Bad Breath In Cats

Many cats suffer with not just bad breath, which can be a symptom of something more sinister lurking within the oral cavity, but all too often they are suffering from truly painful and debilitating dental and oral health diseases.

The top five most common dental and oral health conditions will be discussed more in depth in this article.

Periodontal disease

is the most common dental disease found in our companion animal pets. Left undetected and untreated, it can lead to significant pain and infection of the oral cavity and result in tooth loss, due to the destruction of the “house the tooth lives in”. The word, periodontal, literally refers to the structures surrounding the dentition or teeth, this includes both hard tissues like bone and soft tissues like the periodontal ligament and attached gingiva. When periodontal disease ensues both the cat’s immune system and bacterial toxins are in play causing inflammation. Chronic inflammation can cause destruction of the periodontium resulting in more advanced disease that becomes irreversible. Bacteria in the biofilm that accumulates on the teeth known as plaque bacteria is fairly harmless; however, without daily homecare such as teeth brushing, these bacteria invade below the free marginal gingiva or sulcus. Concurrently, minerals in the saliva of the patient combine with the plaque to form a harder substrate known as tartar or calculus. Calculus alone is not the enemy; however, it forms a larger surface area that is porous to allow bacteria in plaque to flourish. Eventually the bacteria along with the plaque will break through the barrier at the bottom of the normal sulcus, the junctional epithelium, and form sub-gingival calculus and plaque. When this occurs, the body mounts a larger defense against the invasion if the cat’s immune system is healthy. White blood cells come into the area between the bone and the soft tissue.1 In many cases the harmful bacteria can quickly overwhelm the body’s defense system when the numbers of bacteria are immense.1 White blood cells function by removing the bacteria; however, during this process chemicals excreted by the white blood cells can cause severe inflammation, which can lead to the destruction of bone and soft tissue, further worsening periodontal disease.1

It is very important that periodontal disease does not go undetected. The only way to truly assess the health of the oral cavity is to place the cat under general anesthesia, obtain full mouth dental radiographs and probe and chart the dentition and periodontal structures. This needs to happen early in the cat’s life due to the aggressive nature of periodontal disease and its onset prior to three years of age in many cats.1

Once periodontal disease has been diagnosed it can be categorized as either reversible or irreversible. Reversible disease is disease that has not yet caused destruction of the alveolar bone surrounding the teeth or the periodontal ligament. This disease is restricted to inflammation of the attached gingival tissues only, further defined as gingivitis.1,2 If the dental disease is discovered at this stage the teeth can be professionally scaled and polished on at least an annual basis and daily homecare can commence to ensure the plaque bacteria does not stay on the teeth long enough to invade below the gingival margin. Irreversible periodontal disease is often treated by extracting teeth in areas where the disease has progressed to a high percentage of loss of bone and periodontal ligament causing tooth mobility. Oral surgery to remove teeth will allow the soft tissue to heal and the disease in that particular area to have the best chance of resolving. However, extraction of teeth is not our goal, we would rather address this disease early and prevent it before it ever happens.

Tooth resorption

unfortunately is thought to affect a large percentage of cats, some studies sighting nearly 50% of cats, it may be up to 75% of cats that are older than five years of age.2 This condition is very painful and progressive with no known cause or prevention. Detection at an early stage is key. Outward signs for the observant veterinary professional are redness of the gingival tissues at the gingival margin focal to one or more teeth or missing teeth especially the third mandibular pre-molars. Tooth resorption is thought to originate in the cementum that covers the root’s surface, progressing into the dentin. It can affect just the root, crown or both root and crown. Treatment of this tooth destroying condition usually involves extraction of the teeth affected. Full mouth dental radiographs are required for further evaluation of the extent and type of the disease, this will help dictate the correct extraction method.

Tooth fractures

are not that uncommon in cats, especially of their canine teeth. Cats have a unique root canal that terminates very near to the tip of the tooth’s crown, thus even a very slight tip fracture is most likely categorized as a complicated crown fracture (CCF). Complicated crown fractures require root-canal therapy or extraction.1,2 Fractured teeth expose the sensitive nerve, blood and lymphatics inside the tooth to the oral cavity. Initially fractured teeth are very painful, inflammation ensues and leads to pulpitis, leading to the death and infection of the endodontic vital tissues of the tooth. Exploring the tip of the fractured crown and further obtaining full mouth dental radiographs will help to determine if the fracture involves the endodontic system of the tooth.1,2

Stomatitis

in cats can be severe and lead to anorexia and severe pain in the oral cavity. Thankfully, it is not as common as the other conditions we have discussed; however, it is very debilitating when it does occur. The main difference to note in stomatitis vs. periodontitis is the inflammation involves the oral mucosa and is not limited to the attached gingival tissues surrounding the teeth.1,2 The client may notice the cat is not eating well, especially food that requires chewing or oral manipulation, lack of normal grooming, appearing unkempt, running away from the food dish or water dish, drooling, vocalization when eating or food dropping out of the mouth. The cat’s immune system, invasive plaque bacteria and other factors which could include the viral status of the cat has been considered to be at play in this condition. Often full mouth extractions are the treatment of choice to create a plaque free mouth and to seek resolution to this exquisitely painful feline oral health disease.1,2

Feline juvenile onset gingivitis

affects young cats prior to the age of one shortly after the eruption of the adult dentition.3 Left unchecked this condition can proceed to more advanced stage referred to as juvenile onset periodontitis.3 Observations may include inflammation or bleeding of the attached gingiva, halitosis, proliferative gingiva or gingival enlargements that partially cover crown surfaces creating pseudopockets which harbor more plaque bacteria.3,4 Assessment and treatment involves early recognition in the exam room, anesthesia for full mouth dental radiographs, professional scaling and polishing and then continued homecare to decrease plaque on a daily basis as well as more frequent dental procedures under anesthesia to keep the teeth clean as the cat matures.

In more advanced cases of periodontal destruction, extraction of affected teeth may be necessary as well as in the case of gingival enlargement, gingivectomy may be necessary to reduce pseudopockets to prevent further periodontal disease from progressing.

By Benita Altier, LVT, VTS (Dentistry)
Pawsitive Dental Education