The Three Ds
Periodontal disease is the only serious dental condition that can be effectively prevented. For this, says Dr. Daniel Carmichael, cat owners should keep in mind what he calls "the three D's":
Daily brushing: "Clean your cat's teeth with a toothbrush once a day. Most people don't want to do this, but it's the best of all preventive measures."
Diet: "There are cat foods on the market today that are shown to reduce plaque and tartar by 50 percent. Ask your veterinarian for a recommendation."
Dentistry: "Take your cat once a year for a professional cleaning and examination. Make sure it's done under anesthesia - that's the only way!"
Most cats experience dental problems at some point. Here's how to help.
A cat grows two sets of teeth during its lifetime. The first set comprises 26 deciduous teeth, otherwise known as milk teeth. They start to appear when a kitten is about four weeks old, and by six weeks of age or so, the full complement is present. By the time the kitten is about six months old, the deciduous teeth will have fallen out and been replaced by 30 permanent teeth - tailor-made by Mother Nature for catching prey, ripping it to pieces and chewing it up. They're also useful for self-defense.
The term permanent, however, isn't quite accurate, since a sizable portion of the adult cat population will eventually lose one or more of their teeth as the result of injury or disease. According to Daniel Carmichael, DVM, a dental specialist at the Center for Specialized Veterinary Care in Westbury, NY, only about 10 percent of cats will make it through life without experiencing some sort of dental problem. And in many cases, the problem can be treated only by extraction of an affected tooth, if not a whole lot of them.
Nature and Nurture
To some degree, says Dr. Carmichael, genetics play a role in determining which cats are more susceptible than others to dental disease, pointing out that some purebreds - such as Abyssinians, Siamese, Maine Coons, Persians and Somalis - tend to be at greatest risk. But the overriding cause of dental problems can be traced to the modern cat's diet.
"The cat is a carnivore," says Dr. Carmichael. "His teeth are meant to be kept strong and clean by chewing up the flesh and bones of birds, rodents and other prey. Today, the cat subsists basically on a diet of the mush that we feed. We are inadvertantly setting our cats up for serious dental problems."
Four types of feline dental disease make up the vast majority of problems for which the extraction of one or more teeth may be the only remedy:
Periodontal disease is the most common, affecting an estimated 85 percent of cats over the age of six. In this disease, layers of plaque accumulate and harden on the tooth surface. Bacterial poisons and enzymes from the plaque eventually prompt an inflammatory response in the gums (gingiva) that, if left untreated, leads to severe gum inflammation (gingivitis). In cats, advanced periodontal disease can quickly progress to an end-stage condition for which extraction is the only reasonable treatment option.
Feline odontoclastic resorptive lesions (FORL) is another comparatively common dental affliction, affecting an estimated 50 percent of cats. This disease is characterized by plaque-caused lesions that start in the bone tissue (dentin) just below the enamel. Due to an inappropriate immune-system response, the tissue is unable to rebuild itself, and the lesions can progress rapidly and damage the tooth and its root irreparably. In Dr. Carmichael's opinion, any tooth in which FORL has extended to the point at which lesions pose a threat to the pulp chamber must be extracted.
Feline gingivitis/stomatitis syndrome (FGS) is a relatively uncommon condition, occurring in about one in 100 cats, most frequently among those with feline leukemia virus (FeLV), feline immunodeficiency virus (FIV), or other viral, nutritional or hormonal conditions. Although antibiotics and steroid therapy may be helpful in some cases, extraction of most or all teeth may be the only treatment option.
Fractured teeth may occur as the result of trauma or, less commonly, through chewing. "Doing nothing," Dr. Carmichael points out, "leaves a broken tooth that is painful and a possible avenue for infection. Extraction thus fulfills the goals of relieving the affected cat's pain and preventing infection."
Signs that a cat is suffering dental problems, says Dr. Carmichael, include bad breath, red and swollen gums, pawing at the mouth and refusal to eat hard food. But cats are unlikely to display pain, he explains: "Cats are descended from wild animals, and it's very deep in them that if they show weakness, they might become prey themselves."
The only way to "really find out what's going on" in a cat's mouth, says Dr. Carmichael, is to examine the animal's teeth under general anesthesia and, if necessary, take X-rays. The cat will usually be anesthetized for as long as it takes to clean its teeth, do the examination and perform treatment as needed. If extraction is necessary, the procedure should take about 45 minutes to an hour.
Unless a tooth is so deteriorated that it is ready to fall out, Dr. Carmichael extracts a tooth through surgical removal. "We never just yank a tooth," he explains. "Rather, we lift the gum tissue on the outside of the tooth and use a high-powered water-cooled drill to remove some of the bone tissue that is holding the tooth in the mouth. Then, with special instruments, we remove the tooth and sew the gums back together with dissolvable suture material." Any licensed veterinarian is qualified to clean, examine and extract teeth. According to Dr. Carmichael, the cost of an extraction, depending on the difficulty of the procedure, will typically range from $25 to $100, excluding any anesthesia and any necessary laboratory tests.
Shortly after the extraction, he says, the cat wakes up and goes home with a few days' supply of pain medicine. "One thing that I can guarantee," says Dr. Carmichael, "is that the cat will never miss a tooth that's been extracted. It will feel better, eat better and do better overall without it."
By Tom Ewing