The importance of feline oral health

Content submitted by BasePaws, a dvm360® Strategic Alliance Partner

Yes, cats indeed have periodontal disease and can follow the typical course of the disease, accumulating soft plaque that hardens into calculus or tartar with minerals from the saliva. Without home care (brushing or wipes), this can accumulate and contribute to infection and inflammation of the periodontal structures (attached gingiva, periodontal ligament, alveolar bone and cementum on the root). The amount of destruction of these tissues, attachment loss (AL), is measured by probing depths and radiographs. Many cats can have significant amounts of calculus with minimal AL (stage 1 or stage 2 periodontal disease at if there is up to 25% AL), Others can have minimal plaque and calculus with significant AL or even ulcerative disease such as feline chronic gingivostomatitis (stomatitis). If the periodontal disease progresses to stage 3 (26 to 50% AL), then treatment for strategic teeth such as canine teeth might be considered, but at stage 4 (greater than 50% AL), extraction is usually recommended. In theory, with early professional cleaning and good home care, periodontal disease is relatively preventable.

Further dental issues

However, how many cats are seen for routine dental therapy? In fact, with potentially fewer wellness veterinary visits, oral and dental disease can progress without detection until there is significant enough changes to make the pet uncomfortable. In addition to periodontal disease, a frequent dental issue that can impact feline oral health and comfort is the development of tooth resorption (TR). Tooth resorption is now a more general term used for any type of resorptive lesion, but the most common one encountered in the veterinary profession is Type 2, odontoclastic or replacement resorption of feline teeth. Type 2 TR typically starts in the roots, with bone replacing the periodontal ligament (PDL) and root structures, identified radiographically as a loss of the PDL and affected root. These lesions become uncomfortable once a portion of the crown is involved, often with gingival tissue growing into the defects. Unless a practitioner intervenes and extracts the remaining portion of the tooth, this can stay painful until the crown is lost completely.

Another significant feline dental problem is feline chronic gingivostomatitis (FCGS). Unlike standard periodontal disease—where the presence of bacteria in the plaque drives a fairly stable loss of attachment tissues—cats with FCGS seem to have an over-responsive immune or inflammatory response to the presence of plaque on the tooth surfaces and in the oral cavity. Significant inflammation and ulceration of the gingival and alveolar mucosa around the teeth can indicate more severe periodontal disease, and once there is inflammation in the caudal mouth (previously referred to as faucitis), the diagnosis of FCGS can be made. At that point, most patients benefit from full mouth extractions but may need other therapy to manage refractory inflammation.

The fallout

While it may seem that these issues are just about teeth, discomfort in the oral cavity can be of particular importance to cats. While dogs will continue to eat and function fairly well with extensive oral disease, cats seem to need the slightest excuse to stop eating well. Cessation of grooming with the appearance of an unkempt coat may be an indication of oral pain and discomfort, as well. The field is also learning more about the impact a chronic inflammatory process can have on systemic health, beyond the bacteremia and potential “metastatic infection” to distant organs.

Overcoming obstacles

The challenge of this is regular care that involves getting cats into the veterinary office for examinations, preventive care, and treatment. To begin with, there are many resources that can ease those travel woes, such as the Fear Free tips about using a cat-friendly carrier that your feline patient has been conditioned to tolerate, as well as the use of gabapentin prior to the visit to help reduce anxiety. In addition, it may now be possible to predict dental disease by testing the feline oral microbiome. This tool comes from companies that offer screening tests to evaluate and assess the feline microbiome to provide early warning of potential issues.

Keeping a mouth healthy can play an important role to keeping a cat healthy, so early detection and regular therapy is critical.