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 Congratulations to Zoe!
She's a beautiful kitty who came to us with a mouthful of troubles. Her first examination with Dr. Sappington revealed a painful secret she had been living with. Only months before her mouth had been checked at her previous veterinarian and it looked wonderful. In the time that followed she developed a large number of painful cat cavities-known as FORLs (Feline Oral Resorptive Leasons).
These are nothing like the cavities that we humans can suffer from, and are unique to cats. More than fifty percent of cats over three years old will be affected by tooth resorption. These tooth defects have also been called cavities, neck lesions, external or internal root resorptions or cervical line erosions. Teeth that are affected by these lesions will erode and eventually disappear when they are absorbed back into the cat's body. The root structure breaks down; then the enamel and most of the tooth becomes ruined, and bone replaces the tooth. This most commonly happens where the gum meets the tooth surface. Molars are most commonly affected; however, tooth resorptions can be found on any tooth. The reason for the resorption is unknown, but there are theories supporting the idea of an autoimmune response.
Cats affected with tooth resorption may show excessive salivation, bleeding in the mouth, or have difficulty eating. Tooth resorptions can be quite painful. But, a majority of affected cats do not show obvious clinical signs-making it hard for loving owners to know there's any kind of problem. Because they are so good at hiding their pain and discomfort, their owner might only notice small behavioral changes if anything; such as becoming more solitary and playing less. Most of the time, they are only detected during a comprehensive physical exam by a veterinarian. When a lesion is suspected, the Doctor might try touching it with a finger or cotton swab. When touching the lesion, it causes pain and even jaw spasms. Radiographs and a more thorough exam done under anesthesia are helpful in making definitive diagnosis and treatment planning.
There are five recognized stages of tooth resorption. Initially, in stage 1 only an enamel defect is noted. The lesion is usually minimally sensitive because it has not entered the dentin. In stage 2, the lesion penetrates enamel and dentin. When resorption progresses into the pulp chamber (nerve) stage 3 has occurred. In stage 4, large amounts of the tooth's hard structure have been destroyed. By the time stage 5 has occurred, most of the tooth has been resorped, leaving only a bump covered by gum tissue. Any time after stage 3, bacteria can enter the root canal and cause a root abscess; a source of more pain, infection, and inflammation. The picture below shows the progression of a lesion.
You can read about each stage in more detail at http://www.petsmile.org/owners/dental_disease/forls.html.
Sometimes these painful lesions affect more that just the teeth. In Zoe's case, her gums were severely inflamed. We were able to anesthetize her, take radiographs, and do a thorough oral examination.
We found 4 teeth with FORLs, and 2 more teeth that were so destroyed, only the roots remained. Dr. Forbes surgically extracted all of the affected teeth plus a few more that were likely to be next. In these severe cases, it?s not unusual to extract all of the molars and premolars as a preventative measure. At the rate Zoe?s teeth were being resorped, Dr. Forbes pulled 5 extra teeth to prevent Zoe from needing another surgery in a few months.
Zoe did very well for her surgery. She was given an antibiotic injection that lasted her for two weeks to prevent infection and help her mouth heal. (Also she didn't need to be given pills or liquid orally with her sore mouth!) She also had some pain medication to keep her comfortable. She recovered fully and is doing wonderfully at home. She is feeling so much better now. She is more social, running, rolling around and acting playful again. Sometimes we don't notice that these activities dissipate some over time because kitties are so good at hiding their pain. Often once we've resolved their problems they have an amazing transformation back to their normal happy self. We were so happy to be able to give Zoe her much needed relief!
Sources:
THE DENTAL CARE SERIES By Jan Bellows D.V.M. DipAVDC, All Pets Dental Clinic
Tooth Resporption: Stage 3 Photo courtesy of American Veterinary Dental College
http://www.petsmile.org/owners/dental_disease/forls.html.
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