General anesthesia is essential for a proper tooth-by-tooth evaluation. There is a wide array of safe and effective anesthetics and monitoring equipment that make anesthesia as safe as possible.

Once the cat is under general anesthesia, the dental cleaning procedure begins. The first steps are charting – the teeth are examined for the presence of any loose or fractured teeth, visible tooth resorption, root exposure, periodontal disease, and gingivitis/gingival recession. Then scaling is performed, scaling involves removing the tartar both above and below the gum line, on both the inside and the outside of the teeth. This is done with ultrasonic cleaning equipment and with hand instruments. The last step involves polishing, which smoothes the surfaces of the teeth (inside and outside), making them resistant to additional plaque formation.

Intra-oral x-rays are taken with every dental procedure. This is because it is common for cats to have more than one resorptive area, and oftentimes, the resorptive pathology is below the gum line. This means the only way to diagnose it is by taking an image of the tooth root. Diseased, non-salvageable teeth are extracted. For most teeth, extraction involves the surgical creation of a “gingival flap” (allowing better access to the tooth root, and allowing to more easily suture the tooth socket closed). Prior to any extraction, local or regional analgesia (pain) blocks are performed. When the procedure is completed, the cat is moved to a post-surgical area to recover from the anesthesia.

It is important to note that often there are no obvious signs of dental disease. Most cats who have dental disease still eat without a noticeable change in appetite. Signs of dental pathology can include bad breath, dropping food or chewing only on one side of the mouth, facial swellings or draining wounds, bleeding or discharge from the mouth or nose, sneezing, pawing at the mouth, tooth grinding, or discoloured teeth.

The breed of the cat also can be a factor in dental disease. Some breeds, including Abyssinians, oriental breeds, and Persians, are more susceptible to dental disease than other breeds. Very short-nosed breeds, invariably have abnormally positioned teeth. Their jawbones are often too small to accommodate the teeth, resulting in overcrowding and misalignment of teeth.

More than half of the 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 affected by lesions will erode and finally disappear when they are absorbed back into the cat’s body. The root structure breaks down; then the enamel and most of the tooth become 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 theories supporting an autoimmune response have been proposed.

Cats affected with tooth resorption may show excessive salivation, bleeding in the mouth, or have difficulty eating. Tooth resorptions can be quite painful. A majority of affected cats do not show obvious clinical signs. Most times, it is up to the clinician to diagnose the lesions upon oral examination. Diagnostic aids include a probe or cotton-tipped applicator applied to the suspected resorption; when the probe touches the lesion, it causes pain and jaw spasms. Radiographs are helpful in making a definitive diagnosis.