The Hidden Disease That Can Affect 80% of Cats by Age 3

Analysis by Dr. Karen Shaw Becker

cat dental problems

Story at-a-glance -

  • Like us, cats get baby teeth which are replaced in year 1 by 30 adult permanent teeth meant to last for a lifetime
  • Unfortunately, the majority of cats by age 3 have gum disease that can cause pain, abscesses, infection, loose or lost teeth, and bone loss
  • Feline stomatitis is another oral condition cats acquire that is intensely painful; many kitties with the disease undergo a full mouth extraction to alleviate pain, allow them to eat comfortably again, and improve quality of life
  • Tooth resorption is another condition that afflicts cats and is actually the most common feline oral disease; like stomatitis, tooth resorption requires aggressive treatment to preserve cats’ health and quality of life

You may not realize it, but just like little humans, kittens get both baby teeth — called deciduous or milk teeth — and permanent adult teeth.

At 2 to 4 weeks of age, the first baby teeth — the small front teeth called incisors — begin to erupt from kitty's gums. The last to erupt are the premolars, which are the larger teeth towards the back of the mouth; they tend to appear at 5 to 6 weeks of age. In total, kittens end up with 26 baby teeth, including 12 incisors (6 upper, 6 lower), 4 canines (2 upper, 2 lower), and 10 premolars (6 upper, 4 lower).

Starting at around 4 months of age, a kitten's adult teeth will begin replacing his baby teeth. One of the reasons many people don't realize cats get two sets of teeth is because those tiny milk teeth tend to disappear into the environment after they fall out at mealtime, or during play or grooming activities.

Well before kitty turns a year old, his baby teeth will have been replaced with 30 adult teeth, which includes all those listed above, plus 2 upper and 2 lower molars. Those 30 teeth are intended to serve your cat for the rest of his life, which is why it's so important to get kittens used to having their teeth brushed and undergoing regular veterinary dental exams.

Gum Disease Is Underway in Most Cats by Age 3

When it comes to your kitty's oral health, seeing is not believing. In fact, unless you've been brushing those tiny teeth regularly, chances are you've not actually seen deep inside your cat's mouth. Kitties who've been taught to tolerate human hands in and around their mouths will often put up with visual inspections, but as a general rule, they don't appreciate bodily "invasions" of this sort.

That said, even if your cat lets you peek and poke around in her mouth, if she has oral disease, it's often occurring below the gum line, hidden from view. Bacteria that can't be seen with the naked eye can damage the tissues connecting the teeth and jaw.

Astonishingly, 70% to 80% percent of cats have gum (periodontal) disease by the age of 3. There are also a couple of other odd, but serious feline dental conditions you should be aware of, which I'll discuss as well.

Feline Periodontal Disease

Plaque that collects on your kitty's teeth hardens into tartar within a few days. Tartar sticks to the teeth and begins to irritate the gums. Irritated gums then progress to the inflammatory condition called gingivitis. Cats with gingivitis have red rather than pink gums, and they often also have unpleasant breath. Other signs of gum disease can include:

  • Difficulty eating or chewing on only one side of the mouth
  • Lack of appetite
  • Drooling
  • Mild swelling of the face
  • Bleeding from the mouth and/or nose

Another sign of oral disease in kitties is lack of grooming, resulting in a dull or greasy or matted coat.

If the tartar on your cat's teeth isn't removed, it accumulates under the gums, eventually causing them to pull away from the teeth. This creates small pockets in the gum tissue that trap additional bacteria in the mouth.

At this stage, your kitty is dealing with an irreversible condition called periodontal disease, which not only causes significant pain, but can also result in abscesses, infections, loose or missing teeth, and bone loss. How quickly this process takes place depends on several factors, including your cat's age, overall health, diet, breed, genetics, and the frequency and quality of dental care she receives.

What many pet parents don't realize is their cat's oral health can affect more than just her mouth. There's an established link between gum disease and heart disease in humans and dogs (studies on cats are scarce, but it's reasonable to assume a similar link exists for felines).

Researchers also suspect certain strains of oral bacteria may lead to heart problems. Some types of bacteria found in the mouth produce sticky proteins that can adhere to artery walls, causing them to thicken. Mouth bacteria are also known to promote the formation of blood clots that can damage the heart.

Three of the most effective ways to maintain your cat's dental and gum health is through daily brushing, feeding the right diet, and regular veterinary wellness checkups that include a dental exam.

Feline Stomatitis

Feline stomatitis (FS) is a chronic, serious, and very painful oral condition that occurs in cats. Stomatitis-related inflammation appears in the mouth as angry red swollen tissue. It can be localized, but it usually involves the whole mouth and often the back of the throat. The underlying bone in the mouth can also become inflamed or infected.

The condition starts as gum disease (gingivitis), which appears as redness at the gum line. Often the entire gum becomes red and inflamed, but it starts with a red ring around the teeth, usually at the premolars and molars. You may not see any plaque or tartar on the teeth, yet the gum is an angry red, especially at the junc­tion of the tooth and gum.

Stomatitis causes such intense pain that it can destroy a kitty's quality of life. If your cat has the condition, you might notice behaviors such as difficulty eating, depression, irritability, aggression, or hiding. Excessive drooling is also a common symptom, along with gums that bleed easily.

Thankfully, there's been some recent progress in understanding more about this terrible disease and even better, there may be a way to completely resolve the pain and inflammation it causes through a procedure called guided bone regeneration.

The bad news is that not every cat will be a good candidate for the procedure and in addition, most cases of feline stomatitis are diagnosed very late in the game, when kitty's breath has become unbearable or she's not eating well. By this time, the whole mouth is typically swollen. There can also be ulcerations on the roof of the mouth, the tongue, the lips and throat.

The most important thing to remember about a cat with stomatitis is that she's in a tremendous amount of pain all the time. A kitty in that much pain, for that long, who isn't eating well, is in serious danger. This is the point at which full-mouth tooth extraction is usually discussed. It's an aggres­sive approach, but FS is an aggressive disease, and when things have progressed to a point where kitty is no longer eating, it's a life-threatening situation.

The good news is that many cats (between 50% and 60%, according to estimates) who undergo full mouth extractions experience dramatic relief and have significantly improved quality of life after their teeth are removed.

To avoid chronic complications from full mouth extractions, I believe it's best to work with a board-certified veterinary dentist. Digital X-rays should be taken after extraction to make sure all of the tooth roots have been successfully removed. Pain manage­ment must be instituted and maintained until post-surgical discomfort is resolved and healing has occurred.

You can read more about the guided bone regeneration procedure, as well as my recommendations for medical and lifestyle management for cases of mild stomatitis, here.

Tooth Resorption

Many cats with stomatitis also have tooth resorption, which is the most common feline oral disease. Estimates are that about 30 to 40 percent of healthy adult cats, and from 60 to 80 percent of kitties who visit the veterinarian for treatment of dental disease have the condition.

The exact cause of resorptive lesions is unknown. It is thought that perhaps the inflammation caused by plaque stimulates odontoclast cells that erode tooth enamel. Other possible causes include autoimmune disease, viral infections, a problem with calcium metabolism, or changes in pH in the mouth.1

Tooth resorption is the gradual destruction of a tooth or teeth caused by cells called odontoclasts. The process usually starts on the outside of a tooth at the gum line and is most common in premolars in the lower jaw but can occur in any tooth.

If the resorption is obvious, it can look as if gum tissue has grown over or into the tooth. It can also appear as if there's a hole in the tooth, which is why the condition is sometimes mistakenly thought to be a cavity. Less visible resorptions are found using magnification devices and lighting in an anesthetized pet. Resorptions under the gum line are diagnosed through dental x-rays.

Tooth resorption is a painful condition; however, many pets show no obvious signs of discomfort unless and until a lesion is actually touched. Sometimes an affected kitty will drool excessively, bleed from the mouth, have difficulty eating, or muscle spasms or trembling of the jaw. Occasionally there can also be vomiting of unchewed food, behavior changes and bad breath.

Dental x-rays are the first step in treating patients with tooth resorption. They're critically important to visualize lesions under the gum line and fractured tooth fragments, as well as to help determine the best treatment approach.

Complete extraction of the tooth undergoing resorption, all fragments, and all root structure is the recommended treatment for the condition unless the resorption has reached stage 5 and all inflammation has resolved. However, extraction can be a tricky procedure to perform because affected teeth are usually quite fragile and often fracture and splinter during removal.

Not every veterinary practice is equipped to deal with tooth resorptions. Dental x-ray and adequate surgical magnification equipment are necessary, as is proper training. If your pet is diagnosed with tooth resorption, you should ensure your vet's office is properly equipped and staffed to treat the disease. If not, you should request a referral to a specialist.

Please see Is Your Pet Undergoing This Painful Tooth Remodeling Process? for more information on tooth resorption, including prevention tips.