“ Sure his teeth are a little dirty but he’s still eating so they can’t be that bad, right?”  This is one of the biggest myths in veterinary medicine yet it is sadly repeated almost daily by my clients.  It’s certainly understandable though – if we have a toothache, we tend to alter our diet rapidly to find foods that are suitably easy to chew and then book ourselves in to see the dentist as soon as possible.  Cats (and dogs, but we’ll focus on cats in this article) would probably do the same, if they could, but I can’t recall the last time I saw Fluffy order her own meals or pick up the telephone!  Cats are still in many ways wild animals with natural instincts, and those instincts tell them that if they don’t eat, they’ll die.  For the same reasons, they are masters of hiding their pain, illnesses or anything that might make them seem vulnerable.  Therefore a cat with a toothache will probably act and eat very much like a cat without a toothache, suffering in silence.  Sure, there are some dental conditions that will cause a cat to stop eating, but by the time this happens they are usually so severe that they have become systemically ill (with infection and fever, for example) after weeks or months of living with the problem.  As responsible pet owners, it’s our job to make sure that our pets don’t have to quietly suffer with dental pain.

What kinds of dental disease do cats get?

  • Periodontal disease – Like us, cats’ teeth accumulate plaque (bacteria and debris that sticks to the outer surface of the tooth causing discolouration).  At this stage, the condition is reversible if treated with preventative home care.   But if left untreated, this plaque builds up over time into thick calculus that can only be removed using special tools under anaesthesia.  But the brown calculus is only the surface of the problem.  The gums surrounding the ‘dirty’ teeth become red and inflamed (a condition called gingivitis), and this inflammation hurts.  Over time, the inflammation eats away at the gums and the tissue that holds the tooth into the gums (the periodontal ligament), resulting in loose teeth that can hurt with every chew.  And as we’ll see later, this inflammation sometimes even eats away at the tooth itself.  Severe periodontal disease is not only painful and smelly, but dangerous too as it can lead to or exacerbate existing liver, kidney, and heart disease.
  • Feline Chronic Gingivostomatitis (FCGS) – Sometimes the gingivitis (inflammation of the gums) get so bad that all of the gum tissue around the teeth becomes bright red and swells, even to the point that the teeth become hidden under all the affected tissue.  Sometimes ulcers can form on the adjacent lip tissue or at the back of the mouth as well.  An extremely painful condition, FCGS is unfortunately not an uncommon disorder.  Despite much research, it is still unclear what actually causes this condition, although we do know that the bacteria in the plaque make it worse.  Many of these cats will test positive for Calicivirus (a virus commonly found in cats and often without causing any symptoms) but the significance of that is unknown.  It is thought to be in part due to an aberrant or inappropriate reaction by the cat’s immune system to something that would not normally cause a problem (normal mouth bacteria or even the most mild plaque buildup).  Treatment is difficult and frustrating and may include everything from antibiotics and steroids to the extraction of the majority of teeth in the mouth (as drastic as this sounds, this has proven to be the most successful treatment thus far), with varying degrees of success.  This is a very unfortunate condition for all parties involved – cat, owner and vet.
  • Feline Odontoclastic Resorptive Lesions (also called FORLs, resorptive lesions, or neck lesions) – These lesions affect more than a third of adult domestic cats, the second most common dental disorder after periodontal disease.  Resorptive lesions have been found in the skulls of cats dating back to the thirteenth century so the condition is far from new, however we have seen a dramatic rise in documented cases since the development of x-rays.  These lesions are particularly difficult for owners to pick up on because the disease process mostly occurs under the gumline, often with just a small area of redness or irregular shape to the gumline.  But underneath the gum, the tooth is being eaten away.  Sometimes the visible part of the tooth breaks off, leading us to believe that the tooth has simply fallen out (not that that isn’t also a problem!), leaving the fractured root to be re-absorbed or resorbed into the jaw bone.  Even if the tooth doesn’t break all the way off, it is still left with a big hole in it.  Anyone who has ever broken a tooth can testify to how unpleasant it feels!  Because it can be difficult to see resorptive lesions, the best and sometimes only way to diagnose them is with an x-ray.  The treatment for resorptive lesions is extraction of the affected tooth or teeth.
  • Broken teeth are another problem to look out for, in addition to the lesions mentioned above.  The long, sharp canine teeth are the ones that we see fractured most commonly, typically broken during a fight or if they get stuck somewhere, but any tooth can be affected especially if the cat has been in a road traffic accident or other trauma.  Broken teeth are often ignored, again assuming that because the cat is eating that it’s not a problem, but a fracture that exposes the pulp (living tissue which contains blood vessels and nerves) within the tooth can cause not only infection but a great deal of pain.  There may be a few cases when your vet may recommend that a fractured tooth be left alone (for example, if both the fracture and the cat are very old and/or it would be a high-risk anaesthesia), but in most cases they should be removed surgically.
  • Finally, malocclusion or the inability of the cat to close its mouth and chew properly, can have serious effects on its health.  This can occur when teeth fail to erupt correctly (for example, if the kitten teeth remain after the adult teeth come in) or with poor breeding in the case of brachycephalic breeds (such as Persians that have squished in faces).  If the teeth don’t fit together properly, they will sometimes dig into the opposing gum and cause painful ulcers.  Any baby teeth that are still present by the time the adult teeth have fully erupted should be removed surgically.  Severely brachycephalic cats also tend to have serious problems with their upper airway and sinuses resulting in breathing problems.   There is little that can be done to help these poor victims of bad breeding but we can help the situation as a whole by encouraging the breeding of only healthy, happy cats.

Up to 70% of cats will experience some degree of dental disease by the time they are 3 years old, and the odds get even worse with age.  But with a little bit of preventative care and awareness of the conditions above so that problems can be fixed quickly when they do arise, we can help make sure that our feline friends don’t have to suffer with dental pain in silence.  Part 2 of this article will discuss how to prevent and treat dental disease in cats.