Dental Care for Cat Periodontal Disease

What is periodontal disease and what causes it?

Periodontal disease is a term that includes gingivitis (inflammation of the gum) and periodontitis (inflammation of the deep support tissues of the dental elements). It’s one of the most frequent chronic inflammatory diseases in cats, dogs and people. Cats and dogs, of all breeds and all ages, can develop periodontal disease although it tends to be more severe in brachycephalic breeds, small breeds and older animals. Untreated periodontal disease causes severe pain, tooth loss, abscesses and bone loss and can impair major organs’ function.

Gingivitis is the first stage of the disease, and it is caused by plaque-induced infection of the gum. Plaque is the biofilm formed by bacteria, food particles and saliva, which sticks on the teeth surface. Bacterial overgrowth in the dental plaque triggers and maintains gingival inflammation. Plaque accumulation induces mineralization into calculus (tartar), which exacerbates the inflammation, diminishes the effect of the normal mechanical cleaning when eating or chewing and promotes the spread of the process. When the inflammation reaches the deep supporting structures of the teeth, such as the periodontal ligament, early periodontitis occurs.

Periodontitis is increasingly severe with the accumulation of calculus. As a matter of the fact, tartar provides a more rigid surface onto which plaque can stick more securely and bacteria can grow strongly. When the plaque microbes or inflammatory complexes reach the bloodstream, they can harm the kidneys, the liver and even the heart valves.

Stages of Periodontal Disease

There are four stages of periodontal disease (refer to image). At Stage1, we have gingivitis recognized by redness, swelling and painful gums, which easily bleed. Early periodontitis occurs when the infection reaches the periodontal ligament. At Stage2, gums will become even more painful, often bleeding, and they might start pulling away from the teeth. The moderate periodontitis or Stage3 is marked by more severe lesions of the gum and the periodontal structures. In advanced periodontitis or Stage4, we notice inflammation of the alveolar bone, the tooth root is no more covered by gum tissue for the larger part, resulting in poor adhesion of the tooth to its supporting structures and even loss of elements.

In many cats, infection by feline calicivirus leads to extremely severe inflammation of the gum and the oral mucosa. This viral infection initiates the inflammation giving access to a secondary bacterial infection which under specific circumstances can be fatal to the cat. In this case, the cat succumbs to the infection complications in the one hand and/or to the anorexia and the dehydration due to the sore mouth in the other hand.

How do I recognize if my cat has periodontal disease? Symptoms to look out for:

• Cat has halitosis (bad breath)
• Pet is drooling a lot
• Reacts badly when you try to open his mouth: Jaw opening reflex which means painful mouth
• Any swelling, bleeding or ulceration in his gingiva
• Cat eats less than usual or is unable to eat through trying (showing interest in food).

In the presence of one or more of those signs, it is very likely that your cat has either gingivitis or periodontitis. It is then advisable to visit a Veterinarian to examine and confirm your suspicion and offer a solution.

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At the clinic, your vet will start with a general exam, excluding other possible causes. Subsequently, he will carry on by examining the oral cavity of your animal looking for signs of drooling, foul smell, gum inflammation, bleeding or ulceration, etc. As this might hurt your cat, it is not always possible to access and examine the oral cavity sufficiently to get a full picture, hence most thorough oral investigations are done under full anaesthesia. It consists of a visual examination of the gingiva, measurement of the periodontal pocket using a specific probe, determination of teeth root exposure and teeth mobility and checking for resorption or destruction of some teeth.

Dental radiography is an important tool to get full information of the root condition and highlight any osteomyelitis (inflammation of the jaw bones) or bone decay, herewith giving vital information to select the best treatment and give a prognosis for the longer term. As we have said often dental disease can result in organ failure, it is recommended to do a full blood analysis prior to the full anaesthesia to ensure a safe procedure and recovery but also to add to the overall information, leading to the best possible treatment options.

How to treat and prevent periodontal disease?

The treatment plan depends on the stage of the disease. Gingivitis can be treated by brushing off the plaque using a toothbrush (quite difficult in most cats). Choosing a special food to delay plaque buildup, and mechanically helps to scrape off plaque and minor tartar will delay ongoing decay of the teeth. In more severe cases a course of anti-inflammatory and antibiotics could help reduce the pain and the infection, although in this case, we recommend already doing a full dental investigation and cleaning under anaesthesia and with dental X-rays to properly stage the problems, as in a less advanced stage you can still halt the progress of periodontal inflammation and rescue the tooth elements. For advanced stages (3&4) of periodontal disease, it is imperative to sedate the animal for a proper diagnosis of his oral cavity, we will follow through with a professional dental scaling under full anaesthesia. This is the only way to get rid of the plaque and the tartar, apparent and hidden under the gum.

Dental polishing helps reduce tartar buildup for a certain time. This is very important to prevent infection to spread locally to neighboring tissues (jaw bones, oral cavity, throat, cheek) and systemically to vital organs (kidneys, liver, heart) through the bloodstream.

Severe Teeth or Dental Elements

For severely affected teeth/molars, or root abscesses, getting them extracted by dental surgery is essential to fight the inflammation and regain oral cavity health. Your cat will adapt to this condition and will do very well even if he has many teeth removed.

Once the teeth have been cleaned and the inflammatory process is under control, you will be advised to initiate a dental diet and to continue regular monitoring and in case possible cleaning your cat’s teeth to prevent the disease from recurring.

Our nursing staff can show you some tricks on how to brush teeth, however, in cats this will remain a challenge. An oral rinse, water addition can help delay plaque formation and tartar buildup, herewith reducing the infection and controlling the bacterial load in the oral cavity. Regular check-ups to ensure timely professional dental scaling is recommended to keep further decay at bay and ensure the quality of life till late age.

Read more about Periodontal Disease in Dogs.

Written by Dr. Adnene Salhi, ABVC Veterinarian

*Reference: Image from Colin E Harvey: Management of periodontal disease: understanding the options, Vet Clin North Am Small Anim Pract, 2005 Jul;35(4):819-36.