Tanya's Comprehensive Guide to Feline Chronic Kidney Disease

A cat with a full set of teeth has thirty teeth, consisting of canines (the four long pointy teeth at the front, known as fangs in our house), incisors (those tiny little teeth at the front), pre-molars and molars. Animal Dentistry and Oral Surgery Specialists explain more about feline teeth. The Royal Veterinary College explains the numbering system for feline teeth used by vets.

Unfortunately, cats are prone to dental problems, just as humans are, and they can start surprisingly early in life. Cornell University College of Veterinary Medicine reports that between 50 and 90% of cats over the age of four have some kind of dental disease. Therefore it is important to monitor your cat's oral health.

Vet Dentistry discusses feline oral problems.

International Cat Care discusses feline dental disease.

The Animal Medical Center New York has several articles about dental problems in cats.

Periodontal Disease: Ginigivitis and Periodontitis

Dental problems are not confined to the teeth. Many dental problems actually begin in the gums (gingiva).

If teeth are not kept clean, plaque forms on them and causes problems, particularly under the gum line (subgingival) where plaque cannot be seen. Initially the gums may become red, sore and inflamed, which is known as gingivitis. If the gums remain inflamed, over time it may lead to periodontitis, which eventually can result in loose or damaged teeth.

Aggie Animal Dental Center explains more about periodontal disease and its stages.

The 2019 AAHA dental care guidelines for dogs and cats (2019) Bellows J, Berg ML, Dennis S, Harvey R, Lobprise HB, Snyder CJ, Stone AES, Van de Wetering AG Journal of the American Animal Hospital Association 55(2) pp49-69 divide periodontal disease into four stages, with treatment depending upon which stage is present.

Feline Odontoclastic Resorptive Lesions (FORL)

Cats are also prone to a dental condition called feline odontoclastic resorptive lesions or FORL or tooth resorption (also known as neck lesions or cat cavities). This condition was previously only seen in cats, though apparently some dogs are now trying to get in on the act. Animal Dentistry and Oral Surgery Specialists state that well over 50% of adult cats develop this problem.

Worryingly, FORLs can start quite early in life: Prevalence of odontoclastic resorptive lesions in a population of clinically healthy cats (2001) Ingham KE, Gorrel C, Blackburn J & Farnsworth W Journal of Small Animal Practice 42 pp439-443 found the overall prevalence of FORLs in this study was 29%, even though the mean age of the cats in the study was only 4.92. FORLs may be seen in Siamese or Burmese cats before they even reach one year old.

FORLs used to be known as cat cavities because they sometimes look a bit like a cavity in human teeth. However, they are not actually cavities. Cavities occur when bacteria attack the teeth from the outside and work their way into the tooth; whereas with FORLs the problem occurs within the tooth and gradually works its way out, often exposing roots.

FORLS are often divided into five classes:

FORL Class

Effects

Treatment

Class 1

Enamel affected but not dentin.

Not overly sensitive.

A cleaning by your vet following by daily tooth brushing at home may slow the progression of class 1 FORLs.

Class 2

Enamel and dentin affected.

More sensitive.

Some vets attempt restoration (fillings) for class 2 FORLs but success tends to be limited and temporary. Extraction is advised.

Class 3

Enamel, dentin and pulp affected.

Very painful.

Extraction is necessary.

Class 4

Enamel, dentin, pulp and crown affected.

Extremely painful.

Extraction is necessary but may be difficult.

Class 5

The crown is completely resorbed.

Extremely painful.

Extraction is necessary but is much harder to do because the tooth tends to fragment as it is removed. Crown amputation (leaving the roots behind) may be necessary but is not ideal.

You will note that there is no mention of antibiotics under possible treatments. This is because antibiotics do not help with FORLs.

More advanced FORLS are 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 despite this, since FORLs start on the inside of the teeth, they can be very hard to detect because often there are no visible signs, especially in the early stages; and it doesn't help that our stoical cats instinctively try to hide the fact that they are in pain.

A trembling jaw: what resorptive tooth lesions mean for your cat (2013) Schaible L The Water Bowl says "If your vet suspects your cat may have a FORL, they may use a cotton-tipped applicator to press against the suspected lesion. This causes pain when the FORL is touched and the cat's jaw actually spasms. The trembling is not subtle and is often alarming to the pet parent. While this is clearly not pleasant for the patient, this is the best way I know to demonstrate to the pet parent the pain their cat is in and likely has been experiencing for some time."

Even this is not foolproof: Dr Schaible goes on to say "In some cases, the FORL will be covered with inflamed gum tissue and is only detected while the patient is under anesthesia having a dental cleaning performed." Animal Dentistry and Oral Surgery Specialists have photos of this, where it looks as if the gum is growing over a part of the tooth near the gum.

The best way to diagnose FORLS is via x-ray, which can detect class 1 and 2 FORLs before pain is present. If your cat is to undergo a dental under anaesthesia, always ask for x-rays of the entire mouth. Personally, if I were putting a CKD cat through a dental, I would ask for any teeth affected by FORLS to be removed.

Cats who have had a FORL are very likely to develop more in the future. How to detect and treat feline odontoclastic resorptive lesions (2005) Carmichael DT Veterinary Medicine says "If a cat has an FORL in one tooth, it is safe to assume that the cat is at a high risk for other teeth to eventually become affected." You can help slow the progression of class 1 FORLs by brushing your cat's teeth daily. A trembling jaw: what resorptive tooth lesions mean for your cat (2013) Schaible L The Water Bowl recommends pressing a Q-tip against where a tooth meets the gum once a month, to check for a pain response or bleeding. If either is present, take your cat to the vet.

For some strange reason, cats with FORLs may develop a low urine specific gravity (USG). This may improve once the FORLs have been treated.

Pet Place has some information about FORL.

Veterinary Dentistry and Oral Surgery of New Mexico has a helpful overview of FORLs.

Cornell University College of Veterinary Medicine discusses FORLS.

Feline Odontoclastic Resorptive Lesions (2003) Gorrel C Presentation to the 28th World Congress of the World Small Animal Veterinary Association explains more about FORLs.

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 relationship between FORL, vitamin D and kidney insufficiency.

The Importance of Dental Health

Dental problems hurt. A lot. As if that were not enough, dental problems appear to 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 heart disease and the oral bacteria associated with poor dental hygiene. Colgate reports on this. There is also increasing evidence that dental disease is associated with both CKD and diabetes in humans.

Similar links are thought to exist in cats. Littleton West Animal Hospital states that "Dental disease doesn’t affect just the mouth. It can lead to more serious health problems including heart, lung and kidney disease."

Arizona Veterinary Dental Specialists says "periodontal disease is usually under-treated, and may cause multiple problems in the oral cavity and may be associated with damage to internal organs in some patients as they age."

Veterinary Dental Specialties & Oral Surgery says "The reason that a broken pet tooth with direct pulp exposure presents a problem is that after the tooth is fractured, bacteria from the mouth gain access to the root canal and infect the tooth. Eventually, the tooth will die and become a bacterial haven. The bacteria then leak out through the bottom of the tooth, and infect the bone in that area. Eventually, the bacteria cause bone destruction around the tips of the tooth root. Next, the blood vessels in the area pick up the bacteria and spread it to other areas of the body, including the liver & kidneys which filter the blood, and potentially to the heart valves, which damage these vital organs."

Dental problems may also cause pyelonephritis. Veterinary Partner says pyelonephritis is "caused by a bacterial invasion. The kidney infection may have come from the bladder through the ureters, the bloodstream, or have invaded via other organs. Infection via the bladder/ureters is the most common route. Urinary stasis, urethral obstruction, kidney stones, trauma, and depressed immunity may predispose the pet to pyelonephritis. The bloodstream route of infection may be caused by bacterial endocarditis, diskospondylitis, abscesses, and dental disease."

Dental Health and CKD

There is increasing evidence that dental disease is associated with CKD in humans, though further research is needed. Periodontal disease and risks of kidney function decline and mortality in older people: a community-based cohort study (2015) Chen YT, Shih CJ, Ou SM, Hung SC, Lin CH, Tarng DC American Journal of Kidney Disease 66(2) pp223-30 looked at a group of people aged over 65 in Taiwan. The study concludes "The results indicate that periodontal disease is a risk factor for all-cause and cardiovascular mortality and eGFR decline ≥ 30% over 2 to 3 years in older people."

There also appears to be a link in cats between dental problems and CKD. Risk factors for development of chronic kidney disease in cats (2016) Finch NC, Syme HM & Elliott J Journal of Veterinary Internal Medicine 30(2) pp602-10 states "It is possible that oral inflammation may lead to kidneys damage through unknown mechanisms" and concludes "Our study suggests independent associations between both vaccination frequency and severity of dental disease and development of CKD" but states that further studies are necessary to investigate why this might be the case.

Some cats with periodontal disease who need dental treatment under anaesthesia may develop CKD shortly afterwards. Risk factors associated with the development of chronic kidney disease in cats evaluated at primary care veterinary hospitals (2014) Greene JP, Lefebvre SL, Wang M, Yang M, Lund EM & Polzin DJ Journal of the American Veterinary Medical Association 244 pp320–327 found that "Risk factors for CKD in cats included ... prior periodontal disease or cystitis, anesthesia or documented dehydration in the preceding year."

A more recent study appeared to support these earlier findings. Survival analysis to evaluate associations between periodontal disease and the risk of development of chronic azotemic kidney disease in cats evaluated at primary care veterinary hospitals (2018) Trevejo RT, Lefebvre SL, Yang M, Rhoads C, Goldstein G & Lund EM Journal of the American Veterinary Medical Association 252(6) pp710-720 evaluated cats at 829 hospitals over a period of more than eleven years, comparing cats with periodontal disease to cats without periodontal disease. The study found that periodontal disease (PD) "was associated with increased risk of CKD; risk was highest for cats with stage 3 or 4 PD. Risk of CKD increased with age. Purebred cats had greater risk of CKD than mixed-breed cats. General anesthesia within the year before study exit and diagnosis of cystitis at any point prior to study exit (including prior to study entry) were each associated with increased CKD risk. Diagnosis of diabetes mellitus or hepatic lipidosis at any point prior to study exit was associated with decreased CKD risk."

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. I have heard from a number of people whose cats' kidney values improved when their dental problems were addressed.

Symptoms

Common symptoms of dental problems include:

teeth grinding
not eating
dropping food out of the mouth
tilting the head when eating
eating on one side of the mouth only
pawing at the mouth. This may also be a sign of a rare condition called Feline Orofacial Pain Syndrome (FOPS), which is a pain disorder predominantly seen in Burmese cats. Feline orofacial pain (FOPS) (2009) Rusbridge C has some information about this condition.
lipsmacking
drooling
not chewing food
approaching food, then walking away
being a little subdued

Performing a complete oral examination (2012) Rawlinson J Presentation to the 73rd SCIVAC International Congress 2012 pp389-390 discusses some possible symptoms of dental problems in cats.

Not every cat will exhibit symptoms according to Arizona Veterinary Dental Specialists, which says "Unfortunately, other than bad breath, there are few signs of the disease process evident to the owner, and professional dental cleaning and periodontal therapy often comes too late to prevent extensive disease or to save teeth."

Some of the above symptoms may have other causes (for example, lipsmacking may be a sign of nausea). See Index of Symptoms and Treatments for more information.

Treatments

There are a number of possible treatments available, and your vet can decide which you need to use based on your cat's particular problems and the severity of those problems.

The treatments below are listed in order of invasiveness. The treatments you can do at home may help prevent or delay the need for more invasive treatments.

The American Veterinary Dental College provides an overview of dental treatments for cats (go to the bottom of the page).

Brushing teeth

Diet

Oral products

Co-enzyme Q10 (CoQ10)
Antibiotics

Cleanings while conscious

Dental surgery

Brushing Teeth

Just like humans, cats benefit from having their teeth cleaned regularly at home with a toothbrush. This may help slow the progression of both periodontal disease and FORLs.

You can buy special small toothbrushes for cats and also special toothpastes in various flavours. My cats hated the vanilla flavour but seemed to quite like the poultry flavour.

Do not use human toothpaste or baking soda to clean your cat's teeth. According to Camillus Animal Clinic, some human toothpastes contain ingredients that are inappropriate for cats, while baking soda is too alkaline and may upset the acid balance in the stomach if swallowed.

Start off gradually, and let your cat get used to the toothbrush first, and then to the toothpaste, before you put them both together. Some people find their cats prefer a cloth to a toothbrush. And take your time, it doesn't matter if it takes several weeks to get your cat into a routine.

Cornell University College of Veterinary Medicine has a four week training programme for brushing a cat's teeth.

Henna cleans her cats' teeth is a video by a member of Tanya's CKD Support Group showing how she brushes her cats' teeth.

Upper Canada Animal Hospital has a video showing you how to gradually get your cat used to tooth brushing.

Virbac makes C.E.T. oral hygiene kits for cats.

Medi-Vet sells a variety of dental health products for cats, including toothpastes and toothbrushes.

Thriving Pets sells CET kits.

Toothpastes and toothbrushes are also widely available including from most vets.

Diet

It used to be thought that dry foods were better for dental health than canned foods, but this is now thought unlikely to be the case. The Cat Doctor says "most dry food diets do not keep the teeth clean, as many people have been led to believe."

However, there are some therapeutic foods available for dental health, e.g.Hill's t/d. Dr Milinda Lommer, a veterinary dentist, explains that these are designed so that the cat's teeth must penetrate the kibble, which removes plaque. The kibble size also helps. Some members of Tanya's CKD Support Group do find this type of food makes a difference to their cats' dental health.

The Veterinary Oral Health Council has a list of accepted products for cats.

Essential Fatty Acids (EFAs)

Essential fatty acids (EFAs) are polyunsaturated fats (sometimes abbreviated as PUFA). They are essential because the cat's body cannot synthesise them in sufficient amounts, so they have to be obtained from food.

The two main types of EFAs are omega-3 and omega-6. Since cats as obligate carnivores benefit from animal-based products, the most appropriate form of essential fatty acid supplement is fish oil. Fish oil contains omega-3 fatty acids in the form of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).

Omega 3 fatty acids and periodontitis in US adults (2010) Naqvi AZ, Buettner C, Phillips RS, Davis RB & Mukamal KJ Journal of the American Dietary Association 110(11) pp1669–1675 states "In summary, we found that n-3 intake, particularly DHA and EPA, are inversely associated with periodontitis in the US population. To date, the treatment of periodontitis has primarily involved mechanical cleaning and local antibiotic application. Thus, a dietary therapy, if effective, might be a less expensive and safer method for the prevention and treatment of periodontitis. Given the evidence indicating a role for n-3s in other chronic inflammatory conditions, it is possible that treating periodontitis with n-3s could have the added benefit of preventing other chronic diseases associated with inflammation, including ischemic cerebrovascular disease, as well. Both of these questions warrant further investigation in prospective cohort and randomized clinical trials."

Earlier research found that the use of a product called 1-TDC improved periodontal disease in rabbits. Topical oral 1-tetradecanol complex in the treatment of periodontal diseases in cats (2019) Kubitza FML & Anthony JMG Journal of Feline Medicine and Surgery 21(12) pp1141-1148 looked at the use of this product in cats and found that cats receiving one 1-TDC capsule (525mg) a day for six weeks had "significant reductions in all parameters of clinical periodontal disease except tooth mobility at 6 weeks. The 1-TDC group exhibited a statistically significant reduction in pocket depth, clinical attachment loss, gingival index and bleeding on probing." (Interestingly, the control group received olive oil (0.25 ml per gel capsule a day) and although these cats had no improvement in their periodontal health, it did not get worse).

1-TDC is made by Elite Science and it is "a proprietary blend of fatty acids derived from beef tallow." It also contains a small amount of fish oil . It is available from Amazon or Heartland Veterinary Supply.

Essential fatty acids are discussed in more detail on the Nutritional Requirements page.

Oral Products

There are a number of products available to assist with oral health which can either be rubbed on your cat's teeth or added to drinking water.

The Veterinary Oral Health Council has a list of accepted products for cats.

Maxi/Guard

Addison Labs make some products which some members of Tanya's CKD Support Group find helpful..

Maxi/Guard OraZn is a tasteless gel that can be rubbed on the gums.

Maxi/Guard Oral Cleansing Gel is recommended for post-surgery use, though it does contain vitamin C.

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.

There were similar findings in 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 am not aware of any more recent research, and I don't know anybody who has tried this in a cat, but I cannot think it would be sufficient to help you avoid dental surgery. if you want to try it, check with your vet first. More information on CoQ10 can be found here.

Antibiotics

Antibiotics may occasionally be prescribed:

to try to dampen down dental problems which are not too advanced; or

if your vet is reluctant to perform a dental under anaesthesia because of your cat's other health issues

Using antibiotics to stop bacteria reproducing is bacteriostatic, whereas using antibiotics to kill the bacteria is known as bacteriocidal.

Using antibiotics in this way is not ideal because they will not resolve the problem if it is periodontal disease.

Cats with oral infections often do need antibiotics, however, they are unlikely to be sufficient in isolation. Position statement: the use of antibiotics in veterinary dentistry (2019) American Veterinary Dental College states "Antibiotics should never be considered a monotherapy for treatment of oral infections, and should not be used as preventive management of oral conditions."

Antibiotics should ideally not be given repeatedly because this may lead to antibiotic resistance.

Antibiotics may also be prescribed if your cat undergoes a dental under anaesthesia, in which case antibiotics should be given for a couple of days in advance, and continued for 5-7 days afterwards. Some vets seem to be reluctant to prescribe antibiotics before dentals, however, Position statement: the use of antibiotics in veterinary dentistry (2019) American Veterinary Dental College states "Patients that are scheduled for an oral procedure may benefit from pre-treatment with an appropriate antibiotic to improve the health of infected oral tissues, however a full course treatment is always recommended. Bacteremia is a recognized sequela to dental scaling and other oral procedures. Healthy animals are able to overcome this bacteremia without the use of systemic antibiotics. However, use of a systemically administered antibiotic is recommended to reduce bacteremia for animals that are immune compromised, have underlying systemic disease (such as clinically-evident cardiac, hepatic, and renal diseases) and/or when severe oral infection is present."

Clindamycin (Antirobe) is the best choice of antibiotic in most cases, 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.

There is more information about clindamycin here.

Cleanings While Conscious (Anaesthesia-Free Dentistry)

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. Therefore this sort of procedure is largely cosmetic (it may be of some use for cats who have had a dental performed recently, though tooth brushing might suffice).

Problems with this approach include:

this is a largely cosmetic procedure, because the problem area is under the gumline, which can only be reached if the cat is unconscious.

nevertheless, it can be traumatic and painful for the cat.

it is not possible to see any problems that need treating, such as FORLs.

it is not possible to take x-rays to look for such problems.

if you pay for these procedures regularly, you will probably end up spending as much as or more than you would have spent on proper cleanings.

Companion animal dental scaling without anesthesia (2004) American Veterinary Dental College says "Removal of dental tartar on the visible surfaces of the teeth has little effect on a pet’s health, and provides a false sense of accomplishment. The effect is purely cosmetic." It also explains the other risks of dental scaling performed without anaesthesia.

The 2019 AAHA dental care guidelines for dogs and cats (2019) Bellows J, Berg ML, Dennis S, Harvey R, Lobprise HB, Snyder CJ, Stone AES, Van de Wetering AG Journal of the American Animal Hospital Association 55(2) pp49-69 say "Without general anesthesia, an accurate diagnosis cannot be made, patient pain cannot be addressed, the patient’s airway cannot be protected from aspiration, and disease cannot be appropriately treated."

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

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

Dental Surgery

Eventually you may find that your cat needs dental surgery under anaesthesia. This enables your vet to clean under the gumline to help fight periodontal disease and/or to remove unhealthy teeth, perhaps because of FORLs 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 advanced FORLs, it is so painful that even cats under general anaesthesia may react when an affected tooth is touched.

What is a professional veterinary dental cleaning American Veterinary Dental College explains what a dental under anaesthetic entails.

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

If your cat does need a dental, there are ways to minimise the risks.

Preparing for Surgery

Use a veterinary dental specialist if possible.

In the USA, you can find a specialist at the American Veterinary Dental College, or at the Academy of Veterinary Dentistry.

The British Veterinary Dental Association no longer seems to have a list of its members with contact details, but you could ask your vet for a referral.

You should always have a physical exam and bloodwork performed 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.

Consider a chest x-ray to check the lungs are clear.

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 before the surgery (since anaesthetics may reduce blood pressure). AAHA Anesthesia and Monitoring Guidelines for Dogs and Cats (2020) Grubb T, Sager J, Gaynor JS, Montgomery E, Parker JA, Shafford H & Tearney C Journal of the American Animal Hospital Association 56(2) pp59-82 advises stopping benazepril and has a list of which medications can normally be given and which not.

Antibiotics should be given to the cat, ideally starting a day or two before the procedure and continuing for 5-7 days afterwards. I often hear from people whose vets are reluctant to give antibiotics to cats before surgery. I would refer such vets to Position statement: the use of antibiotics in veterinary dentistry (2019) American Veterinary Dental College, which says "Patients that are scheduled for an oral procedure may benefit from pre-treatment with an appropriate antibiotic to improve the health of infected oral tissues, however a full course treatment is always recommended. Bacteremia is a recognized sequela to dental scaling and other oral procedures. Healthy animals are able to overcome this bacteremia without the use of systemic antibiotics. However, use of a systemically administered antibiotic is recommended to reduce bacteremia for animals that are immune compromised, have underlying systemic disease (such as clinically-evident cardiac, hepatic, and renal diseases) and/or when severe oral infection is present."

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.

It is very important to fast your cat before anaesthesia. This will usually be done for several hours before surgery, often overnight, but a shorter period may be possible in some cases, so be guided by your vet. Your cat may be allowed to drink water until a couple of hours before surgery, which can be helpful for a CKD cat, but your vet will decide what is the best approach for your cat.

Ensure all members of the team caring for your cat are aware of your cat's needs. One member of Tanya's Support Group pinned a reminder list to her cat's carrying basket when dropping him off for his dental.

During Surgery

Read up on anaesthesia and discuss with your vet which anaesthetic agents to use. Some vets use nerve blocks (local anaesthetic) during dental surgery to reduce the amount of inhaled anaesthesia needed and to provide pain control. The 2019 AAHA dental care guidelines for dogs and cats (2019) Bellows J, Berg ML, Dennis S, Harvey R, Lobprise HB, Snyder CJ, Stone AES, Van de Wetering AG Journal of the American Animal Hospital Association 55(2) pp49-69 say "The use of local anesthetics as dental blocks dramatically decreases the depth of general anesthesia needed, and thereby helps support blood pressure, decreases ventilatory depression, provides analgesia, and generally increases safety." Skills laboratory: how to perform four oral regional nerve blocks in dogs and cats (2012) Beckman B Veterinary Medicine explains more about the use of nerve blocks (this article is rather technical).

Who will be performing the anaesthesia and monitoring the cat during the procedure? Obviously you want somebody who is both skilled and experienced. Monitoring anesthetized dental patients: the five parameter approach (2010) Bellows J DVM360 Magazine explains more about this.

Blood pressure should be monitored throughout the procedure.

A cat should always be given intravenous fluids during the procedure, and a CKD cat should also receive IV fluids before and after the surgery (see Anaesthesia).

Always ask for X-rays to be performed so that the condition of the teeth can be examined properly and any teeth affected by FORLs can be identified and removed. Why should you do whole-mouth intra-oral dental radiographs? (2013) Hale F The Canadian Veterinary Journal 54(9) pp889–890 says "If you have a live patient with an oral cavity under general anesthesia, you should do whole-mouth intra-oral dental radiographs." Amongst other reasons it states "tooth resorption is so common in cats, you should assume every cat has some tooth resorption until proven otherwise (by detailed clinical and radiographic evaluation."

Ask that a mouth gag (used to hold the mouth open during surgery) is not used. Their use has been associated with blindness in cats. Open wide: Blindness in cats after the use of mouth gags (2014) Reiter AM The Veterinary Journal 201 pp5-6 explains more about this.

Long Beach Animal Hospital recommends a final rinse with chlorhexidine to help kill bacteria.

After Surgery

Your cat should be monitored closely after surgery. AAFP feline anesthesia guidelines (2018) Robertson SA, Gogolski SM, Pascoe P, Shafford HL, Sager J & Griffenhagen GM Journal of Feline Medicine and Surgery 20(7) pp602-634 state that "Sixty percent of all anesthetic-related cat deaths occur during the recovery period, especially the first 3 h."

Some cats develop a low temperature following anaesthesia. Anaesthesia for the geriatric dog and cat (2008) Hughes JML Irish Veterinary Journal 61(6) pp380–387 states "the elderly patient is at increased risk of developing hypothermia. Shivering increases oxygen demand in the recovery period; if this demand is not met, arrhythmias often develop. Duration of anaesthesia should be kept to a minimum and all efforts taken to keep elderly patients warm". Therefore you should ensure that your cat is kept warm and his/her temperature monitored afterwards. The American Association of Feline Practitioners Senior Care Guidelines (2009) Pittari J, Rodan I, Beekman G, Gunn-Moore D, Polzin D, Taboada J, Tuzio H & Zoran D Journal of Feline Medicine & Surgery 11 pp763-778 states "Since hypothermia is common, evaluate body temperature every 15 mins, continuing postoperatively until the cat is ambulatory or normothermic. Support body temperature by using tools such as a heated cage, hot air blankets, water-circulating heating pad, and/or booties." If your vet uses a heat pad, this should only be used once the cat is able to move off the pad of his/her own volition should they start to feel too hot.

Anaesthesia for the geriatric dog and cat (2008) Hughes JML Irish Veterinary Journal 61(6) pp380–387 also states "All recovering geriatric patients should receive oxygen supplementation and be monitored closely until their protective pharyngeal reflexes have returned."

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 (possibly causing hoarseness) 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.

Painkillers are usually necessary after dental surgery. WSAVA guidelines for recognition, assessment and treatment of pain (2014) Mathews K, Kronen PW, Lascelles D, Nolan A, Robertson S, Steagall PVM, Wright B & Yamashita K Journal of Small Animal Practice 55(6) ppE10–E68 points out that "pain associated with surgery is 100% predictable." 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.

Clinical and microbiological effects of oral zinc ascorbate gel in cats (2001) Clarke DE Journal of Veterinary Dentistry 18 indicates that using zinc ascorbate gel as an oral antiseptic may improve dental health, particularly following a dental 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.

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 (who developed a torn trachea), even though we followed all the above guidelines.

Success Stories

Immediately above I describe some of the problems I have encountered during dentals in my cats. However, I would say there are many, many more success stories than problems.

You have to understand that dental problems can cause a lot of pain, but your cat may well not show it. Veterinary Dental Specialties & Oral Surgery, talking about broken teeth, say ""Pet teeth with direct root canal exposure are excruciatingly painful to a dog or cat. Unfortunately, only very rarely will animals show discomfort, as they are evolutionarily conditioned to mask pain fairly well, preferring to suffer in silence. This allows owners (and veterinarians) to ignore the problem, as “it doesn’t seem to bother the pet”. But we now know that these animals are suffering with consequences both locally in the mouth as well as systemically throughout the body. This means that in today’s current age of veterinary medicine, it is no longer appropriate or acceptable to ignore broken teeth in our patients."

Dental pain sucks, big time. What is the point of your cat living a longer life if that life is filled with pain?

Many members of Tanya's CKD Support Group have had dentals performed on their cats with great reluctance, only to find their cats not only come through very well, they actually look and act much better than before the dental. Veterinary Dental Specialties & Oral Surgery says "We have had numerous clients who have told us that their pet is not bothered by its broken tooth when it is discovered, that later tell us joyfully that their pet is acting “5 years younger” just two weeks after the problem is fixed."

As a bonus, many cats' kidney bloodwork improves following a dental. Veterinary Dental Specialties & Oral Surgery says "infected teeth (and periodontal disease) can so greatly affect the rest of the body and its vital organs that we have had numerous patients with elevated liver and kidney enzymes found on the pre-op blood which then improve or return to normal levels within two weeks of the dental procedure."

One 13 year old cat on Tanya's Support Group had BUN of 107 mg/dl and creatinine of 10.1 mg/dl back in November 2011. His caregiver was told he had severe dental problems and was offered either a dental or euthanasia, so she opted for the dental. Following the dental, her cat's creatinine fell to 1.9 mg/dl and he has remained stable to date, with his numbers only recently (2017) worsening.

Another cat had creatinine of 3.4 mg/dl before her dental. After the dental her creatinine fell to 1.9 mg/dl and she is still alive, five years later.

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This page last updated: 11 November 2020

Links on this page last checked: 02 May 2020

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TREATING YOUR CAT WITHOUT VETERINARY ADVICE CAN BE EXTREMELY DANGEROUS.

I have tried very hard to ensure that the information provided in this website is accurate, but I am NOT a vet, just an ordinary person who has lived through CKD with three cats. This website is for educational purposes only, and is not intended to be used to diagnose or treat any cat. Before trying any of the treatments described herein, you MUST consult a qualified veterinarian and obtain professional advice on the correct regimen for your cat and his or her particular requirements; and you should only use any treatments described here with the full knowledge and approval of your vet. No responsibility can be accepted.

If your cat appears to be in pain or distress, do not waste time on the internet, contact your vet immediately.

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