By Arnold Plotnick, MS, DVM, ACVIM
Tooth Or Consequences
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).
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.
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.
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.