and she is still alive, five years
later.
TREATING YOUR CAT WITHOUT VETERINARY ADVICE CAN BE
EXTREMELY DANGEROUS.
I have
tried very hard to ensure that the information provided in this website is
accurate, but I am NOT a vet, just an ordinary person who has lived
through CKD with three cats. This website is for educational purposes
only, and is not intended to be used to diagnose or treat any cat. Before
trying any of the treatments described herein, you MUST consult a
qualified veterinarian and obtain professional advice on the correct
regimen for your cat and his or her particular requirements; and you
should only use any treatments described here with the full knowledge and
approval of your vet. No responsibility can be accepted.
If your cat
appears to be in pain or distress, do not waste time on the internet,
contact your vet immediately.
This site was
created using Microsoft software, and therefore it is best viewed in
Internet Explorer. I know it doesn't always display too well in other
browsers, but I'm not an IT expert so I'm afraid I don't know how to
change that. I would love it to display perfectly everywhere, but my focus
is on making the information available. When I get time, I'll try to
improve how it displays in other browsers.
This site is a labour of love, from which I do not make
a penny. Please do not steal from me by taking credit for my work.
If you wish to
link to this site, please feel free to do so. Please make it clear that
this is a link and not your own work. I would appreciate being informed of
your link.