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How to Fix a Cat’s Painful Mouth

February 10, 2013


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“Freddy grinds his teeth when he eats, hisses, or yawns”

Ginger short-haired tabby cat sleeps under anesthesia with his paws tucked over his chest.

Freddy sleeps through surgery

Betsy was beside herself. The 46-year-old teacher held a grey plastic cat carrier, the kind you can buy in any big box store in America with the clips around the middle holding the top and bottom together and the plastic grid door on the front that looks like a children’s toy prison for cats.

A natural cream-colored faux-sheepskin bed, 4 cat toy mousies, and 6 pieces of cat treats littered the bottom of the carrier. Freddy mushed himself into the back of the barrier with his nose pointing toward the back roof corner. He thought, or hoped, that Doc Truli couldn’t see him, or at least, wouldn’t try to extract him from his carrier. Completely uncooperative and unappreciative, Freddy started to drool in silent nervous panic.

“Doc, Freddy has been grinding his teeth for a few years now, and recently he started drooling when he eats,” said Betsy. “I thought he was angry with me because we moved to a new house. But then he started drooling and I thought maybe he’s sick.”

Doc Truli started unclipping the plastic attachments around the midriff of the carrier. With a practiced flourish, she lifted the carrier top while supporting the door so it would not crash onto the petrified ginger cat.

An oral examination revealed urgent problems.

Severe Chronic Feline Gingivo-Stomatitis

tartar, gingivitis, red, sore, painful gums in a 16-year-old cat

16-year-old cat dental disease

Cat molars with yellow, hard, rough tartar covering the tips of the teeth

Cat Calculus

The pictures show the story of a cat with inflamed, sore, friable, bleeding gums. The gingival (gum) tissue was overgrown, red, fell apart at a slight touch, and oozed blood at the slightest surface pressure. Imagine trying to eat with gums like that! A yellow thick, rough tartar (synonym for calculus) glistening with a biofilm of bacteria and food particles and saliva known as plaque covered Freddy’s teeth.

“Chronic” means of long-standing duration. In medicine, chronic usually two weeks or longer. Many patients have chronic mouth problems for years before they see a veterinarian for evaluation.

“Gingivo” means relating to the gingiva. The gingiva are the specialized oral mucosal lining surfaces. The gingiva on the jawbone and right next to the teeth is called attached gingiva. The unattached gingiva is the inner cheek surfaces and the slick, smooth inner surfaces of the lips. Unattached mucosal lining covers the back of your mouth where it meets the throat – this is called the pharynx (pronounced fay-rinks).

“Stoma” means “opening.” In medical speak, a stoma is any opening. Like the mouth is a stoma. “Itis” means inflammation. So stomatitis just means inflammation of the mouth. Your veterinarian should specify in the treatment notes exactly which parts of the mouth are affected because the treatment and prognosis – or expectations for recovery and speed of recovery – vary depending on the location.

Because Freddy’s inflammation involved the pharynx at the back of the mouth, his time for recovery was predicted to be at least five weeks after surgery.

Lower back molars in 16-year-old ginger cat have holes in them and red, sore gums

Chronic gingivo-stomatitis and rotten molars

close up of the upper fourth premolar in a 16-year-old cat with painful gingivitis and painful teeth causing tooth grinding

Thick cat calculus and red gingivitis

“Freddy needs immediate dental surgery,” advised Doc Truli.

Questions to Ask Your Veterinarian Before Surgery

Freddy’s mom Betsy was afraid of surgery for her 16-year-old ginger cat. She asked, “Is he too old for surgery?” “How will he do with anesthesia?” “Why did this happen?” “Isn’t there anything else we can try first?”

Questions Cat Parents Ask About Dental Surgery

  • Is my cat too old for anesthesia?
  • How will the anesthesia affect my cat?
  • Why did his teeth get like this?
  • Can we try medicine before we go to surgery; surgery seems so extreme?
  • How much will it cost?
  • Will the dental surgery cure my cat?

“While the mouth is this severe and red and painful and the symptoms have been going on for a long time, surgery to clean the teeth, examination of each tooth, and dental radiographs (“x-rays”) of the whole mouth are mandatory for any cat healthy enough to withstand anesthesia,” says Doc Truli.

Digital Dental Mouth X-Rays Tell a Bigger Story

In addition to the red, sore gums, Freddy also suffered from broken incisor teeth and horizontal bone loss.

Fractured Cat Incisors

X-ray of a cat's upper front teeth showing broken off roots below the gumlines.

Fractured Incisor (far right), Root fragment (far left)

“Often, high-quality dental digital radiographs reveal fractured incisor teeth in cats and small dogs,” says Doc Truli. Freddy suffered from two broken maxillary (upper) incisors. The are normally six upper incisors in cats. On physical examination, Freddy looked like her has only five. But the radiographs revealed one broken root and one root with the crown (top) of the tooth completely gone! These root pieces die and trigger the body to treat them like foreign material – like thorns in the mouth. They must be removed for the comfort and health of the patient.

Horizontal Bone Loss and Rotten Molars

x-ray shows a black void in the back root of the 2-root lower molar.

Rotten Cat Molar

Another rotten tooth x-ray.

Another rotten tooth.

The gums are bumpy, fragile and bleed easily when touched because of advanced plasmacytic stomatitis

Sore gums and empty socket

The radiographs also showed Doc Truli the health of the jawbone underneath the red, sore gums. Particularly in the back of the mouth, the bone was 50-70% lost around the roots of the molars. Anything over 50% is defined as end-stage periodontal disease. The teeth must be removed to slow the destruction of bone and oral tissues. Slowing the inflammation and destruction helps return the mouth to normal appearance and function.

The picture of the empty tooth socket (above) demonstrated the severe redness and bumpy texture of the gums in the back of the mouth. Because the inflammation was mostly in the back, Freddy ground his teeth when he stretched his mouth open or pulled his lips back to hiss, meow, yawn, or eat.

Basic Points About Feline Chronic Gingivo-Stomatitis

  • Science has not determined why it happens.
  • Feline leukemia and feline aids virus complicate it.
  • Feline calicivirus may contribute to starting it or making it severe.
  • Allergies to food ingredients or plaque on the teeth may cause or continue it in some cats.
  • Once the gums feel better, daily toothbrushing is the best treatment known (and often painful or impossible depending on the cat.)
  • Veterinary Oral Health Council (VOHC)- approved dental water additive and treats may help prevent plaque and therefore, decrease inflammation
  • Every cat with this condition should receive life-long oral care. Families should plan on at least annual professional cleanings under anesthesia.

Want to read more in depth about feline chronic gingivo stomatitis? Dr. Fraser A. Hale, DVM, FAVD, Dipl AVDC wrote an excellent overview for veterinarians.

Freddy Update

At his five-week visit, Freddy was eating well, gaining weight, but still grinding his teeth. His gums were still cherry red. He tested negative for known variants of calicivirus, feline leukemia, feline aids, bartonellosis, antibiotics and injectable and oral steroids do not quell his inflammation. He takes his water additive, eats hypoallergenic food (ultra-hydrolyzed protein source), and eats his VOHC approved treats. We added probiotics and omega-3 fish oils in an attempt to balance his immune system, but so far, it is not helping or hurting.

We have not attempted immunomodulatory drugs like cyclosporin or interferon. His people do not wish to expose his body to those particular drugs.

Doc Truli is planning another surgery to remove his upper molars that are now non-functional without the lower rotten molars. Feline chronic gingivo-stomatitis often frustrates and confounds medical science.

2 Comments leave one →
  1. February 10, 2013 7:53 pm

    Poor sweet well..

  2. karen permalink
    February 10, 2013 5:05 pm

    Great post! So many people never think of having their cats’ teeth checked, until they get really bad. I adopted a 14-year old cat, and was shocked to see the state of her teeth. I almost die when I have a tooth problem, how must it not feel if you can’t properly complain, physiologically eat to stay alive and never get treatment for that?

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