The Periodontal Disease Puzzle
Can Kitty’s Teeth Be Saved?
Iris Zinck
According to the American Veterinary Dental College (AVDC), most cats have some evidence of periodontal disease by three years of age. By four years, the actual number may be as high as 85% (VetStreet.com). Consequently, the odds are extremely high SOMEBODY in your house whose oral health could benefit from your reading this article!
Gingivitis versus Stomatitis
Although there are different types of periodontal disease (and different stages within each one), general-practice vets often do not make a clear distinction between gingivitis—the most common manifestation of gum disease—and stomatitis—a more serious disease which typically requires extraction of most of the teeth. It is not unusual for the owner of a cat exhibiting symptoms of gingivitis to be told that the best treatment may well be a full-mouth extraction. Consequently, obtaining the best treatment for your cat’s situation— and preserving the teeth, if possible—is likely to require the assistance of a dental specialist.To learn more about the difference between these two conditions, their treatment, and management, I was fortunate to be able to interview Dr. James Anthony, DVM, of Red Bank Veterinary Hospital in New Jersey. Dr. Anthony is board-certified by both the American Veterinary Dental College and its European equivalent. He holds degrees from Western College of Veterinary Medicine (Saskatchewan, Canada), the Royal College of Veterinary Surgeons (London, England), and the Academy of Veterinary Dentistry (Orlando, Florida). In addition, he has taught courses and seminars in the U.S., Canada, the Philippines, Brazil, and several other countries.
Dr. Anthony explained, “Gingivitis is an inflammation of the gums . . . the body’s response (inflammation) to a biofilm made up of bacteria (80%) and other debris that is accumulated on the tooth surface, mainly the gingival area.” Left untreated, “this inflammation leads to more advanced periodontal disease around the supportive structures of the teeth.” The most frequent symptom of gingivitis is redness at the gum line. Others include swelling, discomfort, and, in severe cases, bleeding of the gums. Owners may notice changes in the cat’s appetite, a preference for soft foods, drooling, and/or halitosis (bad breath) (Cornell).
When asked about the difference between gingivitis and stomatitis, Dr. Anthony noted, “Stomatitis affects the supportive structures of the teeth, but also—and more importantly—the other areas of the oral cavity such as the alveolar mucosa. It can extend to the back of the oral cavity (retropharyngeal area).” He stated, “Gingivitis is not a precursor to stomatitis but can be associated with it.”
Diagnosis and Treatment of Periodontal Problems
Given the wide range in the appearance and severity of periodontal disease symptoms in cats, it is the position of the AVDC that cases cannot be properly evaluated or treated without general anesthesia for veterinary patients. This not only enables a thorough cleaning to remove plaque, but also allows dental radiographs (X-rays) to be taken. These radiographs are one of the most important tools available to a veterinary dentist, as they “allow the internal anatomy of the teeth, the roots and the bone that surrounds the roots, to be examined.” (AVDC). Because cats that present with a single problem (such as gingivitis) often have other problems which cannot be detected with a physical examination, interpretation of these radiographs is essential to determine whether your cat’s case can be managed by regular cleanings in conjunction with a home management program, or whether he/she may be better off with a full-mouth or partial extraction. (AVDC)
Dr. Anthony sees total mouth extraction as a last resort in treating FCGSS (feline chronic gingivitis stomatitis syndrome). “What we do is first see what the owner can and will do for home care. We then treat the advanced periodontal disease and extract teeth that have a very poor chance of success in treatment and implement a home care program that is unique for both the owner and the cat.” This increases the chances of the cat accepting it and the owner being able do it regularly. He stressed, “Home care is always a major component of success in these cases and if the caretakers cannot or will not try home care, extractions of the premolars and molar may be necessary.”
His treatment methodology involves “a multi-modal approach to home care, where we try to improve the overall health of the oral cavity in a few ways. The first is inflammation control. 1TDC, 1-tetradeconal complex, is an example of a product which is helpful here (See sidebar). Secondly, we try to strengthen the gingiva to make it stronger to resist periodontal disease (an example is Maxi/Guard oral cleansing products). Third, we try to prevent plaque (bacteria with other materials that create a biofilm on the tooth surface) by controlling bacteria in the oral cavity (example is using a chlorohexidine cleaning product).” He mentioned that another way to control plaque is with a product which can help prevent plaque adhesion, such as Healthy Mouth, or one which mechanically removes it (a dental diet such as Hills t/d, and or tooth brushing). He also noted, “Re-checks with your veterinarian are also important to make sure the program is working.”
Information about the above-mentioned products indicated that for best results, their use should be initiated following a dental cleaning. This makes sense; if you are starting out with a cleaner mouth, it is going to be much easier to keep it that way! But using them before a cleaning does no harm and may enable pet owners to delay the need for one or lengthen the amount of time between cleanings. (One exception to this recommendation is 1TDC, which can be used at the first sign of inflammation and, according to many cat owners in the Northeast U.S., can be helpful in slowing the progression of periodontal disease.)
Implications For a Breeding Program
What if the cat you are treating for periodontal disease is an important component of your breeding program? Dr. Anthony noted that some breeds do seem to have a predisposition to it, due to inbreeding and a weaker immune system. While he did not identify specific breeds, research indicates Abyssinians (VetStreet), Persians, and Exotics (Icatcare) may be particularly prone to periodontal problems. I have also personally noted several instances within my Siberian breeding program.
Should these cats be removed from breeding programs? “Ideally, yes,” said Dr. Anthony, “if the condition is due to a weakened immune system.” However, he also noted that sometimes the gene pool is so narrow that this may be hard to do and commented, “just because the cat has periodontal disease is no reason to remove them from the breeding program.” A better strategy may be to use the affected cat only with unrelated mates (if possible), and to avoid any double-ups on it in your pedigrees.
According to Dr. Anthony, food selection has no impact on whether or not a cat is likely to develop periodontal disease and a raw diet does not make a difference. Cats with active disease, however, are likely to prefer soft food. Interestingly, cats who undergo extractions usually have no problem returning to their regular diet and are able to eat and digest dry food.
To Learn More. . .
If your cat has symptoms of gingivitis and your vet is suggesting extraction as a solution, consider a consultation with a board-certified veterinary dentist before you agree. These veterinarians have undergone 2-6 years of additional training in this specialty, and passed a rigorous written and practical exam. They are experts in all aspects of oral health, including the diagnosis and treatment of periodontal disease, gingivitis, periodontitis, tooth resorption, fractured teeth, oral masses, trauma, malocclusions, abscessed teeth, stomatitis, and much more. Referrals can be obtained by going to the AVDC site and clicking the link to “Locate a Veterinary Dental Specialist.”
Sources:
https://www.petmd.com/cat/conditions/mouth/c_ct_periodontal_disease?page=show
http://www.vetstreet.com/care/periodontal-disease-in-cats
https://icatcare.org/advice/cat-health/dental-disease-cats
Dr. James Anthony, BSc(Agr), DVM, MRCVS, FAVD, DAVDC, DEVDC, PAg, Online interview, 12/12/18
Originally published Cat Talk Magazine
