FELINE TOOTH RESORPTION
This video on our resorptive lesions treatment is courtesy of Dr. Brook Niemiec, DVM Diplomate, American Veterinary Dental College, Fellow, Academy of Veterinary Dentistry. His website is www.dogbeachvet.com.
By Fraser Hale, DVM, FAVD, Diplomate ACVD; http://www.toothvet.ca/PDFfiles/ResorptiveLesions.pdf
What Are Resorptive Lesions?
One of the most common and painful problems in cats is a condition called neck lesions. The proper name is Feline Odontoclastic Resorptive Lesions, or FORLs. They show up as holes in the enamel and dentin of the teeth, starting at or below the gum line.
Human cavities form when bacteria digest the teeth with acids and enzymes. Resorptive lesions work differently. A cat’s own body resorbs its teeth. Cells called odontoclasts settle into these defects and dissolve the tooth structure. Vets have not found the exact cause of FORLs yet, and while several theories exist, none fully explain the facts.
How Resorptive Lesions Progress
FORLs get worse over time, so vets grade them by severity to plan treatment. Stage I lesions are early defects that reach less than 0.5 mm into the tooth and affect only the enamel. Stage II lesions cause more erosion into the dentin but have not yet reached the pulp. Stage III lesions cause considerable loss of the crown and involve the pulp. Stage IV lesions cause extensive crown loss, while stage V lesions leave the crown completely gone, with only parts of the root visible on X-rays.
Once a defect reaches the dentin, the tooth becomes very sensitive to heat, cold, and touch. These teeth often hurt so much that even a fully anesthetized cat reacts when a vet probes the area. Once the lesion reaches the pulp, it causes real pain, and bacteria gain easy access to the tooth root, where an abscess can form. Tooth root abscesses are known to cause chronic infections that reach the heart valves, liver, kidneys, spleen, joints, bones, and nervous system. Over time, this ongoing infection can make a cat’s organs fail faster, aging the cat more quickly.
Treating Resorptive Lesions
Catching the problem early is both the goal and the hardest part of treatment. Since this issue often starts below the gum, vets can only find stage I and most stage II lesions by probing under the gum while the cat is anesthetized. Dental X-rays also help spot lesions on the roots. Your cat should get this check every time it comes in for a routine dental visit.
For select stage I and stage II cases, a vet may save the tooth with a special filling that bonds to the tooth and releases fluoride. Sadly, most lesions are too advanced to restore by the time someone finds them. Because the cause remains unclear, no one can guarantee that a filling will stop the lesion from getting worse.
Stage III, IV, and V lesions have already destroyed too much of the tooth to restore. In these cases, extraction is the only humane option, since it removes the source of pain and infection.
Preventing Resorptive Lesions
Vets do not fully understand what causes this condition, so clear prevention advice does not exist yet. Still, a few habits seem to help. Start by keeping the teeth clean. Your vet handles the deep cleaning, and various home-care products made for cats can help reduce plaque buildup afterward.
Fluoride, whether in a daily home-care product or a weekly gel, may also make your cat’s teeth less prone to this painful disease. Because fluoride is toxic if swallowed, use care when applying it at home.
Limitations of Treatment
Restoring a lesion today does not stop new ones from forming later. Long-term studies also show a poor success rate with restorations, since the resorption often continues under or around the repair. On top of that, these restorative materials require precise technique. If a vet doesn’t apply them exactly right, they will not bond to the tooth.
Current thinking holds that vets can restore very early lesions, as long as they feel confident in the technique and owners commit to long-term home care. After treatment, vets should recheck the teeth every six to twelve months.
Understanding Dental Pain in Cats
Many cat owners say their cats don’t seem to be in pain, even with neck lesions. This makes sense from an evolutionary standpoint. Wild cats that show signs of illness or weakness risk becoming another animal’s prey. If dental pain stopped them from eating, they would grow too weak to hunt and eventually starve. So cats tend to hide their pain and carry on as usual. Despite this, many owners notice a real improvement in their cat’s mood and energy after treatment or extraction of a painful tooth.
Conclusion
Whether you choose extraction or restoration, our resorptive lesions treatment makes sure neck lesions don’t go untreated. Left alone, they cause real pain and suffering, so they need prompt care.
