Why does my cat need to be anesthetized; isn’t anesthesia risky?

It is impossible to do an adequate job cleaning a cat’s teeth, take dental x-rays, or extract diseased teeth in an awake cat. While it is true that anesthesia is not completely without risk, at Cambridge Cat Clinic we do everything we can to make that risk as small as possible. This includes the following measures:

• A pre-anesthetic physical exam by the doctor to check for heart murmurs, or other physical signs of disease.

• Blood and urine analyses to make sure that there are no health issues that are not evident on physical exam. It is also important to make sure that the patient can metabolize, or remove, the anesthetic drugs from their system properly.

• Using the safest anesthetic drugs possible.

• Continuous monitoring of multiple physical parameters during anesthesia such as heart rate, body temperature, blood pressure, blood oxygenation, and respiratory status.

• Maintaining the patient on iv fluids to ensure adequate hydration and warming beds to maintain body temperature under anesthesia.

• Ultimately, the risks of not performing the dental procedure need to be weighed against the risk of anesthesia. Untreated dental disease constitutes a health issue in that it can be a source of local and more systemic infection, as well as a significant quality of life issue in that it is a source of ongoing oral pain.

Isn’t my cat too old for anesthesia?

Increased age doesn’t necessarily mean increased anesthetic risk. Age itself is not a disease, it just statistically increases our chance of disease. As doctors, we judge a patient’s suitability for anesthesia based on as complete an assessment of their health as possible by performing the physical exam and blood work mentioned above. We then base our recommendation on an entire medical picture of your cat, not just their age.

 My cat is eating fine; besides, wouldn’t I know if my cat were in pain?

Not always. It is a common misconception that a cat in dental pain will cry out or not eat. While it is not unheard of for a cat with dental disease to be reluctant to eat, drop their food, or even hiss or growl at their food, it is by far not the typical scenario. It is far more common for cats to hide their discomfort and show minimal to no change in their eating habits. This is because cats have evolved from ancestors that were prey as well as predators and for survival, prey animals need to hide any sign of illness or weakness that may suggest to a predator that they are an easy target. Sometimes, subtle symptoms are present that only become clear to the owner in retrospect, when they are no longer present after the dental disease is treated.

Will my cat need to have teeth extracted?

Obviously, the ideal is for all cats to be able to keep all of their teeth for their entire life, but, as in people, dental disease is common. A diseased tooth is not a functional tooth and becomes a liability in terms of health and comfort. The most common reasons for the recommendation to extract a tooth are as follows:

• The tooth is broken. A broken tooth is extremely painful and increases the risk of a dental abscess.

• The tooth is loose. This is usually the result of advanced periodontal disease which has broken down the attachment of the tooth to the surrounding tissue/bone.

• The tooth is infected. Even if antibiotics were administered, as long as the problematic tooth is left, the infection will inevitably recur.

• The tooth has a deficit (hole) in the enamel. The most common problem seen in cats’ teeth is tooth resorption, where there is progressive loss of the hard part of  the tooth over time. It often occurs at or below the gum line. If the pulp (the sensitive inner part of the tooth) is exposed it is very painful, particularly when touched. The breakdown of the tooth structure can also make the tooth prone to breakage, which is extremely painful. Once tooth resorption has started, the tooth must be removed since it will continue to progress, regardless of any type of filling or sealant placed in it.

• There is evidence of inflammation, infection, or bone loss seen on dental radiographs (x-rays). These processes are indications of disease and, therefore, pain.

 Won’t my cat be in pain if teeth are extracted?

In cases of dental infection or broken teeth the cat may actually be in less pain immediately after the procedure since the diseased teeth are gone. In all cases of extraction we take a multi-layer approach to pain control. Pain medication is given before administering anesthesia and nerve blocks are administered to numb the area before the extractions are even begun. Patients are discharged with pain medication to be given at home in order to prevent post-procedure discomfort. In most cases, the cats are ready and willing to eat soft food that same evening.

How will my cat be able to eat if any teeth are removed?

The short answer is: “Better than with diseased teeth present in the mouth since the source of pain has been removed.” The longer explanation follows: While humans rely on thorough chewing of their food as the first step of the digestive process (as evidenced by the shape of our molars which are optimized for grinding), cats basically skip this step. Their teeth look more like blades and their function is to shear off chunks of their prey which is then swallowed without much chewing at all. This is why we often have the impression that our cats are barely chewing their food; it’s because it’s true. Domestic cats don’t have to hunt for a living, so they have their food served to them by us already in small pieces, whether it be dry or canned food. In fact, cats that have had to have all of their teeth extracted due to disease can eat perfectly well. The main exception to this is that it may not be suitable to feed cats with insufficient number of teeth the larger tartar control/dental kibble, but that is decided on a case-by-case basis.

 Can’t you just chip off the tartar in the office visit?

Most cats aren’t sufficiently cooperative for this. But more importantly, it is only a cosmetic fix. The most medically significant placque and tartar exist below the gum line, where it starts the cycle of inflammation and infection that leads to the breakdown of the connection between the tooth and surrounding tissue, pain, and ultimately tooth loss. This area can only be cleaned in an anesthetized patient. Moreover, dental radiographs (x-rays) can only be performed in an anesthetized patient.

 Why are dental radiographs (x-rays) important? Can’t you just clean the teeth and remove the ones that are obviously diseased?

Dental x-rays are important for human dental care, and we can tell the dentist where/if it hurts. They are even more important in our patients who have no way of communicating their discomfort (and are by nature, very stoic and tend to hide it). Approximately 40% of all dental disease in the cat is only visible on x-ray (i.e. not detectable by the naked eye). If it’s not detected, it can’t be treated. An analogy is that if a patient has surgery for bladder stones and only the obvious ones are removed, leaving some behind, the patient will still experience discomfort because the job was not completely done. We want to make sure that all dental procedures are jobs completely done and that your cat derives maximal benefit from the procedure.

 A dental procedure has been recommended for my cat. Can’t I just start feeding dental food/treats and/or start brushing their teeth and see if that improves things?

While tooth brushing can be an extremely effective approach to home care, it needs to be done at least every other day to make a difference and it will not remove any placque or tartar that’s already present. Moreover, if there is any dental discomfort present, your cat will actually become averse to tooth brushing since it will be painful.

Many treats marketed as “dental treats” are so small that a cat may chew them only once at most. Since it is the chewing action that helps prevent tartar deposition, you would have to feed your cat such a large number of treats to have any effect on their teeth that it would be inappropriate. Tartar control diets can be effective at slowing down tartar deposition since the kibble size is large, forcing most cats to chew. While they may help in cases of very mild tartar or gingivitis, they are contraindicated in more advanced dental disease since it will be painful for the cat to try to chew the kibble (and as mentioned above, cats often don’t show signs of that pain.) It is important that these diets be only fed on the advice of a veterinarian who has evaluated your cats’ teeth and determined that it is a safe and appropriate food for them.