Opinion on amount of ops needed for tooth extractions

[Madeline06]

Hello,

Looking for anyone who has experience with this… My cat has gingivitis and the vet told us he needed an almost full mouth extraction - all teeth (molars and pre molars) removed except the canines and incisors. He had his dental done a few weeks a go - but they only removed one side (top and bottom) saying he needs a 2nd surgery in a months time.

We booked the 2nd surgery today, and the vet said that she will “try” to remove all of the pre molars and molars from the other side but this may run into a third operation. Is this normal? It’s very expensive and sadly our insurance doesn’t cover it, so I worry she is doing it to make more money out of us. I also worry about my cat having general anaesthetic repeated times, and also I’ve heard that there’s a risk of breaking the jaw during these kind of operations, so surely this is making that risk higher plus all the other risks? I’m happy to be told my suspicions are wrong here and that this is all normal.. but as I am anxious I just wanted to ask peoples opinions who have been through this before.


I have emailed 4 other vets around here for 2nd opinions as well as I just don’t know what to do going forward. I have another cat who will need most her teeth out this year as well and I just feel lost like I don’t know what to do about it. I just worry my vets are telling me my cats need teeth out when maybe they don’t. My cats are really young as well, the 2 with issues are 2 and 3 years old. I just want to do what’s best for them but I don’t fully trust my vet. She’s very rude and unapproachable which doesn’t help things as it just makes me more suspicious of her

 

[Furballsmom]

Hi! I think you're right to be checking and obtaining other opinions, for both cats actually.

This is from Cornell's Feline Health Center;
Feline Dental Disease.

"Luckily for cats who have already developed gingivitis, the condition is usually reversible. The recommended treatment will depend upon how severe your cat’s case is and on the underlying cause, and may involve cleaning your cat’s teeth at home, giving him or her antibiotics (either taken as a pill or as an oral rinse), scaling of inflammation-inducing plaque from the teeth (which usually requires anesthesia), the use of immunosuppressive drugs, and in extreme cases, the removing of teeth that may serve as sources of inflammation. There is little or no evidence that treating gingivitis with antibiotics alone is effective.

In cases of feline gingivitis that are due to systemic or infectious underlying diseases, it is important to address the primary disease in order to manage the gingivitis.

Periodontitis
If gingivitis is not controlled, it can progress to periodontitis, a condition that eventually cannot be reversed. In periodontitis, the tissues that attach the tooth to the underlying gums and bone are weakened as a result of damaging substances produced by disease-causing bacteria and the inflammation caused by the cat’s own immune system.

The destruction of the tissues that attach the tooth to both the soft and bony structures that anchor the tooth may lead to loose teeth and tooth loss. Periodontitis is almost always the result of untreated gingivitis, so controlling this inciting process is crucial.

Clinical Signs/Diagnosis

Given that gingivitis leads to periodontitis, most cats with periodontitis will show signs of gingivitis (redness, swelling, bleeding along the gingiva at the base of the teeth), and may also be reluctant or unwilling to eat, drool, turn their heads to the side when chewing, and develop halitosis. In addition to these signs, they may show recession of the gingiva, exposure of tooth root surfaces, and mobility of the teeth. In extreme cases, a cat may lose one or more teeth.

A complete evaluation of cats with periodontitis involves probing the gums, and examining X-rays of the head and jaw, which require anesthesia.

Treatment

To treat feline periodontitis, your veterinarian will recommend removing plaque and mineral buildup by scaling and polishing the teeth while trying to save the teeth wherever possible. In extreme cases of periodontitis, extraction of teeth, sometimes of numerous teeth, may be required."

 

[fionasmom]

I would work back from "rude and inapproachable" which I think is very important. No reason for her to be that way to a paying client, if nothing else. There can be reasons for not doing extended procedures, but you are on the right track to get second opinions. If you had said that your vet very kindly sat down with you and answered all your questions and explained all her reasons, that might be a different story.

Are there any veterinary dentists in your area, even if it means a little bit of a drive?

 

[Antonio65]

Done this twice, on two cats, and they both had a full extraction (except for the canines and incisors) in one session, one anesthesia.
What your vet is proposing sounds strange to me.

 

[Antonio65]

...giving him or her antibiotics (either taken as a pill or as an oral rinse), scaling of inflammation-inducing plaque from the teeth (which usually requires anesthesia), the use of immunosuppressive drugs, and in extreme cases, the removing of teeth that may serve as sources of inflammation
...
In extreme cases of periodontitis, extraction of teeth, sometimes of numerous teeth, may be required."

Removing teeth in a semi-feral with stomatitis - Photos

 

[Mighty Orange]

If you live in northern Ohio let me know. I know of a dental center for cats that charges 150.00 no matter who many teeth, this includes cleaning and painkillers and antibiotics.

 

[Alldara]

Some recent studies on stomachitis have shown that Omega, especially sub-q is very helpful. I'd discuss this as well with anyone you get a second opinion from.

 

[Antonio65]

Some recent studies on stomachitis have shown that Omega, especially sub-q is very helpful. I'd discuss this as well with anyone you get a second opinion from.

What do you mean by Omega?

 

[Alldara]

I think the studies are mostly with Omega 6 fatty acid

Inflammation and wound healing in cats with chronic gingivitis/stomatitis after extraction of all premolars and molars were not affected by feeding of two diets with different omega-6/omega-3 polyunsaturated fatty acid ratios - PubMed

 

[Antonio65]

I think the studies are mostly with Omega 6 fatty acid

Inflammation and wound healing in cats with chronic gingivitis/stomatitis after extraction of all premolars and molars were not affected by feeding of two diets with different omega-6/omega-3 polyunsaturated fatty acid ratios - PubMed

Probably it's just me, but I fail to understand the meaning of this paper.
It says:
In this study, we hypothesize that a cat food with an omega-6 polyunsaturated fatty acid (ω6 PUFA) to ω3 PUFA ratio of 10:1 reduces inflammation of the FCGS and accelerates soft tissue wound healing of the gingiva after dental extractions

then it says:
feeding diets with dietary ω6:ω3 PUFA ratios of 10:1 and 40:1, given to cats with FCGS for 4 weeks after extraction of all premolars and molars, did not alter the degree of inflammation or wound healing.

So, does ω6:ω3 PUFA ratio help or does it not the wound healing?

 

[Alldara]

Probably it's just me, but I fail to understand the meaning of this paper.
It says:
In this study, we hypothesize that a cat food with an omega-6 polyunsaturated fatty acid (ω6 PUFA) to ω3 PUFA ratio of 10:1 reduces inflammation of the FCGS and accelerates soft tissue wound healing of the gingiva after dental extractions

then it says:
feeding diets with dietary ω6:ω3 PUFA ratios of 10:1 and 40:1, given to cats with FCGS for 4 weeks after extraction of all premolars and molars, did not alter the degree of inflammation or wound healing.

So, does ω6:ω3 PUFA ratio help or does it not the wound healing?

The first paragraph you read is the hypothesis that kicks off the study.

The second paragraph was their conclusion: "The diet with the 10:1 ratio lowered PGD(2) , PGE(2) and LTB(4) plasma levels significantly, compared to the diet with the 40:1 ratio (p = 0.05, p = 0.04, and p = 0.02 respectively). However, feeding diets with dietary ω6:ω3 PUFA ratios of 10:1 and 40:1, given to cats with FCGS for 4 weeks after extraction of all premolars and molars, did not alter the degree of inflammation or wound healing."

So it lowers inflammation levels but did not reduce healing time.