Taking care of teeth.

“My vet says that my eight-year-old cat has bad teeth and gums, and needs an anesthetic to sort them out. Why is this necessary and what can be done to prevent my younger cat from developing the same problem?"

Your question is a very valid one because although we understand a lot about the causes of dental disease in cats, there are some conditions that are poorly understood. It is also a complete mystery why two littermates, living together in the same household and eating the same food may develop dental disease at entirely different rates. It would be best to deal with the second part of your question first and look at the causes of feline dental disease and the steps that can be taken to prevent them. We can then examine the various forms of treatment for dental disease, why they require an anaesthetic, and the relative risks involved.

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Causes of dental disease: Gingivitis.
Healthy teeth depend upon healthy gums. Gingivitis, an inflammation of the gums, is the typical underlying cause of feline dental problems, and can occur as a disease process in its own right or secondary to tooth problems. Primary gingivitis is quite common in the cat, and can be difficult to treat.

It usually causes redness and bleeding of the gums, which may cause difficulty in eating particularly if other areas of the mouth are also inflamed. In extreme cases a cat may even back away from his food, as if he is scared of it, or start pawing in pain at his mouth.

Viral infections
Viral infections, particularly feline immunodeficiency virus (FIV) and feline calicivirus (FCV) are identified in cats with gingivitis. Other diseases that affect the organ systems of the cat can be reflected in changes in the gums, particularly kidney disease, so a blood screen is advisable for any cats affected with the condition.

In many cases the underlying cause is unidentifiable, although it is thought that a disorder in the cat's immune system is commonly at fault. In these cases, palliative treatment (antibiotics) to control secondary bacterial infection, sometimes combined with anti-inflammatory drugs to reduce the soreness, are all that can be done to keep the cat comfortable.

The most common cause of bad teeth in cats is periodontitis, commonly started by an accumulation of soft tartar and hard calculus on the teeth, which leads to gingivitis. If left untreated, this progresses to recession of the gums, so that food and bacteria get trapped in the pockets that form between the tooth and gum, and then infection tracks down into the bony socket of the tooth, loosening it, and sometimes causing an abscess to develop on the root.

Enamel erosion
Cats do not get dental decay due to caries, like humans, because they do not eat enough sweet foods to encourage that type of bacteria to develop. However, they do suffer from an erosion of the enamel coating of the teeth. This makes affected teeth prone to breaking off, but can also be very painful if the nerve of the tooth is exposed.
This enamel erosion is not due to an external factor, but to the cats own cells that normally produce enamel going into reverse, and reabsorbing it. We do not understand why this occurs, but it generally results in the extraction of the tooth to prevent pain, because even if sophisticated filling techniques are used, the fillings will loosen and fall out as more enamel, becomes reabsorbed.


Trauma
Broken teeth, especially the large canine teeth, commonly result from road traffic accidents, or when a cat makes a 'five oint landing' on his four legs and chin after falling from a height. Minor chips can be left untreated but if the pulp cavity is exposed, it may be considered desirable to root-fill the tooth to avoid infection tracking down the root. If this happens, infection can cause a painful abscess to develop in the gum.
Veterinary dentists
Up until recently, veterinary dentistry consisted of little more than pulling out teeth that were causing problems. Recent times have seen a more enlightened approach to dental care for our pets, and it has become one of the major areas of expansion of veterinary care. This is reflected in the growth of the British Veterinary Dental Association, which now has more than 60 members.

When veterinary practices first began to carry out more challenging work than simple extractions and de scaling, many turned to human dentists to assist with techniques such as root fillings and the restoration of damaged teeth. Nowadays, however, many vets have a particular interest in veterinary dentistry, and a few specialize entirely in that line of work.

There has been considerable debate within the profession in recent months, when it was suggested that qualified veterinary nurses were not permitted to carry out dental extractions under the legal guidelines laid down by the Royal College of Veterinary Surgeons.
    
In fact, vet nurses are allowed to carry out minor surgical procedures under the direction of a vet, and are usually responsible for the routine descaling of teeth under anaesthetic. Many vet nurses are extremely skilled at practical veterinary dentistry, and have attended advanced courses on the subject. The current state of affairs is that vet nurses are only permitted to carry out straightforward extractions, and should turn to a vet to assist more directly with complicated procedures with which they may not feel fully competent.

An owner's view
writer Elizabeth Perry's cats Chloe and Kira, were the patients for the step-by-step guide.

I had noticed a bit of tartar build-up on my cats' teeth, and knew that they needed them cleaning, but I have to admit I was very nervous at the thought of Chloe and Kira having a general anaesthetic, particularly as it wasn't for an 'essential' procedure. However, I knew that the sooner the teeth were cleaned, the better it would for their health. Ten-year-old Kira was blood-tested before receiving an anaesthetic - it's advisable for cats aged over six to be tested to check their liver and kidney function. Both cats were given a pre-med to relax them before the procedure. Unlike most owners, I was allowed to observe the procedure and I was very impressed with the level of care shown to the cats.
Each cat was monitored closely by head nurse, Michelle Cosgrove, while vet Conor Day performed the procedure - known as a 'dental'. Fortunately, neither cat needed anything more than a scale and polish, which took only about 20 minutes from when the anaesthetic was administered to when they started to regain consciousness.

After the procedure, the cats had to remain at the clinic for a couple of hours before being discharged. I was advised to keep them in that night (climbing and jumping after an anaesthetic is not advised) and to feed a light supper of chicken and rice. Both Chloe and Kira had completely recovered from their ordeal within a few hours of being home.

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