During our wellness appointments, we perform a full physical examination to ensure that the pet is healthy on that day to receive its vaccines.
On this particular day, just like any other, I am seeing a 9-year-old female spayed domestic short-haired cat who is also bordering the morbidly obese line, never really surprising. What did shock me was that her gums were so inflamed that the lower canine teeth have made indents into the gums on the upper canine teeth.
This is what I call classic for alveolar osteitis. This is also a severe case of it. You can see that the base of the tooth, where the gum and tooth meet, shows that the tooth is being extruded from the cat's mouth.
Here's a photo of Indi's teeth to compare. She's such a trooper, letting me use her as a model, since there are always treats involved. She has normal gum colour, and the gingiva at the base of the canine tooth is not bulging like our case today. She is also not missing any of her incisors, like our patient.
When I first started to see bulging of the gums of some cats, with no evidence of gingivitis, I would put a "watch" on that cat, because those cats are suspicious for having tooth root disease - disease that is below the gum line that we cannot see. Our computer system sets reminders, so I would set one for a dentistry in a month or two, just to check in on these cats. For the most part, these are painful, but we need to convince owners that this is the case.
In addition to the bulging and inflamed gums around the maxillary canines, our patient also has a proliferation of gingiva on the premolar behind the canine. This is a clinical presentation of a resorptive lesion. I suspect that this tooth will have a hole in it on radiographs.
This cat needs dental care. The inflammation and pressure from the remodeled bone is causing the canine teeth to be extruded from this cats mouth. Unfortunately, this is a condition that we do not know how to prevent, yet. We don't have a single causative agent, but it may have an auto-immune component where the immune system attacks the tooth structure. Since some of these cases are started well below the gum line, away from the bacteria in the mouth, that means it is of non-infectious cause. However, other cases may be due to oral bacteria. It may have something to do with Vitamin D and inflammatory cytokines involved in osteoclast activity. This can be difficult to explain to cat owners.
Very frustrating indeed. Thus far, the recommended treatment is extraction of the teeth.
So, I tell the owner, yes, your cat has gained weight since her last visit, we are going to need to cut back on the calories, and she has severe dental disease and should have dental extractions.
A common response to this is, "But she’s still eating. She must not be in pain."
Two-thirds of that canine tooth are below that gum line, and I am confident that the x-rays are going to show disease. At minimum, we should give her some pain control and give her the benefit of the doubt by putting our feet in her paws. I know from personal experience that cavities are extremely painful. Eating is survival, and most cats will continue to eat because they need to survive.
My job is to educate owners. I cannot force them to make decisions on their pet's care, I can only educate and provide options that are in the best interest of the patient. Veterinarians need to advocate for the welfare of the animals in their care, as it is in our veterinary oath to relief pain and suffering, including the pain associated with dental disease.