Case of the Week: Koli Poki

Koli Poki is an eight-year-old Burmese that was brought into the clinic to have her teeth checked. Her owners were concerned because she did not seem to be eating well. When I examined her, I found that she had moderate tartar build-up over most of the teeth and the gum above her upper left carnassial tooth was very inflamed. The carnassial tooth is the fourth premolar (cats typically do not have the first premolar present) and has one large and two small roots.

I prescribed an antibiotic to start right away and scheduled her for a dental procedure. I knew I would need to extract this tooth but would also probe and radiograph (x-ray) all of her teeth to see if there were any other problems.

Once Koli Poki was anesthetized for her dental procedure, I was able to thoroughly examine her mouth and discovered many problems with her teeth. She was already missing seven teeth, including her upper right carnassial tooth. Two of her premolars had resorptive lesions - erosions of the enamel of the teeth - which are usually progressive and painful. She had gingival recession at multiple spots including the upper left carnassial and there was gingivitis around most of the teeth. I also did radiographs of all her teeth and found a large amount of bone loss around the roots of her incisors, premolars and molars.

I extracted all of the teeth that were mobile, had resorptive lesions, or a large amount of gingival recession and periodontal bone loss. In all, I extracted fourteen of Koli Poki's teeth. I closed the gum tissue with sutures that dissolve, usually within one to three weeks. I then treated all the extraction sites with the Companion Therapy Laser. Unlike our surgical laser that we use to cut tissues, the therapy laser works to reduce inflammation and pain and helps to speed healing. We also gave her an injection of an anti-inflammatory medication, which also helps with pain, and prescribed oral pain medication for a few days.

The following day, Koli Poki's owner reported that she was doing well. She was eating and acting normally. At her progress exam a week later, her owners were very happy with her recovery. They said she was more active and affectionate than she had been for a while. Her gums were healing very well although they were still a little inflamed. She was eating well and did not seem to have any pain.

Most of our patients develop some dental disease over their lifetime. Even though Koli Poki did show some symptoms of a problem, it was subtle and many cats do not show any signs of pain. Although Koli Poki's owners did notice a problem, they had no idea how severe her dental disease was. They are very happy that we were able to relieve her pain.

A thorough dental exam and radiographs under anesthesia are the best way to investigate any possible problems. At every physical exam, we look for any indication of dental disease and can recommend if your cat needs a dental cleaning and a more thorough exam under anesthesia. Tooth lesions can be very painful but the symptoms a cat will show can be very subtle. Many of our clients, like Koli Poki's owners, are not able to see how much the painful teeth are affecting their cat until they see how much better their cat feels after the problems are resolved.

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Dr. Judy Karnia

Feline Dental Health - It's Always Important

Every February, several veterinary groups, including The American Veterinary Medicine Association (AVMA) and the American Veterinary Dental Society (AVDS) designate the month as Pet Dental Health Month. During this time, the importance of regular dental care is emphasized.

While the official Pet Dental Health Month is drawing to a close this year, the effects of gingivitis and periodontal disease in cats can be so far-reaching it seems as though every month should be dedicated to dental health. According to the AVDS, 70% of cats show signs of oral disease by age three, and 85% of all adult pets have periodontal disease. Left untreated, harmful bacteria from the oral cavity can spread throughout the bloodstream to infect the heart, lungs, liver and kidneys.

Dental disease is the most common disease in cats, and studies confirm a strong relationship between the presence of dental disease and poor general health. Even though cats are very good at hiding any problems, dental disease is a painful condition. Left untreated, many pets suffer silently and age prematurely. As several of our recent Cases of the Week illustrate (see: Bianca; Tommy; Sweetheart), preventing and treating dental disease will keep your cat healthier and improve his quality of life.

Dental disease begins when a combination of food, bacteria and saliva combine to form plaque on the teeth. If plaque is not removed, it mineralizes and forms calculus. As plaque and calculus build up, they lead to gingivitis, an inflammation along the gum line. This is painful for your cat and encourages bacterial toxins to form along the gum. At this stage, gingivitis is reversible with professional dental cleaning and oral home care.

If gingivitis is untreated, there will be a progression to periodontal disease, a destructive process causing a breakdown of the supporting structure of the teeth. This will cause oral pain, loose teeth, and more severe oral infection. As periodontal disease progresses, the gums recede and become more permeable. This allows bacteria to enter and travel through the bloodstream leading to heart, liver, and kidney disease.

Whether your cat is a youngster with shiny white teeth or has advanced dental disease and halitosis, the combination of your good home care and our medical treatment will ensure a healthy mouth and body for your cat. Your cat will live a happier, more comfortable, and longer life.

The first step to ensuring your cat's dental health is a visit to your veterinarian for a thorough exam of the mouth and the entire body. If tartar, calculus, gingivitis, or periodontal disease is already present, your cat will need dental treatment. During the exam, home dental care will also be discussed. If the tartar and gingivitis is moderate to severe, a professional dental cleaning will be needed.

To perform a thorough, safe, and comfortable dental treatment, your cat must be anesthetized. In many cases, the veterinarian can only determine which teeth may have lesions and/or need extraction after the teeth are cleaned and dental xrays are reviewed.

Many cat owners are understandably concerned with having their cats anesthetized. While there is a slight risk with anesthesia, there is much greater likelihood that continued dental infection will adversely impact your cat's health and comfort. Healthy teeth are well worth the risk of general anesthesia. At Scottsdale Cat Clinic, your cat's safety and comfort are our primary concern during anesthesia. We use very safe anesthetic agents and monitor your cat closely throughout the procedure.

Please contact us if you would like more information about our dental care and cleanings. You may reach us by phone at 480.970.1175 or by email at info@scottsdalecatclinic.com

Case of the Week: Bianca

Bianca is a seven and a half year old medium haired cat. Her owners brought her to the clinic because she was having trouble eating and her bottom jaw was shaking. She would also hold her mouth open as if she was having difficulty closing it.

On her exam, she was very sensitive to touch around her mouth and pulled her head away when I tried to open it. I could see tartar build-up on her teeth and gingivitis. There was gum recession at her upper right canine tooth and swelling of the gum there. We ran a blood panel and it was normal except for a mild increase in the protein levels due to inflammation or infection. Bianca also tested negative for Feline Leukemia Virus and Feline Immunodeficiency Virus.

Bianca's problems could have been due to a neurologic disease or a problem with her jaw. However, I thought the most likely cause of Bianca's problems was pain in her teeth and started her on antibiotics and pain medication. She started feeling better and was eating normally again with a couple of days. We anesthetized her to clean her teeth and exam them more thoroughly. Her upper canine tooth had a large resportive lesion and moved in the socket. The dental radiographs showed the root of the tooth was still present. By careful probing of the teeth, I also found resorptive lesions in three other teeth and a large periodontal pocket around the other upper canine tooth. Almost all of her incisors and one of the lower canine teeth were already missing.

I extracted both upper canine teeth and the three teeth with resorptive lesions. I sutured the gums closed with absorbable stitches and did a thorough cleaning of the teeth, polished them and applied a sealant. I gave her an anti-inflammatory medication to control the inflammation and discomfort and sent her home with more antibiotics and pain medications.

While Bianca was under anesthesia we found another hidden problem. Jill, our veterinary assistant, found a tapeworm segment near Bianca's anus. Bianca is an indoor cat and therefore likely to have had the tapeworm for years. Even indoor cats can carry intestinal parasites and often show no symptoms. Fecal tests can help us find many intestinal parasites but tapeworms usually do not shed eggs that would be found in those tests. The tapeworm didn't appear to be causing any problems at the time for Bianca, and it was just a lucky find while she was here. I gave her an injection to clear the tapeworms from her body.

At Bianca's progress exam a week later, she was doing very well. Her owners said that she was more active and playing, and eating well. She was not showing any more signs of pain.

Dental disease is very common in cats and can cause varying levels of pain depending on the severity of the disease. Many cats can suffer a good deal of pain but do not show any signs. Bianca likely had discomfort long before she showed signs. This is why it is important for cats to have regular semi-annual exams and dental cleanings when recommended by your veterinarian. Cat's won't tell us what's wrong and they often hide symptoms. Your veterinarian and technicians can spot trouble before it becomes severe.

Dr. Judy Karnia

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