Introduction
Dental problems are
the most common disease that we see in cats. They can lead to bad
breath, swollen and bleeding gums, loose teeth, and oral pain, and
difficulty eating. Cats are secretive by nature, and it can be
difficult to tell if a cat is experiencing oral discomfort.
Occasionally, cats will reveal that the mouth is hurting by pawing at
their mouths, drooling, or deliberately turning their heads to one side
as they eat, to avoid chewing on the side of the mouth that’s painful.
Some cats will completely stop eating due to dental pain. Others may
stop eating dry food and only eat wet food. This is often mistaken as
the cat becoming “finicky” about their food, when in actuality, they’d
love to eat the dry food, but they can’t because it’s become painful to
crunch.
Kitty mouths 101
Kittens are born with
no teeth. At 1 to 2 weeks of age, the deciduous teeth (“baby” teeth)
erupt. At 6 weeks of age, all 26 baby teeth should be present. At 4 to
5 months of age, the baby teeth are shed, and the permanent teeth
erupt. By 6 months of age, all 30 adult teeth will have erupted. The
30 teeth include 12 little incisors in front, four canine teeth (the two
upper and two lower “fangs”), ten pre-molars, and four molars. The
periodontium consists of structures around the teeth, namely, the
periodontal ligaments that attach the gums to the teeth and hold it in
place, the alveolar bone (the “tooth socket”), and the gingiva (the
gums).
Periodontal disease
Disease processes
occur in the mouth more than anywhere else in a cat’s body.
Periodontal disease
is very common in cats. Untreated, it can lead to oral pain, abscess
formation, osteomyelitis (bone infection), and tooth loss. Oral
bacteria can enter the bloodstream through diseased oral tissues,
affecting other organs as well, most notably the heart valves and
kidneys.
Periodontal disease
is an inflammation of the periodontium – the tissues surrounding the
teeth described above. Periodontal disease is caused by plaque - the
sticky bacteria-laden coating on the tooth surface - and the body’s
response to those bacteria and the toxins they release. As the immune
system responds to the plaque, the gums become inflamed. This is the
first phase of periodontal disease: gingivitis. As the inflammation
progresses, the second phase of periodontal disease – periodontitis –
occurs. Periodontitis is a condition where both soft and bony tissues
are affected, and cats may develop receding gums, bone loss, and
periodontal ligament damage. If not removed, plaque mineralizes into
tartar (also called calculus) in a few days. Calculus requires
mechanical removal.
Fortunately, the
first stage (gingivitis) is reversible, so long as a professional
cleaning is performed and a home care program is instituted.
Periodontitis, the more serious second phase of periodontal disease, is
irreversible. The early stages of periodontal disease are characterized
by gingivitis and halitosis (bad breath). Up to 80% of cats 3 years of
age and older suffer from gingivitis. Veterinarians must look for the
red flags of gingivitis and begin professional cleaning, in some cases,
between 6 months and 1 year.
Once periodontal
disease has progressed to periodontitis, treatment is more about damage
control than prevention. Determining how advanced periodontal disease is
involves a thorough oral exam, including measuring the depth of
periodontal pockets, how much gum recession has occurred, and
radiographic findings. Periodontal grading should be combined with
quality intraoral dental x-rays. X-rays are often necessary to
determine whether a tooth can be saved or not, and are used to reveal
the presence and/or degree of bone loss, presence of tooth root
abscesses, root fractures, root resorption, and retained roots.
Treatment of
periodontal disease requires professional cleaning. This is done under
general anesthesia. Most cases of advanced periodontal disease can be
prevented if detected early and treated appropriately. The plaque and
calculus are removed, and the root surfaces are cleaned. This is
accomplished with hand instruments as well as ultrasonic equipment.
Cats should be given antibiotics a few days prior to the dental
procedure, and be continued a few days after the procedure. Clindamycin
and amoxicillin-clavulanate are two commonly prescribed and very
effective antibiotics for this purpose. Home care is essential after
professional cleaning to prevent or delay future recurrence of
periodontal disease.
 
Home care
Daily homecare is
essential, and includes tooth brushing. Brushing your cat’s teeth can
go a long way toward preventing dental disease. Plaque bacteria can
colonize the tooth surface in just 24 to 36 hours. This means that
within a few days of a professional dental prophylaxis, the teeth are
already starting to accumulate the plaque bacteria that cause
periodontal disease. The ultimate goal of homecare is to remove plaque
before it becomes calculus.
Dental homecare
should be introduced during kittenhood, so cats become used to having
their lips lifted, their mouth and gums touch and handled, and their
teeth brushed. Finger brushes have become very popular. These brushes
slip over the owner’s finger, and an enzymatic toothpaste is applied to
the brush and is then brushed onto the teeth. The toothpastes are
flavored with cats in mind (the “poultry” flavor is popular in my
practice), and many cats tolerate the procedure, albeit reluctantly.
Toothpastes designed for humans are inappropriate for cats and should
never be used. Brushing every day would be ideal, but for cats this is
unrealistic. Brushing twice or three times weekly is a reasonable and
attainable goal. Not all patients will allow brushing, however, the
wealth of dental hygiene products available, such as gels, oral rinses
and sprays, has made it easier for cat owners to find a home care
regimen for cats that simply won’t tolerate brushing. There are some
cats that won’t tolerate any oral manipulation at all. These
cats need regular dental checkups at least every four to six months.
Dental diets and treats
Dental diets are a
somewhat recent veterinary development. These diets are designed to
prevent or dramatically slow the accumulation of tartar on the teeth.
Dental diets do not replace homecare, however, and they may not be
appropriate in cases of advanced periodontitis, as the hard kibbles can
irritate the gums.
There are lots of
toys, treats and chews designed to promote dental health in dogs. Cats,
as we know, are much more discrete about what they put in their mouths.
Pet stores do carry similar chew toys with cats in mind, although most
cats, in my experience, tend to ignore these products. Tartar-control
treats, however, seem to be popular with many cats. Cat owners who
regularly give their cats treats should consider using crunchy
tartar-control treats vs. the softer treats, especially for cats prone
to dental disease.
Conclusion
By taking care of
your cat’s teeth, you’re helping care for its overall health. Regular
veterinary checkups and follow-up exams are necessary to maintain good
dental health, especially if home dental care is not provided or
tolerated by your cat.
Sidebar: The
signs of gingivitis:
-
Red, swollen,
and/or bleeding gums
-
Bad breath
-
Finicky eating
habits
-
Reluctance to
chew hard food
Sidebar: Juvenile-onset gingivitis
As pets age, most
will experience some gingivitis which, if not addressed promptly,
develops into periodontitis and advanced periodontal disease. In cats,
however, gingivitis can occur as young as 6 or 8 months, often times
associated with little or not calculus accumulation. We call this
condition “juvenile-onset gingivitis”. If left untreated, by 1 to 2
years of age, there may be irreversible periodontal disease. The exact
cause of this condition is unknown, but genetics may play a role, since
purebred cats, especially Siamese, Abyssinians, and Persians are
predisposed. Daily home care is essential in cats with this condition
to avoid tooth loss.
Updated
2/9/06 |
