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Dental Disease In Cats: A Dentistry Expert's Guide

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Introduction

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Oral health is a crucial, but often overlooked aspect of your cat's overall wellbeing. Just like humans, cats can experience a range of dental problems, which, if left untreated, can lead to more serious health complications. In this article, we take you through the different types of dental disease, the symptoms to look out for, as well as the treatments available and what you can do at home to protect your cat’s teeth.

To bring you the most fascinating insights into feline dental health, we've turned to Dr. Jose Carlos Almansa Ruiz, a recognised expert in the field of veterinary dentistry.

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Interesting facts about a cat's teeth

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Despite their cosy lap-cat image, domestic cats retain a remarkable feature from their wild ancestors – a set of razor-sharp teeth. These teeth are a vestige of their past as skilled hunters, and though their current lifestyle is far less predatory, their dental architecture remains an essential part of their anatomy.

• Adult cats have 30 teeth (16 on top, 14 on bottom), while kittens have 26 baby teeth
• Kittens start to lose their baby teeth around 12 weeks, with adult teeth appearing soon after
• The cat's small front teeth (incisors) are mainly used for grooming and removing old nail casings
• Four of the upper teeth in your cat's mouth (upper 2^nd premolar and 1^st molar teeth) are vestigial teeth and do not play a role in grooming or eating
• Cats often hide pain, making dental problems hard to detect without proactive monitoring
• The likelihood of developing periodontal disease significantly increases with age in cats

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What do healthy teeth look like?

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When inspecting your cat's teeth, you should notice they are clean and bright white, without any signs of chipping or damage. When it comes to their gums, a healthy appearance is key. They should present a smooth, pink surface, free from any sores or lesions. It's also crucial that there's no evidence of redness, swelling, or bleeding – these can be tell-tale signs of underlying health issues. Keeping an eye on these details can help ensure your cat's oral health remains in top condition.

It is also important to understand the relationship between your cat's upper and lower teeth; your cat should be able to close their mouth without any contact between the teeth, or between the teeth and the soft tissues of the mouth. If the upper and lower jaws do not fit together properly, it is known as malocclusion. This is seen more commonly in brachycephalic cat breeds (those with short faces), such as Persians and British Shorthair cats. You can find helpful tips for checking your cat's teeth in this YouTube video by the PDSA.

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What are the symptoms of dental disease in cats?

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Cats often hide their pain, making it challenging to spot dental issues. However, certain signs can alert you to potential problems. In this section, we'll highlight key symptoms to watch for, helping you catch dental issues early and keep your cat's oral health on track. Some common symptoms that suggest dental disease are:

• Eating less than normal
• Eating more slowly than normal
• Dropping food out of their mouth or around the bowl
• Hissing or growling at the food bowl
• Pawing at the face
• Making funny faces when eating
• Bad breath (often a fishy smell)
• Reduced grooming/dishevelled appearance
• Weight loss

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Dental disease progresses gradually, and some cats will continue to eat even with extremely painful mouths. Signs that indicate a visit to the vet is needed include bleeding from the mouth, rubbing or pawing at the mouth, eating significantly less than normal, or a sudden drop in appetite. Bad breath can also be an indicator of dental disease.

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What are the common types of dental disease that cats can get?

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Dental disease is alarmingly common in cats, with research from the Cornell University Feline Health Centre indicating that 50-90% of cats over four years old experience some form of dental illness. This startling statistic underscores the importance of being aware of the most common oral health issues facing our feline friends.

The top dental problems frequently observed in cats across our veterinary practices are:

• Periodontal disease
• Gingivostomatitis
• Tooth resorption
• Fractured teeth
• Malocclusion
• Oral tumours

peridontal

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Periodontal disease

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This is the most commonly diagnosed disease in cats in the UK. Periodontal disease is caused by bacteria in the mouth. Initially, inflammation of the gums (Gingivitis) occurs. This is reversible but, if not treated, will progress to an irreversible stage of inflammation (Periodontitis). This affects the tissues supporting the teeth in the jaws and will eventually result in the loss of the teeth.

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Gingivostomatitis

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Gingivostomatitis is a severe and chronic inflammation of the gums and soft tissues of the mouth. This disease is characterised by an abnormal inflammatory response to the dental plaque present on the cat's teeth, causing inflammation affecting large areas of the mouth, including the gums. Gingivostomatitis can affect up to 26.6% of domestic cats. Cats affected by this disease show signs of moderate to severe pain, often resulting in them stopping eating altogether. The trigger for Gingivostomatitis is unknown, but cats living in multi-cat households are most at risk of developing Gingivostomatitis, and affected cats are commonly carriers of a virus responsible for cat flu (Calicivirus).

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Tooth resorption

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This condition affects between 28.5-67% of domestic cats, with incidence increasing the older the cat is. Feline tooth resorption resembles tooth decay in humans, where the tooth is eaten away. Unlike in people, however, bacteria is not the culprit for tooth resorption in cats. Instead, your cat’s own body is responsible for the destruction, with cells in the surrounding bone becoming activated and starting to destroy the tooth. This is a slow process until the crown of the tooth is lost, and the roots are replaced by bone. This then causes significant oral pain, due to the nerve of the tooth being exposed. The trigger for tooth resorption in cats is unknown. Resorptive lesions can often be seen by eye but are best diagnosed using x-ray. Affected teeth will need to be removed.

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Fractured teeth

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Due to the position of the canine teeth in the cat’s mouth, these teeth are exposed to large forces and, potentially, trauma. Injuries can result in the loss of tooth structure, potentially causing exposure of the dental nerve. If this happens, it will be very sensitive and treatment is necessary to resolve pain and infection. If not treated, fractured teeth can lead to bigger problems such as infection of the jaw bone or nasal passages (known as rhinitis).

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Malocclusion

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Malocclusion means that the teeth are not properly aligned. This can result in trauma to the soft tissues or teeth where they meet. The most common breeds showing signs of malocclusion are the British Shorthair (BSH) and Persian breeds; in the BSH, it is common to see the top big premolar damaging the gum or tissues of the bottom jaw, resulting in pain, gum recession, and loss of teeth.

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Oral tumours

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Tumours of the oral cavity of cats represent around 10% of all tumours diagnosed in all parts of the body. In cats, the most common tumour diagnosed in the oral cavity is called Squamous Cell Carcinoma. This tumour is most commonly found under the tongue, meaning they can remain hidden until they are very advanced. Oral tumours often have similar symptoms to dental disease, such as reduced appetite, smelly breath and bleeding from the mouth. There are several predisposing factors for cats to develop this type of tumour, such as eating poor-quality commercial diets or wearing flea collars. Living in households where people smoke can also cause oral tumours, as tobacco smoke adheres to the cat’s coat and is transferred to the tissues inside the mouth during grooming.

Thankfully, with the right dental care and regular monitoring, the most prevalent types of these dental diseases can either be prevented or effectively managed.

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What are the risk factors?

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Understanding the risk factors for dental disease in cats is key to prevention. There are many risk factors for dental disease. Some are controllable and others aren’t.

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Risk factors you can control:

1. Lack of regular dental care (such as tooth brushing)
2. Diet consisting of mainly soft food
3. Viruses such as calicivirus, herpesvirus and FeLV, that can be prevented by vaccination

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Risk factors you can’t control:

1. Age
2. Genetics

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Historically, it was thought that purebred cats had a higher incidence of dental disease than “moggies”, however, more recent studies have failed to prove this theory. It is not fully understood why some cats develop conditions such as resorptive lesions and chronic Gingivostomatitis, which means we do not know how to prevent them occurring. They do, however, seem to be worsened by the presence of inflammation such as Gingivitis, so maintaining general good oral health is recommended for all cats.

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How is dental disease in cats diagnosed?

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Diagnosing dental disease in cats involves specific steps and techniques.

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Clinical Exam

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The initial step in diagnosing dental disease is a clinical examination by a veterinarian or veterinary nurse. They can identify signs of dental disease and its severity during this exam.

The presence of dental disease can be seen on a clinical exam by a vet or nurse, and we can often judge whether it is mild, moderate or severe. A complete mouth assessment can only be performed under general anaesthetic though, even in a very well-behaved patient.

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Complete Mouth Assessment

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For a thorough diagnosis, a complete assessment of the cat's mouth is necessary. This is typically done under general anesthesia, as it allows for a detailed examination even in well-behaved pets.

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X-ray

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Only the crown of the tooth sits above the gum line; the tooth roots sit within the jaw and can be as large as or longer than the crown. To fully assess both the roots and the jawbone around them, x-rays are required. In cats especially, resorptive lesions may be present close to the gum line, or cause damage to the tooth roots that can only be identified on x-ray. It is reported that up to 40% of cats have lesions affecting the tooth roots on x-ray, despite the crown of the tooth appearing healthy. For this reason, it is often recommended to take x-rays of your cat’s whole mouth.

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What treatments are available for dental disease?

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Effective treatment of dental disease in cats is crucial for alleviating discomfort and preventing further health complications.

Home Care for Mild Cases: Cats with mild dental disease, characterized by little or no tartar, can often be managed with diligent home care, including regular teeth brushing to slow down the progression of the disease.

Dental Procedures for Moderate Cases: Cats with moderate tartar buildup or mild Gingivitis usually require a dental procedure to resolve these issues and prevent them from worsening. This procedure is typically recommended within three months of the initial examination. Following the procedure, ongoing home care is essential to delay the recurrence of dental disease.

Immediate Procedures for Severe Cases: In cases of Periodontitis, which indicates severe dental disease, an immediate dental procedure is advised. Periodontitis is a painful condition, and if left untreated, there's a risk of infection spreading from the mouth to other parts of the body.

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What if a dental procedure is recommended?

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If the vet or nurse advises your cat would benefit from a dental procedure, there is a good chance that ignoring this will cause worsening of the dental disease and potential discomfort for your cat. This means that when the procedure is eventually performed it will be more complex, probably taking longer and costing more. There is a greater chance that more teeth will require extraction. By acting early, we have a much better chance of restoring oral health and preserving teeth.

Dental procedures in cats are always performed under anaesthetic, as it is simply not possible to do a thorough clean with pets awake. Although no anaesthetic is completely risk-free, we use personalised drug protocols for each individual patient, along with experienced staff and high-spec monitoring equipment to make the procedure as safe as possible. If you have specific concerns about your pet having a dental procedure, please speak to a member of the team; we are happy to answer any questions you may have.

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How to prevent dental disease in your cat

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Maintaining the health of your cat's teeth and gums is not just about preventing bad breath; it's essential for their overall wellbeing. A robust dental care routine can significantly reduce the risk of dental diseases. In this section, Dr Jose Carlos Almansia Ruizshares their top tips to keep your cat’s mouth healthy.

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Regular tooth brushing

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Just like our own mouths, regular brushing is the best way to keep teeth healthy. The mechanical action of a toothbrush is the most effective way to remove plaque from the teeth. Most pets can be taught to accept tooth brushing, but younger pets tend to learn faster than older animals.

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Regular oral health check-ups

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Ideally, we want to identify dental disease in the earliest stages so that we have the best chance of intervening, keeping the mouth healthy and preserving the teeth. Spotting the first signs of dental disease is best done by a trained professional, during regular checkups with a vet or nurse. These should happen every 6 months, or sooner if you have concerns.

You should also try to open and look at your cat’s mouth once a week. Check for bad smells (especially if this is worse than normal), broken teeth, and redness of the gums. Even if you aren't confident looking at the teeth, doing this regularly will get your cat used to having their mouth examined. This means the vet or nurse is more likely to be able to have a good look in the clinic, without your cat being worried about what is happening.

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Diet

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Cats that are fed dry biscuit diets tend to have less tartar than those fed only on wet food. This is because the mechanical action of crunching biscuits helps reduce plaque build-up. It does however rely on cats chewing the biscuits and not just swallowing them whole! Prescription dental care diets are available that can further reduce tartar formation; look for one that is proven to work or ask your practice for a recommendation.

Products

Various oral rinses and gels are available, most containing chlorhexidine to reduce bacteria and plaque. Many are effective, however, there are also many ineffective products available online; look for products with the VOHC (Veterinary Oral Health Council) seal or the list on their website.

Veterinary care

Following the advice on this page will help to keep your cat’s mouth as healthy as possible. If all the preventative measures are used, this will dramatically slow down tartar formation. Unfortunately, however, nothing will prevent dental disease completely. Some pathologies, such as tooth resorption, cannot be prevented as we still do not know what triggers them.

It is recommended that every cat has regular checks with a vet or veterinary nurse to allow a complete oral health assessment and treatment plan (known as COHAT). A conscious examination of the mouth is usually possible in a well-behaved cat. However, this only allows identification of superficial problems. Just like a floating iceberg, only the tip is visible, but the majority of the tooth is hidden within the jaw.

The gold standard COHAT requires the cat to have an anaesthetic, during which a full oral examination is carried out. The amount of tartar is recorded, along with the degree of gum disease present, signs of tooth resorption and any damaged or fractured teeth. The mouth is checked for changes such as infection or growths on the gums. The teeth are cleaned using an ultrasonic scaler before a fine probe is used to explore the edges of each tooth, identifying gingival pockets, root exposure, resorptive lesions or mobile teeth. Cats have 30 teeth, so it can take some time to fully assess the whole mouth.

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Summary

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Dental disease is very common in pet cats, with incidence increasing in older animals. If left undiagnosed and untreated, dental disease can cause pain, tooth loss and even organ problems. There are many steps you can take at home to keep your cat’s mouth as healthy as possible, however, these should be utilised in addition to regular checks with a vet or vet nurse. It is common and advisable for your cat to have several dental procedures during their lifetime (as we humans do!), but regular oral home care can greatly reduce the frequency and severity of these, keeping your cat happy and healthy!

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^References

^{O’Neill DG, Blenkarn A, Brodbelt DC, Church DB, Freeman A. Periodontal disease in cats under primary veterinary care in the UK: frequency and risk factors. Journal of Feline Medicine and Surgery. 2023;25(3). doi:10.1177/1098612X231158154}

^{Perry R, Tutt C. Periodontal disease in cats: Back to basics – with an eye on the future. Journal of Feline Medicine and Surgery. 2015;17(1):45-65. doi:10.1177/1098612X14560099}