There are several types of dental disease that occur in cats. Even though your cat may not be showing it, cats have a very high threshold for pain, and we can guarantee that they are feeling some degree of pain and discomfort. Your cat was diagnosed with:
Grade I Periodontal Disease / Grade II Periodontal Disease / Grade III Periodontal Disease
Grade IV Periodontal Disease / FORLs
Periodontal disease is inflammation or loss of the tissues that hold the tooth in place. This is most commonly a result of plaque that accumulates at the junction of tooth and supportive tissues. Plaque is a mixture of saliva, food, and bacteria that start to accumulate on your cat?s teeth. If left untreated, the affected tooth may eventually fall out, but only after years of pain and discomfort.
Grade I Periodontal Disease:
� Also known as gingivitis, this is when the soft tissues around your cat?s tooth start to become inflamed as a result of the plaque on your cat?s teeth starting to migrate below the gum line.
� This will appear as reddened inflamed gums, primarily in the area where the gums touch the teeth.
� Once the plaque starts to migrate below the gum line, this is where early treatment becomes important. The only way to remove plaque at or below the gum line is with an ultrasonic scaler. This requires that your cat goes under anesthesia, but this is a fairly short procedure, and usually does not take more than 30 minutes.
o Brushing your cat?s teeth and feeding tartar treats will help, but only to prevent more plaque from forming, they will not eliminate the plaque that is already present. If your cat already has gingivitis, brushing their teeth may be painful and result in bleeding, which may also make your cat less cooperative.
Grade II Periodontal Disease:
� This means that your cat has up to 25% bone loss around the tooth. While this is not always easy to see, if we see more significant gingivitis, or loss of gum tissue, we can presumptively diagnose grade II periodontal disease.
� A dental x-ray will confirm stage II periodontal disease, but this does require putting your cat under anesthesia to take.
� At this stage, we may still save your cat?s tooth with aggressive subgingival scaling under anesthesia, antibiotics, and home care to help prevent the progression of the disease.
Grade III Periodontal Disease:
� With grade III periodontal disease, your cat now has 25%-50% of bone loss around the tooth as a result of infection from the plaque that has migrated into the root area. We may also see root abscesses at this stage, which are extremely painful.
� If we can see more than 25% of your cat?s tooth root exposed, or if we see swelling or drainage indicating an abscess or infection deep in the tooth root, we can presumptively diagnose stage III periodontal disease, but it can be confirmed with dental x-rays.
� At this point, it is extremely hard to save the tooth, and it is best to just extract the tooth to eliminate the source of pain for your cat.
� Dental extractions do lengthen the amount of time that your cat is under anesthesia and therefore increase the cost. This is another reason why we recommend a dental cleaning in the earlier stages of periodontal disease..
Grade IV Periodontal Disease:
� Your cat now has greater than 50% bone loss around the tooth as a result of infection from the plaque. If all of the roots of the tooth are affected, then the tooth may also be loose.
� We will commonly see significant infection visibly oozing out from the roots at this point. We may also see bone swelling as a result of the infection migrating into the bone around the tooth, known as osteomyelitis. It is impossible to save the tooth at this point, it must be extracted to remove the source of pain and infection. Your cat will also need to be treated with long term antibiotics after we remove the affected teeth.
� It is common to see multiple teeth affected with grade IV periodontal disease.
� This stands for Feline Odontoclastic Resorptive Lesions. This is when a section of your cat?s tooth actually starts to dissolve. We see this most commonly at the gum line, but we can see it in other areas of the tooth as well.
� With FORLs, we will see what looks like a cavity or defect in the surface of your cat?s tooth. When these occur along the gum line, we will also see gum tissue that is red and inflamed growing up over the resorptive lesion as the body does its best to protect the diseased tooth.
� The roots of the tooth will start to dissolve as well, and turn into bone, which is only evident on a dental x-ray.
� No one knows for sure what causes these in cats, but diet, heredity and dental health are thought to play a part.
� If you have ever had a sensitive tooth, where you can feel the air on it, and hot and cold items are painful to it, that is what your cat is feeling with a FORL.
� There is no treatment for FORLs other than to remove the diseased tooth. If left untreated, eventually the tooth will dissolve completely, and the roots will resorb into the bone, but that can take several years to occur, and in the meantime, your cat has a painful tooth.
Based on what we found on your cat?s oral exam today, we recommend:
Brushing Teeth at Home / Tartar Treats or Diet / Dental Cleaning
Dental Cleaning with Possible Extractions / Dental Cleaning with Extractions
Cost varies widely, as we do not always know for sure the extent of your cat?s dental disease until we are able to look inside of your cat?s mouth under anesthesia. A rough guide (as of 2012) is approximately:
� Initial anesthesia including pain medications and premedicants: $150
� Teeth cleaning: $50
� IV fluids during surgery (required for extractions): $40
� Pre-surgical blood work (required for all cats over the age of 10): $65
� Extractions (includes anesthesia time): $75-$150 per tooth
� Post operative antibiotics and pain medications to go home: $10-$100
When you are looking at these cost estimates, please keep in mind that they are only estimates. Every cat is different in the extent of their dental disease, and the work required to remove diseased teeth. We recommend this procedure to eliminate your cat?s pain and discomfort, and to help prevent additional disease in the future.
If you have any questions regarding any of the above, please feel free to contact us at All Feline Hospital at 402-467-2711 or firstname.lastname@example.org.