Vet examination of teeth

Please bear with me as I provide a little background info. before getting to my question (to go directly to my question, scroll down [question is in all caps]).

For ~the last month, Hilda has refused to eat her wet food (we feed all four cats very small portions of dry Natural Balance food 3x/day and a small amount of Natural Balance wet food for dinner). She has also been reluctant to eat the dry food (she usually does, eventually, but doesn't eat her entire portion). This is VERY unusual for Hilda, who has always loved her food (we had to quit free feeding the cats because Hilda developed a weight problem) and has always been a very quick eater. She now takes the longest to eat and usually doesn't finish all of her food.

When this first started, Hilda was throwing up 1-3x/week, typically after she had just eaten her food. I thought she might not like her wet food anymore because she was associating the vomit with the wet food (this had happened a year ago when she had a stomach virus; for several weeks after that incident, she didn't like some of the flavors of wet food). She hasn't thrown up in the last 1-2 weeks.

It also appeared to me that she was having difficulty chewing the dry food. For the last week, she has preferred to eat the dry food out of her brother's food bowl (!). I'm wondering if she does have tooth pain, if she might be associating the pain with her own food bowl (ie, location where her food bowl is).

I took Hilda to the vet~ two weeks ago and informed the vet that I was worried something might be wrong with one or more of Hilda's teeth. The vet pried open her mouth and said her teeth appeared fine. She gave Hilda a physical examination (no blood work) and said she appeared fine. She said several cats had been in that week with somewhat similar symptoms and perhaps the heat was having an odd effect on Hilda (Hilda is an indoor-only cat).

My question: IS IT TYPICAL FOR VETS TO ASSESS THE HEALTH OF A CAT'S TEETH (WHEN A PROBLEM TOOTH IS SUSPECTED) ONLY BY LOOKING AT THE TEETH, OR ARE X-RAYS (OR SOME OTHER METHOD) TYPICALLY USED?

Hilda is getting enough food per day (so that is not a problem) but it just bothers me that her appetite seems off and that she seems to have trouble chewing her food. I want to make sure I do everything I can for her (I don't want her to be in pain); but at the same time, I do not want to unnecessarily take her to the vet (we are still paying down a very large credit card bill for previous vet care) if this is the standard way to diagnose a bad tooth. I'm wondering if anyone else has had anything similar happen?

Thanks!

Hi Aelurophile-

I can understand why you're concerned about Hilda - change in appetite, vomiting, and obvious discomfort while eating are usually indicative of a problem. Extreme heat can have an effect on appetite, but unless it's constant, I don't think it would cause prolonged inappetance, vomiting and difficulty chewing.

You didn't mention Hilda's age, nor if she's had bloodwork before your latest vet visit. If she did have fairly recent bloodwork, that could explain why your vet didn't run a new panel. If Hilda hasn't had bloodwork lately, IMO it would've been a good idea to have had it done.

I think it's common for many vets to simply do a visual exam of the mouth. I would hope your vet did more than open Hilda's mouth and take just a quick look. Most cats aren't happy about having to open their mouths, and to get a really thorough look it may require opening their mouths several times to see all parts of the mouth, including looking under the tongue.

Cats can develop FORLs (feline odontoclastic resorptive lesions) which can be very painful. My dental tech tells me that it can be hard to assess when a cat has a FORL without probing the gumline where it meets the teeth. Even then, they sometimes still aren't visible until plaque has been scraped off a tooth during a dental cleaning. My animal hospital (which is large with several specialists) does dental x-rays during the course of a dental cleaning, but I don't believe this is typical for most small vet practices.

I know you don't want to go to the vet again, but I think a second opinion by another vet would be a good idea since Hilda is still not eating normally. You may even be able to find a feline dental specialist (I didn't know they existed until my dental tech gave me a list of such specialists in my state!)

If you do a search on FORL in cats, you'll find lots of detailed information. One site that explains FORLs also discusses ongoing home dental care, including how to brush your cat's teeth : http://www.cats.about.com/cs/dentalh...ide__kitty.htm Click on "Open Wide, Kitty!"

Please let us know how Hilda's doing.

My vets have always assessed whether they need a dental by looking at their teeth and gums. For x-rays, they have to be sedated, so this wouldn't be that much of an option really.

Thank you KTLynn and Booktigger for your responses.

Hilda is 3.5 years old. To date, she hasn't had any bloodwork. In my vet's defense, she did say that she didn't see any problems and wanted to hold off on anything more invasive unless the symptoms worsened (since she is not throwing up anymore, I guess her symptoms have somewhat improved). When her mouth was examined, the vet held it open for a couple of minutes and appeared to study the entire mouth (although I don't think she probed any of the surfaces with her fingers). In a prior exam the vet noticed a small spot (pinker than surrounding area) on the gum underneath Hilda's tongue. She looked at it again and said that it hasn't grown and doesn't see anything wrong with it otherwise.

I hadn't realized that the cat has to be sedated for an x-ray, but that makes sense (I can't imagine that any cat would cooperate with what is involved in taking an x-ray). Mostly, I'm just wanting to make sure that the exam proceeded as normal. It sounds like it did.

We do have a specialty clinic somewhat near us (~50 miles away). We had to take one of our cats to the dermatologist there (hence, the large credit card bill!). I'm not sure if they have a dental specialist there, but I would expect that they probably do (they seem to have a lot of specialists).

This morning, Hilda was eager for her dry food and ate all of it! I will continue to observe her.One other fact that I neglected to mention (although I don't know that it is an important one) is that, lately, she has become a very messy dry food eater. When she bites into a piece (these are very small pieces--~ the size of a lentil), it will often split and fall out of her mouth. I only mention this because I haven't really noticed this occurring with the other cats (they do occassionally drop some pieces of food but not with every meal).

KTLynn, If it looks like she is still uncomfortable, would you recommend that I take Hilda to another vet for an exam or that I ask my current vet (who I would like to keep seeing) to clean her teeth and x-ray them?

Thanks!

I have found that cats with dental issues normally prefer dry over wet. I honestly have never heard of a vet x-raying teeth though, only cleaning and extracting - I have had 5 cats had dentals (one had to have 3), and they have no probs, but at her age, cleaning might be all they need. If that is the case, you can keep on top of it yourself with these special gels, and food. I would be tempted to go back if she isn't right - my vet prefers to wait until their teeth are causing them more issues, but that could be cos they are senior cats, adn obv the anaesthetic isn't good for them.

When Jaffa had his dental the vet said they wouldn't know until they had him under anaesthetic whether they'd need to do xrays. As it happened they didn't but I don't think they can get a good enough look at the teeth and gums until the cat is at least sedated, let alone actually do the xrays.

My cat just had a dental done adn right after they put him under they did xrays to see if any teeth were loose. But going in we knew the teeth were badly in need of a cleaning-he only lost one tooth(which was loosened due to a sore on gum(dr said it wasnt abcess yet but would be one if nothign was done) RJ

Aelurophile-
It's very good news that Hilda's vomiting has stopped!

It sounds like your vet took a good look in Hilda's mouth. As I and others have said, though, the only way to do a detailed exam and take x-rays is to have your cat put under anesthesia. If your vet had seen signs of gingivitis and/or plaque build-up, I'd think she would've recommended a dental cleaning. Since she didn't, Hilda's teeth must look pretty good - clean, with no areas of inflammation around teeth, or a red line along the gums. You (and Hilda!) are lucky since most cats develop gingivitis, even at young ages.

Still, you know Hilda best. Since her eating habits have changed, there must be a reason why. It takes her longer to eat dry food now, and she's become "messy" when eating it.

There's no reason why you can't continue to see your vet, since you like her, yet also be able to consult with a dental specialist if there's one in your area. It wouldn't be a bad idea to have your vet do bloodwork on Hilda's next visit, too. Even though Hilda's still young, it's helpful to have a "baseline" blood panel to compare future panels with.

Just wondering - does your vet do dental x-rays?

Hope Hilda continues to improve

Thank you to all for your responses. I talked to Hilda's vet and I am taking her back in tomorrow afternoon. She is going to examine Hilda's teeth again and also do some bloodwork. I also told her that two of my other cats (Elvin & Hetty) have been very aggressive with Hilda for the last couple of days; so perhaps they can smell something wrong.

If the bloodwork/exam doesn't shed light on this situation, the next option is to do full body x-rays and/or dental x-rays (they do them at my vet clinic but she would need to be anesthetized for this).

I always have mixed feelings on tests like these: I want the problem to be identified so we can treat what is troubling my furry little loved one, but yet I don't want anything to be found because I don't want anything to be wrong either!

How is Hilda doing now?

Also, can everyone let me know how much you're paying for a dental exam & cleaning? Including anesthesia and x-rays, the quote I got the other day was much more than I expected. (My kitty is 15 months old and has inflamed gums).

Thanks

Thank you for asking about Hilda. The last couple of weeks have been a real rollercoaster. I took Hilda back in and the vet thought that the spot on her tongue had grown larger. She advised me to have her teeth cleaned and she said she would take a biopsy of of the spot. I took Hilda in the following week. Later that afternoon (a Thursday), the vet called and said she was very concerned. She had found another lesion on Hilda's tongue. She said she suspected it might be cancer. She gave me a brief run-down on oral cancer for cats: it's pretty much untreatable (the cat would need to have the tongue, jaw, and throat removed, which is obviously not doable), it spreads very fast, and the cat's mouth eventually becomes so sore that it quits eating. She sounded pretty convinced that it was oral cancer--even talked to me about putting Hilda on a feeding tube eventually, which I didn't want to do (been there, done that with another cat and I still feel guilty about that--that I extended his life past the point where he was comfortable). She said that without the feeding tube, Hilda might die within a month. I was devastated. I hadn't expected anything that severe--Hilda is only 3.5 years old! I spent the next couple of days reading everything I could about oral cancer on the internet and it all sounded horrible. The thought of losing Hilda so fast and of her being in so much pain was pretty unbearable. On the following Tuesday, we got the results back: no traces of cancer! Some "odd" bacteria was detected but that was all. The vet had already given Hilda a steroid shot for the pain and she wanted to wait a week to see how it worked. It seemed to work well; Hilda is almost back to her self (although she refuses to eat her "premium" cat food--she only wants the junk food! And of course I indulge her). I took her back to the vet the other day and the vet prescribed an antibiotic for 10 days and wants to see Hilda again in 6-8 weeks.

The entire situation is a bit perplexing to me. First, the vet made it seem like Hilda was on the verge of death and then, she doesn't want to see Hilda again for 6-8 weeks (4-6 weeks after she is done with the medication). My husband wants us to use a different vet. I guess we should but I feel guilty. I know medicine isn't the exact science we would like it to be.

Anway, regarding pricing: to get Hilda's teeth cleaned (including anesthesia, of course), a steroid injection (for the lesions), and to have one small tooth removed (vet discovered bad tooth during teeth cleaning), cost $383. ~6 months ago, one of my cats had an abcessed tooth. To have that treated (removed) and have his teeth cleaned cost almost $500 (I about had a heart attack when they told me that--I hadn't been warned about the price beforehand). I have an elderly cat whose teeth I had cleaned ~1.5 years ago. My vet was running a 10% off dental hygiene month. I think that trip cost ~250. I'm not sure if any or all of these trips involved x-rays or not. On average, to have a cat's teeth cleaned seems to cost around $225-275 if there are no complications (ie, teeth needing pulled). I did hear a somewhat justifiable reason for these prices (on another forum on teeth cleaning): these procedures usually take more than an hour and require the assitance of two technicians in additon to the vet (consider the salary of all three for this time) and we are also paying for the equipment. I still think the prices are higher than necessary but I can understand it a bit more.

I forgot to add one additional piece of information: in prior postings, I was asking whether or not x-rays are needed to detect problems with teeth. I asked my vet how reliable a visual exam is and she said that cats' teeth have relatively shallow roots (compared with humans) and cats have somewhat thin gums, so the majority of problems can be detected without x-rays.