Dental disease is the most common health problem in adult cats. Most of the studies I have read on the matter are compatible with my personal experience as a veterinarian: dental disease affects a majority of cats more than three years old.
Dental disease in cats occurs mostly because our feline companions don’t brush their teeth. Food particles thus adhere to the teeth, and bacterial grow on the food. The bacteria produces a biofilm, plaque, that serves as a physical matrix for further bacterial growth. Over time, the matrix hardens into calculus (tartar). And the infection spreads: It moves into the gums and then into the ligaments surrounding the tooth and potentially into the root of the tooth itself. Pain, inflammation, tooth loss, and potential exacerbation of conditions, ranging from kidney disease to heart disease, result.
I therefore have recommended tooth brushing to owners of cats and dogs throughout my career. The responses I’ve encountered have ranged from eager acceptance to mild amusement to outright derision. However, my eight years of brushing my pal Buster’s teeth have paid off: He has no significant dental disease at this time.
In additon to standard periodontal disease described above, cats also are prone to a painful type of tooth problem called a feline odontoclastic resorptive lesion (FORL). There is likely a hereditary link to FORLs. They are exquisitely painful, and they can be identified on physical examination by a defect in the tooth’s enamel (although intra-oral radiography is the best method for identifying the lesions). FORLs cause exquisite pain, and at this time they can be treated only by extraction of the affected tooth or teeth.
Enter Abby. She is a 14-year-old brown tabby whom Denise and I recently inherited. She’s a sweet little thing, but she’s very timid. It took a couple of weeks for her to come out from under the bed. Once she did, I did what every vet does with every new animal: I casually evaluated her.
Abby had a heart murmur and a palpably enlarged thyroid gland. The two often go together, since thyrotoxic heart disease is a common cause of heart murmurs in senior cats. When I looked in her mouth, I noted that she also had severe periodontal disease and several obvious FORLs. Her dental disease explained something else about her. Abby smelled badly, and her coat was rough and unkempt.
Cats with dental disease have lots of bacteria in their mouth. Bacteria smell bad. Cats groom with their mouths; the malodorous, infected saliva in the mouth thus contaminates the entire body. And cats with dental disease don’t groom as well as those with healthy mouths due to pain; thus, their coats won’t be as well groomed.
There was no question about it: Abby needed dental work. That should be a piece of cake for a veterinarian, right?
Under normal circumstances it would have been. But I’m an emergency vet, and chronic dental disease is not often an emergency. My clinic thus lacks the equipment necessary to perform comprehensive dental work.
I did what I usually do in circumstances when a pet needs care that can’t be provided at the emergency clinic. I called a friend from vet school.
My friend practices at a high-quality clinic in San Francisco. It’s not the cheapest clinic in town. In fact, I probably could have found a practice that would have performed Abby’s dental work for half the price. But I would have only gotten half as much value.
For instance, I know that my friend uses balanced, safe anesthetic protocols. Intravenous fluids and comprehensive anesthetic monitoring are employed in every pet. I enquired about dental radiographs and nerve blocks to reduce pain from the extractions that I knew would be necessary. They were available.
These things cost money. But they’re worth it. I wanted Abby to be safe and to have a speedy, non-painful recovery. Let’s face it: In many situations such as this, one gets what one pays for.
Before the procedure I took Abby to my clinic for pre-anesthetic diagnostics and imaging. Her blood pressure was normal. A complete blood count and serum chemistry panel were normal. A urinalysis and urine culture did not show any evidence of pathology. Her thyroid tested normally. I performed a brief ultrasound of her heart: I saw no evidence of cardiomyopathy. Her murmur is likely a benign anomaly. She was cleared for anesthesia.
On the day of the procedure, Denise dropped Abby off at my friend’s clinic. I expected her to come home and take a couple of days to recover. I expected that four extractions would be necessary. I anticipated that after her recovery, she would be happier and more active, and she would smell better and groom better.
Abby came home that night, and it turned out that I was wrong about only one of my expectations. It did not take Abby a couple of days to recover. She felt great straight out of the gate. She immediately ate and she stopped hiding under the bed. She has become more social and she smells wonderful, with a soft, luxuriant coat. The pain and inflammation in her mouth clearly were affecting her temperament. She’s a much happier and friendlier girl now that they’re gone.
This episode has renewed my conviction in the health benefits that cats receive from dental work. Don’t let your cat suffer with an unhealthy mouth. Dental work is good for cats who need it.