Feline Dental Health
Feline Tooth Resorption (Feline Odontoclastic Resorption Lesions, FORLs)
A common feline oral condition is tooth resorption. More than half of all cats older than three years will have at least one tooth affected by resorption. These tooth defects have been called cavities, neck lesions, external or internal root resorptions, cervical line erosions, but most commonly they are called feline odontoclastic resorption lesions or FORLs.
FORLs are usually found on the outside of the tooth where the gum meets the dental surface. The lower jaw premolars are mostly affected, however tooth resorption can be found on any tooth.
The cause is unknown, but theories supporting an autoimmune response, calicivirus, and metabolic imbalances relating to calcium regulation have been proposed. Commonly the resorption starts at the gum line and progresses, eroding sensitive dentin. Some affected cats show pain and jaw spasms whenever the lesion is touched. Others show increased salivation, oral bleeding, or difficulty eating. Your veterinarian will check for tooth resorption by touching the affected area with a dental probe. These areas are sensitive to probing, and a reaction to the probe is diagnostic of a resorption lesion.
There are five recognized stages of tooth resorption. Initially in stage 1 only an enamel defect is noted. The lesion is usually minimally sensitive because it has not entered the dentin. In stage 2, the lesion penetrates enamel and dentin. When resorption progresses into the pulp chamber (nerve) stage 3 has occurred. In stage 4, large amounts of the tooth’s hard structure have been destroyed. By the time stage 5 has occurred, most of the tooth has been resorbed, leaving only a bump covered by gum tissue.
If your cat is diagnosed with a FORL a complete oral health assessment and treatment (COHAT) will be recommended. This is a dental procedure done under general anesthetic and includes a complete oral examination, full mouth dental x-rays, dental charting, extraction or amputation of the affected teeth and a dental cleaning and polishing.
- Oral examination under anesthetic allows for the veterinarian to do a complete examination to note all teeth affected by FORLs and other possible concerns with the oral cavity.
- Dental x-rays are essential to evaluate all the teeth to determine the best course of therapy. Depending on what is seen on the x-rays, treatment for tooth resorption involves either extraction of the entire tooth and roots, a partial tooth extraction or crown amputation. It will also allow us to see if any other teeth are showing any beginning signs of FORLs below the gum line.
- During dental charting the veterinarian will assess the extent and identify the stage of the FORL. This is done by using a dental probe. Probing the FORL may have been done while your cat was awake to identify the presence of it, however doing it again while under anesthetic allows the veterinarian to thoroughly explore the FORL and as previously mentioned, identify what stage it is at.
- Extractions and/or crown amputations will then be done. The area around the tooth is frozen with a nerve block to reduce the level of anesthetic needed during the procedure, reduce overall patient discomfort and make recovery more comfortable. Extraction of the smaller single rooted teeth require the tooth to be elevated away from the gum attachment and then extracted. In teeth with multiple roots, the bone (crown) of the tooth must first be cut to create “multiple single rooted teeth” before they can be extracted. Large rooted teeth such as the canines require a much more invasive extraction process, including the creation of a gum flap in order to extract the root and tooth properly. A crown amputation is when only the portion of the tooth above the gum line is removed. This is done when the root of the tooth is degenerating on its own. The degenerated root or lack of root will be seen on the dental x-ray.
- A complete dental cleaning with the ultrasonic scaler of the inside and outside of the remaining teeth, as well as dental polishing will be done before waking your cat up from the anesthetic.
Once your cat has been diagnosed with having FORLs, home dental care is very important. Daily brushing will help keep the gums and remaining teeth healthy. However a cat with FORLs will be prone to them for the rest of their life. Frequent dental checks to monitor the remaining teeth will be necessary. Multiple COHAT procedures may be needed throughout their life and they may eventually need to have all their teeth extracted.
Cats can also be affected by inflammation of the entire mouth called stomatitis or lymphocytic plasmacytic syndrome (LPS). Feline stomatitis is thought to be autoimmune in nature. The feline immune system seems to overreact to dental plaque around a cat’s teeth, triggering inflammation in the tissues of the mouth. There might be more of a tendency for certain breeds like the Siamese to develop stomatitis and it is often found in cats with diseases of the immune system like the feline immunodeficiency virus (FIV) or feline leukemia virus (FeLV).
Many cats affected by stomatitis will be unable to eat, develop weight loss, and have excess salivation. Oral examination often reveals a cobble stone-like redness in the throat area and severe inflammation where the tooth and gums meet. You may not see any tartar on the teeth, yet the whole gum line is an angry red, especially at the junction of the tooth and gum. The premolar and molar areas are usually affected more than the canines and incisors. Gingivitis, FORLs or gum disease can also be present in cats with this condition as well.
Managing a case of feline stomatitis can be challenging. Oftentimes attempts at conservative therapy are not effective, nor is medical care. The most effective option for treatment of advanced feline stomatitis is a full mouth extractions. That means removing all your cat’s teeth. This procedure may be referred out to a veterinary dental specialist or done over two procedures. Dental x-rays will also be taken to ensure all the tooth roots were removed successfully. This is a very aggressive procedure, but remember this disease process is also very aggressive, and when you have full, degenerative disease occurring in the mouth, without aggressive intervention, many cats will stop eating and more medical issues will arise.
Many cats with full mouth extractions experience dramatic relief and have a significantly improved quality of life after their teeth (which were the source of all the inflammation, infection and pain) have been completely removed. They will be happier and healthier for the rest of their life. Most cats are still able to eat small kibble, even after getting their teeth removed, or you may be recommended to switch over to a canned diet for your cat.