Ask These 13 Questions Before You Schedule Your Cat’s Dental Procedure

dental-procedure

Guest post by Andrea Tasi, VMD

Editor’s note: Andrea Tasi, VMD, who is our wonderful vet, owns and operates Just Cats, Naturally, a housecall based, feline-exclusive practice dedicated to the holistic, individualized approach to each cat. Dr. Tasi uses classical homeopathy, nutritional therapy, and behavior/environment-related techniques to help healthy cats stay well and help ill cats regain their health. Whenever one of Dr. Tasi’s feline clients needs any kind of dental work, even just a routine cleaning, she makes sure that her clients as these questions before scheduling a procedure.

1. Is the veterinarian who will perform the procedure experienced in cat dentistry, including anesthesia, dental extractions, and dental x-rays?

Obviously, the more experience the doctor has, the more likely that s/he has better dentistry skills. Cats are NOT small dogs!!

2. What pre-dental lab work, if any, is required in a younger cat?

For cats under 7 years of age, a CBC (complete blood count) and “mini” serum chemistry is a reasonable data base. FeLV/FIV testing, if status is unknown or if the cat goes outside, may also be required.

3. What lab work is required in older cats?

I strongly suggest, and most veterinarians agree, with running more complete screening on older cats, especially those over 10-12 years of age. I suggest a CBC, serum chemistry panel, T4 (thyroid level), and a urinalysis. I do not use or recommend a type of test called a “Free T4” as it has very little diagnostic value in most cats, although some clinicians feel otherwise. FeLV/FIV testing, if status is unknown, or if the cat goes outside, may also be required.

4. Does the clinic have the ability to take dental radiographs (x-rays)?

I am convinced that the availability of dental x-rays is an important component of high quality dental work in cats. Cats frequently develop a type of tooth decay called “tooth resorptive disease of felines” (TRDF) that often begins below the gumline. The cause of these lesions is not completely understood. Without x-rays these can be missed, resulting in leaving teeth in the mouth that will often “go bad” very soon and require another procedure to extract. One cannot fill these cavity-like lesions; once they have advanced to a certain stage the tooth needs to be extracted. X-rays also help to document whether an extraction is complete or not: leaving fragments behind may sometimes (but not always) cause problems. If any of the canine (fang) teeth need extracting, it is especially important that no root be left behind. Lastly, dental x-rays are useful to evaluate structural integrity of the jawbones, especially important to rule out cancers and prevent injury (breakage) of the jaw during extractions.

5. What type of dental equipment does the clinic have?

“High speed” dental equipment is essential for dental work that involves extractions.

6. What type of anesthesia will be used?

The safest anesthetic protocols involve “induction” (getting the patient “to sleep” initially) with some injectable form of anesthetic drug(s) and then “maintenance” with an inhaled gas form of anesthesia, typically isoflorane. Some veterinarians routinely “gas down” cats, in other words administer only gas anesthesia, via a mask or chamber, as they feel it is “safer”. I strongly object to doing this, as it is very stressful for the cat and, more importantly, gas anesthesia is much more likely to cause low blood pressure than correct use of injectable induction drugs. I suggest avoiding the following anesthetic drugs whenever possible, as safer alternatives are available: xylazine, domitor, telazol. I am also not so fond of ketamine, but if used in low doses in an appropriate combination with other drugs it can be used safely.

7. Will my cat be intubated during dental work?

Placement of a properly sized endotracheal tube is essential for protecting the cat’s airway and lungs from aspiration and for delivery of anesthetic gas.

8. How will my cat be kept warm during and after the procedure?

Small animals lose body heat quickly, especially under anesthesia. Cats should be kept warm by circulating warm water or warm air beds, NEVER BY ELECTRIC HEATING PADS WHICH CAN CAUSE SEVERE BURNS. The cat should also be protected from getting wet during the dental procedure by some sort of water-resistant covering.

9. How will the cat be monitored during anesthesia and who will be doing the monitoring?

The key to minimizing risks during general anesthesia is careful monitoring of the patient. The veterinarian should work with a veterinary technician experienced in monitoring patients under anesthesia. MONITORING BLOOD PRESSURE (preferably with an instrument called a Doppler) IS ABSOLUTELY ESSENTIAL. There is no way I would ever anesthetize any of my own cats without monitoring their blood pressure accurately, and there is no way to assess blood pressure without a blood pressure monitor. If blood pressure drops below 60mm Hg, blood flow to the kidneys is compromised and can cause death of kidney cells. The cat may “wake up” and “look fine” but will have permanent damage to the most age-sensitive part of their body. In addition to monitoring blood pressure, it is also important to monitor body temperature, heart rate and rhythm, and ideally blood oxygen levels (pulse oximetry and/ or capnography).

10. Will my cat have an intravenous catheter placed?

Any cat under anesthesia should have an IV catheter in place to administer IV fluids or any drugs necessary should there be a drop in blood pressure or other problem. If there is no IV catheter in place, valuable time will be lost trying to “find a vein” to give an injection if an emergency arises. The cat should receive IV fluids during the procedure.

11. If my cat needs extractions, or anything else that may cause pain, what type of pain management will be used?

There have been great advances in veterinary pain management in recent years; however, I think some pain drugs are potentially dangerous to cats, especially older cats. I suggest avoiding all NSAID’s (non-steroidal-anti-inflammatory drugs) in cats over 7-8 years of age, because of the potential for kidney damage. If NSAID drugs are used, they should not be administered while the cat is under anesthesia as this increases the risk of kidney damage. Buprenorphine (Buprenex) is my favorite pain drug for cats. Local anesthetic injected into the areas of extractions (before the extraction is performed) is very helpful in minimizing pain on recovery from anesthesia.

12. How long will my cat have to stay at the clinic?

Cats become stressed away from home, so every effort should be made to minimize time in the clinic, but not to the degree that patient safety is compromised. Once a cat is up and awake from anesthesia (coordinated enough to move about without falling), they should be discharged as soon as possible, unless there is some other problem that they are being monitored for.

13. What follow up care will be necessary?

Sometimes, antibiotics are prescribed after dental work, but not always. When extractions are performed it is never a bad idea to recheck the mouth in 2-3 weeks to make sure healing is complete. We cannot rely on the cats to show us if there are problems in their mouths. Home care for cats can be tough, as they do not generally “like” having their teeth brushed. With patience, some cats will tolerate home brushing.

Unless a cat is completely unable to tolerate being handled safely at the vet clinic, a cat should never be vaccinated the same day it undergoes an anesthetic procedure, such as a dental cleaning. Asking a cat’s immune system to handle the challenges of anesthesia, teeth cleaning, and immunization all at the same time is asking too much, in my opinion. Vaccination should be separated from anesthesia by at least 3 weeks.

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30 Comments on Ask These 13 Questions Before You Schedule Your Cat’s Dental Procedure

  1. Vitalah Simon
    September 15, 2017 at 3:23 pm (2 months ago)

    Are there feline dentists who will operate on a cat WITHOUT the cat having a rabies vaccine?

    Reply
    • Ingrid
      September 18, 2017 at 5:56 am (2 months ago)

      Each practice will have their own rules, so you’d have to contact them individually.

      Reply
  2. Oz
    August 2, 2017 at 3:25 pm (4 months ago)

    This was a great read and perfect timing! Thank you 🙂

    Our little (3.5kg) 3 year old tortoiseshell Alice has had a rough time with her digestion since we adopted her from Cats Protection.

    She is on probiotics at the moment but this last weeks vet visit has revealed some really red areas on her gums with build up of plaque .
    The vet told us that once her tummy is better she needs to undergo this treatment.
    We are happy for her to go under if this is going to help her, but my question is” how do we find the underlying reason and start prevention ?”
    She is on wet only diet now as kibble made her eat tunnes of grass and be sick each time.
    Do you think the acid from the stomach could be affecting her oral Heath ? Due to vomiting so much in the past ?

    What can one do , other than home brushing , to keep their cats tooth decay and gum disease free?

    Thank you,
    Oz

    Reply
    • Ingrid
      August 2, 2017 at 4:12 pm (4 months ago)

      Brushing is the best way to prevent dental disease. A wet canned or raw diet should help with her GI issues. Of course, genetics also play a part.

      Reply
  3. Dr Patti Pillsbury
    August 2, 2017 at 1:25 pm (4 months ago)

    Great advice Dr Ingrid! That’s exactly what we do at my practice in Michigan. I cringe when I hear of details being done without digital x-ray

    Dr Patti

    Reply
    • Dr Patti Pillsbury
      August 2, 2017 at 1:26 pm (4 months ago)

      * dentals, darn autocorrect!

      Reply
    • Ingrid
      August 2, 2017 at 4:23 pm (4 months ago)

      I’m not a doctor, Dr. Patti, this advice comes from Dr. Tasi. I really wish that one of the major veterinary organizations would put out a statement that performing dental care without the availability of dental x-rays is considered sub-standard care.

      Reply
  4. Ann
    July 31, 2017 at 1:10 pm (4 months ago)

    Thanks so much for this list! Before I spend the $1K+ on dental cleaning & extractions on my 11 year old former rescue, I want to make sure that my current vet has the most up to date equipment & protocol. The question in one of the Comments about a pre-op thoracic X-ray struck a nerve with me. If another vet had done that for my poor 8-year old rescue a number of years ago, they would have discovered the massive lymphoma that killed her 3 months later.

    Reply
    • Ingrid
      July 31, 2017 at 4:31 pm (4 months ago)

      I’m so glad this list came at the right time for you, Ann. All my best to your kitty!

      Reply
  5. Karen
    June 11, 2017 at 5:30 am (5 months ago)

    I have two 8 year old cats who are biological siblings. They both had a dental cleaning last week and my vet sent me home with an antibiotic for both of them. My girl had moderate plaque buildup and did well with her cleaning, but my boy’s teeth had much more buildup and ended up needing a single tooth extraction. I’m not 100% sure which tooth it was but I saw it afterwards and it was really small. Both cats got an antibiotic injection at the vet before I took them home, and I’ve now given them 3 days of their at home antibiotic, but the liquid tastes horrible and I’m having one hell of a time trying to get them to sit still and take it. First day I did ok, second day was more challenging, and today (third day) they knew what was coming and really fought me over it. When it comes time to give their antibiotic tomorrow, I know this is going to be even harder. Is 3 days enough? I was hoping to try to mix it into some food, but my vet said since it tastes so bad they probably won’t eat the food with it in there. I don’t want any infections, but I also don’t want to stress out my cats if it’s not necessary. They’re both still having some re-introduction issues as it is and I’ve had to keep them separated since they’ve forgotten they used to live each other, so the added trauma of forcing this dropper full of aweful liquid is probably not helping on the stress front, at least it isn’t for me! Would the antibiotics be effective with only a 3 day dose? Any advice would be appreciated.

    Reply
    • Ingrid
      June 11, 2017 at 5:42 am (5 months ago)

      That’s a lot of stress you’re dealing with, between the non-recognition issues and trying to medicate them, Karen! It’s usually not a good idea to stop a course of antibiotics before its completion, but check with your vet. It really depends on the type of drug your cats got by injection, and the type of drug they were sent home with. It’s also possible to get the medication compounded into a tuna or meat flavored liquid.

      Reply
  6. Scarlett
    March 2, 2017 at 8:27 pm (9 months ago)

    Thank you for this helpful article. What do you think about elderly cats with dental disease? My cat is 18 years old and my parents never got her teeth cleaned, it certainly wasn’t the done thing as I was growing up. She has been in my care only 2 years and now that I am aware of how bad dental disease effects them I want to do something about it. She is 18 with kidney disease so I am highly concerned about putting her under and if she will wake up at all, not to mention if she will recover from tooth extractions. She also vomits from pain medication.
    She still eats plenty, her food is wet and soft or I mix water with her kibble so it’s soft aswell.
    I know over the counter teeth cleaners do pretty much nothing but I still put some in her water.
    Could keeping her on antibiotics be a viable option instead of putting her under or do I really have no choice?

    Reply
    • Ingrid
      March 3, 2017 at 6:19 am (9 months ago)

      I would discuss this with your vet, or ideally, a veterinary dentist, Scarlett. Anesthesia can be tailored to be safe even for elderly cats wit health issues, but even if it’s not an option for Scarlett, a specialist should be able to advise you about whether antibiotics and perhaps a different pain medication may help her.

      Reply
  7. L maddux
    February 20, 2017 at 3:03 pm (9 months ago)

    you say avoid telazol which I know has ketamine in it , I asked my vet not to use it but he said it was safe? I have a 10-year-old Manx & a 6-year-old jungle-bob ( that’s jungle cat & pixie bob,and also an a 4-year-old f1 savannah , what I’m asking is if they where your cats what would you use on them? you can e-mail private if you like. how long should it take to wake up? the last time he used the telazol on the f1 savannah ( they call the f1 a serval ) it was out for a good 20 hours i know because they are afraid of her so they send her home still a sleep. thank you

    Reply
    • Ingrid
      February 20, 2017 at 4:49 pm (9 months ago)

      I would not use it for my cats. I would also consider finding a vet who is comfortable working with F1 Savannahs. Sending a cat who has not woken up from anesthesia home is asking for trouble.

      Reply
  8. Deb
    February 20, 2017 at 9:15 am (9 months ago)

    Very important article. We adopted Mom’s 2 cats, siblings, and they had very bad teeth/gums. They did undergo this procedure and we noticed a marked change in their playfulness. Yes, cats rarely “admit” to being in pain, I suppose a survival instinct. It is certainly not an inexpensive procedure, but if the kitties have bad teeth and gums, it can absolutely affect their overall health, just like in humans.

    Reply
    • Ingrid
      February 20, 2017 at 11:17 am (9 months ago)

      It is amazing how much of a difference in behavior you can see after a cat’s dental issues have been addressed.

      Reply
  9. Maureen
    January 10, 2017 at 6:49 pm (10 months ago)

    Great info, thanks. Do you think older cats also require a thoracic xray to screen for anesthesia vulnerabilities? Does this screening make a big difference predicting problems? Thanks.

    Reply
  10. Braden Bills
    October 31, 2016 at 9:19 am (1 year ago)

    I want to make sure that my cat’s teeth get taken care of. It makes sense that I would want to understand what the doctor plans to do! It’s interesting that they often use anesthesia. It makes sense that they would have a hard time getting them to cooperate otherwise!

    Reply
  11. Tami
    August 4, 2016 at 4:42 pm (1 year ago)

    Very helpful information
    You never think of all the right questions to ask then presented with the your cat’s need for dental extraction. I am very happy with my vet and will ask these questions so I can be very comfortable with my decisions.
    Thank You

    Reply
  12. Mahshtay
    July 7, 2016 at 2:06 pm (1 year ago)

    Thank you so much for this post. At his recent check up, I was told my cat had a tooth resorption and needed an extraction. Rather than schedule something immediately, I started doing research. I called several other vets and asked all the questions you have here (plus a few others). Turns out everyone’s prices are about the same ($1300!!) for the full procedure. I’m going to stay with my original vet because they have the best equipment and are willing to accommodate all my requests like not wanting to use Convenia. Our appointment is scheduled for next week. I’m still nervous about it but feel I’ve done all I can do to prepare. Thanks again for your info, it’s been a big help.

    Reply
    • Ingrid
      July 8, 2016 at 5:44 am (1 year ago)

      I’m so glad this helped. I know it’s impossible to not be nervous! All my best to you and your cat.

      Reply
  13. Kelley
    September 20, 2015 at 2:09 am (2 years ago)

    No veterinarian I have ever had has done dental xays. I guess I will have to ask for a referral for dentals.

    Reply
  14. Patty
    September 15, 2015 at 4:32 pm (2 years ago)

    Excellent & important post. I adopted a 5-year old retired Ragdoll queen a few years ago. I had a dental cleaning done with her first visit to my cats’ only vet. Initially she appeared to have some pocketing and the normal accumulation of tartar. X-rays revealed extensive bone loss and infection under her lower molars & pre-molars & she ended up having them removed. The procedure included a 2-week follow-up to check for proper healing & revealed that she had such an unusually close bite that her top teeth were now digging into her lower gums. We waited another two weeks and there was no improvement. She was so uncomfortable she started to become nippy with me.

    When the vet held her mouth open for me I almost cried because it looked so raw. I proceeded to have her upper molars & pre-molars removed. As a pre-cautionary measure we decided to remove her canines to eliminate the need for any further surgery, leaving only her little upper & lower incisors.

    I received pre & post x-rays from the vet. Her pain protocols included an extended release buprenorphine injection & a 3-day course of Onsior tablets which I crushed into her food. She did really well after the surgeries & it has not changed her eating habits or appearance at all. The best part, though, is I now have a different cat! The nipping stopped and she transformed from the rather edgy diva with a short fuse I had adopted into a calm and loving sweetheart. I now believe that she was already suffering from some dental pain when she came to me. A vet tech told me she had an identical experience with her Persian rescue who had to have all her teeth removed for a different issue.

    Moral of the story: Use a vet experienced with cat dentistry who uses pre & post x-rays as part of the dentistry protocol and includes a follow-up visit to verify proper healing after surgery. Ask what anesthesia & pain protocols will
    be followed. And never rule out dental disease & pain as a cause of negative behavior changes.

    Reply
    • Ingrid
      September 15, 2015 at 5:19 pm (2 years ago)

      Thank you for sharing your experience, Patty. It is remarkable how much pain can change behavior.

      Reply
  15. Elizabeth
    September 14, 2015 at 10:41 am (2 years ago)

    Thanks for this article, it came just in time because 1 of my boys has tooth resorption and needs an extraction.

    Reply
  16. Fur Everywhere
    September 14, 2015 at 10:23 am (2 years ago)

    Thank you so much for sharing this guest post , Ingrid. I will definitely be asking more questions the next time one of my kitties needs a dental procedure. I do know that our vet takes x-rays and that she uses bupenorphine for after-surgery pain, but I’m unsure of what type of anesthesia she uses, and I would definitely like to know that! I’ll bookmark this so I can refer to it later.

    Reply
  17. Elizabeth Colleran
    September 14, 2015 at 7:23 am (2 years ago)

    As a feline specialist, I am always relieved to read a comprehensive explanation of what every cat owner (and veterinarian) should know. I would add that digital radiographs are preferable as they are more detailed and faster to perform, shortening anesthesia time.

    Reply
    • Ingrid
      September 14, 2015 at 5:09 pm (2 years ago)

      I agree, Elizabeth. Anything that can help reduce anesthesia time is a good thing!

      Reply
  18. Summer
    September 14, 2015 at 2:51 am (2 years ago)

    What a thorough list – thank you for this!

    Reply

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