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The Importance of Dental Health

Precautions During Dental Procedures Dental Websites

Torn Trachea

 

Introduction

Harpsie only ever had two dentals in his life but, being Harpsie, he developed potentially life-threatening complications following the second one. Nevertheless, I do not regret him having his dentals - toothache is horrible.

 

The Importance of Dental Health 

Recent research indicates that there may be a link between poor dental hygiene and other diseases. This is worrying, because the majority of cats do have some degree of periodontal disease - by the age of 12 months, as many as 70% of cats already have dental problems. Untreated periodontal disease in humans seems to affect the heart, whereas in cats it seems to affect the kidneys. This happens because the toxins from infected teeth and gums enter the cat's bloodstream and are filtered by the kidneys; the cat's body tries to build antibodies which may be left behind in the kidneys and which may eventually cause damage.  

 

In addition, of course, dental problems can be extremely painful! And since cats instinctively try to hide pain, your cat could be suffering chronic pain without you realising it. Cats are prone to a particular dental condition called Feline Odontoclastic Resorptive Lesions or FORL. This condition is so painful that even cats under anaesthesia may react when an affected tooth is touched, yet often it is completely undetectable to the casual observer.

 

So keep a close eye on your cat's mouth and seek your vet's advice if necessary; a course of antibiotics given at the right time might enable you to avoid worse problems developing. However, cats often have dental problems which are not detectable by visual inspection. Harpsie's veterinary dentist x-rayed Harpsie's teeth once he was under anaesthetic, and detected several problems that way that otherwise would not have been detected or treated.

 

FORL and other really bad teeth problems can only be treated under general anaesthetic: dental cleanings performed while the cat is awake are largely cosmetic. If your cat is to undergo a dental under anaesthesia, I would always ask for x-rays to be taken to check for FORL, so any affected teeth can be removed.

 

Aggie Animal Dental Service, owned by a veterinary dentist, explains why dental cleanings performed while a cat is awake are really only cosmetic.

Dental Vet explains commonly seen feline dental problems.

 

Precautions During Dental Procedures

Whilst it is important that dental problems be dealt with, dental procedures carried out under general anaesthesia are surgery, and problems are possible.

 

One of the main risks is that dental procedures may seem to trigger kidney problems, in that often a cat with periodontal disease who undergoes dental treatment under anaesthesia may develop renal failure (CRF) shortly afterwards. It cannot be proven that the CRF has been triggered by the dental procedure, and it is also quite possible that the anaesthetic played a role by reducing blood pressure to the kidneys; but there does seem to be a possible connection.

 

If your cat requires dental treatment of any kind, you should consider the following precautions:

  1. If you are in the UK or the USA, you may wish to have a veterinary dental specialist perform the dental work. Unfortunately, there are not many of these specialists around.  

  1. If your cat requires tooth removal or other dental work under anaesthesia, antibiotics should be given to the cat for several days in advance, and continued for 5-7 days afterwards. Harpsie's veterinary dentist and nephrologist both recommended clindamycin (Antirobe) prior to his dental because this is particularly good at killing anaerobic bacteria which are often found in the mouth. Mar Vista Vet has some information about clindamycin.

  2. Ask the vet to use an anaesthetic agent called isoflurane or another called sevoflurane - these are both gases, which put less strain on the cat's body than other types of anaesthetic, and they also enable the vet to stop the procedure and bring your cat round immediately if there are any problems during the surgery. This does not reduce the risk of anaesthesia completely, since another type of anaesthetic may be needed in order to induce unconsciousness (ask your vet about this if you can), but it may minimise it. Veterinary Anesthesia and Analgesia Support Group recommends a particular protocol for anaesthesia in renal patients, and has general information about anaesthesia.

  3. It is advisable to place any cat on IV fluids during and after any dental procedures in order to avoid falls in blood pressure during the procedure; such falls in blood pressure can reduce blood flow to the kidneys, which may lead to the kidneys failing a few days later. CRF cats should be placed on IV fluids before any dental procedures, as well as during and after them.

  4. Blood pressure should be monitored during any procedure, because the use of anaesthetics may reduce it. If your cat is on blood pressure medication, ask your vet if you need to stop the medication a couple of days before any treatment requiring anaesthesia.

  5. Clinical and microbiological effects of oral zinc ascorbate gel in cats (2001) Clarke DE Journal of Veterinary Dentistry 18 indicates that using zinc ascorbate gel as an oral antiseptic may improve dental health, particularly following a dental procedure.

Dental Websites

Cornell University College of Veterinary Medicine has a video showing how to brush your cat's teeth.

Medi-Vet sells cat-sized toothbrushes.

Nelson Animal Hospital has photographs of the different stages of oral disease and information on precautions during dental procedures.

Advances in feline dentistry is a paper presented by Dr TJ Klein to the 23rd Waltham/Ohio State University Symposium.

Dental Vet explains commonly seen feline dental problems.

American Veterinary Dental College explains why dental scaling performed without anaesthesia is only of cosmetic benefit.

Dr Milinda Lommer, a veterinary dentist, explains why cosmetic cleaning of the teeth is no substitute for a thorough medical cleaning.

Feline Advisory Bureau - an overview of feline mouth problems by the UK feline charity.

Feline Odontoclastic Resorptive Lesions (2003) is a presentation by Cecilia Gorrel to the 28th World Congress of the World Small Animal Veterinary Association.

Vet Dentistry discusses feline oral problems.

American Veterinary Medical Association has advice on dental care for cats.

Long Beach Animal Hospital has detailed information on dental procedures.

University of Illinois College of Veterinary Medicine has information on dental care  and what happens during dental procedures.

Veterinary Anesthesia and Analgesic Support Group provides information on anesthesia protocol, along with its protocol for anaesthesia in renal patients.

Long Beach Animal Hospital has detailed information on anaesthesia. 

 

Torn Trachea

 

A dental is a surgical procedure requiring anaesthetic, and there will always be risks associated with such procedures, no matter how careful you are. In the vast majority of cases, all will be well, but occasionally problems can arise, and Harpsie, being Harpsie, decided to be one such case.

 

Tuesday - Dental Day

Harpsie had a dental in September 2004, when he was 12.5 years old. He had not had one for six years, and badly needed one, but we had been too nervous to do one because of his various health issues. Eventually we decided we had to do this in case Harpsie was in pain - toothache is no joke. We took every possible precaution: Harpsie saw his nephrologist and cardiologist for evaluation beforehand, including bloodwork and ultrasounds, isofluorane was used, Harpsie was on IV fluids during and after the procedure, and he was on antibiotics before and after. I hate having my cats put under anaesthesia, but since Harpsie had to be under for the dental anyway, we decided to kill two birds with one stone and a tracheal wash was also performed whilst Harpsie was under for the dental to check for lung infections and asthma.

 

Harpsie had five teeth removed, including his two broken fangs. The dentist thought Harpsie had probably been in some pain but of course, being a cat, he didn't complain. He broke one of those fangs when he was a kitten, but it had not been removed during his previous dental six years earlier (or before then) because he didn't seem to be in any pain from it. I felt bad he had been in pain, and hoped he'll be a lot more comfortable now.

 

I was able to bring Harpsie home a few hours after surgery. When we arrived home, Harpsie wobbled into the kitchen and began inhaling dry food. This was good, but the vet had said he'd prefer Harpsie to eat wet food to start with. Harpsie didn't really like tinned food at this time, but he would sometimes eat Hill's a/d, so I opened a tin and he polished it off in a couple of hours. Inbetween eating, he rested with his head on the edge of his food bowl. He then sat on my husband's lap and purred, but he kept trying to rub his head on us, so I think perhaps the painkillers were wearing off. He began another bowl of a/d, and then he went to sleep in our bedroom in his basket with his a/d nearby.

 

Wednesday - Day 1 Post Surgery

The next day Harpsie didn't actually get up until 9.30, when I took him some fresh a/d. During the day he slept mostly, but would go into the kitchen and smell the food and take one bite, then stop. I think his mouth was hurting by now. I gave him his painkillers, which apparently can make a cat lethargic but he was acting this way before I gave him the painkillers. He did walk past Catdancer on his way to the kitchen and took a swipe at it, which cheered us up no end. But then he returned to just lying in his basket.

 

That evening he began to do massive pees and leak urine where he lay! I was very worried that he had a kidney infection again, but I didn't think he could take his usual Baytril because he was on Antirobe for his teeth.

 

Thursday - Day 2 Post Surgery

Fortunately, the next day Harpsie was peeing normally, so presumably the increased urination had been to do with all the IV fluids working their way through him. However, he was still mainly resting in his basket, apart from when he would go to the kitchen and half-heartedly try to eat. We had about eight bowls of food down and he would walk up to each, then walk away, though he did eat about a teaspoon of Fancy Feast. He also wasn't talking to me when I went up to him like he usually does. He wasn't bossing me about when he walked past me like he normally does either. Unfortunately, he began scratching his skin because the different foods were clearly triggering his food allergies.

 

Friday - Day 3 Post Surgery

On the Friday Harpsie was about the same. I spoke to the hospital, who said they should probably take a look at him, so off we went. It was not good news. He had to be hospitalised because he had a tear in his trachea! This may have been caused by the tracheal wash itself, though such tears may also be caused by the anaesthesia process. They said normally a tear like this is minor and heals quickly in a cat but Harpsie's  was not healing as it should.

 

With a torn trachea, air can leak out of the trachea into the cat's body. In severe cases, the air that has leaked out presses on the lungs from the outside and can stop the lungs from inflating. This can quickly become fatal, although I did not fully appreciate just how dangerous it was until I discussed it several months later with my UK vet. She told me Harpsie had been very lucky to survive.

 

Harpsie had to be admitted and monitored in the hospital in the ICU. A torn trachea is also very painful so they wanted to give him IV painkillers. Harpsie also had a galloping heart rhythm and his blood pressure was 180, which were both probably caused by pain and/or stress. This happened to be our wedding anniversary, and it was a thoroughly miserable one for both of us as we worried about Harpsie.

 

One of the fang sockets where a fang was removed also began to bleed while they were examining Harpsie, so they wanted to keep an eye on that too and make sure it didn't bleed again. Harpsie also had a slight fever.

 

Saturday - Day 4 Post Surgery

Harpsie was supposed to stay in hospital for two nights, but of course he refused to eat there. By Saturday afternoon his temperature had returned to normal, and his blood pressure was normal at 140. His bloodwork was also normal apart from one liver value (ALT) which was very slightly high (Harpsie's liver values were often a little off). His throat appeared to be improving, he did not react when they pressed on it, so they felt he was no longer really in pain from it. So Harpsie was allowed to come home on Saturday evening.

 

Harpsie was quite alert, and definitely pleased to be home. He purred a bit for us, and since he had been given an appetite stimulant at the hospital, he ate a reasonable amount.

 

Sunday - Day 5 Post Surgery

Harpsie refused his breakfast. We had been told that the air that had leaked out of his trachea inside his body was causing him to feel very full. They said this was going to gradually spread around his body and then hopefully slowly dissipate over a period of about a week. Basically, he was going to swell up and look like the Michelin Man and be not very comfortable, and there was nothing they could do about it.  I suspected he was already uncomfortable, because he would not eat and kept moving around.

 

We had been told that if Harpsie developed breathing difficulties, we had to take him back to hospital immediately. Fortunately, this did not happen, and in fact Harpsie did not swell up too much. He gradually returned more or less to his old self, until he had his epilepsy crisis about three weeks later - one vet told us there might be a correlation.

 

We were unlucky that Harpsie had problems following his dental, tracheal wash and anaesthesia, but lucky that he pulled through. It is natural for a cat to be a little subdued following anaesthesia, but if it lasts more than a couple of days, or if you see other worrying signs (like ongoing inappetance), do please take your cat back to the vet. Incidentally, Harpsie did have a bacterial infection in his lungs, but he also had asthma.

 

For some strange reason, following his dental Harpsie gradually switched from being a cat who are almost exclusively dry food to a cat who ate almost exclusively wet food.

 

 

 

 

 

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This page last updated: 11 February 2008

 

Links on this page last checked: 2 February 2008

 

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