The importance of feline oral health (Proceedings)
In a recent survey of the health status of over 31,000 dogs and over 15,000 cats examined at veterinary practices in the United States, the most commonly reported disorders were dental calculus (20.5% prevalence in dogs; 24.2% in cats) and gingivitis (19.5% prevalence in dogs; 13.1% in cats) (Lund, Armstrong et al. 1999). Yet according to the 2003 AAHA compliance study, only 35% of dogs and cats with grade 2 or higher periodontal disease receive treatment, and only 15% of those with grade 1 disease receive treatment (The Path to High-Quality Care, American Animal Hospital Assoc., 2003). Since periodontal disease is often preventable, veterinarians have an excellent opportunity to educate clients and improve wellness care for cats by developing an oral health care program.
It is generally accepted that cats lag behind dogs in oral health care, in parallel with the gap in providing overall veterinary care to cats versus dogs. When it comes to oral care, there are several additional factors that may limit oral health care for cats. For example, it may not be easy to perform an oral exam in the conscious cat, and owners are less likely to notice oral disease in cats compared to dogs. Owners do not always understand the importance or value of oral care for either cats or dogs.
Many common oral diseases, such as feline odontoclastic resorptive lesions (FORLs), are painful and impair quality of life. A reluctance to eat due to oral pain can lead to poor body condition, especially in geriatric cats. Chronic oral pain can cause behavior changes such as irritability, lethargy, depression or aggression. Since periodontal disease develops gradually, the cat has time to adapt to the pain, and the owner may misinterpret any changes as simply due to "old age." Often the impact of dental disease on a particular cat is not evident until the owner notices the dramatic improvement after treatment.In human dentistry, there is increasing recognition of the potential systemic risks associated with periodontal disease, such as cardiovascular disease and bacterial pneumonia. People with diabetes mellitus are 15 times more likely to have tooth loss than people without diabetes. The increased risk appears to be due to several factors, including an impaired host defense against bacterial infection. Cats with diabetes mellitus often have periodontal disease. Part of the management plan for a diabetic cat with poor glycemic control must include management of periodontal disease.
The majority of periodontal pathogens are gram-negative bacteria. In addition to the local inflammatory response causing the periodontitis, systemic bacteremia or endotoxemia with elaboration of inflammatory mediators may occur. Target organs that may sustain damage include the liver, kidneys and lungs. While little research has been conducted on this topic in the cat, evidence from other species, particularly humans and dogs (DeBowes, Mosier et al. 1996), would appear to validate concerns. Other known complications from untreated periodontal disease include osteomyelitis, tooth root abscesses, and oronasal fistulas.
Oral disease may also be a marker for more serious systemic disease in cats. In a 2006 nationwide study of 8,982 cats with oral disease, 14.2% were retrovirus positive (IDEXX Laboratories, data on file). This is much higher than the general population rate of about 3% (Levy, Scott et al. 2006). Knowing the retrovirus status of a cat is essential for optimal assessment, wellness management, and treatment.
Oral ATP (Assessment, Treatment, Prevention) for cats
All cats should receive an oral exam as part of annual wellness care. A good oral exam should include the gingiva, the vestibule (area between the gums and the cheek), palatal and lingual surfaces of the mouth, dorsal and ventral surfaces of the tongue, and the visible pharynx. The sublingual space warrants special attention as it is a common site for neoplasia, particularly squamous cell carcinoma. To examine this area, push the base of the tongue toward the palate with a finger between the rami of the mandible. Local lymph nodes should be palpated for enlargement and the maxilla and mandible should be palpated for swellings or pain. Examine the cat for occlusal abnormalities before opening the mouth, particularly in brachycephalic or dolicocephalic breeds.