Thursday, August 19, 2010

Case of the Week: Sweetheart

Sweetheart is a four-year-old calico cat. She came into the clinic because her family had recently moved here and she needed a refill on medications for her chronic Feline Herpes infection. Due to her chronic problems, her owners keep a close eye on her, but they had not noticed anything unusual with her besides her typical watery eyes and sneezing.

During the exam, I noticed a small lesion on one of her lower premolar teeth. Cats frequently will develop this erosive lesion, called a Feline Odontoclastic Resorptive Lesion (FORL). The cause of these lesions is not known, and an affected cat tends to develop the lesions in multiple teeth over its life. As FORL progresses, the lesion becomes very painful as the loss of enamel exposes the nerves in the pulp of the tooth. The only treatment is to extract the tooth to remove the pain and source of infection.

Sweetheart quickly moved her face away when I touched this tooth showing how painful it was. Her owners were surprised to learn of the problem. Sweetheart had shown no signs of distress. Yet in looking back, they had noticed she was holding her head at a slight angle when chewing and was leaving crumbs of food on the floor when she ate.

They scheduled her the next week for a dental procedure, including ultrasonic scaling and polishing of the teeth, a complete exam under anesthesia, dental radiographs (xrays) and extraction of the affected tooth. When examining her teeth under anesthesia, I found that the opposite lower premolar also had an FORL. The dental radiographs showed that both of the teeth had some resorption of the roots of the teeth as well. The rest of her teeth appeared normal. I placed a nerve block on each side of her mouth to numb the areas, then extracted these two teeth.

The day after the surgery, when I called Sweetheart's mom to check in on her, she said that Sweetheart was doing very well. She was back to her usual self the evening of the procedure and was eating well. At her progress exam two weeks later, the gums had healed well. Her mom was very happy with how well Sweetheart was doing and happy that she no longer had to clean up crumbs around Sweetheart's dish any more. After her extractions she was eating completely normally without any mess.

Cats are very good at hiding dental discomfort. They rarely stop eating, even with severe dental disease. Few even show the subtle signs of discomfort that Sweetheart did. If your cat will let you, you can try lifting his lip to look at his teeth. If you see any yellow or brown matter on the teeth, or redness of the gums, your cat may have dental disease that needs to be treated. If he is reluctant to let you touch his mouth, he may be feeling pain from gingivitis or an FORL. Regular veterinary examination of your cat every six months will help us to find problems early and treat them before they cause pain or infection. We can also discuss what you can do at home to reduce tartar build-up and minimize dental disease. The more knowledge you have about your cat's health, the happier your cat will be.

- Dr. Judy Karnia

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