TANYA'S

COMPREHENSIVE GUIDE TO

FELINE CHRONIC KIDNEY DISEASE

 

 

DENTAL PROBLEMS

 

ON THIS PAGE:


The Importance of Dental Health


Feline Odontoclastic Resorptive Lesions (FORL)


Treatments


Brushing Teeth


Oral Gel Products


Coenzyme Q10


Antibiotics


Conscious Cleanings


Dental Surgery


 

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Home > Related Diseases > Dental Problems

 


Overview


  • Dental problems are very common in cats. They often develop a condition unique to cats called FORL, which is excruciatingly painful but not usually visible.

  • It is important to treat dental problems because they may damage the kidneys and heart.

  • There are several treatments you can try, some of which can be easily and cheaply done at home.

  • if your cat does need to undergo dental surgery, there are precautions your vet can take to reduce the risks.


The Importance of Dental Health                                                                      Back to Page Index


 

It appears that dental problems may be linked to an increased risk of other health issues. Although the precise mechanism is not known, scientists believe that in humans there may be a link between the oral bacteria associated with poor dental hygiene and heart disease. The National Institute of Dental and Craniofacial Research reports on studies to date. A similar link is thought to exist in cats. The American Animal Hospital Association states that "Dental disease doesn’t affect just the mouth. It can lead to more serious health problems including heart, lung and kidney disease."

 

The majority of cats have some degree of periodontal disease, and dental problems can arise or worsen because of CKD. Conversely, dental problems may seem to trigger CKD, in that a cat with periodontal disease who undergoes dental treatment under anaesthesia may develop CKD shortly afterwards. It cannot be proven that the CKD has been triggered by the dental disease, and it is also possible that the anaesthetic played a role; but dental procedures do appear to carry some degree of risk, although the risks can be greatly minimised if precautions are taken (see below).

 

Certainly I feel that it is important to keep a close eye on your cat's dental health, as indicated by our own small survey of two CKD cats - Tanya was very healthy apart from the occasional dental abscess, and when we trapped Thomas, he had three badly abscessed teeth.

 

Vet Dentistry discusses feline oral problems.

Dental Vet explains commonly seen feline dental problems.

 


Feline Odontoclastic Resorptive Lesions (FORL)                                                 Back to Page Index


 

Cats are prone to a particular dental condition called Feline Odontoclastic Resorptive Lesions or FORL (also known as neck lesions). This condition is so painful that, as shown in a video from Long Beach Animal Hospital, even cats under anaesthesia may react when an affected tooth is touched, yet often it is completely undetectable except via X-ray.

 

There is no treatment for FORL other than removal, so if your cat is to undergo a dental under anaesthesia, I would always ask for x-rays to be taken to check for FORL, so any affected teeth can be removed.

Pet Education explains more about FORL.

Pet Place has some information about FORL.

Update on the etiology of tooth resorption in domestic cats (2005) Reiter AM, Lewis JR & Okuda A Veterinary Clinics Small Animal Practice 35 pp913-942 mentions that cats with FORL tend to have higher levels of vitamin D and lower urine specific gravity and mentions that further studies are needed to investigate the relationshop between FORL, vitamin D and kidney insufficiency.

Advances in feline dentistry is a paper presented by Dr TJ Klein to the 23rd Waltham/Ohio State University Symposium with an overview of FORL and dental problems in cats generally.

Feline Odontoclastic Resorptive Lesions (2003) is a presentation by Cecilia Gorrel to the 28th World Congress of the World Small Animal Veterinary Association.

 


Symptoms                                                                                                            Back to Page Index


Common symptoms of dental problems include teeth grinding, not eating, pawing at the mouth or drooling. Some cats may approach food, then walk away. Your cat may also seem a little subdued.

 

Manhattan Cat Specialists have more information about drooling.

 


Treatments                                                                                                                                         Back to Page Index


 

The American Veterinary Dental College provides an overview of dental treatments for cats.

Brushing Teeth


Just like humans, cats benefit from having their teeth cleaned regularly at home with a toothbrush. You can buy special small toothbrushes for cats and special toothpaste in various flavours. I tried this on my Indie and must confess it wasn't a great success but I do know of quite a few people who clean their cats' teeth regularly with no problems. If you decide to try this, start off gradually, and let your cat get used to the toothbrush first, before you add the toothpaste.

 

Cornell University College of Veterinary Medicine has a video showing how to brush your cat's teeth.

American Veterinary Medical Association has a video on how to brush your cat's teeth.

Medi-Vet sells cat-sized toothbrushes.

 

Oral Gel Products


Biotene makes several products which people have found helpful. Be careful that you choose the correct products though, because some in their range are not suitable.

Co-enzyme Q10


Antioxidants mop up free radicals in the body, which are associated with aging and disease. Co-enzyme Q10 (CoQ10), also known as ubiquinone or ubiquinol, is an antioxidant that is used by the body in energy production. Human research indicates that it may be helpful in the treatment of periodontal disease.

 

Effect of topical application of coenzyme Q10 on adult periodontitis (1994) Hanioka T, Tanaka M, Ojima M, Shizukuishi S & Folkers K Molecular aspects of medicine 15 Suppl pp241-8 found that the topical application of CoQ10 appeared to improve periodontitis in humans. Sugano, N, et al. There were similar findings in more recent research by Nihon University School of Dentistry presented to The 63rd Meeting of the Vitamin Society of Japan, Hiroshima, Japan on 4th and 5th June 2011.

 

I don't know anybody who has tried this in a cat, but if you want to try it, check with your vet first. More information on CoQ10 can be found here.

 

Antibiotics


If your cat has dental problems which are not too advanced, or if your vet is reluctant to perform a dental under anaesthesia because of your cat's CKD, a course of antibiotics may be prescribed instead. Even if your vet is prepared to perform a dental under anaesthesia on your CKD cat, antibiotics should be given for several days in advance, and continued for 5-7 days afterwards. 

 

The best choice in most cases is an antibiotic called clindamycin (Antirobe), because this is particularly good at killing anaerobic bacteria which are often found in the mouth. When my PKD cat had a dental, this was the antibiotic which both the veterinary dentist and kidney specialist recommended for him.

 

Mar Vista Vet has an overview of clindamycin.

Pfizer, the manufacturer of Antirobe, provides some information about it.

 

Cleanings While Conscious


Some vets and groomers offer teeth cleanings performed while the cat is awake. Unfortunately it is not possible to perform a proper dental cleaning on a conscious cat, because the problem area is under the gumline, which can only be reached if the cat is unconscious. Therefore this sort of procedure is largely cosmetic, however it may be of some use for cats who have had a dental performed recently, though tooth brushing (see above) might suffice.

 

American Veterinary Dental College explains why dental scaling performed without anaesthesia is only of cosmetic benefit.

Dr Milinda Lommer, a veterinary dentist, explains why cosmetic cleaning of the teeth is no substitute for a thorough medical cleaning.

Aggie Animal Dental Service, owned by Dr Lommer, discusses this issue in more detail.

 

Dental Surgery


Eventually you may find that your cat needs dental surgery under anaesthesia, to clean under the gumline to help fight periodontal disease and/or to remove unhealthy teeth, perhaps because of FORL or abscesses.

 

Many people are terrified of having their cat undergo a dental, but if your cat is suffering severe dental problems, you probably have little choice because it becomes a quality of life issue. Dental problems can be extremely painful! And since cats instinctively try to hide pain, your cat could be suffering chronic pain without you realising it. Americans are famous for their standards of dental care so probably don't know how bad toothache can be; but I'm English, so, as night follows day, I have bad teeth (though in my defence I would like to point out that they are naturally beautifully straight - no orthodontist necessary for me!). Therefore, yes, I have had toothache, and I can tell you it is absolutely horrible, and a dental abscess is unbelievably painful. If your cat has FORL, a dental condition unique to cats, it is so painful that even cats under general anaesthesia may react when an affected tooth is touched.

 

If your cat does need a dental, there are ways to minimise the risks, as follows:

 

Preparing for Surgery


  • You should always have a physical exam and bloodwork done and blood pressure checked before surgery, so any problems can be addressed. If your cat has heart issues, you may also wish to see a veterinary cardiologist prior to surgery.

     

  • If your cat is on blood pressure medication such as amlodipine (Norvasc) or benazepril (Fortekor), ask your vet if you need to stop the medication a couple of days before the surgery (since anaesthetics may reduce blood pressure).

  • Antibiotics should be given to the cat, ideally starting a day or two before the procedure and continuing for 5-7 days afterwards. Policy statement: the use of antibiotics in veterinary dentistry (2005) American Veterinary Dental College mentions that antibiotics are recommended for cats with kidney disease who are having oral procedures.

  • CKD cats should be placed on IV fluids for a few hours before, during and after any dental procedures. All cats should be placed on IV fluids during and after any dental procedures. This is to avoid reduced blood flow and falls in blood pressure during the procedure, which may damage the kidneys.

During Surgery


  • Blood pressure should be monitored throughout the procedure.

  • I would always ask for X-rays to be performed so that the condition of the teeth can be examined properly and any teeth affected by FORL can be identified and removed.

After Surgery


  • Some cats develop a low temperature following anaesthesia, so ensure that your cat's temperature will be monitored afterwards. Your cat might benefit from a heat pad immediately following surgery.

  • If inhaled anaesthesia has been used, your cat will have a tube down the throat during surgery (intubation), which can cause the throat to feel a little sore for a day or two afterwards.

  • Blood pressure should also be monitored for a week or so afterwards because surgery and anaesthesia may cause increases in blood pressure following the procedure.

  • Your cat may be able to come home a few hours after surgery, or may have to stay in the hospital overnight or for a day or so. If you bring him or her home soon after surgery, keep him/her in a warm, quiet place. Your cat may be a little wobbly at first, but this should soon improve. If you have any concerns, contact your vet.

  • If a lot of work is done, painkillers may be necessary. My Indie (non-CKD) had extensive extractions, and was given a Fentanyl patch on her back leg to help her oral pain. Buprenorphine is also used for many cats following dentals with few problems. Make sure your vet does not give Metacam to your cat.

Dr Greg McDonald has a video about what happens during anaesthesia and dentals in cats.

Long Beach Animal Hospital has detailed information on dental procedures.

Cat Hospital of Chicago has a checklist for cats undergoing dental surgery.

 

Most cats do cope with dental surgery; but it is still surgery, and problems may occur in some cases. Some cats will start eating immediately following a dental, but may then worsen a day or two later as the painkillers wear off. Many cats take a while to regain their appetite. Our Indie, non-CKD, was given a dental at the age of nine because she simply stopped eating because of dental pain. Although she recovered relatively quickly from the surgery, she still went through an extended period of not eating afterwards, which had me at my wit's end. If your cat does not resume eating and also seems to be gaining weight following a dental, check with your vet because occasionally more serious problems can arise, as happened to Harpsie, even though we followed all the above guidelines.

 

Back to Page Index

This page last updated: 22 September 2013

Links on this page last checked: 02 April 2012

 

The group is hosted on yahoo!groups, part of yahoo. It has its own address separate from Tanya's website. You can either click here or copy and paste this link into your browser:

 

http://pets.groups.yahoo.com/group/tanyas-ckd-support/

 

If you are already familiar with yahoo!groups, just click on the link and apply to join (and don't forget to complete the short questionnaire you'll be sent), but if you'd like to know more about how the group works, read on.

 

I own and run the group, but I am ably assisted by two moderators, Anne V and Anne A. They help with membership queries, approve messages, and do lots of boring admin stuff behind the scenes to help the group run smoothly for the members.

 

The group has various sections, including a photos section and a realtime chat function but for most people the most important part of the group is its message section. Basically, a member who wants support, vet recommendations, or to hear how others are coping with a particular problem, sends a message to the rest of the group. Other members then respond if they can. All messages sent to the group are stored in a message archive which members can search if they wish.

 

The group is private, i.e. messages sent to it are only visible to members, so people are not posting to the internet at large. The names of group members are also private, so nobody will know you are a member unless you choose to send messages to the group.

 


Joining the Group                                                                                                                        Back to Page Index


 

There are two ways to join the group, via the group's website or via e-mail:

 

How to Join the Group via E-mail


Just send an e-mail to

tanyas-ckd-support-subscribe@yahoogroups.com

You should then receive an e-mail in response asking you to confirm that you definitely want to join the group. Just click Reply and send.

 

If you join the group via e-mail, you will be able to send and receive e-mails to the group, but you will not be able to access the group website and read the message archives or look at the photos. If you wish to do that, you will need to set up a yahoo! ID by visiting the group website.

 

How to Join the Group via the Web


You can visit the group's homepage and follow the instructions. If you do this, yahoo!groups will help you set up your yahoo! ID, which gives you access to the group message archive etc. A yahoo! ID is not the same thing as an e-mail address.

 

Here are the steps to follow. Don't worry, this all sounds far worse than it is! You should find that in practice it all works more smoothly than it sounds when you're trying to explain it in writing:

 

Existing yahoo! ID

  1. Go to the group website: http://pets.groups.yahoo.com/group/tanyas-ckd-support/

  2. Click on the Join this Group button and you'll be taken to a Sign In to Yahoo! page.

  3. Sign in and link Tanya's Support Group to your existing account.

  4. Choose the e-mail address you wish to use for the group (see below).

  5. There is a little box for you to tell me why you would like to join the group. You don't need to be inventive or fancy, it's not a competition, it's just an extra check by yahoo!groups to keep spammers out.

  6. Choose your message delivery options (see below).

  7. Scroll down and click on the blue Join button at the bottom right of the page.

New yahoo! ID

  1. Go to the group website: http://pets.groups.yahoo.com/group/tanyas-ckd-support/

  2. Click on the Join this Group button and you'll be taken to a Sign In to Yahoo! page.

  3. Scroll down a little and click on the Create New Account button.

  4. On the next page you can create your new account. Some people are somewhat inventive in their responses, but in such cases it is important to remember what responses have been given in case the information is needed later to access the account. I can't see any of this stuff, it's entirely private between you and yahoo!groups, so I cannot help in case of later queries. 

  5. Once the account is successfully set up, you'll be taken to a Congratulations! page.

  6. Before you click on the Continue button on the Congratulations! page, untick the box that makes yahoo! your homepage (unless that is what you want).

  7. Also click on the Edit Marketing Preferences link below the Continue button. This takes you to another page where they helpfully opt you in to everything, so go through and set it as you wish.

  8. Then on the same separate page click on Account Info at the top of the page. You will be asked for your password again and taken to the Account Info page. Click on Profile and opt out of the various choices as you wish. The key thing is, you do have choices here, you can make things as public or private as you wish.

  9. Now click on the Continue button on the original page. You will be taken back to the group page to choose your membership settings.

  10. Choose the e-mail address you wish to use for the group (see below).

  11. There is a little box for you to tell me why you would like to join the group. You don't need to be inventive or fancy, it's not a competition, it's just an extra check by yahoo!groups to keep spammers out.

  12. Choose your message delivery options (see below).

  13. Scroll down and click on the blue Join button at the bottom right of the page.


Membership Settings                                                                                          Back to Page Index


 

There are various choices you need to make regarding your membership of the group. The most important are which e-mail address to use, and which way you read messages sent to the group by group members.

 

Membership Settings: Your E-mail Address


You need to decide which e-mail address you wish to use for the group. If you have created a yahoo! ID, yahoo!groups will normally have also set up a free yahoo! e-mail account for you based on your new yahoo ID. You can use this e-mail address to access the group if you wish, but it's not essential, you can use any e-mail address you wish. Since yahoo! is now scanning messages for advertising purposes (similar to gmail), I would recommend not using yahoo! e-mail if possible (though it would probably be better than using your work address for private stuff).

 

If you do not want to use your free yahoo! e-mail address, click on Add e-mail address to add a different one. Be aware, if you don't add a new address here, yahoo! will use the yahoo! e-mail address as a default address. So if you don't receive the membership questionnaire, it may well be because it's gone to your new yahoo! e-mail address.

 

If you ever wish to change the e-mail address you are using for the group, you can do that here:

http://pets.groups.yahoo.com/group/tanyas-ckd-support/join

 

Membership Settings: Message Delivery


This sets up how you will access messages that are sent to the group.

 

This is a pretty active group. If you're looking after your CKD cat, you want support but you probably don't want a full inbox all the time. To help you manage this issue, you have three options for messages, and you can switch between them all as you wish:

  1. Individual E-mails

  2. Daily Digest

  3. Web Only (No e-mail)

Individual E-mails


This is the default setting. If you apply to join the group via e-mail, you will end up with this setting. If you apply to join the group via the group's webpage, if you don't choose one of the other settings, this is the one you will end up with.

 

This setting means that as soon as somebody sends a message to the group, it is sent directly to your inbox. It's a good choice if you might want to know immediately if somebody has responded to you, or if you would like to store some of the group messages for your reference. It's also good for being able to quickly delete messages which don't interest you.

 

The downside is that this is a busy group, averaging 50-100 group messages each day, so your inbox can quickly get full. One solution is to create a folder to use for group messages. All messages sent to the group have a tag in the subject line [tanya-crf] so you can filter all messages from the group to a new folder using this tag if you wish.

 

With both individual e-mail and message digest options, you can also choose the format of messages sent to you (Display Format), either Fully Featured (html, pretty colours etc.) or Traditional (plain text).

 

Message Digest


This means that you receive e-mails from the group, but yahoo!groups waits until there are about 25 messages available and sends them to you all in one go. With this option, you would therefore only receive 2-4 e-mails a day from the group, but it means you have to wait for responses (though you can still check on the group website for messages) and it can be more difficult to find what you are looking for within each digest.

 

With both individual e-mail and message digest options, you can also choose the format of messages sent to you (Display Format), either Fully Featured (html, pretty colours etc.) or Traditional (plain text).

 

Web Only (No Mail)


This means that you receive no messages at all from the group. This is a wise choice if you are using a work e-mail address, or if you cannot cope with the group's message volume. With this system you simply go to the group's website and read the messages that interest you there. Even if this is not your usual choice, it can be helpful to use this option if you are going on holiday.

 

So make your choices, then click the Join button at the bottom right of the page.

 


Important: Membership Questionnaire                                                           Back to Page Index


OK, so you've successfully applied to join the group. However, there is one more thing you need to do in order to join. I want to protect the group members from spammers, so whichever way you apply to join the group, you will receive a short questionnaire asking:

  1. Your first name

  2. The country where you live

  3. Your CKD cat's name and age

You need to respond to this before your membership will be approved.

 

Please don't worry about saying "the right thing." This is not a test to see if you are "good enough" for the group, everybody is welcome here, whoever they are or wherever they come from, as long as they want to help their cat. This questionnaire is basically just to reassure us that you are a real person applying to join rather than somebody trying to sell stuff and spam the group, but it also enables us to tailor our responses to your group messages e.g. if we moderators know where you live, we will not suggest treatments not available there.

 

Please note, only the two Annes and I can see your responses to these questions. The group will not know anything about you unless you choose to introduce yourself.

 

Once you respond to the questionnaire, your membership application should be approved very quickly (most people are approved within two hours or less).

 

Occasionally the questionnaire goes missing. You think we haven't sent it, and we think you haven't responded! If we haven't heard from you five days after you apply to join, we will send you a reminder. Unfortunately, we can only use the address you've used to sign up for the group, so if you've accidentally used your new yahoo e-mail address without realising it (see above), you won't see either the questionnaire or our reminder. If you don't hear from us, please simply write to us at tanyas-ckd-support-owner@yahoogroups.com and let us know. Please respond to the three questions in your response and we will either approve you (if your membership is pending) or send you a personal invitation to join the group (if your membership application has disappeared into a black hole).

 


Messages                                                                                                                                          Back to Page Index


 

Message Options: Sending Messages


You don't have to post, you can just lurk if you prefer.

 

If you wish to change the name that appears on messages you send to the group, Yahoo! explains how you can do that.

 

Starting a Thread


  1. You can simply send an e-mail to ask your question by sending it to tanyas-ckd-support@yahoogroups.com.

  2. You can go to the group website, click on Post Message in the sidebar on the left, and then write your message there.

Replying to an Existing Message


Messages sent in response to another message on the group also go directly to the group, not to the individual to whom you are replying. Therefore if you wish to respond to a message somebody else has sent, you can simply click reply on your e-mail programme. If you reply via the group website, you can click on the message in the group archives, then click reply which is top left above the message.

 

If you're changing the subject, or replying to a Digest (which have the subject line of Digest No. xxx), please change the subject line appropriately to something more meaningful. And please remove everything except that to which you are replying.

 

If you wish to reply privately to somebody, you will need to press reply, then delete the group e-mail address and paste their personal e-mail address into the To: line if you are using e-mail. If you are replying via the group website, you will see a little envelope over on the right under the person's name. If you click on that, your message will go to that person.

 

Message Content


You are welcome to discuss anything relating to care of your CKD cat. We do have a few guidelines we ask people to follow though:

  1. Please do not refer to vets or vet clinics by name for legal reasons. Just say "my vet" or "Dr J".

  2. Please do not ask for money or other donations.

  3. Since this is a very busy group, we ask that condolences are sent privately to the bereaved group member. Certain other messages should also be sent privately e.g. short "me too" messages, off topic posts etc.

  4. Please trim your posts.

Moderation of Messages


When you first join the group, your messages will be moderated for a short while. This means that they will not reach the group immediately, but will first be read and approved by one of the moderators. We do this to ensure that:

  1. you are not a spammer;

  2. you are keeping to other group guidelines (e.g. not naming your vet publicly);

  3. you are trimming your messages appropriately.

If you comply with the group guidelines sent to you when you join the group, you will be taken off moderation quickly. The main reason people stay on moderation is because they do not trim their posts. So please read up on this in the group guidelines. If you get stuck, just ask for help.

 


Leaving the Group                                                                                                Back to Page Index


 

Some people decide to leave the group. Their cat may have died, or they may find the message volume is too much, or they simply decide it's not the place for them. Leaving is fine, but if you're thinking of leaving simply because you cannot cope with message volume, please consider changing your message options first, such as by going no mail. This means your inbox will not be full, but you can still reach out for support quickly when you need it.

 

If you are leaving because your cat has died, please consider joining our sister group, Tanya's Feline Loss Support:

http://pets.groups.yahoo.com/group/tanyas-feline-loss/

 


Conclusion                                                                                                            Back to Page Index


I do hope you've decided to join Tanya's CKD Support Group! It can give you support, it can give you hope. It can make you smile too - where else would people share your thrill at hearing that your constipated cat has pooped? (Believe me, when you've been dealing with CKD for a while, things like this are real triumphs which can absolutely make your day).

 

I personally read every message sent to the group. I don't respond to every post (my priority is running this website) but I do keep an eye on things and post occasionally if I can add to what has already been said.

 


Group Quick Links                                                                                               Back to Page Index


Some of these only work if you are already a member of the group.

 

Weblinks


Group homepage:                                                 http://pets.groups.yahoo.com/group/tanyas-ckd-support/

Managing your membership options:                  http://pets.groups.yahoo.com/group/tanyas-ckd-support/join

Messages archive                                                 http://pets.groups.yahoo.com/group/tanyas-ckd-support/messages

 

E-mail Addresses


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