CERTIFIED ORAL PAIN FREE #44-Treating Tooth Resorption-Root Resorption [TRRR] in the Cat~#44
Donald H DeForge, VMD
Fellow of the Academy of Veterinary Dentistry
Resorptive Lesions in Cats [FORL]
Tooth Resorption-Root Resorption [TRRR]
The Pain Hunt
Tooth Resorption and Root Resorption [TRRR] in the Cat
Comprehensive Oral Radiology Evaluation and Treatment [CORET]
The term Feline Odontoclastic-Osteoclastic Root Resorptive Lesion [FORL] has been commonly used to describe cavities/caries in cats.
A more acceptable term is ~
Tooth Resorption and Root Resorption-TRRR
No one knows the cause of TRRR in cats; the term cavities or caries in not utilized by animal dentists~~~Typical caries in dogs and people are actually passive inorganic demineralization of enamel which can be restored with advanced dental materials.
TRRR in cats occurs as an active progressive destruction of the dental tissues by clastic cells. These teeth cannot be restored because of their progressive nature.
A dental explorer with the patient awake should never be used to detect TRRR. If the explorer is inserted peri-pulp or intra-pulp, it can cause severe pain. This type of exam must only be performed under General Inhalation Anesthesia.
TRRR is one of the most under-reported; poorly understood; and non-diagnosed painful oral conditions in the cat. The affected teeth will become painful as soon as resorption results in pulp exposure.
General Out-Patient Oral Exams are important and can point to TRRR; only dental x-ray with the patient under General Inhalation Anesthesia after~~~ appropriate pre-anesthesia testing~~~ will definitively recognize all pathology.
Many cats with TRRR have sub-gingival [below the gum-line] pathology. that is why dental x-ray is so important.
Suspicious TRRR teeth may evidence~~ above the gum line~~ a loss of tooth structure [i.e. a concavity] where the crown of the tooth meets the root-i.e. Cemento-Enamel Junction-CEJ.
The gingiva-can be red, swollen, and ulcerated at these sites.
In some cats, the TRRR sites can be covered with calculus [i.e. tartar] in the crown of the tooth making them impossible to identify.
Dental x-rays are ESSENTIAL in any TRRR suspicious site. In cats with suspected TRRR, all teeth must be x-rayed while under general inhalation anesthesia.
Cats coming in for routine oral health treatment-i.e. cleaning- should have full mouth x-rays to eliminate occult TRRR that is below the gum-line
These lesions are painful and progressive!
Signs of ORAL PAIN in TRRR:
Not eating well
Avoiding dry food
Forcing the food into the back of the mouth to swallow
Disinterest in playing
Changed patterns of contact with the pet owner
Chewing on one side of the mouth
Withdrawal and Hiding
Wanted only soft table food and canned cat foods
Refusing Hard Cat Treats
Not all signs are present in all cats! You must take a step back and look carefully for any change in behavior that could be pain-centered in nature. Even if the signs of pain are not easily noticeable...... that does not mean that pain is not present!
See your LDVM for oral x-rays under general inhalation anesthesia if you are unsure!
Extraction of the affected teeth is the currently recommended treatment for a cat with advanced TRRR~~~
Variable stages of root resorption result in a high risk of root fracture during exodontia.
All cats with suspected TRRR must have pre- and post-exodontal dental X-ray!
Oral surgery techniques and principles are critical to avoid accidental fracture of the mandible or maxillary complications during tooth extraction!
If the General Veterinary Doctor [GVD] is not trained in advanced exodontal techniques, it is best to refer the patient to an animal dentist for care~~~
Root fractures with retention of apical fragments or non-removal of bone sequestra may result in persistent pain and/or osteomyelitis of the alveolar bone[socket]~~~
The Coronectomy Procedure [i.e. tooth recontouring-odontoplasty] can be used to treat TRRR. Coronectomy is never used on fractured teeth; in patients with apical periodontitis; and/or other significant root pathology. If this technique is utilized......... all patients must return in one year for follow up oral x-rays.
If the Coronectomy is not advised after dental x-ray, full tooth extraction [exodontia] is recommended!
If unsure if Coronectomy can be performed after oral radiology is completed, consult with an Animal Radiologist or an Animal Dentist for their expert opinion. [One such Telemedicine Radiology Consulting and Diagnostic Service is: E-VetDiagnostics.com]
Contact: Dr. Don DeForge