Dental Care

Unlike its human owner, the cat seldom develops cavities. Like its human owner, the most common and serious dental problem is periodontal disease. Periodontal disease is a disease of the supporting tissue of the teeth. It is the most common infectious disease of animals and man today. 85% of cats over the age of 3 years old are affected. Periodontal disease is progressive and irreversible by nature, and can lead to severe health problems including loss of appetite, generalized infections, kidney, liver or heart disease, and behavioral changes. The disease begins as a simple marginal gingivitis and progresses to periodontitis with bone loss and eventual loss of teeth. The process begins with the accumulation of plaque, which is a soft granular deposit, on the tooth surfaces. Thin layers are not visible. Plaque undergoes mineralization to form calculus (or tartar) which promotes gingivitis because it provides a rough surface for the accumulation of additional plaque. Bacteria thrive in plaque and on calculus formations and the normal bacterial flora of the mouth changes. Bad breath due to accumulation of pus, dying tissue, food debris, and bacteria may be the first noticeable symptom of periodontal disease. Periodontitis results from the inability of the body's immune system to fight the continual destructive forces of the oral bacterial toxins. The length of this process from mild gingivitis to periodontitis with bone and tooth loss depends on the cat's genetic capabilities, immune system, diet, environment, and most importantly, the owner's awareness of the problem, willingness to do home care, and initiative in obtaining professional veterinary care. Gingivitis is a reversible disease process with appropriate treatment. Periodontitis is usually a permanent condition due to bone loss, but can often be controlled if identified early. Severe periodontal disease is a painful condition for the cat. Remember, your cat cannot tell you he has a tooth ache. In most cases, he learns to tolerate the pain.

You have been advised that your cat needs to have his teeth cleaned. This is called a dental or oral prophylaxis. Dental hygiene is as important for your cat as it is for yourself. Imagine if you never brushed your teeth or had a periodic cleaning! Gingivitis and periodontal disease are the most commonly diagnosed disease processes in the otherwise healthy cat. If left untreated, the disease process progresses and causes pain and eventual loss of teeth. Uncontrolled periodontal disease can become systemic and predispose the cat to problems such as heart failure, liver and kidney disease, septicemia (bacterial infection of the blood), and behavioral changes.

Anesthesia is required to properly scale and polish the teeth. All cats should have a physical examination before anesthesia. We further recommend that cats 8 years and older have bloodwork before anesthesia to evaluate the kidney and liver function. If indicated, a thyroid level should also be checked. If there is severe gingivitis and/or stomatitis (inflammation of the tissues of the mouth), testing for Feline Leukemia (FeLV) and Feline Immunodeficiency Virus (FIV) is recommended.

The cat should have no food after midnight the night before the prophylaxis and be admitted to the hospital between 8-8:30AM the day of the procedure. Special arrangements can be made to drop off between 7:30 and 8:00AM. The cat will be given a sedative to allow the insertion of an endotracheal tube and will be maintained on an anesthetic gas. The tartar and plaque are removed with an ultrasonic scaler that produces vibrations that fracture the calculus and flushes it away with a water mist. Next the gum line and the tooth roots are examined and appropriate therapy is initiated. Our intent is to save as many teeth as possible; however, this is not always feasible depending on the condition of the individual tooth. Next the teeth are polished. This will smooth rough surfaces of the teeth and slow down the accumulation of new plaque and tartar. A fluoride treatment is recommended and is mandatory if cervical line lesions (holes in the enamel) are present. The cat will be released in the afternoon and his/her dental health, home care recommendations, and the need for further treatment will be discussed at that time.

This is a bactericidal adhesive gel containing ZincChlorhexidine. Formulated for aggressive plaque control and for active oral infections, this adhesive gel increases the contact time between the active ingredient chlorhexidine, and the oral tissues. This increased contact time is important when treating moderate to severe conditions. CHX Guard LA is recommended for initial treatment of moderate to severe gingivitis, active periodontitis, acute oral infections or active inflammatory conditions. The product is packaged in an easy to use "dial-a dose" syringe. The syringe is designed to be held below the pet’s field of vision. The syringe contains 32 numbered units. The dosage for cats is one unit for each side of the mouth. Initially, it should be applied once every 24 hours.

C.E.T. FORTE is a transparent gel with a highly effective abrasive system to aid in the removal of surface tooth staining and to smooth the enamel surface which will slow down the accumulation of plaque and tartar. Its dual enzyme system works with the saliva’s naturally occurring antimicrobial defense mechanism to inhibit the growth and acid production of plaque forming bacteria. All of this and a great seafood flavor! The C.E.T. FORTE Kit will help you introduce your cat to daily home dental care. The kit includes a booklet with the necessary steps to introduce your cat to dental care, C.E.T.FORTE gel, toothbrush, fingerbrush and cannula.

This diet has been designed to reduce accumulations of plaque, stain, and tartar. The food is designed so that it does not shatter when chewed. Its unique texture allows the tooth to penetrate it and "wipes" accumulations off of the tooth’s surface.

C.E.T. FORTE Chews combine the mechanical abrasive action of chewing freeze-dried fish with a dual-enzyme, antibacterial system. One treat a day is given. To initially encourage the cat to chew it, break it into several smaller pieces. Dental hygiene has never been easier!

This is an antibiotic that is highly effective against the common anaerobic bacteria found in the oral cavity. It comes in liquid and capsule forms. In severe cases of periodontal disease, it may be started 3-5 days prior to teeth cleaning and continued afterwards. The form may be more palatable if refrigerated.

degree	Gingivitis	Periodontitis	Inflammatory/Immune-mediated Oral Disease
Mild	1. Tooth brushing with C.E.T. FORTE daily 2.CHX Guard LA gel daily for 2 weeks 3. C.E.T. FORTE Chews 4. Prescription Diet t/d	1. Tooth brushing with C.E.T. FORTE daily; begin 5-7 days after prophylaxis 2.CHX Guard LA gel daily for 2 weeks; may begin 2-3 days before prophylaxis 3. C.E.T. FORTE Chews 4. Prescription Diet t/d 5. Antirobe Antibiotic; may begin 3-5 days before prophylaxis	1. Tooth brushing with C.E.T. FORTE daily 2.CHX Guard LA gel daily for 2 weeks 3. Antibiotic Therapy 4. Anti-inflammatory Therapy
Moderate	1. Tooth brushing with C.E.T. FORTE daily; Begin 5-7 days after prophylaxis 2.CHX Guard LA gel daily for 2 weeks; may begin 2-3 days before prophylaxis 3. C.E.T. FORTE Chews 4. Prescription Diet t/d 5. Antirobe Antibiotic; may begin 3-5 days before prophylaxis	1. Tooth brushing with C.E.T. FORTE daily; begin 5-7 days after prophylaxis 2.CHX Guard LA gel daily for 2 weeks; may begin 2-3 days before prophylaxis 3. C.E.T. FORTE Chews (if indicated) *4. Prescription Diet t/d* (if indicated) 5. Antirobe Antibiotic; may begin 3-5 days before prophylaxis**	1. Tooth brushing with C.E.T. FORTE daily 2.CHX Guard LA gel daily for 2 weeks 3. Antibiotic Therapy 4. Anti-inflammatory Therapy
Severe	1. Tooth brushing with C.E.T. FORTE daily; begin 10-14 days after prophylaxis 2.CHX Guard LA gel daily for 2 weeks; may begin 2-3 days before prophylaxis 3. C.E.T. FORTE Chews (if indicated) *4. Prescription Diet t/d* (if indicated) 5. Antirobe Antibiotic; may begin 3-5 days before prophylaxis**	1. Tooth brushing with C.E.T. FORTE daily; begin 5-7 days after prophylaxis 2.CHX Guard LA gel daily for 2 weeks; may begin 2-3 days before prophylaxis 3. Antirobe Antibiotic; may begin 3-5 days before prophylaxis	1.CHX Guard LA gel daily for 2 weeks 2. Antibiotic Therapy 3. Anti-inflammatory Therapy

Procedure	Topical Oral Care Product
Routine Prophylaxis (supragingival pathology only; no root surface treatment)	1. CHX Oral Cleansing Solution: lavage oral cavity of anesthetized patient immediately before, during, and immediately after prophy 2. See Dispensing Guide recommendations for Mild Periodontal Disease
Moderate Prophylaxis (Moderate subgingival pathology present; root surface treatment necessary; possible minor extractions)	1. CHX Oral Cleansing Solution: lavage oral cavity of anesthetized patient immediately before, during, and immediately after prophy 2. See Dispensing Guide recommendations for Moderate Periodontal Disease
Extensive Prophylaxis (extensive subgingival pathology present; root surface treatment necessary; possible major extractions)	1. CHX Oral Cleansing Solution: lavage oral cavity of anesthetized patient immediately before and during prophy 2. CHX LA: immediately after prophy, apply a thin bead to gingival margin 3. See Dispensing Guide recommendations for Severe Periodontal Disease
Minor Extractions	1. CHX Oral Cleansing Solution: generously lavage in and around the extraction site
Major Extractions	1. CHX Oral Cleansing Solution: generously lavage in and around the extraction site 2. CHX Guard LA: place gel in extraction site
Biopsy	1. CHX Oral Cleansing Solution: generously lavage biopsy site 2. CHX Guard LA: place gel in wound before closure
Soft Tissue Trauma	1. CHX Oral Cleansing Solution: generously lavage the involved soft tissues 2. CHX Guard LA: place gel in wound before closure