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March 2019

My Cat has a dental cavity (resorptive lesion)?  What now?

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Many cats are prone to dental resorption lesions that may look similar to human cavities.  Unlike humans who develop cavities due to bacteria and acid eating away the enamel, the cause of these resorptive lesions in cats are unknown.  Many cats do not show any clinical signs with early resorptive lesions.  They do progress however, some at a faster rate than others.  As these lesions progress you may note salivation, mouth pain, gingival redness, tooth fractures, deformities or even missing teeth.  Some cats will ‘chatter’ when eating or the area of the lesion is even gently touched.  Monitoring early superficial lesions is acceptable as long as pain is not present with a thorough oral exam, dental cleaning, and radiographs to visualize the depth and extent of the lesion and the root.  Fluoride and restoration/fillings, like what is commonly used in humans, have been unsuccessful in preventing progression of these lesions.  The treatment of choice is extraction of the effected tooth.  Based on the radiographic appearance of the roots (sometimes they will also resorb or become part of the jaw) an extraction is planned.  If the roots are also resorbing, a crown amputation may be the preferred treatment.  This is when only the visible portion of the tooth is removed allowing preservation of the jaw structure.  If only the crown of the tooth is involved and the roots appear intact, a full extraction is recommended.  Your cat’s mouth will be much healthier and less painful in the long run with either a crown amputation or extraction when resorptive lesions are present.  Cats adapt very well to missing teeth and most continue to eat dry kibble with no problems.  Your cat’s mouth is healthier and much less painful when these resorptive lesions are managed appropriately with regular monitoring (physical exams), brushing of the teeth, professional cleanings, and extraction when necessary. 

OUCH – a tooth fracture?  Now what? 

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Even though tooth enamel is the hardest substance in the body, tooth fractures are all too common in dogs and cats.  They may not show any obvious signs of pain or infection and most continue to eat normally.  However, if left untreated they can result in chronic pain, infection, facial swelling/abscess, and tooth loss.  Dogs are more likely to fracture a carnassial tooth (upper fourth premolar or largest tooth in mouth) and cats a carnassial or a canine tooth but any tooth is susceptible.  Chewing on bones, rocks, plastic toys, or cage bars, and direct trauma from fighting, a fall, being hit by a car, and catching objects like frisbees are the most common causes of tooth fractures.  Uncomplicated fractures involve only the enamel and the tooth may or may not become diseased.  Complicated fractures occur when the pulp is exposed to the oral cavity.  This leads to pain and infection.  The exposed pulp chamber is a direct pathway for bacteria to gain access to the bone holding the tooth in place.

 Approximately two thirds of the tooth is under the gumline.  The entire tooth including the root, periodontal ligament, and surrounding bone are evaluated with a dental radiograph (xray).  Based on the findings, treatment options include surgical extraction, pulpotomy (partial root canal with capping) if a fresher lesion, or root canal therapy.  Tooth restoration or fillings are less successful in pets due to their indiscriminate chewing behavior.  The goal is to retain all teeth in the mouth.  Root canal therapy has a 95% success rate when done properly, however sometimes extraction is the best choice.  Extracting a tooth is a surgical procedure and may require splitting multiple roots and placing multiple absorbable sutures.  Most dogs and cats eat normal dry kibble a week or so after an extraction.  It is important to examine your pet’s teeth frequently since they rarely show signs of oral pain.  Any fractured tooth should be examined by your veterinarian, radiographed and treatment options discussed so that chronic pain and infection can be prevented. 

 

Pictures courtesy of DVM360 show fractured canines and carnassial teeth with pulp exposure.