Many of the dental disorders of cats are similar to those found in people. However, cavities almost never occur in cats. Treatment methods are also similar to those used with people. Proper dental care can help keep your cat’s teeth and gums healthy. Learning the terms your veterinarian uses to describe dental disorders will help you understand and discuss any dental problems your cat may develop (see table Dental Terms below).
Gum (periodontal) disease is infection and inflammation of the tissue surrounding the teeth. It is caused by the accumulation of many different bacteria (plaque) at and below the gum line due—in part—to a lack of proper oral hygiene. This infection causes inflammation of the gums, the ligaments that anchor the teeth, and the surrounding bone. If periodontal disease goes untreated, teeth can be lost due to the loss of their supporting tissues. There are 2 forms of periodontal disease: gingivitis and periodontitis. Treatment for gingivitis and periodontitis includes a professional dental cleaning by your veterinarian. This requires anesthesia. Treatments performed without anesthesia may make the tooth look better but do not treat the underlying problem: plaque below the gum line.
In gingivitis, the gums become inflamed because of bacterial plaque, but the ligaments and bone are not yet affected. The gums change in color from coral-pink to red or purple, and the edge of the gum swells. The gums tend to bleed on contact. Bad breath is common. Gingivitis can be reversed with proper tooth cleaning but, if untreated, may lead to periodontitis (see below).
A form of juvenile-onset gingivitis is seen in some cats at 6 to 8 months of age. Cats with this condition often have swollen gums and bad breath.
Gingivitis can usually be treated by thorough professional cleaning of the teeth performed under anesthesia. This includes cleaning below the gum line. If gingivitis does not improve, your cat should be examined again to determine if more extensive cleaning is required. When cleanings are completed, your veterinarian may apply a sealant to the teeth to prevent bacterial buildup and improve healing. Cats that do not respond to treatment should be evaluated for other diseases, such as immune system problems, diabetes, and especially feline Bartonella infection (cat scratch fever). Gingivitis will reoccur if the teeth are not kept clean and free of plaque.
In periodontitis, the tissue damage is more severe and includes the gums, the ligaments, and bone. It usually is seen after the development of plaque, tartar, and gingivitis. It is irreversible and results in permanent loss of tooth support. In some cats this disease can be seen as early as 1 year of age.
Periodontitis is treated with a thorough professional cleaning above and below the gum line performed under anesthesia. Your veterinarian can determine the extent of bone support loss by taking x-rays of the jaws. Periodontitis often requires more thorough treatment than gingivitis, and additional procedures may be necessary to treat disease deep within the gums. Extractions are often necessary. They allow the tissue to heal, and cats do surprisingly well without the teeth. In addition, surgery may be needed to gain access to the root surface for cleaning. Finally, veterinarians will treat any factors contributing to periodontitis, such as tooth crowding or underlying diseases.
If your cat has been treated for periodontitis, you will need to continue oral hygiene care at home. Follow your veterinarian’s instructions, which might include daily toothbrushing, dietary changes, plaque prevention gel, and oral rinses. Frequent (every 3 months to 1 year) preventive cleanings will help to avoid relapse and prevent further bone loss.
The most important point to remember is that gum disease rarely develops around clean teeth. At-home methods to keep your pet’s teeth clean, such as toothbrushing, along with regular dental examinations, are the best ways to help prevent gum disease. Brush your cat's teeth every day. Plaque that remains on the teeth for more than 3 days turns into a hard material (called calculus) that cannot be removed by a toothbrush. If your cat does not allow toothbrushing, try at least to wipe the teeth with gauze pad every 2 to 3 days. Some treats and some dry foods can also help to remove plaque; ask for your veterinarian for recommendations of suitable options. Your veterinarian might also apply a barrier sealant or recommend a plaque prevention gel.
Endodontic disease occurs inside the teeth. The causes include injury, enamel defects, and tooth decay. Endodontic disease can cause additional disease (such as an abscess, granuloma, or cyst) to develop at the base of the tooth's root. Teeth with endodontic disease require extraction or a root canal procedure. Signs can include poor appetite, painful teeth that your cat resists having touched or tapped, or a tooth with a reddish-brown, purple, or gray color. However, most cats mask their signs, and waiting until signs occur is not in the cat’s best interest. X-rays of the mouth will reveal the presence of disease before signs occur.
Feline Gingivitis/Stomatitis Syndrome
A cat’s mouth may react intensely to disease and become severely inflamed. Signs include mouth pain, drooling, bad breath, and loss of appetite. A veterinarian’s examination may reveal inflammation of the gums, the inside of the mouth, and the upper throat. The underlying disease must be diagnosed accurately in order for treatment to be successful. Many viral and bacterial diseases contribute to this problem. Some cats are also infected by the bacteria that cause cat scratch fever (a disease that can be passed to people), which must be considered as a possible cause.
The only effective treatment is the extraction of most or all of their teeth. This solution is not as bad as it sounds, because most cats can eat moist food (and eventually even solid food) even after the teeth have been extracted.
Tooth Resorption (Cervical Line Lesions or Feline Odontoclastic Resorptive Lesions)
Cats do not develop cavities like those seen in humans. However, they may develop resorptive lesions (also called cervical line lesions or feline odontoclastic resorptive lesions). In fact, these are the most frequently seen dental abnormality in cats. The cause is often unknown, but some resorptive lesions appear to be stimulated by inflammation (such as periodontitis or endodontic disease). The condition results in the breakdown and loss of tooth material and is often associated with bright red, inflamed gums. The crown of the tooth may be completely lost, with the root that is left covered over by the gum. Signs associated with cervical line lesions include pain on contact, loss of appetite, drooling, and generally not feeling well. Because cats are good at hiding pain, you may not notice any signs.
Resorptive (cervical line) lesions are common in cats and lead to destruction of affected teeth.
The condition is not thought to be contagious. Damage to the roots of the teeth can be detected with x-rays of the jaws. In most cases, affected teeth will need to be extracted. Most resorptive lesions cannot be prevented because the cause is usually unknown.
Developmental problems with the teeth include a misaligned bite and defects in the tooth enamel. These abnormalities often have a genetic component. In general, abnormalities that affect a cat's comfort, health, or ability to function require treatment; those that only affect the look (aesthetics) of the tooth do not.
Proper growth and development of the mouth and teeth depends on a series of events that must occur in proper sequence or longterm complications will occur. Early detection and intervention is the best way to prevent more serious problems later in the cat’s life. Dental development can be divided into 3 stages: Stage 1 is from 0 to 16 weeks of age, Stage 2 is from 16 weeks to 7 months of age, and Stage 3 is from 7 months to 1½ years of age.
Stage 1: Kittens are born with relatively long upper jaws (“overbite”), which allow them to nurse. As the kitten grows and begins to eat solid food, the lower jaw goes through a growth spurt. If certain of the lower baby teeth come in before the growth spurt, they can get caught behind the upper teeth and prevent the lower jaw from developing to its proper length. The usual treatment is to remove several of the baby lower teeth. This will allow the lower jaw to reach its full length and avert problems with the permanent teeth.
The reverse situation can also occur. In these cases, the lower jaw grows faster than usual and becomes too long for the upper jaw, producing an “underbite.” This condition can be detected as early as 8 weeks of age. Again, certain teeth from the upper jaw may become caught behind those of the lower jaw, preventing proper growth of the upper jaw. As in the previous situation, the treatment is usually to extract several teeth; in this case, upper teeth are removed.
Stage 2: The most important problem that can occur during this stage is the retention of baby teeth. Abnormal tooth position and bite may result if the baby teeth are not lost at the time the corresponding permanent teeth are coming in. If retained baby teeth are removed by a veterinarian as soon as they are noticed; complications can usually be prevented.
Another developmental defect noted in this stage is abnormal positioning (tilting) of the upper canine teeth. Depending on the specific situation and age of the cat, orthodontic treatment (that is, “braces” for your pet) can be used to align teeth in their correct positions. This treatment is only effective in some cats. In most cases, tooth shortening or extractions might be necessary.
Stage 3: Additional types of incorrect tooth placement and crowding of teeth can occur during this stage of your pet’s growth. Treatment, if necessary, may include orthodontic treatment and possibly tooth extraction.
During the development of tooth enamel, fevers and the deposition of certain chemicals within the tooth may cause permanent damage and malformed teeth. Severe malnutrition in young cats or trauma to a tooth may also cause enamel defects. These defects may occur only in certain areas (usually in horizontal lines that extend around the tooth) or affect the entire tooth. Treatment of these conditions can include the bonding of synthetic materials to the teeth, fluoride treatment, and frequent dental preventive care.
Trauma to the Face and Jaw
Fractured teeth and jaws often occur because of trauma (for example, fighting with other animals, falls, and automobile accidents). The jaw can also be fractured because it has been weakened by severe periodontitis or cancer. A cat with a fractured jaw may hold its mouth open or be unable to eat. Fractured teeth should be inspected by a veterinarian to determine whether there has been damage to the center of the tooth (the pulp). If fractures extend into the pulp, root canal treatment or tooth extraction will be needed. Wounds to the gums or other soft tissues should be treated by the veterinarian as well.
Bone fractures will need to be stabilized by the veterinarian using wires, pins, or other materials. As long as the correct bite position can be maintained, healing is rapid and most of the supporting material can be removed by the veterinarian in about 6 to 8 weeks. A feeding tube may be needed if the cat has difficulty eating while the injury heals.