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Did you know, we probably see more cats for dental problems than dogs? Just like dogs, cats can suffer with tartar build up, periodontal disease and damage to their teeth such as fractures. However, there are two additional conditions that are seen almost exclusively in cats, and almost never in dogs.
Tooth resorption is very common. It has been recorded in 30-40% of healthy cats; in cats presenting for dental treatment, tooth resorption is found in about 70% of cases. The condition has had many names over the years; you might also hear it referred to as enamel defects, neck lesions, or feline oral resorbtive lesions (FORLs). In this condition, the enamel of the teeth is broken down by the body. This process initially starts under the gum line, and moves towards the tip of the tooth. Once the defect in the enamel reaches the surface, the soft inner pulp of the tooth is exposed to the air. The pulp contains all the blood vessels and nerves supplying the tooth. From this point onwards, the lesion is very painful.
As with all dental issues, cats with tooth resorption more often than not don’t display any overt signs of pain. Occasionally you will see them drop food as they are chewing it. They may seem to be hungry but then suddenly turn away. Any cat showing these signs should be examined by a vet. At your cat’s annual health check appointment, your vet will examine your pet’s teeth and will inform you if they see any lesions. Often they are very small and subtle and can only be detected under anaesthetic by a combination of x-rays and probing the teeth.
Once a resorptive lesion develops, we cannot save that tooth. If left untreated, eventually all the enamel of the tooth would dissolve away and the gum would heal. Generally if a cat has missing teeth but has never had previous dental work, this is due to resorption. However, this process takes a prolonged period of time and there is no real way to control pain in the meantime. For this reason, affected teeth must be extracted as soon as is reasonably possible.
Unfortunately, we don’t currently know the cause of tooth resorption. Cats that suffer tooth resorption on one tooth will almost inevitably develop it on other teeth. For this reason, regular checks of their teeth are vital, and most will have to undergo more than one dental procedure as the condition progresses. There seems to be a link to gingival inflammation in some cases. Keeping your cat’s teeth clean by brushing or using a dental specific diet may prevent these. It will also reduce tartar build up, which can hide resorptive lesions, meaning that any that do develop are diagnosed and addressed promptly.
Gingivostomatitis complex is severe generalised inflammation of the soft tissues of the gum (gingiva) and mouth (stoma). While we see gingivitis associated with plaque and bacteria, in feline gingivostomatitis the inflammation is out of all proportion to any build up of plaque.
Gingivostomatitis is incredibly painful, especially if very severe. Affected cats will often be unwilling or unable to eat, they may salivate and they often have very unpleasant breath. Their saliva will often stain their coat a brownish colour where they have been grooming. They are often very reluctant to have their mouth opened and examined due to the pain.
We don’t yet know the exact cause of gingivostomatitis complex. Affected cats have always been previously infected with a virus known as feline calicivirus – but not all cats with calicivirus will go on to develop gingivostomatitis. Essentially, it is thought to be an over-reaction of the immune system to plaque and bacteria in the mouth, or possibly even something in the tooth structure itself.
There are two main options for treatment of cats with gingivostomatitis complex. Normal oral hygiene measures are insufficient to control plaque and inflammation – and in any case tooth brushing would be far too painful for affected cats. The current most recommended treatment is what is termed ‘full mouth extractions’. As you might imagine, that is extraction of all their teeth, or more correctly usually their cheek teeth. In some cases their canines are affected as well. This seems very extreme, but in many cases, especially young cats, it is the best option for maintaining ongoing quality of life for these cats. Studies have shown that around 60% of these cases will resolve fully after extractions, and 20% will be significantly improved.
The other mainstay of treatment of this distressing condition, is regular use of medication to control the excessive immune reaction. This is often a good option for cases where full mouth extractions are not possible or considered to be the best choice for the cat. The most reliable drugs at producing these effects are corticosteroids. However, use of these drugs is not without the risk of side effects or adverse effects, which in cats may include the development of diabetes. In addition, they often seem to become less effective over time. A few cats will not be cured by total dental extractions and will still need a variety of medical treatments lifelong.