Dental for an old cat - checklist to ask vets

[Molly_the_tortoise_shell]

HI All,

I've compiled a list of things I want to ask my vet regarding my cats (13.5years) dental treatment for gingivitis. Just wanted to see if it sounds okay and if I have missed anything off?

(After a bad event few months ago, I am super cautious now and want to understand everything fully. My cat eats fine and is generally healthy, hence I have been in 2 minds about getting this treatment done)

Things to ask vet:
Full blood panel vs routine pre-anesthetic panel (on day of surgery)
Do they use IV catheter and give IV fluids during anaesthesia? Can we request it?
What type of anaesthesia are they using? Sevoflurane ? What about sedatives?
Will she be intubated?
Will Xrays be done? What about potential extractions?
What sort of monitoring? BP? Heart Rate? SpO2?
Eye lube / Eye protection to prevent debris from mouth getting in?
How is she monitored whilst coming out of anaesthesia?
How long will she be with the vets?
Ask them to walk us through entire procedure

Many thanks

- worried cat owner

 

[Furballsmom]

Hi! Welcome!!
13 years isn't that old but if there's gingivitis, if she were mine I'd be having this done. There's the discomfort which can eventually turn into pain, plus dental health impacts organs in the rest of the body to a very large degree.

One thing you can mention that I always do is for them to be very careful when they intubate and when they roll her over, so that her vocal cords are as effected as little as possible. My Poppy's voice has been just fine these last couple of dentals.

I think you would need to ask for xrays, and I'm not sure about the rest of your questions - these would definitely be things to talk to the vet with. I think she's lucky to have you

 

[35 year catdad]

I've been lucky with 3 cats who lived without dental problems till age 19
I never fed them any corn, wheat, soy, (some oats fiber) but not high cab foods and think that played a part in their dental health.
Also we have used Tropiclean liquid dental health solution in their filtered water. It has green tea, zinc gluconate, and what looks like a probiotic. All ingredients they say are 99.43% naturally obtained.
Re: unfiltered water: I think chlorine destroys their natural mouth flora.
Then the bad bugs take over.
I would get another opinion from another vet? this sounds like $1,000 in work ouch
Best of luck for the Tortie and her Mom

 

[fionasmom]

Welcome to The Cat Site! I do understand where you are coming from with the questions. When I have had surgeries for my animals, I have always had long discussions with the vet and, in these days of COVID, send in a list of questions for the pre op appointment which the vet can then systematically answer over the phone. My philosophy is that you are paying a lot for these services, so any question you have is valid. The only part I would add, although you did say that you would want to be walked through the entire procedure, is specific questions about what will go on in her mouth, even with no extractions and what is the home aftercare for that. Pain killers, special food, grogginess, signs that something requires the vet's attention?

 

[TianShi]

I've been lucky with 3 cats who lived without dental problems till age 19
I never fed them any corn, wheat, soy, (some oats fiber) but not high cab foods and think that played a part in their dental health.
Also we have used Tropiclean liquid dental health solution in their filtered water. It has green tea, zinc gluconate, and what looks like a probiotic. All ingredients they say are 99.43% naturally obtained.
Re: unfiltered water: I think chlorine destroys their natural mouth flora.
Then the bad bugs take over.
I would get another opinion from another vet? this sounds like $1,000 in work ouch
Best of luck for the Tortie and her Mom

This is such helpfull reply <3 I need to get that water conditions like yesterday!! I have 3 cats haha.. well 4 but 3 of my own.

 

[Molly_the_tortoise_shell]

Hi! Welcome!!
13 years isn't that old but if there's gingivitis, if she were mine I'd be having this done. There's the discomfort which can eventually turn into pain, plus dental health impacts organs in the rest of the body to a very large degree.

One thing you can mention that I always do is for them to be very careful when they intubate and when they roll her over, so that her vocal cords are as effected as little as possible. My Poppy's voice has been just fine these last couple of dentals.

I think you would need to ask for xrays, and I'm not sure about the rest of your questions - these would definitely be things to talk to the vet with. I think she's lucky to have you

Thank you for your advise. I wasn't aware of the intubation damaging vocal cords so i will put that on my list too.

I've been lucky with 3 cats who lived without dental problems till age 19
I never fed them any corn, wheat, soy, (some oats fiber) but not high cab foods and think that played a part in their dental health.
Also we have used Tropiclean liquid dental health solution in their filtered water. It has green tea, zinc gluconate, and what looks like a probiotic. All ingredients they say are 99.43% naturally obtained.
Re: unfiltered water: I think chlorine destroys their natural mouth flora.
Then the bad bugs take over.
I would get another opinion from another vet? this sounds like $1,000 in work ouch
Best of luck for the Tortie and her Mom

I'm from the UK, I think they quoted me around £100 for the dental clean, but with extractions it could go to £250 / £300 depending on number of extractions. The money isn't an issue, just want her to come back in one piece! And cat dad here

Welcome to The Cat Site! I do understand where you are coming from with the questions. When I have had surgeries for my animals, I have always had long discussions with the vet and, in these days of COVID, send in a list of questions for the pre op appointment which the vet can then systematically answer over the phone. My philosophy is that you are paying a lot for these services, so any question you have is valid. The only part I would add, although you did say that you would want to be walked through the entire procedure, is specific questions about what will go on in her mouth, even with no extractions and what is the home aftercare for that. Pain killers, special food, grogginess, signs that something requires the vet's attention?

Good points you make, I will add specific aftercare questions to my list. I would be very hesitant of giving Meloxicam, as we think that medicine caused renal failure in our 9month cat a few months ago. Only after researching it a lot more, did I realise this drug is blacklisted for cats in USA, yet given out freely in the UK.

Thank you all, and as this is a cat site, here is Miss Molly!

IMG-5538

IMG-5540

 

[fionasmom]

She is a little beauty. Speak up about your concerns regarding Meloxicam to the vet if he wants to use it.

 

[daftcat75]

She's adorable! I had a tortie that had a lot of dental work in her final years due to tooth resorption.

Some things I might add:

1. No Convenia. I don't know what it's like in the UK. But here, vets like to give the Convenia shot because it's a one-shot antibiotic that lasts for weeks. The trouble is that it's not well tolerated by some cats. And for those cats, there's no taking it back. They just have to ride it out until it wears off a few weeks later. If she's never had Convenia before, now isn't the time to figure out which camp she falls into.
2. Buprenorphine SR/simbadol (goes by a few names) is a long-lasting pain relief (up to 72 hours.) If they do extractions, go ahead and let them give her that shot. Just know ahead of time that you'll get a loopy, restless cat who may not sleep for three days. BUT! You won't have to squirt pain medicine in her freshly sore mouth two or three times a day while she's on that shot. The reaction to simbadol is alarming enough that it has its own thread here on thecatsite. Just search for it. It will pass and you will have your cat back to normal in three days.
3. So why would you consent to a three day crazy kitty opiate trip? This could be your Molly if she has extractions and doesn't get adequate pain relief:
View media item 422562I had every intention to continue her pain relief at home the same night. But they kept her overnight without giving her anything. That is the last time I tell the vets to skip the bupe SR shot. I'd rather have a loopy kitty than an angry one in pain.
4. If they do any canine extractions, I would make a follow up appointment with a dental specialist for about six months out (which conveniently is the waiting time for many veterinary dentists) to check for any problems that can develop when extracting the canines; namely things like lip entrapment or gum ulceration. Canines serve a structural role in the mouth. When one (or more) is extracted, the opposing teeth are not stopped from biting into lip and gum like they would be in a full mouth. A specialist will know what to look for and how to help her out. General vets know enough to know when a tooth needs to go and how to extract it. But these kinds of issues that can happen after canine extractions is usually beyond the experience or expertise of a general vet.

 

[Molly_the_tortoise_shell]

Hi
daftcat75 ,

Thank you so much for all of that information, I have made some notes and will be asking my vet about the points you raise. I hope no extractions are needed and its just the dental clean, but we won't know until she goes under

 

[daftcat75]

Hi
daftcat75 ,

Thank you so much for all of that information, I have made some notes and will be asking my vet about the points you raise. I hope no extractions are needed and its just the dental clean, but we won't know until she goes under

Once she’s under, the vet may not be willing or able to pause his work to call you. If teeth need to go, they should go. Waiting on them won’t help. Specialists are so few and far between that it’s better to let your general vet do the work now and get a specialist to review how it went six months later. Because, no exaggeration here, if you make that specialist appointment now, it will very likely be six months out to the first available appointment. Your general vet may also resent the suggestion that he’s not capable of doing the work. I would sign off ahead of time on any extractions that might be necessary. Put in your request for no Convenia and yes to the long lasting bupe (if extractions are needed.) If none of her canines are extracted, she probably won’t need a specialist follow up. You can always cancel a specialist appointment if you don’t need it. But if you wait until she needs a specialist, you’ll likely still be waiting six months just for that initial consultation. Better to use the specialist as a backstop than as primary care.

 

[Molly_the_tortoise_shell]

Hi All, Just an update. I finally managed to speak to the vets, here's what they told me:

- Full blood panels routine pre-anaesthetic panel (on day of surgery)
Pre-routine test (£55) tests for haematology, platelets, anaemia, kidney liver, glucose. The full panel test also includes calcium globulin, specific proteins etc. Thyroid not tested in either of these, have to do that separately

- IV Fluids given during the procedure

- Types of sedatives/anaesthesia used: Propfolol (spelling) to put her to sleep initially. Then isoflurane (spelling) and oxygen

- Will she be intubated? yes

- Nurse monitors temperature, bp, etc during procedure

- This practice doesn't have the facility for dental xrays unfortunately. They vets go by visual (they did tell me they do carry out this procedure routinely). I'd have to take my cat to another of their branches in my city if I wanted the xray done as part of the procedure. However i'd be unfamiliar with any of the vets there, and its further away from my house vs this branch. (5mins vs 15-20mins car journey)

- Home Aftercare --> for dental clean vs extractions? methadone given for pre-op painkiller, meloxicam for aftercare if extractions. Could opt for buprenorphine (opioid based) drops to squirt in mouth

- I'd drop her off between 8 and 9am. They did say they tend to do more sterile procedures first, and dental procedures later on. Whatever that means, made me a bit worried that she'd be stuck in a cage for a good few hours before its her turn.

What do people think? Any concerns?

Price isn't a concern but for whats it worth, they quoted me approx £250 for the dental clean and polish plus £55 for the pre blood test (basic one) ranging up to £650 including extractions.

Thanks fellow cat folks

 

[daftcat75]

I don't know all the ins and outs of dental procedures and practices so I can't comment on all that.

However, that they can't do X-rays concerns me. Some dental problems begin below the gum-line and cats hide pain. That means some dental problems can go on for a long time before they become visually apparent. I would rather drive my cat another 20 minutes and see a new vet even if you're only getting X-rays. Though honestly, I would rather have any extractions done by someone who can take X-rays before and after rather than simply sending the X-rays back to a vet who doesn't use them.

 

[Molly_the_tortoise_shell]

I don't know all the ins and outs of dental procedures and practices so I can't comment on all that.

However, that they can't do X-rays concerns me. Some dental problems begin below the gum-line and cats hide pain. That means some dental problems can go on for a long time before they become visually apparent. I would rather drive my cat another 20 minutes and see a new vet even if you're only getting X-rays. Though honestly, I would rather have any extractions done by someone who can take X-rays before and after rather than simply sending the X-rays back to a vet who doesn't use them.

Hi daftcat,

For dental work including possible extractions, is the norm generally xrays before and after the surgery? I can understand doing it before, just trying to see why an 'after' is needed

Yes 20mins drive isnt ideal but not too bad, my cat hates car journeys and so having the vets 5min away has been handy.

 

[daftcat75]

Hi daftcat,

For dental work including possible extractions, is the norm generally xrays before and after the surgery? I can understand doing it before, just trying to see why an 'after' is needed

Yes 20mins drive isnt ideal but not too bad, my cat hates car journeys and so having the vets 5min away has been handy.

If they do extractions, they should do an "after" to make sure the extraction proceeded smoothly. Sometimes an extracted tooth doesn't come out as one piece. "After" x-rays ensures that root fragments are not left behind. Being able to take x-rays before and after may very well reduce the total number of vet visits making the longer drive worth it. They will be able to better assess what needs to be done and can determine if it was done correctly the first time.