Feline Dentistry-What a Pain! Part 2

Dentistry – What a Pain!  Part 2

By Erika Ball, DVM

If you read our last discussion, you learned some shocking facts about the lack of dentistry training in veterinary medicine as well as how anesthesia is necessary for proper dental cleaning.  We also discussed ways in which anesthesia can be made significantly safer by following some simple principles.  This discussion will go more into depth about the dental procedure itself.

When you go to the dentist they take x-rays of your teeth before making any final decisions about tooth extraction.  If they don’t you should really consider a going to a different dentist.  More and more we are applying these same principles to veterinary dentistry.  It is now considered to be malpractice to perform dentistry on a pet without the benefit of dental x-rays.  Yet, fewer than 30% of veterinary practices even own a dental x-ray, let alone use it.  This is a completely different piece of equipment than your traditional x-ray machine that most practices have.  Dental x-ray equipment also comes with a considerable price tag, which helps explain why most practices don’t have it.  There is also a steep learning curve involved in taking and interpreting dental x-rays, and without proper formal training (not just what the sales rep gives you in 1-2 hours), it can be frustrating to the average vet.  This may result in leaving the x-ray unit unused, sitting in a closet.  Every pet should have a full set of x-rays taken at the time of the dental procedure, not just of those teeth that are suspicious on oral exam.  Many diseases of the teeth occur below the gum line where you cannot see with the naked eye. Without x-rays you are missing significant disease that needs to be addressed.  X-rays should also be taken following any extractions to be sure that no tooth roots are left behind.  Unfortunately this problem is all too common, especially in cats, who have extremely fragile teeth.

Nerve blocks should also be performed to lessen the pain experienced by the pet.  This also allows us to administer a lower level anesthesia, which in turn makes the procedure much safer.  This requires training and practice to perform correctly and effectively.  

Finally, the extraction process itself – This is a procedure that only a veterinarian with proper training should be performing.  It is illegal to allow any other staff including technicians, to do this.  Despite this law, it is an extremely common practice for technicians to be extracting teeth, often without any supervision by a veterinarian.  I will be the first to admit that when I started doing dentistry I didn’t have a clue what I was doing.  I used to dread it, because deep in my heart I knew there was probably a better way.  The problem is, if you read my first article, cats hide evidence of pain.  They will eat despite having painful teeth and will continue to do so even after improper extraction techniques that result in painful retained roots.  You as an owner may never know if your cat’s (or dogs) dental was performed properly and that they may still be in pain.  Proper extractions involve creating gingival flaps and exposing the roots of the teeth to be extracted to lessen the likelihood of root fracture (it is especially easy to fracture roots in cats!).  Once the tooth (or teeth) are extracted X-rays should be taken to verify complete removal of the roots.  The gingival flap is then sutured closed to prevent a painful condition known as dry socket.  Now, with multiple training courses, shadowing veterinary dentists, and years of practicing these learned techniques, I love dentistry.  It is the single most rewarding thing that I do that I know results in an improvement of my patients’ quality of life.  When these patients come in for their rechecks 2 weeks post oral surgery my owners tell me that their cat seems much happier, more playful, many times doing behaviors that they haven’t done in years!  Previously we may have chalked up some of those common “slowing down” behaviors to part of the aging process, when all along it was likely dental pain contributing to those behaviors.

You are probably wondering, “But how will my cat eat without teeth?”.  A valid question for sure.  The answer is that they may even eat better because it no longer hurts to do so.  I have patients that have no teeth at all that refuse to eat anything but dry cat food, and they manage just fine.  I also have patients that continue to hunt and kill mice with little to no teeth.

Since I deal exclusively with cats, any dental discussion that didn’t involve the most common dental problems that this amazing species suffer from would be incomplete.  The most common problem we see is tooth resorption.  This is a condition that can strike just about any adult cat.  In fact, 50% of all cats over the age of 8 have at least one tooth affected by tooth resorption.  There is much about this condition that we don’t understand.  We don’t even know the cause of it as of yet.  What we do know is that there is a type of cell, called an osteoclast, that begins to destroy the tooth.  This can start in the roots of the tooth or in the crown.  The result of this destruction is painful nerve exposure.  There is nothing that can be done to restore these teeth.  The only treatment is to extract the tooth to stop the pain.  X-rays are especially helpful in diagnosing this disease as often the roots are affected, but the crown may look relatively normal (so far, anyway).  X-rays also help us to determine the best approach to extracting the affected tooth.  

Periodontal disease is hardly exclusive to cats, but also very common.  This is one condition that could potentially be prevented or at least slowed by regular cleanings and even home tooth brushing.  I do caution cat owners that the majority of cats will not tolerate this, and if your cat happens to have any painful lesions you may actually be inflicting pain on your cat.  Tooth fractures are also common, and if left untreated will likely lead to a tooth root abscess.  A newly fractured canine tooth may be saved through a root canal procedure, which can only be performed by a veterinary dentist, but these fractures are rarely discovered in time to save the tooth, resulting in the need for extraction.  Probably one of the most horrific oral diseases we see in cats is stomatitis.  It is characterized by severe and exquisitely painful inflammation affecting the entire mouth.  There are many potential causes of this disease, including bacterial or viral infections, or allergic conditions, but regardless of cause, many of these cats will require full dental extractions to relieve the agony that they are suffering as a result of this disease.  Once again, x-rays are essential to ensuring that no speck of tooth is left behind to maximize the success of the procedure.

What I will leave you with are questions that you should always ask before you schedule your pet for a dental:

  • Is the person cleaning the teeth and taking the x-rays the same person that is responsible for monitoring anesthesia (it is impossible to do a good job at both simultaneously)?  
  • Does every patient get an IV catheter and are they kept on fluids during the dental?  
  • Is a breathing tube being inserted to keep oral bacteria and debris from getting into the airway?  
  • Do you have dental x-ray equipment and use it to take full x-rays on every dental, pre and post extractions?  
  • Will I be given a copy of those x-rays?  
  • Who is performing the actual extractions?  
  • Do you use nerve blocks?
  • Do you use gingival flap techniques when performing extractions?  
  • Do you suture closed the gum tissue post extractions as to not leave open sockets that lead to painful dry socket?

As I’ve mentioned, dentistry is my passion, and I could talk about it all day.  My goal was to have at least provided you with enough information about it to allow you to make educated decisions about your cats (or dogs!) dental health.  I hope I’ve accomplished that if nothing else.  Let’s make sure your cat isn’t suffering in silence.  Schedule a dental exam today.