Tuesday, February 14, 2012

Case of the Week: Oz

Oz is a three-year-old flame point Siamese. When he came into the clinic for his six-month Wellness exam, I could see a small amount of gingival recession on his upper right canine tooth - his fang. He had mild dental tartar build-up and mild gingivitis but no other dental problems visible on his exam. He otherwise appeared to be a healthy young cat, so we scheduled him for a routine dental cleaning.

A few weeks later, Oz came into the clinic for his dental cleaning procedure. After a thorough cleaning of the teeth with the ultrasonic scaler, I performed an exam of his mouth. When cats are under anesthesia, I am able to perform a much better exam of their teeth. As you might imagine, probing a cat's gums with a sharp stick is not the easiest thing to do when he is wide awake. I look at all the surfaces of the teeth and probe the gum line for any defects in the enamel or gingival recession. At the upper right canine tooth, where I had seen the gum recession during his exam, there was a 6mm periodontal pocket. Basically, I could place the probe more than half way down along the tooth root. The upper right carnassal too
th, a three-root tooth towards the back of the mouth, also had a large periodontal pocket around both of its two front roots.

The lower teeth also had s
ome gum recession and periodontal pockets. The lower left first premolar had a 1mm pocket. The lower right first premolar and lower right molar each had a 4mm pocket, which is large for these small teeth.

After the cleaning and polishing of the teeth, I took radiographs (x-rays) of all the teeth. There was a larger amount of bone loss evident around many of the lower teeth. Bone loss occurs due to periodontitis, an inflammation of the tissues that hold the tooth in the bone. In Oz's case, two premolars showed substantial loss of bone and his lower right molar had lost so much of the bone that the roots were almost entirely exposed. Remember that at Oz's Wellness exam, all I could see were minor problems. It wasn't until he was sedated and had radiographs taken that I could diagnose the severity of his dental problems.

Oz's x-ray showing bone loss (on left) vs. a normal x-ray (on right)

I extracted four teeth - the upper right canine tooth, carnassal, lower f
irst premolar and molar. The large pockets around these teeth were allowing bacteria and plaque to extend down the roots leading to infection and pain. These teeth also would have eventually become loose in the mouth, causing more discomfort and even making it difficult for Oz to eat. After extraction of the teeth, I closed the gums over the empty sockets and the tissue healed very well.

Oz may have had more trouble on the right side due to the formation of his skull and teeth during development, or because of how he chewed his food. Sometimes, once a small problem starts and causes discomfort, the cat will chew more with the other side of his teeth allowing the plaque to develop even more. We will continue to monitor the rest of his teeth to watch for further problems.

Oz was not showing any symptoms of any mouth discomfort at home and his routine Wellness exam showed only the tip of the iceberg of his dental problems. In many cats, it is very difficult to see the extent of dental problems until we are able to probe the teeth and take radiographs under anesthesia. His case shows us the importance of routine exams and performing dental procedures whenever there is even a hint of dental disease on the exam.

-- Dr. Judy Karnia

Thursday, February 9, 2012

Home Dental Care Tips for Cats

February is annually known as Pet Dental Health Month. To maintain your cat's dental health and to reduce the frequency of needed dental procedures, home care is important. While a small percentage of cats have excellent dental health without any care, the majority will develop tartar, gingivitis and periodontal disease without consistent home care.

Your cat's teeth require cleaning and exercise. Cleaning the teeth removes plaque and bacteria to prevent tartar build up and decrease the amount of harmful bacteria that can pass through the gums. Exercising the teeth keeps the tissue that surrounds the tooth healthy. This helps prevent tooth loss and decreases pockets that can form between the tooth and gum which can collect tartar and bacteria. There are multiple methods to provide home care, depending on your cat's personality and tolerance, and your ability to provide treatment.

Tooth brushing: Brushing your cat's teeth is the single best method if cleaning his or her teeth. Most cats can be taught to accept tooth brushing if you gradually get them used to it. However, do not attempt if your cat is aggressive or prone to biting. Use a toothpaste made especially for cats such as C.E.T. which comes in either seafood or poultry flavors. Do not use human toothpaste - it will upset their stomach and the fluoride can be toxic.

Brushing your cat's teeth might seem difficult or even somewhat silly at first. Your cat may not be thrilled with the idea either, but it can and should be done. It may take a few weeks until your cat accepts tooth brushing. Go slowly and be patient. Offer a treat that your cat really enjoys after you work with your cat each day. You only need to brush the outer surfaces of the teeth, but you should try to brush all the teeth daily if possible. Here are the steps you can follow to get your cat to allow you to brush his or her teeth:
  1. Get your cat used to the flavor of the toothpaste. Place a small amount on your finger and let your cat lick it off.
  2. Get your cat used to having something put into his mouth. Place a small amount of toothpaste on your finger and rub it over your cat's upper canine teeth. Every day, increase the amount of time and surface you cover.
  3. Get your cat used to the toothbrush. Place a small amount of toothpaste onto the brush and let your cat lick it off.
  4. Start brushing the outer surfaces of the teeth.

Dental Diets: Veterinary diets such as Hill's t/d, Purina DH or Royal Canin DD are proven to improve dental health. The kibble is larger to encourage chewing and exercise the teeth. The structure of the kibble is formulated to scrub the teeth as the cat chews. The Hill's diet is coated in hexametaphosphate which prevents the calcification of plaque. All three diets provide all the nutrients your cat needs so they can be the dry portion of your cat's diet or you can mix them into another dry diet.

Maxiguard OraZn Pet Oral Care: OraZn is a gel that reduces the deposition of plaque, aids in the reduction of gum inflammation, and neutralizes mouth odors. It contains Taurine which combines with the Zinc to kill bacteria and reduce the bacterial products that cause halitosis and make the gums more permeable to bacterial toxins. You apply a pea-sized droplet with your finger or a cotton swab onto the outside gum areas above the upper molars on each side of the mouth. Use daily for best results.

Maxiguard Oral Cleansing Gel: This is similar to OraZn but has Vitamin C added to help repair tissue. It is recommended for severe oral problems and after a dental procedure.

Oravet Sealant: Oravet is a waxy sealant that is applied to the outer surfaces of your cat's teeth at the end of his dental procedure. It significantly reduces plaque and tartar formation by creating an invisible barrier that prevents bacteria from attaching to your cat's teeth both above and below the gumline. You can then apply the home care Oravet to the outer surface of your cat's teeth once weekly to maintain the barrier against bacteria. It can be used along with brushing or dental chews.

Dental Chews: There are a variety of chews available. Most of them will exercise your cat's teeth and may help reduce plaque. C.E.T. chews have an antibacterial system and time-tested Dual-Enzyme System to control plaque and eliminate bacteria buildup. They can be fed as a treat once a day and come in poultry and fish flavors.

Dental Rinses: Dental rinses contain chlorheidine or xylitol to fight bacterial and reduce plaque build up. This will also help freshen your pet's breath. Chlorhexidine rinses must be applied directly into the mouth. They fight bacteria for up to twelve hours but can have a taste that is unacceptable to your cat. C.E.T. AquaDent contains xylitol which kills bacteria. It is easy to use - simply add 2 teaspoons to a quart of our cat's drinking water every day. However, when you first add any medication to your cat's water, you must make sure he will drink it. It is especially important if he has any medical problems that he continue to drink his water. Xylitol has been proven to reduce dental disease in humans, and it is safe for cats, but no research has shown how effective it is for their dental health.

All of the products mentioned above are available at Scottsdale Cat Clinic. If you are looking to purchase any of pet dental care products at the pet store or grocery store, it's best to look for products carrying the VOHC (Veterinary Oral Health Council) seal. In order to display the seal, the product must have good scientific research backing their claims.

For more information about these products or about your cat's dental health, please contact us by visiting our website.