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Why is dental health important? Alison Richards BVSc MRCVS looks into feline dentistry

 

The mouth could be considered as the gateway to the body, not only for food and water, but also for disease.  Subsequently, keeping our cats’ mouths as healthy as possible, recognising disease early and treating it, will not only prevent pain and discomfort in our feline friends, but also ensure that other diseases throughout the body are prevented.

There are a number of different diseases that can affect the mouth and the teeth.  Cats are particularly good as a species at hiding pain and dental disease is an area that can be tricky to spot as an owner, as many cats will continue to eat despite their mouths being quite painful.  Often dental disease will reduce the amount a cat will eat to some extent which can be of particular concern in older cats and cats with other illnesses that predispose them to being underweight.

Other signs that your cat may have issues with his teeth include noticing a change in eating habits – your cat may start to favour soft wet food over dry biscuits or may only eat with one side of his mouth.  You may notice bad breath, an increase in dribbling (which may sometimes be accompanied by blood in the saliva) and your cat may find it tricky to groom. Any change in our cat’s behaviour (such as hiding, changes in interaction) could be a symptom of dental pain.

Over the last ten years more and more research has been done to show the link between dental disease and other health conditions.  In humans there is strong evidence to link dental disease with heart disease, strokes, and diabetes.  In cats, there are studies that show a strong link between dental disease and kidney disease, so by keeping our cats’ teeth healthy, we will also benefit their overall health and welfare.

Dental diseases and their treatment    

  • Calculus, gingivitis, and periodontitis

Calculus, also known as tartar, is caused by the build-up of plaque on the teeth which has, over time, hardened due to minerals in the saliva.  The calculus that develops can form an ideal surface for more plaque to be produced by bacteria in the mouth, and as this builds up, it can cause inflammation to the gums, known as gingivitis.  This can cause pain and irritation, and as the gums become more inflamed, their normal barrier function reduces, and the chance of bacterial infection increases.  As dental disease progresses the attachment between the tooth and the bone of the jaw becomes weakened and in severe cases, the roots of the teeth, which are normally below the gum line, are exposed.  If there is a significant level of calculus and gingivitis, or if there are signs of root exposure, then the dental disease should be treated – your vet will give your cat a general anaesthetic and use an ultrasonic scaler to remove the calculus that has built up, they may also polish the teeth following this.  If there is marked loss of the attachment between the tooth and the bone, then the vet will remove the tooth, as this is unlikely to resolve and will continue to cause pain.  Treating this dental disease is important as the condition is likely to be painful, will predispose to serious infection and other illness, and the treatment, in turn, prevents the further development of disease.

  • Tooth fractures

Tooth fractures are not uncommon in cats, with a common site being the large canine teeth.  Fractured teeth will often need to be removed; your vet will assess the level of damage that has occurred.  The teeth have three layers.  The outer layer is made of an incredibly tough material, enamel.  Below this is a layer of dentin, a softer yellow coloured material that acts as a supporting material for the enamel.  In the centre of the tooth is the pulp, this contains blood vessels and nerve endings.  Most of the time, if your cat fractures a tooth, your vet will recommend it is removed under an anaesthetic as it is likely to be painful and infection may track up the exposed pulp.  However, occasionally, there may just be a small chip to the tip of the tooth and the pulp has not been exposed and your vet may advise in this circumstance removal is not necessary but will recommend that the tooth is monitored for any discolouration or pain.

 

    Diet is an important part of dental care

 
  • Feline Odontoclastic Resorptive Lesions

Feline Odontoclastic Resorptive Lesions (FORLs), also known as neck lesions or feline tooth resorption, is a condition unique to cats that we are yet to understand completely.  In this condition, the roots of the affected tooth are broken down by Odontoclast cells (which are involved in the remodelling of teeth) and replaced with bone-like material.  This breakdown can lead to areas of erosions which may then fracture and cause a lot of pain for your cat.  They can often be difficult to spot on the teeth, their position close to the gum-line means they are frequently covered by the surrounding gum (which may be inflamed) or areas of calculus.  The erosion of the teeth progresses gradually, with the dentin and cementum (material that surrounds the pulp below the gum) affected first, then moving into the pulp and also affecting the enamel.  The resorption may not be apparent until the tooth has fractured.  The most common site is the lower premolar tooth.  Some studies suggest that up to 70% of cats may be affected at some point by FORLs, with the prevalence increasing with age, so it is a common and potentially under diagnosed issue in domestic moggies. 

Cats may have FORLs in the absence of any other dental disease.  Dental radiography under general anaesthetic is used to diagnose this condition and also decide on the appropriate treatment.  X-rays show how much of the root has been eroded, if the root is still quite visible on X-ray, the vet will have to remove the entire tooth and root that remains, but if the root is no longer visible the vet will just remove the crown of the tooth (that which is above the gum line). As these lesions can be tricky to spot in a cat when it is awake, if your cat has dental treatment under anaesthetic, your vet will check the mouth thoroughly to ensure any FORLs are spotted.

  • Chronic Gingivostomatitis

Cats with Chronic Gingivostomatitis suffer from extensive gum inflammation.  This is caused by an abnormal immune response to plaque on the teeth.  It is thought that certain viruses may play a role in its development, but we still don’t fully understand why this condition affects certain cats.  Treatment can be difficult, and while some cases respond to medical treatment alone, the majority of cats suffering will also need most, if not all, of their teeth to be removed under general anaesthetic.  This may seem a dramatic solution, but most cats tolerate it very well, are still able to eat normally, and are more comfortable as a result of the reduced inflammation in the gums.

How we can prevent dental disease

Conditions such as Chronic Gingivostomatitis and Feline Odontoclastic Resorptive Lesions can be tricky to prevent in cats, particularly considering we don’t fully understand yet what causes them.  But there are certainly things that we can do to reduce dental issues in our cats.  Having a regular dental check with your veterinary surgeon once or twice a year allows full assessment of the mouth and any problem areas before any dental disease becomes too serious.  These dental checks can be done at the same time as annual health checks, and many veterinary practices run nurse clinics which are a great opportunity to keep an eye on your cat’s teeth.  If tartar is building up, your vet may recommend dental treatment to remove this and prevent the dental disease progressing.

Diet is an important part of dental care for cats.  Ensuring your cat is fed a good quality complete cat food is vital.  If your cat is prone to the build-up of calculus, there are specific dental diets available that help to break this down – our vet will be able to help you decide on the best diet for your cat.  While it can seem tempting to offer your cat treats, these can often be very high in sugar, so are not always good for their teeth. Try offering some of their regular food in an activity feeder or enrichment toy as an alternative.

If your cat will allow you to brush its teeth, this will often be the best way to reduce the build-up of calculus and development of periodontitis.  Specific cat toothpaste which are tasty fish and meat flavours should be used – these contain enzymes, which help with the breakdown of tartar on the teeth and may form a barrier to prevent further plaque developing.

A small finger brush can be used and if your cat is new to having his teeth cleaned, it can help to start off slowly getting them used to having their mouth touched.  Your vet or vet nurse will be able to show you how to go about brushing your cat’s teeth – although not all cats will tolerate it, most will if it is gently introduced (although, always be careful of your fingers!)

This article appeared in the summer 2019 issue of The Cat.  My thanks and appreciation to Francesca Watson, editor of The Cat, for giving me permission to publish this article on my website. 

 

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