Since February is National Cat Health Month and also Pet Dental Month, we thought we would provide you with some information on the two most common dental issues seen in cats by veterinarians.
1. Juvenile Gingivitis
It is generally accepted that accumulation of calculus supra-gingivally, along the gum line, and extension subgingivally (beneath the gums, near the crowns of the teeth) play a role in the progression of gingivitis. In cats it is not uncommon to see the development of gingivitis at 6 to 12 months of age, often times associated with little or no calculus accumulation. Calculus is also called tarter, a hard plaque like buildup on the teeth. The severity of Gingivitis is not always related to the amount of calculus present. The exact cause is unknown, however some theories include, viral, breed disposition (purebred cats such as Persians, Siamese, Abyssinians), genetic and environmental influences, diet, immune suppression, and of course plaque and calculus build up as mentioned earlier.
Clinically, the Gingivitis may be mild localized inflammation of the gingival tissues as seen by a bright red line, to more severe inflammation where the gingival tissues are extremely red and will bleed easily on probing, to severe inflammation and hyperemia resulting in oral pain and bleeding gums. Pseudo pockets will form as a result of severe gingival tissue hyperplasia.
Treatment of gingivitis includes elimination of plaque and calculus formation by performing a thorough dental prophylaxis (teeth cleaning) including supra and sub gingival scaling, polishing and oral rinsing and consistent home dental care. In severe cases of gingival overgrowth, hyperplasia or inflammation it may be necessary to perform gingivectomies or gingivoplasties to eliminate the pseudo pockets that have formed. The final step is to stress the importance of dental home care on a regular basis. Reduction of plaque buildup is essential to treat this form of dental disease. Anecdotally feline dental diet from Royal Canin has shown to help these cases in my opinion, in part due to the higher Omega 3 Fatty Acid content in the diet.
2. Feline Tooth Resorption:
Tooth resorption is the condition in teeth are absorbed and eaten away by the body. This condition has been recognized as early as the 13th and 14th centuries. In the 1920’s and 1930’s Arthur Hopewell-Smith published a series of reports in the Dental Cosmos Journal which later became the Journal of the American Dental Association. Here he described the histological, cellular biology and physiology that he discovered in cats and in humans. These lesions were significantly different than carious lesions, in fact they were similar to the resorption we see in human deciduous teeth. Even though these lesions were recognized and documented in the 1930’s they were not in any veterinary literature until the mid-1950’s. Prior to the 1960’s they were not as prevalent as they are currently, but as commercial cat foods were developed, so has the incidence of tooth resorption. In the mid 1960’s some of the published data about Feline resorptive lesions were thought to be carious and decay type lesions. Later they were described as early progressive subgingival resorptive lesions.
Over the years, many names have been tied to these lesions including neck lesions, cervical line lesions, cervical line erosions, cervical line resorptions, Osteoclastic resorptive lesions, subgingival resorptive lesions, feline dental resorptive (FDR) lesions, feline odontoclastic resorptive lesions (FORLs) to name a few. Now the most recent nomenclature for these lesions is tooth resorption. The main reason is that they not only can affect the entire tooth root and crown but also we are beginning to see these tooth resorptions in dogs as well as the assumption that these tooth resorptions are progressive.
The prevalence of these lesions varies between 20-75% of the cat population and most likely represents the most common feline disease of the tooth structure. Studies without radiographic evaluation may underestimate the pathology found. All feline populations can be affected including domestic cats, feral, exotic cats and large cats. The most common locations are the lower third premolars and molars and the upper fourth premolars, however, they can be seen on all the teeth including the incisors, more commonly known as fangs.
These lesions are painful but, as with all dental and oral disease, the range of clinical signs can vary from anorexia, weight loss, halitosis, ptyalism, dysphagia, etc. to no obvious clinical signs at all. If the lesions remain below the gingival attachment, they are often asymptomatic since they dentin tubules and pulp are not exposed to the oral bacteria and fluids.
The diagnosis and recognition is straightforward. The lesions can be detected by visual inspection, tactile examination with a dental explorer and radiology. In the exam room visual and tactile examination with a Q-tip is adequate and under general anesthesia tactile examination with an explorer and dental radiographs. Often times there is no visible or clinical tooth resorption, however, dental radiographs localized to the root will be seen. Full mouth radiographs are recommended for all cats presented for dental procedures such as dental prophylaxis, extractions or resorptive lesions.
The current treatment of choice is surgical extraction of the affected teeth and roots by creating a gingival flap, removing buccal bone, sectioning the affected teeth, extracting the tooth roots, performing alveoloplasty to smooth the alveolar ridges and then suturing the extraction site closed with absorbable sutures.
In type 2 root types where the root is beginning to be replaced by bone and there is loss of identifiable tooth root structure, Subgingival amputation below the gum line is a treatment option. This is accomplished by removing a portion of the coronal root structure below the gum line with a crosscut fissure or round cutting bur. Alveoloplasty (jawbone reshaping) is performed and the extraction site is closed with absorbable sutures. It is very difficult to extract these teeth that are resorbing, however, there are some veterinary dentists who recommend surgical extraction even with type 2 root disease.
Unfortunately at this current time there is no known treatment or diet that prevents the development and progression of tooth resorption.
Hopefully this post brought some helpful insight into the two most common dental health issues found in felines. Since it is Dental Month, now would be a wonderful time to schedule an oral examination with your vet today for your pet. You can find a list of our vet clinics by clicking here.
For more information on Periodontal Disease that affects both cats and dogs, you can read more on it and watch the excellent video by AVMA by clicking here. You can also watch their video guide on how to brush your pet's teeth by clicking here.