Plus-Hex CLINICAL
Introduction
By 2 years of age, 70 % of cats have already developed one form of dental disease [ 1 ]. This is an alarming statistic and is profoundly underestimated by cat owners and veterinary professionals alike. Unfortunately, a large proportion of cats do not display outward signs of oral pain, and dental diseases frequently go unnoticed, especially if owners rarely look inside their cat ' s mouth.
The impact of prolific oral infections and chronic dental discomfort on the quality of life of cats is not fully appreciated. This article aims to highlight the most common dental diseases affecting the cat population to raise awareness of this debilitating yet hidden problem.
Periodontal disease
Periodontal disease is thought to be the most prevalent dental disease, affecting 68 % of domestic cats [ 2 ]. It is characterised by gradual changes to the periodontal tissues, initiated by an inflammatory response to oral bacteria [ 3 ]. Bacteria, saliva and cellular deposits form plaque, a complex biofilm, which adheres to the teeth. As plaque advances below the gingiva, bacteria thrive within the gingival sulcus( a narrow groove between the tooth and the gumline); the bacteria secrete endotoxins, accelerating cell necrosis and contributing to sustained inflammation [ 3 ]. This biofilm contributes to localised gingivitis, the first stage of periodontal disease [ 4 ]. The initial gingivitis can be reversed if there is meticulous control of plaque and early intervention [ 5 ].
However, in the majority of cases, the plaque mineralises to calculus. Although calculus is not considered to be the primary cause of periodontal disease, its irregular shape facilitates further plaque adherence [ 6 ]. Continued proliferation of bacteria within the gum progresses to gingival recession, forming a periodontal pocket that exposes deeper periodontal tissues [ 7 ]. At this stage, periodontitis supersedes gingivitis, as the periodontal tissues become exposed and inflamed, leading to a steady decline in the tooth ' s structural integrity [ 8 ]. Severe periodontitis concludes with loss of diseased teeth, attributable to horizontal bone loss and root exposure, all of which facilitate an increase in tooth mobility [ 9, 10 ]( Table 1, page 54).
discomfort [ 13 ]. Local indicators include gingivitis, gingival haemorrhage and recession, periodontal pockets and root exposure [ 13 ]. Owing to the gradual nature of periodontitis, damage is often not detected until the developed stages, when it is irreversible [ 14 ].
This disease not only presents local implications but it also has systemic consequences, due to the potential for pathogenic bacteria within the periodontium to enter the bloodstream and disseminate [ 15 ]. Research has linked chronic kidney disease( CKD) with severe periodontal disease [ 13 ]. Several studies have identified periodontitis as a predisposing factor for azotaemia and CKD in older cats, highlighting the significant impact of dental disease on systemic health [ 16 – 18 ].
Feline odontoclastic resorptive lesions
Feline odontoclastic resorptive lesions( FORLs), more commonly termed tooth resorption( TR), is a significant dental pathology and represents the second most prevalent oral disease affecting cats [ 19 ]. It is reported that 60 % of cats over the age of 6 years have these lesions [ 20 ]. Their pathophysiology remains idiopathic despite their high incidence and extensive related research in recent years [ 21 ].
Lesions originate underneath the gumline, affecting the structures supporting the tooth, including the cementum [ 22 ]. The cells responsible include odontoclasts, which destroy the tooth ' s root, replacing it with bony tissue; the lesions eventually advance above the gingiva to affect the dentine, enamel and crown( Figure 1) [ 23 ]. Lesions become visually evident only when they progress above the gumline, presenting as granulation-like tissue on the crown. The lesion erodes the enamel and over time the crown weakens and fractures, resulting in continued root resorption [ 24 ].
Clinical signs of periodontal disease
Without early intervention, periodontal disease has significant implications for a patient ' s quality of life [ 5 ]. Cats are renowned for hiding pain and subtle signs of disease are often overlooked [ 11 ]. The first sign that may be noted by owners is halitosis, followed by inappetence and hypersalivation; these signs are often recognised in late-stage periodontal disease [ 12 ]. However, cats with severe periodontitis can show no changes in appetite, making it difficult for their owners to recognise oral
Figure 1. Advanced feline odontoclastic resorptive lesions present on the crown [ 23 ].
Volume 41( 2) • April 2026
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