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.

 

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This page last updated: 22 September 2013

Links on this page last checked: 02 April 2012