Dental Pain in Cats: A Prospective 6-Month Study

Abstract

Dental pathology is among the most ubiquitous diseases in cats of all ages. Dental pain is yet to be fully understood in cats and therefore its presence is often missed. To better understand feline dental disease as a pain trigger during routine examination and whether disease severity correlates to the degree of pain, a 6-month prospective study in a cats' only veterinary hospital in Portugal was conducted. Sixty-four cats that randomly presented for different clinical procedures were evaluated. Dental and periodontal abnormalities (primary dental parameters, PDP), as well as clinical signs related to dental pain (secondary dental parameters, SDP), were assessed. All cats underwent an oral cavity examination, upon which, the Feline Acute Pain Scale from Colorado State University Veterinary Teaching Hospital (CPS), was used in order to assess pain. Six PDP (periodontal disease, gingival index, calculus index, tooth resorption, tooth fracture and missing teeth) and five SDP (mouth discomfort, halitosis, hypersalivation, difficulty in holding food and several attempts at prehension of food), were compared with CPS pain scores. All SDP were significantly associated to higher CPS pain scores (p < 0.05). The number of missing teeth was significantly associated to higher CPS pain scores (p < 0.0001). A trend was observed between higher CPS pain scores and tooth resorption (p = 0.08). This study concluded that cats with dental disease feel pain during clinical examination and the pain increases as the severity of the disease progresses.

Keywords: behavior observation; cats; dental disease; dental pain; pain assessment.

Figure 1.

Periodontal disease. A/B) Clinical photograph and radiograph of right maxillary arcade showing missing canine, second and third premolar teeth, and calculus accumulation and gingival recession on fourth premolar tooth (108). C/D) Clinical photograph and radiograph of left mandibular arcade showing severe gingivitis, missing third premolar tooth (307), severe periodontitis, loss of alveolar bone height and tooth resorption of distal root of molar tooth (309).

Figure 2.

Periodontal disease. A) Clinical photograph showing gingival enlargement (*) over supraeruption of maxillary right canine tooth (104). B) Radiograph of image A showing bony buccal expansion (*). C) Normal radiographic appearance of tooth 204.

Figure 3.

Tooth resorption. A/B) Clinical photograph and radiograph of maxillary right canine tooth (104) showing stage 4c, type 2 TR (arrowheads). C/D) Clinical photograph and radiograph of missing crown of mandibular left third premolar tooth (307) showing stage 4a, type 3 TR (arrowheads). E) Clinical photograph of missing mandibular right canine tooth (404) (arrow). F) Radiograph showing missing 404 with osteitis and stage 4c, type 1 TR of image E (arrow).

Figure 4.

Radiographic signs of chronic necrotic pulpitis. A) Normal healthy pulp canal. B) Wide pulp canal and periapical radiolucency observed in the maxillary left canine tooth (*).

Figure 5.

Missing teeth. Data showed that cats with increasing numbers of missing teeth were significantly more prone to display increased levels of pain showing higher CPS scores.

Figure 6.

Hypersalivation. Cats without hypersalivation displayed less pain (several CPS score 0), while cats presenting with hypersalivation displayed significantly more pain (CPS scores 2 and 3 only).