Resorptive Lesions, Feline

Feline Odontoclastic Resorption Lesions (FORLs)

By Dr. Karen Burgess

Over time, the root(s) of the teeth are completely destroyed, and in the latter stages of the disease, only the crown (portion of the tooth above the gumline) or portions of the crown remain. In many cats, the end-stage affected tooth is observed as missing.

FORLs were previously and incorrectly referred to as a feline cavity. We now know that cavities and FORLs are distinctly different diseases. Cavities are caused by bacteria, and FORLs, although their true cause is unknown, are not a bacterial disease. Many potential causes for this disease have been investigated, but to date, the true cause of the disease remains elusive, and is one of the current “hot” topics of research in the field of veterinary dentistry.

What are the symptoms of FORLs?
Cats with FORLs are often identified by the chief symptom of teeth “chattering,” sensitivity upon eating/chewing (i.e., dropping food or preferentially chewing on one side of the mouth). Patient’s suffering with FORLs may also salivate profusely. This suggests that there is significant oral pain. On examination, the veterinarian will identify either missing teeth or teeth where portions of the tooth crown are missing. In areas where portions of the crown are missing, the gums in the area are usually observed to cover the missing area, and a red spot is noticed on the crown. The teeth with early FORLs cannot be identified on gross examination, because the disease is localized to the root surface, and can only be documented by radiographs.

Symptomatic cats are usually those that have teeth with partially missing tooth crowns, and where the disease process has moved beyond the root surface. In other cats, despite the severe gross clinical appearance of the lesion, the cat remains unaffected in its behavior pattern: eating, gaining weight and content.

NOTE: Cats are very careful not to demonstrate pain. Signs of pain can be very subtle with these cats. You might notice more calculus (tartar) in specific areas, gingival inflammation (possibly the only sign), increased salivation or changes in food preferences. Owners typically fail to realize their cat is painful until after they experience behavioral changes (happier and more playful cats) subsequent to treatment for these resorbing teeth.

What tests are needed?
Only the end-stage lesions involving the tooth crown can be identified readily on clinical examination, the remainder of lesions must be diagnosed by quick and efficient dental x-rays which is available at Healthy Paws Animal Hospital. Due to a high percentage of cats affected by this disease, cats over the age of 4 are recommended to have dental x-rays as a screening test for the disease when having their teeth cleaned.

What treatment is needed?
FORLs are believed to be a painful disease in the cat, and cats with documented disease should be treated. The primary treatment for this disease is extraction of the affected teeth. When FORLs were believed to be similar to cavities, the lesions or defects in the crown were filled, similar to human cavities. As the disease was further investigated, and follow-up was performed on teeth that had been filled, it became clear despite our best efforts the filled teeth continued to resorb.

Extraction or crown amputation with intentional root retention, are the only currently accepted methods of therapy. The latter is a procedure where the crown of the affected tooth is removed with a bur; leaving the resorbing roots buried in the bone to continue resorbing to completion. The crown amputation procedure alleviates the clinical signs of disease because the exposed and sensitive portion of the tooth is removed. This procedure, however, is limited to affected teeth that have been appropriately x-rayed and have severe tooth root resorption. Teeth with severe root resorption are difficult to impossible to extract, and severe damage to the surrounding bone may result from overzealous attempts at extraction.

Prognosis
The prognosis following extraction or crown amputation of affected teeth is good, but affected cats will always have a predisposition to the development of additional lesions. Follow-up visits on an annual basis are recommended for FORL screening.

Preventative Care
It is helpful to brush your cat’s teeth daily or three times weekly at a minimum. Dental products are available that have been noted to reduce plaque and tartar. Products exhibiting the VOHC label have proven their efficacy and should be purchased over products that do not carry the VOHC label. VOHC products include treats, food, and water additives. Ask a Healthy Paws employee for a list of approved products.

Dentistry, Why to perform

Why Perform a Dental Prophylaxis?

By Dr. Karen Burgess

Cats and dogs, like humans, are prone to an array of mouth issues ranging from tartar and plaque to retained, extra, missing or even twisted teeth! Dental prophylaxes allow veterinarians to determine the overall health of your pet’s mouth, address any issues and prevent future problems.

Dental Disease
The most common oral problem in dogs and cats is dental diseases. Without proper tooth brushing, the buildup of the plaque, tartar, and bacteria can lead to infection. Over 68% of pets over the age of three have some form dental disease. The most common problems are due to periodontal disease, gingivitis and cervical neck lesions.

Periodontal disease is used to describe inflammation or infection of the tissues surrounding the tooth. Accumulation of tartar and calculus on the teeth contributes to gum recession around the base of the tooth. Infection soon follows and the gums recede, exposing sensitive unprotected tooth surfaces. Untreated infection then spreads into the tooth socket and ultimately the tooth loosens and is lost.

Dental Prophylaxis
A dental prophylaxis is performed under general anesthesia. Probing and cleaning of the teeth would be impossible, incomplete, and painful without general anesthesia. Once fully anesthetized all teeth are probed and charted. If any abnormalities are noted, such as deep pockets, missing or extra teeth, digital radiographs are then taken.

Digital radiography allows multiple radiographs to be taken in a short amount of time. This provides an abundant amount of information for the veterinarian to use in making recommendations for extractions or possible diagnosis. Dogs typically require anywhere from 0-4 radiographs whereas cats get full mouth radiographs due to their high incidence of cavities.

Above is a great example of why preventative care is so important and the reasons to start young. Puppies begin losing their teeth at approximately 3 months of age and should have a mouth full of adult teeth by 6 months.  Around this same time dogs are typically spayed or neutered.  While being spayed/neutered at Healthy Paws Animal Hospital the teeth are counted and we make sure that there are no missing, extra or retained puppy teeth.  Finding the reasons for the abnormalities at 6 months can help to alleviate problems like the above cyst.  For this reason, Healthy Paws Animal Hospital provides spay and neuter estimates with full mouth radiographs listed on the high end.

After all radiographs have been taken and any extractions completed the teeth will then be cleaned with an ultrasonic scalar followed by a fluoride polishing.  The ultrasonic instrument is a vibrating probe which aids in the removal of the tartar on the teeth with minimal damage to the tooth enamel.

Preventative Care/Maintenance
Once the teeth are cleaned it is the best time to begin preventative care.  The most effective way of reducing plaque and tartar is to brush the teeth.  Surprisingly, toothpaste is not required- the abrasion of the toothbrush alone helps to remove plaque and tartar from the teeth.  In addition to brushing the teeth recent advances in nutrition have resulted in diets that reduce tartar accumulation such as Hills t/d® diet.  Preventative care has been made easier with so many options ranging from brushing teeth daily to chew toys or water additives.  One tip of advice:  purchase only products with the below VOHC seal of approval.  This seal indicates that the product purchased has proven the effects of tartar and/or plaque removal.

Dentistry, Feline VOHC Products

Feline VOHC Approved Products

By Dr. Karen Burgess

Hill’s PrescriptionT/D Diet (prescription product)

Hill’s Science Diet Oral Care for Cats (over the counter)
Prescription Diet T/D and Science Diet Oral Care are both completely balanced food for cats that were developed to help prevent plaque, tartar, gingivitis, and bad breath (halitosis). Pet owners have mistakenly been led to believe that eating a kibble cat food alone helps prevent dental disease. Most dry cat food actually shatters or crumbles immediately after a pet bites into it thus providing very little mechanical cleansing. T/D and Oral Care kibbles are designed to “stick together” thus encouraging more chewing and essentially scrubbing the teeth as a cat eats. The maximum benefit comes from feeding these diets exclusively after a professional dental cleaning. There has been lesser benefit shown in feeding as little as 25% of the daily diet as T/D. While there is evidence that “dirty” teeth and the associated gumline benefits after 4 months of feeding T/D diet, this should be done with caution as a pet with significant dental disease that is not first addressed may experience pain from eating a dental diet. Similar to all prescription diets, T/D is 100% guaranteed and returnable.

Healthy Mouth Water Additive
A unique and completely natural water additive (free of synthetic ingredients or artificial flavors, read the ingredient list and see for yourself), Healthy Mouth has been shown to decrease plaque by over 70%. Sold in a concentrated form that is mixed with water, Healthy Mouth is both palatable and helpful. Ideally begin to use Healthy Mouth at 6 months of age or when adult teeth are erupting.

Greenies
Greenies brand has a wide variety of treats that have been clinically proven to prevent plaque and tartar. While there are many products available in retail stores that resemble Greenies, only the brand name version has been proven to help with dental disease prevention.

Dentistry, Canine VOHC Products

Canine VOHC Approved Products

By Dr. Karen Burgess

T/D Diet/Oral Care Diet
Prescription Diet T/D is a completely balanced food for dogs that was developed to help prevent plaque, tartar, gingivitis, and bad breath (halitosis). Many Healthy Paws’ patients have in fact taste-tested T/D in the exam room. Pet owners have mistakenly been led to believe that eating a kibble dog food alone helps prevent dental disease. Most dry dog food actually shatters or crumbles immediately after a pet bites into it thus providing very little mechanical cleansing. T/D kibbles are designed to “stick together” thus encouraging more chewing and essentially scrubbing the teeth as the dog or cat eats. The maximum benefit comes from feeding T/D as an exclusive diet after a professional dental cleaning. There has been lesser benefit shown in feeding as little as 25% of the daily diet as T/D. There is also evidence that “dirty” teeth and the associated gumline benefits after 4 months of feeding T/D diet, however this should be done with caution as a pet’s with significant dental disease that is not first addressed may experience pain from eating a dental diet. Similar to all prescription diets, T/D is 100% guaranteed and returnable. Oral Care is an over the counter alternative to T/D with the kibble size being the primary difference. Gingivitis is not addressed by Oral Care while it is by T/D.

Purina Dental Chewz Dog Treats
Purina Dental Chews are a beefhide (rawhide) treat that has been statistically shown to reduce buildup of tartar. Remember that treats should not make up more than 10% of a pet’s caloric intake. Each rawhide is 56 kcals. As always, monitor pets when eating rawhide chews to ensure that they are being thoroughly chewed.

Tartar Shield Soft Rawhide Chews
An American made chewstick made of pulverized rawhide, Tartar Shield was developed by a dental scientist and has been proven to decrease tartar by 54%, plaque by 40%, gingivitis by 28%, and malodor by 19% when used daily. Tartar Shield comes in a variety of sizes and comes with a money back guarantee.

Virbac CET VeggieDent Chews

Healthy Mouth Water Additive
A unique and completely natural (free of synthetic ingredients or artificial flavors, read the ingredient list and see for yourself), Healthy Mouth has been shown to decrease plaque by over 70%. Sold in a concentrated form that is mixed with water, Healthy Mouth is both palatable and helpful. Ideally begin to use Healthy Mouth at 6 months of age or when adult teeth are erupting.

Greenies (Original, Lite, Senior, Veterinary Formula, Hip and Joint)
Greenies brand has a wide variety of treats that have been clinically proven to prevent plaque and tartar. While there are many products available in retail stores that resemble Greenies, only the brand name version has been proven to help with dental disease. In 2006 the Greenie product was reformulated to prevent issues that had been previously noted with digestibility (treats were being swallowed whole and were contributing to gastrointestinal obstruction). While this issue has been addressed and is no longer an issue, any pet eating a treat should be monitored to ensure that they are chewing it into smaller pieces. Anything can be a choking risk, but larger treats and an overly exuberant pet can be a dangerous combination.