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 FORL Lesions

           February is national dental health month, and that includes pet dental health too.  Our hospital, like many others around town and across the country, is offering special discounts for dental work done during this month.  I am pleased this year to see more cats coming in for dental work.  I think that cats sometimes get short shrift in medical attention in general because they often do not give obvious signs that they are having problems, and, to be honest, stuffing a frantic cat into the box of death, listening to it howl all the way to the clinic, and then watching your beloved pet feel bewildered and frightened is not an experience that many people (or cats) want to go out of their way to have.

            Cats are often quite healthy when younger, but one of the biggest problems they face is dental disease.  Dental problems often start at young ages and they can be a source of a lot of pain and suffering.  The good news is that much of the misery caused by dental problems in cats can be fixed.  It just needs to be identified first.

            One of the most common problems that cats experience with their teeth is Feline Odontoclastic Resorptive Lesions, known as FORL for short.  This is a condition where, for generally unknown reasons, cats develop holes in the enamel of their teeth, usually on the gumline.  As time goes by the holes penetrate through all the sensitive layers of the tooth until the living tissue in the center of the tooth is exposed.  Bacteria get into the tooth and cause infection. 

            Imagine how mouth would feel if someone came along and drilled a hole into the side of several of your teeth right at the gumline and then you had to live with your teeth in that condition year after year.  This problem is very painful to cats, even at the early stages, but you often wouldn’t know it just by looking at them.  When I take a dental probe and touch the affected areas gently, however, the cat will chatter its jaw and withdraw in pain.  These lesions are so painful that even anesthetized cats will chatter their jaws when the holes are touched.  On basic oral examination the holes in the teeth may not be very visible because they are covered by a layer of tartar, or because the gums have grown upward and tried to patch over the defect. (Or because the cat is not feeling very cooperative about having his face grabbed and his lips peeled back) Severely affected cats will drool and paw at their mouths.  Occasionally I will see a reluctance to eat as a manifestation of dental pain, but almost all cats will still be eating fairly normally no matter how bad their teeth are.  They just figure out a way to get the food down without using their painful teeth.

            Unfortunately there is no effective treatment for FORL lesions that saves the tooth.  Unlike human cavities, you cannot drill them out and fill them in.  In cats the problem continues to progress anyway.  The best option is to remove affected teeth.  This immediately eliminates a severe source of pain in a tooth that could no longer be of use anyway.  Owners are often surprised at the improvement in attitude and activity they see in their cats after painful dental problems are addressed.  It may have seemed like the cat was just getting older, but when the suffering is gone they can be like kittens again.

             On the Veterinary Information Network there was a posting by a veterinarian who was asking advice about whether or not to anesthetize her generally healthy 21 year old cat in order extract several teeth with FORL lesions that were obviously causing her pain.  There was spirited debate both for and against the procedure.  Certainly anesthesia is physically stressful and can be much harder on very geriatric patients, but allowing continuing suffering was not doing good things for her either.   The veterinarian decided to go ahead and fix the teeth.  Her cat did great and she was delighted at the tremendous improvement in her health and quality of life as a result.  Of course every case needs to be individually evaluated, but it goes to show that fixing dental pain can be very rewarding to both pet and owner.

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