In recent years, we have come to know that dental health maintenance is one of the most important things that we as veterinarians and you as cat owners can do to prolong your cat’s life. Unlike humans, cats do not have the benefit of daily brushing and flossing to rid the mouth of harmful debris and bacteria. Because of this, dental cleaning and evaluation at a veterinarian’s office on a regular basis is the best way to obtain the benefits of a healthy mouth.
Dental Prophylaxis (Cleaning)
There are several reasons why dental care is so important to your cat. The first, of course, is that unhealthy teeth and gums can be very uncomfortable to your pet, even leading to loss of appetite and weight loss in severe cases. Also, when not regularly cleaned, the teeth and gums build up large numbers of bacteria in the form of tartar. It has been discovered that these bacteria can enter the bloodstream and cause serious damage to heart valves, liver and kidneys. We believe this explains many cases of heart and kidney disease previously just chalked up to “old age.”
Dental prophylaxis is a procedure performed in our office under general anesthesia. Your cat’s teeth are scaled to remove tartar, then polished to help delay further plaque formation. A complete set of intraoral dental radiographs are taken to evaluate the teeth for tooth resorption, periodontal disease, fractures and other signs of disease. The doctor then completes a thorough intraoral exam, probing all of the teeth, and performs any treatments or extractions that may be necessary. Every effort is made to give you an accurate estimate prior to your cat’s dental treatment, but please understand that most of the significant diagnostics are performed once your cat is already under anesthesia. It is not uncommon to find problems we could not have predicted prior to the procedure. It is extremely important that you try to be available for us to contact during this procedure to discuss any additional treatments that might be recommended.
Anesthesia for dental procedures will be subject to the same requirements for pre-operative blood work as other surgical procedures.
Tooth Resorption
Tooth resorption is the most common type of dental disease in cats, and is seen more frequently in cats than in any other species. Resorption occurs right at the gumline, and is often almost impossible to detect in the un-anesthetized cat until it is very advanced. These lesions are extremely painful, with some degree of discomfort present even at the very early stages. These lesions generally cause the teeth to become very brittle, and left untreated, most of these teeth will end up breaking, leaving the roots behind. This can lead to severe pain, and occasionally to a disease called lymphocytic plasmacytic stomatitis. This condition is generally believed to be one of the most painful diseases recognized in feline medicine, with the discomfort sometimes becoming so excruciating that a feeding tube must be placed to allow for nutritional support. Tooth resorption can appear as early as one year of age. As no one knows what causes tooth resorption, prevention at this time is not possible. Most cats will develop some of these lesions as they age, regardless of the level of care. When they do develop, treatment options are very limited.
In the case of very early lesions, a dental prophylaxis may slow the progression, but cannot reverse the damage that is already done. Most of the time these lesions will eventually become deeper and cause discomfort. For lesions that are already causing pain, the only treatment option we can offer is extraction. Although extraction seems extreme, in most cases cats return to a much more comfortable state within days of surgery, causing many owners to remark that they had no idea how uncomfortable their pets were before until they got to see the difference. Other treatments, such as restorations with glass ionomers or composites, have been attempted, but have been found to be unsuccessful in slowing or repairing these lesions.
Fasting Starts the Night Before
Our veterinarians recommend no food after midnight or to take up any food bowls before bed the night before so that cats are fasting when they arrive the morning of the procedure. Cats must be under anesthesia for dental procedures. The anesthesia makes the cat temporarily unable to swallow, and it relaxes the epiglottis that prevents food and liquids from getting into the lungs. If a cat vomits during surgery, it is possible for the food and liquid from its stomach to get into the lungs. An empty stomach prevents this from happening.
The Day of your Dental Procedure
We do not believe that what happens while your cat is here should be a mystery to you. For that reason, following is a complete list of the procedures that will be performed when your cat comes to us for a dental prophylaxis.
• We perform a pre-anesthesia physical exam. This involves listening to your cat’s heart and lungs, doing an oral exam if we have not already done so, and obtaining your cat’s vital statistics to establish a baseline for during and after the procedure.
• We draw blood for pre-anesthesia lab work, if requested, or required. We have in-house testing equipment, so your cat’s blood tests will be run prior to the administration of any anesthetic drugs. This allows us the maximum flexibility in our anesthetic protocols. In some rare instances, we may not be able to obtain a blood sample prior to administering pre-anesthetic medications. In these cases, we give a mild sedative so that your cat will allow a blood draw to occur, and then run the tests before complete anesthetic induction.
• A pre-anesthetic injection is given. This injection sedates the cat, thus reducing stress, and starts the pain management process.
• An intravenous catheter will be placed and IV fluids started. This requires that we clip a small spot of hair on one of your cat’s front legs. IV catheters allow the administration of further IV injections without causing pain and distress in your pet. It also gives us a venous port to administer emergency drugs if necessary. IV fluids containing pain medication are administered to help maintain blood pressure to support internal organ health, as well as to prevent dehydration and continue the pain management process.
• General anesthesia will be induced. This is accomplished by an injection of drugs intravenously. The cat is then intubated, which allows the delivery of a gas anesthetic to keep your cat asleep for the duration of the procedure and prevents aspiration of the water and bacteria that will be in your cat’s mouth during the cleaning. We use safe and modern anesthetic protocols that provide for pain control. Most pets wake up minutes after procedures are completed.
• Monitors will be hooked up. Immediately upon induction, your cat will be hooked up to monitors that tell us the heart rate, respiration, blood pressure, and blood oxygen saturation so that we will know immediately if there is any change in your cat’s condition.
• The tartar is scaled off the teeth. Most of this is done with an ultra-sonic scaler similar to the units used in human dental offices. Some of it is done with hand instruments. After the crown, or part of the tooth you can seem, is cleaned, we clean above the gums with very specialized instrumentation.
• The teeth are polished with a pumice-containing paste that makes them smooth, and thus more difficult for bacteria to cling to.
• A fluoride treatment is applied to decrease tooth sensitivity following treatment.
• Radiographs are taken as needed to determine if there are further problems below the gums. Attempting to perform dental treatment without appropriate x-rays would be similar to your doctor trying to set a broken leg without x-rays.
• The teeth and gumline are probed to detect any evidence of tooth resorption, fractures, periodontal disease, or other problems. A diagnostic and treatment plan is formed specifically for your cat.
• Diseased and painful teeth are extracted. At this point, we try to contact you if you have requested that we do so prior to extractions. If you are not available, or have not requested that we call, we will proceed according to our best judgment. We place blocks with local anesthetics to numb the mouth and prevent pain upon waking. Extracting teeth requires additional time and skill. It is a surgical procedure which involves very specialized equipment and knowledge. Only the doctor will extract teeth. The gums are stitched together after the teeth are extracted with a very fine, absorbable suture material that will dissolve within 4-6 weeks.
• Additional pain medication is administered if necessary.
• Your kitty goes home the same day in the afternoon. Sometimes we will send home medication for continued pain relief, and if any teeth have been extracted we will recommend feeding a soft food diet for the next 14 days while the gums heal.
• If your cat has had teeth extracted, You will receive a follow-up visit with a technician at no additional charge in 2 weeks. At this visit we will evaluate healing and discuss home care to help prevent future problems.