How do I keep my cat's teeth clean and healthy?
Brush them. That being said, most cats don't agree with that, and will not cooperate for having their teeth brushed on a daily basis, which is what you need to do to keep the plaque from building up. But if you are feeling adventurous, or if you have a kitten that is still relatively trainable, and you think you can consistently brush your cat's teeth at least once daily for the rest of their life, then go for it. You won't completely prevent dental disease, but you will drastically reduce it. To brush your cat's teeth, use a small toothbrush, either a soft infant toothbrush or a cat toothbrush, cat or dog toothpaste (NOT human toothpaste), and brush their teeth like you would a child's. If you would like a demonstration, ask us the next time you bring your cat in for an exam. For the rest of us that aren't that brave or steadfast, there are other options.
Dental diets. These are diets made with kibble that is larger and harder, so that when cats chew into it, the pieces don't immediately crush into little pieces like most dry food. Instead, the kibble tends to stay mostly intact while the teeth bite into it, scraping the sides of the teeth more effectively, reducing the plaque build up. They don't do much for plaque already at the gum line, but they do help reduce the buildup of it in the first place. You can feed a dental diet to a healthy adult cat as an only diet, or you can mix it in with another dry diet as at least 25% of the diet to still get a benefit from it.
Dental treats. These are treats that are made similarly to dental diets - they are larger and harder, so when cats chew into them, they tend to scrub the side of the teeth to minimize plaque buildup. Keep in mind though that most dental treats are just that, treats, and so they are a little higher in calories.
Chew toys. While most cats don't tend to chew on their toys, some do. If you happen to have a chewer, then heavy duty rope toys, nylabones, or anything that is made specifically for cats or small dogs to chew on is probably going to be okay. Just avoid anything that has small parts or strings that can come off and be ingested by your cat that could cause intestinal blockage issues. Rawhide also doesn't go down well in cats, so avoid those as well. In the wild, a cat will keep their teeth clean by chewing through the bones and skin of their prey. If your cat likes to chew, the right toys can have a similar effect.
Food/water additives. There is a lot of controversy as to whether these actually work or not. There are some brands of foods that add ingredients designed to minimize plaque from sticking to the teeth surfaces. There are also additives that you can purchase to put in your cat's water to do the same thing. The jury is still out on some of these. With diets, as long as they are an AAFCO balanced diet, there is no harm in having the additives. With adding them to water however, the primary concern is that if the water tastes a little funny that your cat may not drink as much, which can be very harmful in the long run. Most of the additives are not toxic, but they have not necessarily been scientifically proven to work. If you really want to try one though, as long as you still have water available with nothing added to it, it shouldn't hurt. You can also get sprays to spray on your cat's teeth. Have fun with that one. You might as well just brush their teeth for the cooperation you are bound to get.
Ultrasonic dental prophylaxis. This is basically the same thing that you get when you go to the dentist. Since cats don't just open up and say ahhh, they do get to go under anesthesia for a dental cleaning. Some cats may need this every 6 months, some cats may need it every 2-4 years, and some cats may never need this. This is the most effective way to keep your cat's teeth clean if you are not able to brush them daily, and even if you do brush them daily, you may still need to do this on occasion. This consists of a complete oral exam under anesthesia, ultrasonic scaling to remove the plaque off of the teeth, and a fluoride polish to smooth out the teeth surfaces from any scratches made by the scaling. If there are any diseased teeth present, at this time we would also remove them if they were past the point of salvaging. If you aren't sure if your cat needs a dental cleaning, that is what your regular veterinary visits are for. If a cleaning is recommended, it is a good idea to do it.
All too often, we will see a cat, recommend a cleaning, no cleaning is done, we see the cat a year later, now we really strongly recommend a cleaning, no cleaning is done, and the next year, we are recommend extractions because of the number of diseased painful teeth in the mouth. If your mouth hurts, you go to the dentist. Your cat doesn't get that option, and they won't tell you that it hurts, until it is so bad that they stop eating. When we recommend a cleaning, please listen to us. Your cat will thank you in the long run. Concerned about anesthesia? For just a routine cleaning, cats are generally only under anesthesia for about 20-30 minutes. For dental extractions, they are usually under anesthesia anywhere from 1-3 hours. Multiple short anesthesia periods are much safer than less often but prolonged anesthesia.
Dental extractions. These are basically what needs to be done when your cat develops dental disease that wasn't prevented. The four most common reasons for needed a dental extraction are: tooth root abscesses, fractured teeth, resorptive lesions, and stomatitis.
Tooth root abscesses happen when plaque has been allowed to get underneath the gumline and travel into the root area. Plaque is basically saliva, food, and bacteria all mixed into a hard glue like paste. As the bacteria in the plaque gets into the root cavity, it continues to multiply as it feeds off of the saliva and food in the plaque. Eventually, it expands enough to create an abscess causing drainage that is noticeable on the surface. It eats away at the bone holding the tooth in the socket, and if left untreated, eventually causes the tooth to become so unstable that it falls out. This is a long process that takes several years to happen, and in the meantime, it hurts. Have you ever had a tooth root abscess? They are incredibly painful. It is not unusual for us to go into a mouth and find multiple abscesses that have been simmering for years. In addition, the infection that is eating away at the bone from below can eventually make its way into the skull and jaw bone causing a chronic painful condition caused osteomyelitis that can take several months of antibiotics to eradicate, and in some cases, can weaken the bone so much that cats can develop what is called a pathologic fracture, where the bone breaks with the slightest bit of pressure. These fractures do not always heal.
Fractured teeth happen most commonly from cat fights or trauma such as being hit by a car or falling out of a tree. The four canines at the front of the mouth are the most commonly fractured teeth, but other teeth can become fractured as well. The problem arises when the tooth is fractured far enough down to expose the pulp cavity of the root. When this happens, not only is the tooth exquisitely sensitive to hot and cold, but that open pulp cavity is basically a tract for bacteria that is normally in the mouth to travel directly into the root cavity where it causes tooth root abscesses and osteomyelitis. This can be fixed one of two ways. Either a root canal can be done to stop the spread of infection, or the tooth can be removed.
Resorptive lesions, formerly knows as FORLs (Feline Odontoclastic Resorptive Lesions), are a type of dental disease found primarily in cats, although they have been found in other animals as well, including dogs. The causes of resorptive lesions are still not completely understood. Regardless, what happens is the tooth literally starts to dissolve from a specific point anywhere on the tooth, and the root of the tooth starts to resorb into bone. Eventually the upper tooth weakens so much from the dissolving area that it breaks off and the root is completely resorbed into bone. This also happens over a several year process, and in the meantime, as the tooth is dissolving, it is very painful as nerve roots are being exposed. The only treatment for this is to remove the tooth as soon as the resorptive lesion is found.
Stomatitis is a hypersensitivity reaction to plaque in the mouth. It seems to have some type of contagious component, but not all cats that are exposed to cats with stomatitis develop it, and as of yet, no one has discovered the exact cause of stomatitis. Every time one researches thinks they have found a cause, some one else disproves them. With stomatitis, the immune system overreacts to the plaque on the teeth in the mouth, resulting in very inflamed oral mucosa and gums. This is a very painful condition, and of all of the types of dental disease, this is the one most likely to cause cats to stop eating. In about 80% of cats, by removing the source of the plaque, the teeth, it will cure the condition. Unfortunately, 20% of cats will still have stomatitis even once all of the teeth are gone, and there is no way to predict before hand. But, because stomatitis is such a chronic painful disease, and there is no good effective long term treatment, we will often do a full mouth extraction (all 30 teeth) to try and eliminate the stomatitis. Because removing this many teeth, roots and all, is very time consuming, we will often do this in 2 different procedures to avoid keeping your cat under for too long under anesthesia.
There is generally a 3-5 day recovery period for cats after having teeth extracted. Have you ever had your wisdom teeth out, or another tooth removed? It takes a while to get back to normal. But, the overwhelming thing that we hear after that recovery period is that owners notice how much more playful and active their cats are. That because the dental disease came on slowly, so owners just assumed that the cats were slowing down due to aging, but once the diseased painful teeth are gone, and the mouth heals, they have a new cat that they haven't seen for years, because their cat feels so much better without the chronic pain in their mouth.