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Prophylactic (Preventive) Dentistry and Periodontal Surgery Under Anesthesia In Cats

Dental disease is a very common problem in cats (and overlooked in veterinary medicine until the past 15-20 years). While true cavities represent the most common dental disease of humans, cats are more frequently bothered by gingivitis and tartar buildup on the teeth, which frequently progresses to "periodontal disease." Periodontal disease means that the structures supporting the tooth below the gumline are diseased. This destruction occurs due to plaque bacteria and their by-products and is an inevitable extension of untreated gingivitis. Many cats are also victims of "tooth resorption" (previously known as "feline odontoclastic resorptive lesions," "FORLs," "neck lesions," which are somewhat similar to cavities in people). Signs of dental disease may be straight-forward (drooling from the mouth, pawing at the mouth, food falling out of the mouth, etc), but more often than not, the signs of dental disease in cats are very subtle. All cats with dental disease will have bad breath, which can be severe in cats with extensive dental disease. Cats as a species tend to hide any pain and discomfort until they are no longer able to do so, which is often when their disease may be quite advanced. This means that many cats with dental disease may have either no outward signs of illness or discomfort, or, alternatively, their signs may be very vague (sleeping slightly more, less active, minimal decrease in appetite, irritability, etc.).

Proper cleaning of the teeth as well as any needed periodontal surgery requires complete cooperation of the patient so that plaque and tartar can be removed properly. General anesthesia is required to thoroughly clean the teeth. "Scraping the tartar off" in the exam room with the cat awake does the cat no favors, it only makes the cat more prone to future tartar development, and certainly does not remove all the tartar, especially that under the gums. As noted above, it is the plaque and tartar below or above the gumline that, left untreated, inevitably leads to more serious periodontal disease and loss of teeth.

Many owners have a high degree of anxiety related to general anesthesia for their cats. While there is always a degree of risk with any anesthetic, be aware that delaying proper dental care may ultimately compromise your cat's health. In other words, in most cases the risk of subsequent illness from diseased teeth is greater than the risk of anesthesia. At the very least, it is good oral hygiene, and in the best interest of your cat's overall comfort, to assure that dental disease is addressed in an appropriately timely fashion.

Dental Cleaning Protocol at Cat Hospital of Chicago

  1. The cat is received by the hospital staff the morning of the dental procedure, and is examined by the veterinarian. Pre-operative laboratory work, if not already done, is performed at this time.
  2. A pre-anesthetic tranquilizer/analgesic (pain medication) is administered and the cat is placed in a hospital cage with a "kitty condo" where he or she can "hide" until time for the dental surgery to begin.
  3. Once the cat is adequately sedated, an intravenous catheter is placed.
  4. Next, general anesthesia (usually with an injectable drug) is "induced." "Induction" means that the injectable drug further sedates the cat so that step #5 can be performed.
  5. An endotracheal tube (or breathing tube) is placed into the cat's windpipe and gas anesthesia is administered through this tube. Anesthesia is maintained for the rest of the surgical procedure with the gas anesthesia.
  6. Anesthetic monitoring devices are attached to the cat in order to ensure his or her safety during the dental procedure. These include continual measurement/monitoring of EKG, heart rate, body temperature, oxygen saturation of red blood cells, efficacy of ventilation, and both manual and monitor-generated blood pressure measurements. (Maintaining adequate blood pressure is critical in assuring proper blood flow to the kidneys and in decreasing overall anesthetic risk). Monitoring these parameters is all done non-invasively, and is critical in helping us to assess cardiac and respiratory function under anesthesia. Obviously, we are also very aware of the patient's breathing, gum color, heart sounds, depth of anesthesia, etc., independent of all the equipment to which the cat is attached. Because low body temperature can adversely affect these parameters, and thus the overall safety of anesthesia, we also make use of a pediatric Bair Hugger warming blanket (just as is used in hospitals for children) for all anesthetized patients. Additionally, we apply infant "booties" to the paws of our patients in order to further aid in heat retention. We have found that the majority of our patients remain normothermic (normal body temperature) with these preventive measures being taken.
  7. Intravenous fluids are also started at this time. (The fluid is a balanced electrolyte solution, and helps to combat both dehydration and an anesthesia-induced drop in blood pressure. The fluid is warmed before entering the cat's body via an IV warming unit). The exact rate of fluid administration is determined based on the cats body weight, hydration status, etc.
  8. "Charting" of the teeth is done by one of our veterinary technicians or nurses. He or she records the presence of any loose or fractured teeth, visible tooth resorption, root exposure, periodontal disease, gingivitis/gingival recession, etc.
  9. Scaling of the teeth is performed by one of our trained veterinary technicians or nurses. Scaling involves removing the tartar both above and below the gum line, on both the inside and the outside of the teeth. This is done with ultrasonic cleaning equipment and with hand instruments.
  10. Flushing or irrigation removes dislodged tartar from the teeth and helps to remove the bacteria that accompany tartar.
  11. Polishing smoothes the surfaces of the teeth (inside and outside), making them resistant to additional plaque formation.
  12. The veterinarian performs an individual exam of every tooth. She probes the gumline for pockets (gaps between the tooth and the gum), and rough areas that may be indicative of feline tooth resorption. She also assesses gum recession, fractured teeth, etc.
  13. Intra-oral x-rays are then taken. We routinely x-ray any teeth with obvious pathology, as well as any tooth with suspected pathology. This allows us to evaluate not only the crown of the tooth, but also the root and the surrounding bone. Additionally, any cat with any teeth showing evidence of resorption will have full-mouth dental images taken of all teeth in the mouth. This is because it is common for cats to have more than one resorptive area, and oftentimes, the resorptive pathology is below the gumline (i.e., involving the root). In these cases, the only way to diagnose it is by taking an image of the tooth root. Dental x-rays are performed, just as they are in humans, by inserting a small square digital probe into the mouth of the cat (the same size as the small square human dental films that are put in our mouths when we are at the dentist), positioning it appropriately, placing the dental x-ray cone at the correct angle against the cat's mouth/face, and taking the image. Our dental images are digital so they are quickly projected onto a nearby computer screen for evaluation by the veterinarian.
  14. Diseased, non-salvageable teeth are extracted by the veterinarian. Some of the more common indications for extraction of teeth in cats include any teeth with resorptive areas, those with root abscesses, loose or mobile teeth, teeth with severe surrounding bone loss seen on dental x-ray images, fractured teeth with exposure of the pulp canal, etc. For most teeth, extraction involves surgical creation of a "gingival flap" (allowing us better access to the tooth root, and allowing us to more easily suture the tooth socket closed). Prior to any extraction, local or regional analgesic (pain) blocks are performed similar to what is done in people prior to any type of periodontal surgery. As with people, a sterile pack of instruments is used for each periodontal surgery.
  15. After the extraction is complete, repeat images are taken of the extraction site to assure that all of the tooth root was effectively removed (in those cases where the entire root must be removed).
  16. All extractions or other periodontal therapeutics (application of tartar prevention or antibiotic gels, etc.) are documented on the cat's dental chart.
  17. Based on the number of extractions and/or the difficulty of the extraction(s), additional analgesics (pain medication), tailored for the individual patient, are administered and prescribed to go home with the patient.

When the surgery is completed, the cat is moved to a post-surgical area and to a cage with heated flooring. He or she is carefully monitored during recovery from the anesthesia. All cats having had dental cleaning and periodontal surgery performed at Cat Hospital of Chicago are discharged the same day of the surgery.

All cats that have had extractions are treated aggressively with pain medication. Some cats, particularly if they have had several extractions, and/or if the owner is unable to give oral medication at home, will be sent home with a pain patch having been applied. This patch slowly releases pain medication in cats over 3-5 days. Other cats will be sent home with one or more oral pain medications. Cats may or may not be sent home with antibiotics after their dental cleaning.

For those cats willing to allow it, and for those owners willing to do it, brushing the teeth is an ideal way to prevent further build-up of tartar. For other cats, use of a therapeutic dental diet may help to retard the re-accumulation of tartar and the subsequent gingivitis. Those patients allowing more aggressive home care are more likely to need fewer professional dental cleanings and less periodontal surgery throughout their lives.

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