Cats and Caries

C is for Cats and the Caries they have...

Not all unsightly teeth are correctable!

Week 2 of kitty dental health brings us to a uniquely feline problem:  caries lesions AKA cavities.  "What?" you say, "People get cavities all the time!"  But cat caries are different.  Human cavities, while unsightly and painful, are usually fixable.  That is to say, the tooth can usually be salvaged with a filling, or if the lesion is deep enough, a root canal et cetera.

Cats have a different sort of problem.  Feline Odontoclastic Resorptive Lesions (FORLs) is the more accurate description for feline cavities.  FORLs are basically openings or holes in the tooth.   FORLs are usually found on the outside surface of the tooth where the gum meets the tooth surface but they can and usually do extend down the tooth root under the gumline.  They are unable to be "fixed" with fillings and the affected teeth are not salvageable.  Extraction of the diseased tooth is the only solution.  And we do need to extract and fix the problem.  Why, you ask?




Pain.
Pain.
Pain.

The lesions are exquisitely painful.  If you have ever had an open cavity, or root canal, the nerve in the canal is directly exposed to outside stimuli.  Every breath of air, every bite of foot, every slight pressure on the lesion is scraping that nerve.  The nerve is so reactive that there is a "chattering" response to any stimuli that can be induced even when kitty is under a general anesthetic!



What do FORLs look like?  


Above the gumline they are usually hidden by overgrowths of gum that are the body's attempt to cover up that nerve exposure.  However that gum is inflamed and doing as poor a job patching the hole as bubble gum on an inner tube.  

Under the gumline is usually even more disease.  A tooth that appears completely normal "up top" can be rotting away underneath.  Teeth affected this way will eventually snap off and leave a ragged, jagged stump to further irritate kitty's mouth.

Extreme tooth resorption seen in an xray

So, you ask, where do FORLs come from, what causes them?

Unfortunately we don't really know that answer.  Lots of causes have been proposed but none have really been proven.  FORLs seem to be a congenital problem, meaning that a cat is predisposed to FORLs from birth.  Of my cats, Millie has had multiple FORLs while Petunia had none.  Same household, same dental care (home and veterinary) and same diet--different genetics.

So what do we do?  Well this is a big problem, affecting an estimated 20 to 60 percent of all cats and close to three-quarters of those five years of age and older.   Routine check ups with your veterinarian will help diagnose this condition early and can save your kitty friend years of debilitating pain.  A basic oral examination will usually indicate a "up top" problem, and when kitty is having her comprehensive oral exam, cleaning and radiographs (xrays), problems under the gumline can be diagnosed and treated.  

What happens if your kitty has to have an extraction?  Extractions are performed surgically by your veterinarian with appropriately cat-sized dental instruments, balanced anesthesia, and, of course, pain control.  Pain control can be many things, but will almost always include perioperative opiods (morphine and morphine like drugs) and usually local anesthetics.  

Afterwards, there is a brief healing period where your kitty should only eat soft or softened food.  After the extraction sites are healed, the only change in your cat's day to day life is to be free of PAIN!  There are many old kitties out there without any teeth left who eat like champions, though I suspect they wouldn't be very good mousers.

As always, the best veterinary care for your cat is accomplished by regular physical exams and consultations with your veterinarian!   

B is for Brush (your teeth!)

Who needs dental care?  Anyone with teeth!  

 According to the American Veterinary Dental College “Periodontal disease is the most common clinical condition in adult dogs and cats, and is entirely preventable. By three years of age, most dogs and cats have some evidence of periodontal disease." 

Some signs of dental disease.

February is National Pet Dental Healthcare Month and in honor of this we will have a 4 part series on taking care of your kitty's teeth.  This week we will go over the most important part of dental care:  what you do at home.


Home care starts with brushing.  Every day.  (Yes, everyday).  Brushing your cat's teeth may seem difficult but here are a few tips to get started.

This is not how to use a toothbrush

 You will need:

A cat.  A toothbrush.  Toothpaste (optional)

The most important part of brushing the teeth is the manual abrasion of debris from the surface of the tooth.  You can use a soft baby toothbrush, a special cat toothbrush, a fingerbrush (my first choice), or a piece of gauze to help you accomplish this.

Fingerbrushes

Using your applicator of choice, gently massage kitty's gums and teeth concentrating first on the surface of the tooth next to the cheeks (the buccal surface).  If you only get this surface brushed, you have accomplished a lot!  The kitty's tongue helps keep the inner surface (the lingual surface) relatively clean.  At first, you may only be able to get you finger/brush in kitty's mouth for a second or 2.  If your cat seems very resistant or stressed out LET HIM GO!!!  A negative, rough experience guarantees 2 things:  you won't get a second chance and you may get bit!  Slow and steady wins the race.  After the brushing, a lot of love and a treat will positively reinforce the experience.  Here is a video produced by the Cornell Veterinary School with some more tips on effectively brushing your cat's teeth.

IF YOU GET BIT BY YOUR CAT, SEEK MEDICAL ATTENTION!

Some notes about available dental hygiene products:

Delicious seafood

Toothpaste is good for 2 things.  First, the taste may make the whole exercise more palatable to your kitty.  Second, a good feline toothpaste will include some type of enzymatic cleaner.  I like the C.E.T. products.  They come in multiple flavors including malt, poultry, vanilla mint and seafood (Yum!)

It is very important to use a pet safe toothpaste!  These are designed so that they are safe if ingested (most human toothpaste is toxic when ingested in large amounts--which isn't much when you weigh 10 pounds!)

Home care also includes things like chew treats.  The most well known of these is probably Greenies.  I also like CET Chews.  Both of these products are designed to be chewed, not gulped.  The material of the chewie then "brushes" the tooth as it moves through and through.

Another "self brushing" product is Hill's prescription diet t/d formula (t/d = Tartar Diet).  As you can see in
the diagram below the fiber matrix of the kibble holds up to the chewing.  If t/d is fed exclusively (which I don't recommend due to

Hill's t/d

Hill's t/d

other dietary concerns to be discussed at a later date) it can be equivalent to brushing kitty's teeth 5 times a week.  When used as a treat on a daily basis, it can be as effective as brushing 3 times a week.  It also has good palatability.

Low at the end of the list of home care are rinses and gels.  You can think of these as mouthwash for cats.  They help hold down bacterial levels in mouths but do not remove existing plaque.  They can help with mouth odor (halitosis) and may slow down the growth of bacteria that create plaque and tartar.

Finally are the products I like to call "You are probably wasting your money".  These include but are not limited to: water additives, breath drops, probiotics specifically for teeth and any product that does not have the VOHC (Veterinary Oral Health Council) seal of approval which can be found on products that have been vetted (hehe) and found to have scientific evidence of effectiveness.

As always, talk to your veterinarian about any concerns about your cat and before undertaking any medical choices!  Regular examinations and a good doctor-patient relationship are necessary to a healthy kitty!

A is for Arthritis

Arthritis.  What do you think of when you hear the word arthritis?  People with gnarled fingers?  Pain?  Difficulty moving?  Aging?  All of the above?  Well it is all these things and more.

Sonny, in my day we caught our own mice!

Often called "wear and tear" arthritis, osteoarthritis (OA) is the most common form of arthritis in cats.  In most cases, over time, cartilage in joints breaks down, and OA symptoms begin to occur.  In cats, the commonly affected joints are in the back, knees, shoulders, and elbows (sound familiar?)  OA can also evolve from a traumatic injury, like a ligament rupture or a broken bone that didn't heal quite right.

Advanced elbow OA

And arthritis is painful (ask anyone who suffers from it!) 

The way cats express pain is different from people and dogs.   With cats, it's  difficult to see the changes in mobility and behaviour that can signal osteoarthritis. Unless you happen to see your cat in the litter box, you might not notice that she's having more difficulty squatting to urinate and can't easily dig to cover her feces. You might not notice that she doesn't jump to the top of the bookcase anymore, and you might like it that she no longer jumps on the counter. You just notice that she's sleeping more and isn't that normal when they get old?

I've got a hint for you,  it's not.

What can be done for our kitty?  Well, nothing will turn back the clock, but we can slow the progression of disease when it is recognized.

Fat cat is sad

1:  Maintain a healthy weight.  Obvious right?  But many of our kitties are carrying around quite a load.  As many as 58% of all pet cats are classed as overweight with 18.7% of these falling into the obese category!


2:  Regular exercise.  Even our geriatrics benefit from routine play.

3:  Pain management.   Numerous products are available to help combat the pain of arthritis; some are best combined with others and some cannot be combined.  What we do know is that arthritis pain is best addressed by what is called a multi-modal approach, meaning that several approaches combined yield better results than any single therapy.

Our first line medications are glucosamines.   These are believed to function both to decrease inflammation around joints reducing discomfort and slowing the progression of arthritic changes, and also to help provide nutrition for the joint fluid that is necessary for a joint to move smoothly.

The most common forms of glucosamines are oral supplements and injectable medication.  For oral supplementation, I like Dasuquin.  It is a powder that can be mixed with kitty's food and has a great track record of palatability. But if your kitty is a finicky eater--and frequently our older kids are--there is another option.

Adequan is an injectable PSGAG (polysulfated aminoglycan) that has proven success in helping maintain joint health.  In kitties, we give a series of injections every 5 days for 1 month, and then monthly for maintenance.  My own Milliecat has benefited from this treatment regime and is able to reach the couch again with ease. 

More advanced medications are available such as non steroidal anti inflammatory drugs such as Onisor, Metacam, and Rimadyl.  They work by reducing the inflammation in the affected joints.  However, these must be used judiciously in cats because there is a very narrow window of safe doses.

And NEVER give a kitty any human medications for pain!  Most will cause illness, and many will cause death!

As always, the best care for your cat is obtained through a thorough exam and consultation with your cat's veterinarian!