Toothache
Dental pain in dogs and cats is a common, yet often overlooked health problem. The term “dental pain” encompasses various painful conditions in the area of the teeth, gums, and surrounding jawbone. Unlike in humans, where cavities are the main cause of toothache, our pets predominantly suffer from periodontal diseases, tooth fractures, and specific degenerative dental diseases. The anatomy of dogs’ and cats’ teeth differs fundamentally from that of humans: While dogs have 42 and cats 30 permanent teeth, both species have significantly deeper tooth roots in proportion to crown length. This anatomical peculiarity means that dental diseases can often go unnoticed for a long time, as damage initially occurs in the invisible root area. Studies show that over 80% of dogs and 70% of cats over three years old already suffer from some form of dental disease that can potentially cause pain. Pain perception occurs via specialized nerve fibers in the pulp (tooth marrow) and in the periodontium (tooth-supporting apparatus), with pain transmission to the brain via the trigeminal nerve.
Causes
The causes of toothache in dogs and cats are diverse and partly differ between the two species. Periodontitis, an inflammatory disease of the periodontal tissues, is the most common cause. It begins with the formation of plaque, a biofilm of bacteria, salivary proteins, and food debris, which hardens into tartar and triggers progressive inflammatory reactions. These lead to gum recession, bone loss, and ultimately to tooth loosening and loss.
Tooth fractures often occur due to trauma or chewing on hard objects. The canines and carnassial teeth are particularly at risk. In fractures with an opened pulp cavity, the pain-sensitive dental nerve is exposed, leading to acute, severe pain. Root tip abscesses, localized infections at the tooth root tip, also cause considerable pain and can lead to swelling in the facial area.
Cats experience a specific condition called FORL (Feline Odontoclastic Resorptive Lesions), which involves progressive resorption of tooth substance, starting at the tooth neck and spreading towards the root and crown. This disease affects about 30-70% of all cats and is extremely painful. The exact etiology is not yet fully understood, but inflammatory mediators and overactive odontoclast cells are considered the main factors.
Other causes include foreign bodies between teeth, persistent deciduous teeth, tooth misalignments, stomatitis (inflammation of the oral mucosa), and tumors in the oral area. Particularly in brachycephalic breeds (pugs, bulldogs, Persian cats), tooth misalignments and related problems occur more frequently due to their skull anatomy.
Symptoms
- Your pet tries to remove something from the oral cavity with its paws.
- It has an appetite but then doesn’t want to eat.
- You see swelling in the area of the jawbones, especially close below the eye.
- Your pet is salivating noticeably more than usual.
Detecting toothache in dogs and cats is often difficult, as our animal companions tend to hide pain symptoms due to evolutionary reasons. Nevertheless, there are characteristic signs that can indicate toothache. Increased salivation (hypersalivation) is a common symptom, as is halitosis (bad breath), which is caused by bacterial decomposition processes in dental diseases. Affected animals often show altered eating behavior, such as chewing on one side, dropping food, sudden preference for soft food, or even food refusal despite obvious hunger.
Behavioral changes can manifest as increased irritability, withdrawal, or lethargy. Some animals rub their snout on furniture or carpets or scratch their face area more frequently. Especially in cats, reduced grooming can indicate pain in the oral area. During examination, affected animals often show increased sensitivity to touches in the head area or resist oral examination.
Visible changes can include reddened, swollen, or bleeding gums, gum recession, exposed tooth necks, discolored or broken teeth, and swelling in the facial area. In advanced diseases, asymmetries in the face may occur due to abscesses or fistulas, from which pus occasionally drains. Especially in cats with FORL, characteristic lesions on the tooth neck can be observed, appearing as reddish, granulomatous changes.
The intensity of symptoms does not always correlate with the severity of the disease, as many animals show only subtle behavioral changes even with significant dental problems. This underscores the importance of regular veterinary checks of the oral cavity.
First Aid
- Examine your pet’s oral cavity (Fig.).
- If you discover a foreign object in the area of the teeth or gums, remove it if it is not wedged.
- Do not use force with a lever.
- For all other symptoms, veterinary diagnosis and treatment are necessary.
- Until the scheduled appointment, use pain medication only after consulting with your veterinarian.
Diagnosis
The diagnosis of dental pain and its causes requires a systematic approach and special diagnostic procedures. Initially, a thorough anamnesis is conducted, during which the pet owner is questioned about changes in behavior, eating habits, and observed symptoms. The clinical examination begins with the inspection of the head and jaw region for asymmetries, swelling, or fistula openings. However, a complete examination of the oral cavity is usually only possible to a limited extent in the awake animal and in most cases requires general anesthesia.
Under anesthesia, a detailed examination of each individual tooth is performed using a periodontal probe and dental mirror. Parameters such as gingival pocket depth, tooth mobility, furcation involvement (exposure of the root bifurcation), and the presence of tartar, fractures, or resorptive lesions are recorded. These findings are documented in a dental chart, which serves as the basis for treatment planning.
Dental radiography is an indispensable part of dental diagnostics. Conventional intraoral X-rays or digital dental radiography allow for the assessment of invisible structures such as tooth roots, periapical regions, and alveolar bone. Especially in cats suspected of having FORL, radiographic examination is essential to assess the extent of resorptions and differentiate between different FORL types.
In more complex cases, advanced imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI) may be used, particularly when tumors or extensive jaw diseases are suspected. In cases of inflammatory processes, additional microbiological examinations or, in rare cases, histopathological examinations of biopsy samples may be necessary.
Pain diagnosis is done indirectly by observing behavior and the reaction to palpation or direct manipulation of the affected areas. Modern pain scales for animals can be used as supportive tools.
Further veterinary measures
If there is no obvious problem, a dental cleaning under general anesthesia and a thorough inspection of each tooth and its surrounding area is recommended.
This examination is complemented by X-rays of the suspicious dental regions using a radiographic technique (digital dental X-ray) that clearly shows the root regions as well.
In exceptional cases, such as when a tumor in the jaw area is suspected, a computed tomography scan may also be necessary.
Many veterinarians are familiar with dental preservation methods, allowing teeth that were previously removed to be saved today. Young animals in particular benefit from this.
Careful dental care and treatment is also beneficial for cats.
However, in the case of a specific degenerative dental disease in cats (FORL), removing the affected teeth is usually advisable to relieve the cat’s pain. The extent of the damage often only becomes apparent in the X-ray image.
In cases of advanced changes in the root area (FORL Type 2), often only the removal of the crown and possibly small portions of the root is appropriate, as remodeling processes of the root and jaw bone have led to a fusion. Differentiation is only possible through X-ray imaging, sparing the cat a deeper surgical procedure.
Supplements
The treatment of dental pain depends on the underlying cause and in most cases requires general anesthesia. For acute pain, pain relief is the primary focus, using analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) or, in severe cases, opioids. In cases of bacterial infections, antibiotics are administered concurrently, with the choice of active ingredient ideally based on an antibiogram.
Professional dental cleaning (dental prophylaxis) forms the basis of periodontitis therapy. This involves removing plaque and tartar using ultrasonic scalers and hand instruments, followed by polishing the tooth surfaces. In advanced periodontitis, additional subgingival debridement, root planing, or in selected cases, regenerative procedures such as the use of bone replacement materials or membranes may be indicated.
For tooth fractures with exposed pulp, various treatment options are available: Vital amputation (partial pulpotomy) with subsequent direct capping is particularly suitable for fresh fractures in young animals with incomplete root growth. For older animals or long-standing fractures, root canal treatment (endodontics) is necessary. This involves removing the infected pulp tissue, preparing and disinfecting the root canal, and then filling it with a biocompatible material. Alternatively, extraction of the affected tooth can be performed.
The therapy for FORL lesions in cats usually consists of extracting the affected teeth, as other treatment approaches are often not successful in the long term. For Type 2 lesions with advanced root resorption and ankylosis, crown amputation (coronectomy) with retention of root remnants may be indicated.
Adequate pain therapy is necessary after every dental treatment. This includes systemic analgesics and, for more extensive procedures, additional local anesthetics or nerve blocks. In cases of chronic stomatitis, immunomodulatory therapy or, in therapy-resistant cases, complete extraction of all teeth (total extraction) may be necessary.
For the prevention of further dental problems, home measures such as regular tooth brushing, dental care diets, or chew toys play an important role. The compliance of the pet owner is crucial for long-term success.
Prognosis and aftercare
The prognosis for dental pain largely depends on the underlying cause, the stage of the disease at the time of diagnosis, and the consistency of aftercare. The prognosis is generally good for dental problems that are detected and treated early. Periodontitis in early stages can be effectively controlled through professional dental cleaning and consistent home dental care, while advanced stages with bone loss and tooth mobility often lead to progressive tooth loss despite treatment.
Careful aftercare is essential following dental procedures. Soft food should be offered in the first few days after treatment, and mechanical stress on the oral cavity should be avoided. Pain therapy is continued for 3-7 days depending on the extent of the procedure. In cases of extractions, attention should be paid to complete wound healing, which is usually completed after 10-14 days. Antibiotics are only prescribed for specific indications such as periapical abscesses or systemic infections and should then be administered for the full recommended period.
In the long term, an individually tailored prevention program is crucial. This includes regular veterinary check-ups at intervals of 6 to 12 months, depending on the individual risk profile of the animal. Shorter control intervals may be advisable for breeds predisposed to dental problems or animals with known pre-existing conditions. Home dental care through daily tooth brushing with special pet toothpaste is the most effective preventive measure. Additionally, dental care food, chew toys with proven effectiveness, or water additives can be used.
For cats with FORL, close monitoring is necessary even after extraction of the affected teeth, as the disease often recurs and can affect other teeth. Regular radiographic check-ups are particularly important here to detect new lesions early.
The quality of life of animals usually improves significantly after successful treatment of dental pain, which is reflected in increased activity, better appetite, and normalized behavior. Pet owners often report that their animal appears “rejuvenated” after treatment, highlighting the considerable impairment caused by chronic dental pain.
Summary
Dental pain in dogs and cats is a common but often underestimated health problem. Unlike humans, where caries dominates, pets mainly suffer from periodontal diseases, tooth fractures, and in cats additionally from the specific disease FORL. The symptoms are diverse and range from increased salivation, bad breath, and altered eating behavior to changes in behavior and visible changes in the oral area. Since animals tend to hide pain symptoms due to evolution, dental problems are often only recognized in advanced stages.
The diagnosis requires a thorough examination of the oral cavity under general anesthesia, complemented by dental X-rays. Treatment depends on the underlying cause and includes conservative measures such as professional dental cleaning, tooth-preserving procedures like root canal treatments, or in advanced cases, the extraction of affected teeth. Adequate pain management is strongly recommended for all procedures.
Regular veterinary check-ups and consistent home dental care are crucial for long-term prognosis. Early detection and treatment of dental problems, as well as preventive measures, can significantly improve the oral health and thus the quality of life of our animal companions. Pet owners should be sensitized to the importance of dental health and consider regular dental examinations as an integral part of health care.
Outlook on current research
Veterinary dentistry continues to evolve, with current research approaches offering promising perspectives for improved diagnostic and therapeutic possibilities. In the field of imaging, three-dimensional techniques such as digital volume tomography (DVT) are gaining importance. These allow for more detailed representation of complex dental and maxillofacial structures with lower radiation exposure compared to conventional computed tomography.
The investigation of the etiology and pathogenesis of FORL in cats is the focus of several study groups. Recent studies suggest connections with systemic factors such as vitamin D metabolism, chronic inflammatory processes, and genetic predispositions. A deeper understanding of these mechanisms could enable future preventive approaches that go beyond the currently common practice of extraction.
In the field of regenerative dentistry, bioactive materials and growth factors are being researched to promote the regeneration of periodontal tissue. Initial clinical studies on guided tissue regeneration (GTR) and the use of enamel matrix proteins show promising results in the treatment of advanced periodontal defects in dogs.
Microbiome research provides new insights into the complex bacterial community in the oral cavity and its role in the development of periodontal diseases. These findings could lead to more targeted antimicrobial strategies that consider the ecological balance instead of broad-spectrum antibiotic action.
Innovative approaches to improving home dental care are also being intensively researched. These include more effective dental care products with specific action against periodontal pathogens, novel application forms for improved compliance, and technological aids for monitoring oral health.
Pain research is developing more sensitive methods for detecting and quantifying dental pain in animals that cannot communicate verbally. Grimace scales and other objective pain assessment tools are being validated to enable earlier intervention.
Interdisciplinary research approaches are also investigating the relationship between oral health and systemic diseases in pets, analogous to the known associations in humans between periodontitis and cardiovascular diseases or diabetes mellitus.
These promising research directions give hope that significant progress in the prevention, diagnosis, and treatment of dental diseases in dogs and cats can be achieved in the coming years, ultimately contributing to an improved quality of life for our animal companions.
Frequently asked questions (FAQs)
- How can I tell if my pet has tooth pain?
Watch for behavioral changes such as increased salivation, bad breath, chewing on one side, dropping food, withdrawing while eating, rubbing the muzzle on objects, or decreased playfulness. In cats, reduced grooming can also be an indication. - Which dog and cat breeds are particularly prone to dental problems?
Small dog breeds like Yorkshire Terriers, Chihuahuas, and Toy Poodles, as well as brachycephalic breeds like Pugs and Bulldogs, are more prone to dental problems. In cats, Persians and other brachycephalic breeds are more frequently affected, while FORL occurs regardless of breed. - How can I prevent dental problems in my pet?
The most important preventive measure is regular tooth brushing with special pet toothpaste. Additionally, dental care diets, scientifically tested chew toys, and regular veterinary check-ups with professional dental cleaning can contribute to prevention. - Is anesthesia really necessary for dental treatment?
Yes, a thorough examination and treatment of teeth are only possible under general anesthesia. Only then can all teeth be fully examined, X-rays taken, and necessary treatments performed painlessly. - Can my pet still eat normally after a tooth extraction?
Most animals can eat normally again shortly after tooth extractions. Dogs and cats chew less intensively than humans anyway and adapt surprisingly well to missing teeth. After extensive extractions, soft food can be offered for a short period. - What is FORL and does it only affect cats?
FORL (Feline Odontoclastic Resorptive Lesions) is a painful condition where tooth substance is progressively broken down. It primarily affects cats, but similar lesions are observed in rare cases in dogs as well. The exact causes are not yet fully understood. - How often should I have my pet’s teeth checked?
Annual dental examinations are recommended, more frequently (every 6 months) for high-risk patients or those with existing dental problems. The first dental examination should occur during puppyhood or kittenhood. - Can dental problems cause other health issues?
Yes, untreated dental diseases can lead to systemic problems. Bacteria from inflamed areas can enter the bloodstream and damage organs such as the heart, liver, and kidneys. Chronic inflammation also strains the immune system. - How do I get my pet used to tooth brushing?
Start slowly with the habituation: First, let your pet taste the toothpaste, then gently massage the lips and gradually move on to touching the teeth with a soft finger or finger cot. Only later introduce a special pet toothbrush. Reward your pet after each session. - What alternatives are there if my pet doesn’t tolerate tooth brushing?
Alternatives include special dental care food, dental snacks with proven effectiveness, chew toys, and water additives. However, these are less effective than regular tooth brushing and should be considered as a supplement, not a replacement. Regular professional dental cleanings remain indispensable.
Literature
- Buck, M F: Management of Periodontitis in Dogs – An Update for Practice. veterinär spiegel 2015; 25(03), 124-129, 2015
- https://tierarztpraxis-reuter.de/forl-bei-katzen-stand-2020/
- Löwe, G. and Löwe, O. (2021). Emergencies in Dogs and Cats – A Veterinary Guide. Kynos-Verlag. 208 p.
- Niemiec BA, Gawor J, Nemec A, et al. World Small Animal Veterinary Association Global Dental Guidelines. Journal of Small Animal Practice. 2020;61(7):395-403. doi:10.1111/jsap.13132
- Reiter AM, Soltero-Rivera MM. Applied Feline Oral Anatomy and Tooth Extraction Techniques: An Illustrated Guide. Journal of Feline Medicine and Surgery. 2022;24(1):31-46. doi:10.1177/1098612X211066312
- Peralta S, Verstraete FJM, Kass PH. Radiographic Evaluation of the Types of Tooth Resorption in Dogs. American Journal of Veterinary Research. 2020;81(12):978-987. doi:10.2460/ajvr.81.12.978
- Gorrel C, Andersson S, Verhaert L. Veterinary Dentistry for the General Practitioner. 2nd ed. Elsevier Health Sciences; 2021.
- Perry R, Tutt C. Periodontal Disease in Cats: Back to Basics — with an Eye on the Future. Journal of Feline Medicine and Surgery. 2021;17(1):45-65. doi:10.1177/1098612X14560099
