Dental Disease in Cats

How common is dental disease in cats?

Dental disease is one of the most common medical conditions seen by veterinarians. More than half of all cats over the age of three have some form of dental disease. The most common problems are gingivitis (an inflammation of the gums caused by the accumulation of plaque), periodontal disease (a progression from gingivitis), and tooth resorption (formerly called feline oral resorptive lesions, or cervical neck lesions).

What are the clinical signs of dental disease?

Many cats do not display signs of dental disease that are detectable by their owners. Full oral examination under general anesthetic  to detect hidden disease is required beginning very early in your cat’s life. If your caat does show signs they may include pawing at her mouth, head shaking, or jaw chattering. She may even chew with obvious discomfort, drop food from her mouth, swallow with difficulty, or drool excessively. The saliva may contain blood. Halitosis (an unpleasant breath odor) is also common.

Dental disease and oral pain may account for the finicky appetites that some cats display. Many cats will refuse dry food or swallow it whole (no chewing) and demonstrate a preference for moist or canned foods. Some cats will have a decreased interest in food or may hesitantly approach their food bowl and show a reluctance to eat. This may lead to noticeable weight loss.

What are the most common dental diseases in cats?

The most common dental diseases in cats are periodontal disease and tooth resorption. 

Periodontal disease is a term used to described infection and the associated inflammation of the periodontum (the tissues surrounding the tooth). Specifically, there are four tissues that make up the periodontium. They are the gingiva, the cementum (covering of the root surface), the periodontal ligament (the ligament attaching the tooth root to the bone) and the alveolar bone.

Periodontal disease starts with early inflammation of the gums (gingivitis). Gingivitis results from plaque (bacterial slime) that accumulates on the tooth surfaces and contacts the gingiva. Plaque is a biofilm and home to many thousands of bacteria.  Some of this plaque is naturally removed during eating or by the action of the cat's tongue. However, without daily brushing, plaque quickly builds and eventually (over 36-48 hours) mineralizes, forming hard tartar (also called calculus). Tartar has a rough surface to which plaque can “stick” more readily. Untreated, gingivitis may lead to further inflammation of the other tissues of the periodontium. Progression of periodontal disease leads to loss of the tooth support and loss of the tooth. 

There may be other consequences of periodontal disease due to the loss of bone including oronasal fistula (a hole from the mouth into the nose), jaw fracture, abscessation with draining tracts that develop in the mouth or on the face or under the chin. Some studies indicate that the bacteria from severe oral disease which gets into the bloodstream may also be associated with pathological changes in major organs such as the heart, liver, and kidney.

What is tooth resorption?

Tooth resorption (formerly known as cervical neck lesions or feline oral resorptive lesions) is a progressive destruction of the tooth (crown and/or root) resulting in slowly progressive "holes" in the affected teeth. Once sensitive parts of the tooth are exposed, these lesions become intensely painful and the only effective and humane treatment is to extract the tooth. While the cause of this disease is unknown, poor oral hygiene can play a role in the disease process (see handout called “Tooth Resorption in Cats” for further details).

Is gingivitis always associated with dental disease?

As teeth erupt there is an increased redness to the gums, and this is known as eruption gingivitis. This should resolve as development progresses.

Some cats, however, develop severe oral inflammation called stomatitis. This is a complex condition for which there has been no specific cause identified. It is believed that cats who develop this disease have an extreme reaction to their own oral bacteria and plaque. The degree and extent of the ensuing inflammation can be extremely painful and cause a significant decrease in the cat’s quality of life and intense distress for both the cat and their owner. 

Treatment involves a detailed oral evaluation under general anesthetic, with extraction of any teeth affected with periodontitis along with a thorough periodontal cleaning of any remaining healthy teeth. Afterwards, various forms of therapy combining both medications such as anti-inflammatories, antibiotics, immunomodulators, and oral homecare is instituted. Each cat is different and medication choices can vary depending on the individual cat’s response. Studies have tended to show that up to 60% of cats can have their disease significantly decreased or even resolved, while 40% of cats continue to struggle with varying degrees of oral inflammation.  Stomatitis cases are best referred to a board-certified veterinary dentist who can tailor therapy to the individual cat. 

What should I do if my cat has signs of dental problems?

If you see that your cat has evidence of tartar accumulation, gingivitis, or is exhibiting any signs of mouth pain or discomfort, you should take her to your family veterinarian for a detailed oral examination. You will be advised of the most appropriate course of treatment, which may involve having your cat's teeth examined, professionally cleaned, and radiographed under general anesthesia.

The rate of tartar accumulation is highly variable between individual cats, and in some cases, this may require professional cleaning on a regular basis, every 6-12 months. Your veterinarian will help you assess what frequency is right for your cat.

Do not try to remove tartar from the teeth yourself with any form of metallic instrument. Aside from potentially harming your cat's mouth or them harming you, you may damage the surface of the tooth by creating microscopic scratches. These scratches provide areas for bacteria to cling to and encourage faster plaque formation which only makes the problem worse. Maintaining a smooth tooth surface is important and is the reason why your dental hygienist always polishes your teeth after removing tartar with dental instruments.

What can I do to help prevent dental disease in my cat?

The best way to prevent dental disease is to reduce the rate at which plaque and tartar builds up on the teeth. Recent advances in pet nutrition have resulted in the development of water additives, treats, and diets that can reduce tartar accumulation. The Veterinary Oral Health Council seal of acceptance (VOHC.org) will only be found on products which have been shown to reduce the accumulation of plaque and/or tartar. Please look for this seal when choosing oral homecare products for your cat.

The most effective way to reduce plaque and tartar is to brush your cat’s teeth daily (see the handout “Brushing Your Cat’s Teeth” for more information). A number of toothbrushes are specially designed for a cat's mouth. Never use human toothpaste. Human toothpastes are foaming products and contain ingredients that should not be swallowed as they could cause internal problems. Use pet toothpastes that are non-foaming and safe to be swallowed – they are available in flavors your cat will find appealing. 

 Ask your veterinarian for further details regarding the recommended dental products for your cat.

With a gentle approach, patience, and perseverance it is possible to brush your cat’s teeth and provide the oral care needed to prevent dental disease.