Toothache

Author: Dr. med. vet. Gisa Löwe | Last modified: 17.02.2026
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Opening the mouth of a Shih Tzu to examine the teeth

Toothache
Toothache is usually caused by tooth fractures, pulp involvement, periodontitis or abscesses. Typical symptoms include refusal to eat, chewing on one side, salivation, bad breath or pain on contact. If left untreated, severe pain and systemic infections can occur.

Toothache in dogs and cats is a common but often overlooked health problem. The term “toothache” encompasses various painful conditions in the area of the teeth, gums and surrounding jaw bone. Unlike in humans, where caries is the main cause of toothache, our pets mainly suffer from periodontal diseases, tooth fractures and special degenerative dental diseases. The anatomy of the dentition of dogs and cats differs fundamentally from that of humans: While dogs have 42 and cats have 30 permanent teeth, both animal species have significantly deeper tooth roots in relation to the crown length. This anatomical peculiarity means that dental diseases can often go unnoticed for a long time, as damage initially occurs in the non-visible root area. Studies show that over 80% of dogs and 70% of cats over three years of age already suffer from a form of dental disease that can potentially cause pain. Pain perception occurs via specialized nerve fibers in the pulp (tooth pulp) 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 varied and differ somewhat between the two animal species. Periodontitis, an inflammatory condition of the tooth-supporting tissues, is the most common cause. It starts with the formation of plaque, a biofilm of bacteria, saliva proteins, and food debris, which hardens into tartar (calculus) and triggers progressive inflammatory conditions. These lead to gingival recession, bone resorption, and ultimately to tooth loosening and tooth loss.

Tooth fractures often result from traumas or chewing on hard objects. The canines (corner teeth) and carnassial teeth are particularly at risk. In fractures with an open pulp cavity, the pain-sensitive tooth nerve is exposed, leading to acute, severe pain. Apical Abscesses, localized infections at the apex of the tooth root, also cause considerable pain and can lead to swelling in the facial area.

In cats, a specific disease called FORL (Feline Odontoclastic Resorptive Lesions) occurs, in which progressive resorption of the tooth substance occurs, starting at the neck of the tooth and spreading towards the root and crown. This disease affects approximately 30–70% of all cats and is extremely painful. The exact etiology has not yet been fully clarified, but inflammatory mediators and overactive odontoclast cells are considered to be the main factors.

Other causes include foreign bodies between the teeth, persistent milk teeth, malocclusion, stomatitis (inflammation of the oral mucosa), and tumors in the oral cavity. In brachycephalic breeds (pugs, bulldogs, Persian cats) in particular, malocclusion and related problems occur more frequently due to their skull anatomy.

Symptoms

Toothache in dogs and cats

Typical Symptoms:

  • Chewing crookedly, food falls out of the mouth, halitosis,
  • Appetite is present, but the animal doesn’t want to eat after all.
  • Animal salivating significantly more than usual.
  • Mouth rubbing, animal trying to remove something from the oral cavity with its paws. Head-shy
  • Swelling in the area of the jaw bones, especially just below the eye.
  • Withdrawal, aggression when touched, possibly swelling

Alarm signs:

  • Significant facial swelling/abscess, fever
  • Inability to open mouth, severe pain
  • Bloody saliva, massive halitosis, apathy
  • Breathing noises with swelling in the throat area

Escalation/course:

  • 24–72 h: Abscess can grow rapidly and rupture
  • Chronic: Weight loss, secondary organ damage (inflammation) possible
  • Increasing swelling or fever → urgent

 

The recognition of toothache in dogs and cats is often difficult because our animal companions tend to hide pain symptoms due to evolution. Nevertheless, there are characteristic signs that may 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, a sudden preference for soft food, or even refusal to eat despite obvious hunger.

Behavioral changes can manifest as increased irritability, withdrawal, or lethargy. Some animals rub their snouts on furniture or carpets or scratch their faces more frequently. Especially in cats, reduced grooming can indicate pain in the oral cavity. During the examination, affected animals often show increased sensitivity to touch in the head area or resist oral examination.

Visible changes may include reddened, swollen, or bleeding gums, gingival recession, exposed tooth necks, discolored or broken teeth, and swelling in the facial area. In advanced diseases, asymmetries in the face can occur due to abscesses or fistula tracts, from which pus occasionally escapes. Especially in cats with FORL, characteristic lesions can be observed on the neck of the tooth, which appear as reddish, granulomatous changes.

The intensity of the 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 underlines the importance of regular veterinary checks of the oral cavity.

First Aid

  1. Examine your animal’s oral cavity (see fig.).
  2. If you discover a foreign body in the area of the teeth or gums, remove it, provided it is not wedged.
  3. Do not apply force by levering.
  4. For all other symptoms, a veterinary diagnosis and therapy is necessary.
  5. Until the scheduled appointment, only use painkillers after consulting your veterinarian.

When should you see a vet sooner?

→ Yellow in case of refusal to eat, significant swelling, fever, or excessive drooling.

Diagnosis

The diagnosis of toothache and its causes requires a systematic approach and special diagnostic procedures. First, a thorough medical history is taken, in which the pet owner is asked about behavioral changes, 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, the 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 carried out 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 (calculus), 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 component of dental diagnostics. Conventional intraoral X-rays or digital dental radiography enable the assessment of non-visible structures such as tooth roots, periapical regions and the alveolar bone. Especially in cats with suspected FORL, X-ray examination is essential to assess the extent of the resorptions and to differentiate between different FORL types.

In more complex cases, further imaging procedures such as computed tomography (CT) or magnetic resonance imaging (MRI) can be used, especially if tumors or extensive jaw diseases are suspected. In the case of inflammatory processes, microbiological examinations or, in rare cases, histopathological examinations of biopsy samples may also be necessary.

Pain diagnosis is carried out indirectly by observing the behavior and reaction to palpation or direct manipulation of the affected areas. Modern pain scales for animals can be used to support this.

Further veterinary measures

If there is no obvious problem, a dental cleaning under general anesthesia is recommended, along with a careful inspection of each tooth and its surroundings.
This examination is supplemented by X-ray images of the suspicious dental regions using an X-ray technique (digital dental X-ray) that clearly shows the root regions.
In exceptional cases, such as when a tumor in the jaw area is suspected, computed tomography is also necessary.
Many veterinarians are familiar with tooth preservation methods, so teeth that were previously removed can now be saved. Young animals in particular benefit from this.
Careful dental care and treatment are also useful 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 of its Pain. Often, the extent of the damage only becomes clear on the X-ray image.
In cases of advanced changes in the root area (FORL Type 2), often only the removal of the tooth crown and possibly small parts of the root is appropriate, as previous remodeling processes of the root and jawbone have led to a fusion. Differentiation is only possible through an X-ray image, which spares the cat a maxillofacial surgical procedure.

Supplements

The treatment of toothache depends on the underlying cause and in most cases requires general anesthesia. In the case of acute pain, the focus is initially on pain relief, with analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) or, in severe cases, opioids being used. In addition, antibiotics are administered for bacterial infections, with the choice of active ingredient ideally based on an antibiogram.

Professional teeth cleaning (dental prophylaxis) forms the basis of periodontitis therapy. In this process, plaque and tartar (calculus) are removed using an ultrasonic scaler and hand instruments, followed by polishing of the tooth surfaces. In advanced periodontitis, subgingival debridement, root planing, or, in selected cases, regenerative procedures such as the use of bone replacement materials or membranes may also be indicated.

In the case of tooth fractures with an open pulp, various treatment options are available: Vital amputation (partial pulpotomy) with subsequent direct capping is particularly suitable for fresh fractures in young animals with root growth that has not yet been completed. In older animals or longer-standing fractures, root canal treatment (endodontics) is necessary. In this process, the infected pulp tissue is removed, the root canal is prepared, disinfected and then filled with a biocompatible material. Alternatively, the affected tooth can be extracted.

Therapy for FORL lesions in cats usually consists of extraction of the affected teeth, as other treatment approaches are usually not successful in the long term. In type 2 lesions with advanced root resorption and ankylosis, crown amputation (coronectomy) with retention of the root remnants may be indicated.

After every dental treatment, adequate pain therapy / analgesic therapy is necessary. This includes systemic analgesics as well as local anesthetics or nerve blocks in the case of more extensive procedures. In chronic stomatitis, an immunomodulatory therapy or, in therapy-resistant cases, a complete extraction of all teeth (total extraction) may be necessary.

Home measures such as regular brushing of teeth, tooth-caring diets or chews play an important role in the prevention of further dental problems. The compliance of the pet owner is crucial for long-term success.

 

Prognosis and aftercare

The prognosis for toothache depends largely 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 recognized and treated early. Periodontitis in early stages can be effectively controlled by professional teeth cleaning and consistent home dental care, while advanced stages with bone resorption and tooth loosening often lead to progressive tooth loss despite treatment.

After dental procedures, careful aftercare is essential. In the first few days after treatment, soft food should be offered, and mechanical stress on the oral cavity should be avoided. The pain therapy is continued for 3–7 days, depending on the extent of the procedure. After extractions, ensure complete wound healing, which is usually complete 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 animal’s individual risk profile. Shorter check-up intervals may be useful for breeds with a predisposition for dental problems or animals with known pre-existing conditions. Domestic dental care through daily brushing with special pet toothpaste is the most effective prevention measure. In addition, dental care food, chews with proven efficacy, or water additives can be used.

In cats with FORL, close monitoring is necessary despite extraction of the affected teeth, as the disease often recurs and can affect other teeth. Regular X-ray checks are particularly important here to detect new Lesions early.

The animals’ quality of life usually improves significantly after successful treatment of toothache, which is reflected in increased activity, better appetite, and normalized Behavior. Pet owners often report that their animal seems “rejuvenated” after treatment, which highlights the significant impairment caused by chronic toothache.

Summary

Toothache in dogs and cats is a common but often underestimated health problem. Unlike in humans, where tooth decay dominates, pets mainly suffer from periodontal diseases, tooth fractures, and, in cats, additionally from the specific disease FORL. The symptoms are varied and range from increased salivation, bad breath, and altered eating behavior to Behavioral changes and visible changes in the mouth area. Because 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, supplemented by dental X-rays. The therapy depends on the underlying cause and includes conservative measures such as professional teeth cleaning, tooth-preserving procedures such as root canal treatments, or, in advanced cases, the extraction of affected teeth. Adequate pain therapy is highly recommended for all procedures.

Regular veterinary check-ups and consistent domestic dental care are crucial for the long-term prognosis. Through early detection and treatment of dental problems as well as preventive measures, the oral health and thus the quality of life of our animal companions can be significantly improved. Pet owners should be sensitized to the topic of dental health and consider regular dental examinations as an integral part of health care.

Outlook on current research

Veterinary dentistry is continuously developing, with current research approaches offering promising perspectives for improved diagnosis and therapy options. In the field of imaging, three-dimensional procedures such as digital volume tomography (DVT) are becoming increasingly important. These enable a more detailed representation of complex dental and maxillofacial structures with lower radiation exposure compared to conventional computed tomography.

The research into the etiology and pathogenesis of FORL in cats is the focus of several study groups. Newer 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 preventive approaches in the future that go beyond the usual extraction.

In the field of regenerative dentistry, bioactive materials and growth factors are being researched to promote the regeneration of the periodontal tissue. Initial clinical studies on guided tissue regeneration, or GTR for short, 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 take ecological balance into account instead of acting with broad antibiotics.

Innovative approaches to improving domestic dental care are also being intensively researched. These include more effective dental care products with specific effects against periodontopathogenic germs, novel application forms for improved compliance, and technological aids for monitoring oral health.

Pain research is developing more sensitive methods for detecting and quantifying toothache in animals that cannot communicate verbally. Grimace Scales and other objective pain assessment tools are being validated to enable earlier intervention.

Interdisciplinary research approaches also examine the connection between oral health and systemic diseases in pets, analogous to the associations known in humans between periodontitis and cardiovascular diseases or diabetes mellitus.

These promising research directions give hope that significant progress can be made in the coming years in the prevention, diagnosis, and therapy of dental diseases in dogs and cats, which will ultimately contribute to an improved quality of life for our animal companions.

Frequently asked questions (FAQs)

  1. How do I know if my animal has a toothache?
    Pay attention to behavioral changes such as increased salivation, bad breath, chewing on one side, dropping food, withdrawing when eating, rubbing the snout on objects, or reduced playfulness. Reduced grooming can also be an indication in cats.
  2. Which dog and cat breeds are particularly susceptible to dental problems?
    Small dog breeds such as Yorkshire Terriers, Chihuahuas and Miniature Poodles as well as brachycephalic breeds such as 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.
  3. How can I prevent dental problems in my pet?
    The most important prevention measure is regular brushing of teeth with special animal toothpaste. In addition, tooth-caring diets, scientifically tested chews and regular veterinary checks with professional teeth cleaning can contribute to prevention.
  4. Is anesthesia really necessary for dental treatment?
    Yes, a thorough examination and treatment of the teeth are only possible under general anesthesia. This is the only way to fully examine all teeth, take X-ray images, and perform necessary treatments pain-free.
  5. Can my animal 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 amazingly well to missing teeth. After extensive extractions, soft food can be offered in the short term.
  6. What is FORL and does it only affect cats?
    FORL (Feline Odontoclastic Resorptive Lesions) is a painful disease in which the tooth substance is progressively broken down. It primarily affects cats, but similar lesions are also observed in dogs in rare cases. The exact causes have not yet been fully clarified.
  7. How often should I have my animal’s teeth checked?
    Annual dental examinations are recommended, more frequently (every 6 months) for risk patients or existing dental problems. The first dental examination should take place as early as puppy or kitten age.
  8. Can dental problems cause other health problems?
    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 inflammatory conditions also put a strain on the immune system.
  9. How do I get my animal used to brushing its teeth?
    Start slowly with getting used to it: First let your animal try 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 animal toothbrush. Reward your animal after each session.
  10. What alternatives are there if my animal does not tolerate brushing its teeth?
    Alternatives include special dental care food, dental snacks with proven effectiveness, chews and water additives. However, these are less effective than regular brushing of teeth and should be regarded as a supplement, not a replacement. Regular, professional teeth cleaning remains 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 pp.
  • 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