At Central Texas Cat Hospital, an oral cavity evaluation is always a part of each examination.
Collecting a history is always the first step in a Comprehensive Oral Health Assessment and Treatment (COHAT). The observant guardian or caretaker has a unique viewpoint to note subtle changes in their cat. Halitosis (bad breath) is a consistent sign of infection or inflammation in the oral cavity. Changes in vocalization may be secondary to swelling or proliferation of tissue in the back of the mouth or pharynx. Non-specific weight loss may indicate the presence of painful dental or oral disease. Cats that are normally very affectionate may shy away from petting if they have a diseased mouth.
Figure 1 Stomatitis
Surgical intervention is sometimes required to correct problems such as gingivitis, stomatitis (inflammation of the oral cavity), and faucitis (inflammation of the back of the throat). These are easy to identify if the cat will allow its mouth to be examined. (Figure 1) These areas of excessive tissue reaction are usually very painful and can in some cases even cause the feline patient to have trouble breathing but are actually thought to be an uncontrolled immune response. Many feline veterinarians believe that these diseases are autoimmune disorders. A jaw chatter is sometimes noted when the feline patients mouth is opened for examination. This is often an indication of an extremely painful oral lesion (i.e. a Feline Oral Resorptive Lesion). Often oral tumors are first identified during routine oral exams. (See Figure 2)
All cats that are over 5 years of age that have not had a COHAT previously should be assessed. Most dental problems that are addressed early can be controlled with less extensive treatments, less anesthetic risk, less postoperative pain and reduced expense to the caretaker.
One of the biggest worries for most feline caretakers contemplating dental diagnostics and treatment is anesthesia. None of the objective assessments (X-rays and dental charting) or treatments can be performed while the patient is awake.
The veterinarians and staff at Central Texas Cat Hospital take our responsibility for your feline family member very seriously. We require that each surgical and dental patient have appropriate laboratory work performed so that we can tailor make the anesthetic protocol for the individual animal. This includes pre-anesthetic sedation and pain management, IV catheter and fluid therapy, anesthetic induction, intubation with a endotracheal tube, anesthetic maintenance with gas anesthetic and oxygen, continuous rate infusion with pain medication intravenously, local and regional nerve blocks, and postoperative analgesics. We utilize state of the art monitoring equipment similar to what is found in human surgical suites. Our dental table is heated and the body temperature of dental patients is constantly monitored. The mouth is frequently flushed with cool water during procedure, and the loss of body heat is a significant concern for the dental surgeon. We also monitor oxygen saturation, blood pressure, ECG, respiration and end tidal CO2.
One of the biggest advances in the field of veterinary dentistry has been the introduction of digital radiology. The ability to have clear, quick images of the teeth, both above and below the gum, has allowed the dental surgeon to assess areas that previously were difficult or impossible to evaluate. In the feline patient, a disease called Feline Oral Resorptive Lesion (FORL) is best diagnosed with dental radiography. In this disease, the roots of the teeth either gradually become part of the bone of the jaw or they develop large cavity-like lesions. (Figure3) Both forms of this disease are very painful. They can only be detected in the early stages by dental x-rays. The teeth may appear normal above the gum or only have a small reddened spot at the gum line. In the past, these teeth were often cleaned and polished during a dental. The analogy that is used is that we were polishing the table top while termites are eating the legs. With better technology we can provide much improved dental health.
Figure 3 (FORL)
Once the teeth are evaluated visually, physically, and radiographically any periodontal disease will be addressed. First a regional anesthetic block is used to deaden the affected jaw and teeth. If surgical extraction is required, a flap of gum tissue is removed from the bone around the tooth. Bone around the tooth (or teeth) is removed with an air driven burr cooled by a water spray and another burr is used to cut the tooth to allow the roots to be extracted. Controlled pressure with a handheld elevator loosens the attachments of the root and the tooth is removed. Any diseased bone is removed with a bone curette and the edges of the extraction site are smoothed. The gum flap is closed over the wound with absorbable suture material. Remaining teeth are cleaned initially by ultrasonic scaling and further cleaned manually above and below the gum line by hand scaling. The teeth are then polished to remove any tiny scratches on the tooth where bacteria and food particles could become attached. The mouth is then flushed with antibacterial solution and the patient is allowed to wake up. We are very careful to maintain the cats temperature during surgery and recovery. Pain control and IV fluids are continued for as long as the animal is hospitalized. Intravenous antibiotics are given during the procedure. Home care instructions and medication are provided with the cat when they go home.
As you can see, at Central Texas Cat Hospital we do more than a dental cleaning.