Unfortunately, the importance of dental care in pets is often not well recognized and/or understood, especially in cats. Poor feline dental hygiene can cause a multitude of oral problems, a decrease in quality of life, and may contribute to diseases in other organ systems. The aim of this paper is to discuss the importance of feline oral hygiene, signs associated with oral diseases, diagnostic and treatment procedures, risk factors, and preventative techniques.
Oral health problems in the feline patient may result from bacterial build-up in plaque and tartar, immune-mediated disorders, oral cancers, tooth fractures, or other patient-specific circumstances. Oral diseases can be quite painful, which can make it difficult for the cat to eat, drink, and groom. Often times the mouth may become so painful that the cat may lose weight because it has stopped eating. This can be very dangerous for cats, as severe or sudden weight loss can cause serious liver complications, as well as exacerbate diseases such as diabetes. Along with this, bacteria residing in the mouth may gain access to the blood stream and cause damage to the heart, kidneys, and liver (1). Furthermore, some oral disease such as stomatitis can be associated with feline retroviral diseases such as feline leukemia (FeLV) and feline immunodeficiency (FIV); dental examination by a veterinarian may be useful in detecting an underlying disease such as FeLV or FIV. (2) Routine dental examinations not only aid in the detection and prevention of painful oral diseases, but also afford the opportunity to significantly impact the overall health and quality of life for feline patients.
According to the American Veterinary Dental Society, approximately 70% of cats will have some form of oral disease by the age of three. Therefore, it is important to watch for signs in not only geriatric patients, who are the most susceptible to dental disease, but in younger cats, as well. Because dental conditions can often be difficult for the veterinarian to identify during routine annual exams, it is very important that owners notify their veterinarian if their pet has been showing any signs of oral complications. Cats with underlying oral disease may present with a change in eating habits, dropping food while eating, difficulty swallowing, pawing at the mouth, bleeding from the oral cavity, bad breath, facial swelling, hypersensitivity of the oral surfaces, weight loss, and behavioral changes, such as aggressiveness and irritability. (3) If any of these signs are present, the veterinarian should be notified so a thorough dental exam may be performed.
It can be difficult for veterinarians to accomplish a comprehensive dental exam, as feline patients often do not tolerate examination of their oral cavity. If the veterinarian suspects an underlying dental problem, he or she will likely suggest that the patient be anesthetized for a thorough dental examination and dental cleaning. It is important that owners recognize the need for anesthetized dental examination, as many underlying diseases cannot be diagnosed properly without a more extensive evaluation of the oral cavity. The veterinarian can easily perform dental radiography, dental probing, and take samples for biopsy while the patient is anesthetized. Along with this, if dental repairs are necessitated, the procedure can often be performed during the same anesthetization period. Furthermore, even if the patient has no serious dental pathology, it allows the veterinarian and veterinary technician to perform an extensive dental cleaning, which will help prevent disease in the future! (4)
Periodontal Disease:. Periodontal disease is the most common pathology found in dogs and cats. It is caused by the accumulation of bacteria in dental plaque and tartar, and results in inflammation and irritation of the gums. Two forms of the disease exist, gingivitis and periodontitis. Gingivitis is the less severe form, and results when only the soft gum tissue is affected. Gums may appear red, irritated, sore, and bleed when touched. The patient often has halitosis, or bad breath. Gingivitis is usually reversible, and will likely resolve with a dental cleaning performed by the veterinarian and a course of antibiotics. However, left untreated, it can progress into the more severe form of periodontitis, in which infection spreads to the underlying bone that supports the tooth. Periodontitis is irreversible, and may result in pocketing of the gums, bone destruction, and loss of teeth. Therefore, it is important that owners treat gingivitis aggressively, by authorizing treatment with their veterinarian, as well as providing appropriate home care techniques, which are discussed in the next section. (5)
a. Healthy gingiva b. Gingiva c. Early Periodontitis d. Severe Periodontitis
Feline Odontoclastic Resorption Lesions (FORLs). FORLs are very common amongst the feline population, statistics indicate that 30% to 60% of cats may be affected by the disease. (6) Chronic, inappropriate activation of odontoclasts is believed to be the cause of FORLs. Odontoclasts function to "chew away" or resorb tissue in the tooth, and are responsible for aiding in tooth repair in the healthy individual. However, in patients with FORLs these odontoclasts are chronically active, and result in inappropriate tooth destruction. The patient usually shows signs of oral pain, and upon physical examination, evidence of erosion may or may not be present. Dental radiographs must be taken for accurate diagnosis if FORLs are suspected. Depending on the type and severity of the FORL, different treatment options may be recommended. Restoration of the affected tooth may be attempted in the early stages, however, this is often times unsuccessful, and complete extraction of the tooth becomes necessary. In some cases, a crown amputation may be performed, in which the crown of the tooth is removed but the root is intentionally retained. However, the most common type of treatment is complete tooth and root extraction of the affected tooth. Veterinarians should explain the benefits the animal will receive from tooth extraction (decreased pain, increased appetite, etc.), as some owners may be reluctant to authorize this form of treatment. (4)
Gingivostomatitis. Gingivostomatitis is an inflammatory condition in which a large area of the gums and oral cavity is affected. It can be extremely painful to the affected patient, and is characterized by red, swollen oral tissue that bleeds easily. Often, cats may present with teeth that are virtually free of plaque, yet the gum tissue and entire oral cavity may be swollen and painful. It is thought to be caused by an exaggerated immune response to bacteria residing in the plaque that coats the teeth, which means that excess bacterial load need not be present to cause inflammation. This differs from gingivitis in which an immune response toward the buildup of plaque and bacteria causes swollen gum tissue. However, just as untreated gingivitis may progress to periodontitis, so may untreated gingivostomatitis. Treatment plans vary from patient to patient, depending on the severity of the disease. Initial treatment generally consists of a thorough dental prophylaxis while the patient is anesthetized to remove the bacterium that is causing the hypersensitive reaction. Many cats will respond well to the cleaning, but will need repeat cleanings throughout the year. At home dental care through teeth brushing and oral rinses is critical in helping to control outbreaks of gingivostomatitis. Other therapeutic approaches include antibiotics and steroid administration. If these therapeutic approaches are unsuccessful, extraction of the premolar and molar teeth may be recommended by the veterinarian. In very serious cases, a full mouth tooth extraction may be necessitated. (6)
Squamous Cell Carcinoma. Squamous cell carcinoma (SCC) is the most commonly encountered oral tumor found in the cat, and, unfortunately the majority of these neoplastic growths are malignant. The affected cat may have difficulty swallowing, bad breath, difficulty eating, or may be asymptomatic. These growths may be difficult to detect for two reasons; they are often found in areas of the oral cavity that cannot be explored without anesthetization, and patients with SCC may remain relatively pain-free until significant growth of the tumor has occurred. If the veterinarian suspects SCC they will likely recommend a surgical biopsy in order to obtain a definitive diagnosis. Unfortunately, SCC is a very aggressive cancer, and the prognosis is generally less than one year from the time of diagnosis. Treatment options have generally proven to be successful in prolonging the life of the cat, and they include combinations of surgical excision of the mass or affected area, radiotherapy, chemotherapy, and non-steroidal ant-inflammatory drugs (NSAIDS). Routine dental exams and dental cleanings are critical to detecting this disease early! (7)
Certain risk factors have been postulated to be associated with occurrence of oral diseases. First, age appears to be the largest contributor to the development of these diseases, as older cats are more susceptible to the development of oral diseases. Diet has also been postulated to play a role in the development of periodontal disease; cats on a wet or soft food diet appear to me more susceptible to contracting these diseases than cats on a hard food diet. (8) Patients with viral diseases such as Feline Leukemia Virus (FeLV), Feline Immunodificiency Virus (FIV), or Calici Virus may also be more susceptible to these oral diseases. (1) Interestingly, recent studies have shown that cats living in a smoking environment are at a much higher risk of developing squamous cell carcinomas than those living in a non-smoking environment. Particles from cigarette smoke stick to their fur, and when they groom themselves, the particles are transferred into the cat's oral cavity. (7) Finally, cats who do not have routine dental examinations and cleanings are at a much greater risk for developing a number of oral diseases.
The most important precaution taken to prevent or detect oral disease is to see a veterinarian annually for a wellness exam, discuss any signs of oral disease with the veterinarian, and be proactive about anesthetized dental exams and cleanings. Along with this, home-care may aid in the prevention process. Owners may elect to brush their cats teeth with a certified pet toothpaste purchased through their veterinarian's office. It may be difficult for the owner and the pet to adjust to tooth brushing activity; however, the benefits to be had may be well worth it in the long run. Along with this, many veterinary offices sell oral rinses that can be placed in the water bowl. These rinses help to prevent the buildup of plaque and tartar. Owners may also elect to switch their pet to an all dry food, if that diet is appropriate for their current medical condition. It has been postulated that crunching on dry food helps to free some of the plaque and tartar buildup on the teeth. (8) It is important to note that at home prevention should not substitute dental care provided by the local veterinary office. Instead, maximum benefits may be obtained when at home prevention is combined with veterinary services. Owners should be aware that it is never too late to become involved in the dental care of their feline friends. Becoming actively engaged in the oral health of our pets can not only increase their quality of life, but may actually increase their longevity and decrease the odds of developing other organ system diseases.
1. "Periodontal Disease is the Most Common Disease Occurring in Pet Dogs and Cats". Veterinary Oral Health Council. (2008)
2. Quimby Jessica M, Elston T, Hawley J, Brewer M, Miller A, and Lappin M. "Evaluation of the association of Bartonella species, feline herpesvirus 1, feline calicivirus, feline leukemia virus and feline immunodeficiency virus with chronic feline gingivostomatitis". Journal of Feline Medicine and Surgery. 10(2008): 66-72.
3. Brill, Timothy. "Dental Care for all Cats". Studio One Networks. 2007.
4. Niemiec, Brook A. "Oral Pathology". Topics in Companion Animal Medicine. 23(2008): 59¥71.
5. Ingham, Kate E, Gorrel C, Blackburn JM, Farnsworth W. "The Effect of Toothbrushing on Periodontal Disease in Cats". American Society for Nutritional Sciences, Journal of Nutrition. 132(2002): 1740S - 1741S.
6. "Chronic Feline Gingivo-Stomatitis (GS)". Veterinary Dental Services.
7. Brooks, Wendy. "Oral Squamous Cell Carcinoma (Feline)". Veterinary Information Network, Inc. (2008).
8. Gawor, Jerry P., Reiter M, Jodkowska K, Kurski, G., Wojtacki M, Kurek A. "Influence of Diet on Oral Health in Cats and Dogs". American Society for Nutritional Sciences, Journal of Nutrition. 136(2006): 2021S-2023S.