Toothache in cats - no thanks!

Dental problems are common - and often underestimated

Dental disease is very common in cats: according to studies, up to three quarters of all cats suffer from dental disease. Sooner or later, almost every cat is affected at some point in its life.

Unfortunately, our furry friends are masters at hiding their (dental) pain. And there is a good and simple reason for this: if you don't eat in the wild, you die. That's why cats often don't stop eating even when they have severe toothache. For us as owners, this is difficult to understand, and the shock is all the greater when the extent of the disease suddenly comes to light during a visit to the vet.

Here are some symptoms of possible dental disease in your cat:

• Mouth odor
• Salivate
• Reddened gums
• Gum overgrowth or broken teeth (typical for FORL)
• Changed Feeding behavior*:
  • Preference for soft or hard lining‍
  • Reduced or increased feed intake‍
  • Hasty eating, especially after walking around the food bowl for a long time‍
  • Loops of the lining‍
  • Dropping of
• Rubbing at or in the mouth with the paws; head shaking
• Biting on hard or unusual objects
• Pain or aggression when touched near the head
• Withdrawal, aggression, reduced play behavior
  

*The gradual or sudden change in eating behavior is the most important characteristic. All of the eating behaviors listed above can also be completely normal if your cat has always eaten like this.

But please remember: the classic cat with dental problems shows little to no symptoms! You can find out more about dental health in our blog post: My cat has tartar! How to properly care for cats' teeth

Our tip: Are you unsure whether your cat has dental problems? We have the perfect solution for you.
We know that many cats don't like visits to the vet. That's why, as a Calingo customer, you have the opportunity to chat or call a vet online for free and from the comfort of your own home. The online vet consultation helps you to better assess your cat's dental health, gives you tips on what you can do and helps you to decide whether a visit to the vet is necessary.

FORL - the dreaded four letters

Any cat owner who has never heard of "FORL" can call themselves a lucky cat. The abbreviation FORL describes a progressive disease of the teeth in which the tissue of the tooth - especially in the area of the tooth root - dissolves and is broken down.

Around half of all cats are affected by this typical feline disease - and contrary to some claims on the Internet, this disease is also often found in cats living in the wild, including large cats of prey.

A brief excursion into naming: RL (short for "resorptive lesions") is the newer name for the still common abbreviation FORL (short for "feline odontoclastic lesions"). Both abbreviations refer to the same disease.

FORL causes holes in the teeth. The disease is so painful for cats that many still chatter their teeth in pain as soon as you touch the holes, even under anesthesia. Nevertheless, the following also applies here: an astonishing number of cats suffering from FORL hardly show any symptoms.

FORL trigger

The causes for the development of the disease have not yet been clearly identified. Recent studies suspect a disturbance in the calcium balance. However, many other factors probably play a role, including, for example

• Genetic predisposition (familial clustering)
• Cat breed (breed-related accumulation)
• Viral diseases
• Chronic inflammation in the mouth
• Stress

These triggers activate the so-called odontoclasts in the cat's mouth: these are the body's own cells that break down the teeth. This is an overreaction of the immune system. FORL is therefore an autoimmune disease in which the immune system attacks its own body.

Since bacteria are not the cause of the cavities in the teeth, they are not caries. The often-heard term "cat caries" is misleading: you cannot counteract the disease by brushing your cat's teeth.

How can I treat FORL in my cat?

And this brings us to the next sobering point: the disease cannot be stopped. The only treatment is to extract the affected teeth. Pain medication and anti-inflammatory drugs can temporarily relieve the pain and bridge the time until an operation, for example, but they are not a long-term solution.

The cat's teeth are extracted under general anesthesia. Of course, any tartar is also removed at the same time. As the disease starts at the roots, every FORL examination includes x-rays of the entire set of teeth, which can be taken under the same anesthetic. It may well be that completely "healthy" teeth are already affected from the outside and therefore need to be extracted.

As the disease progresses gradually, it often affects other teeth over time, so that the typical "FORL patient" needs several dental operations at intervals of around one to several years. In extreme cases, the cat may even need to have all its teeth extracted immediately or over the years.

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What can be done for toothache in cats?

"Not curable", "pull all teeth" and "progressive disease" don't sound very encouraging. And it is true that teeth affected by FORL cannot be repaired or saved in any other way.

However, there are some things you can do to help your cat:

• Pay attention to subtle changes in (eating) behavior
• If the mouth suddenly smells strongly, consult a vet
• Regular dental check-ups at the vet's practice, even if you don't have your cat vaccinated (anymore)
• Have tartar removed regularly (tartar causes inflammation in the mouth, which in turn promotes FORL)
• And most importantly: have the affected teeth extracted!
  

The first piece of good news is that pulling the affected teeth also relieves the pain. So the cat can definitely be helped. The second piece of good news is that our furry friends manage surprisingly well without teeth.

Anesthesia for cats when pulling teeth?

Some cat owners wait far too long to take their cat to the vet out of fear of anesthesia or a guilty conscience. There is no need to feel guilty: you as the owner are not to blame for the disease and you cannot prevent or avoid it. Even if you do everything right, your cat can still get FORL. Or to put it another way: the only wrong thing to do would be to do nothing.

The fear of anesthesia is understandable and not entirely unfounded. Unfortunately, even with the perfect anesthetic, something can always happen. However, the risk of an anesthetic incident is now also lower in veterinary medicine thanks to more advanced drugs, better anesthesia monitoring options and more modern anesthesia equipment. As a rule, the earlier anesthesia is administered, the better. This is because not only the age and general health of your cat has an influence on the risk of anesthesia, but also the dental health itself.

If the disease remains untreated for a long time, it will lead to increasingly severe inflammation throughout the mouth. Regardless of the pain this causes, chronic inflammation is a burden on the body. In short: the longer you wait, the higher the risk of anesthesia.

Incidentally, if FORL is left completely untreated, the consequences can be serious not only for the oral cavity, but for the whole organism. The inflammation can spread to the jawbone, the heart and kidneys can be affected via the bloodstream due to bacteria being washed away, or it can even lead to blood poisoning.

My personal experience as a vet with cats and dental problems

In my several years of practice as a "veterinary dentist" and also from my own experience as a cat mom of a "FORL cat", I can say that these cats always feel much better after having their teeth pulled. Even if no major symptoms were visible before the dental operation, the quality of life of these cats improves significantly.

I have heard such wonderful stories from dozens of cat owners after dental surgery, some of whom were skeptical at first. The cat suddenly enjoyed playing and jumping around again, it let itself be stroked again, it became more trusting towards people and other cats and seems years younger. In short: she can enjoy her cat life to the full again.

Therefore, it is always better to have no teeth than aching teeth!