Feline Oral Resorptive Lesions - what to expect
February 23, 2016 5:51 PM   Subscribe

Beloved cat needs teeth extracted due to Feline Oral Resorptive Lesions. How did this surgery go for your cat? I'm worried, and struggling to choose a vet. Considering cost, equipment, experience, and gut instinct. Which vet should I use?

Male cat, 14 years old, healthy. Needs 2-6 teeth pulled due to feline oral resorptive lesions.
I love this cat with my whole heart.

Brief history:
Skinny cat, low appetite. Normal bloodwork.
3 years after a normal dental checkup, he now has some red and pink areas on his gums and one tooth with a visibly eroded gumline.
Former diet was good dry food; now switched to high-calorie wet food and gaining weight.
He nibbles then wanders off, which I interpret to mean that eating makes his teeth hurt and he needs a break.

2 teeth definitely need to be pulled. 4 more are questionable.
Usually a radiograph is used to check for erosion below the gumline, to find any teeth that look externally fine but may need to be pulled. Teeth are extracted, then another radiograph to find leftover tooth fragments which cause infection if missed, repeat til no fragments are left.

My instinct is that cat is getting older and I don't want to stress him. So catching any hidden damage seems important- seems better to pull lots of teeth once, rather than a few teeth, a few times. I've investigated three vets:

Vet One - Cost: $800
Conscientious and detail-oriented- remembered a lot of details and followed up really attentively. Does not have a dental radiograph, but says she painstakingly pieces-together all tooth fragments on a tray to ensure none are missed, and says she has a great record, which I believe. But without a radiograph she may miss other teeth with hidden erosion, leading to more problems later. Vet One said she understood my desire for a radiograph and suggested Vet Two.

Vet Two - Cost: $1000
Did something that was a red flag for me: touched my cat's bloody-looking eroded gum with bare finger, and then rubbed her own rashy eyes a moment later with the same finger (she appears to have chronic facial eczema). I was pretty grossed out by this and thought it signified a lack of attention to detail and lazy scrub practices. I'm a bit germaphobic so I may be overreacting?
Has a dental radiograph, so even though she's less careful than Vet One, she has a tool that will help catch errors, and also increase likelihood of nipping invisible damage in the bud.
Vet Two said cat is a little old for this surgery but should be ok. Her tone did not really convince me. She suggested Vet Three, who specializes in senior cats.

Vet Three - Cost: $3000 estimate (arrrghhhh)
Specializes in Feline Dentistry for Senior Cats. Has a radiograph. I haven't met her yet but she's the expert in this area in my city. I can pay the fee with some clever budgeting, but I feel sick and guilty about spending so much money on a pet. But I love my pet so much.

Which vet would you choose? (If you know a suitable vet in/near Toronto, I'm also open to suggestions)

When he has this surgery, what should I expect? I'd appreciate tips to increase his comfort, healing, and protect him from my other cat.... and to calm my worries!
posted by pseudostrabismus to Pets & Animals (19 answers total) 2 users marked this as a favorite
Our then-teenaged Kitty had all but four of her teeth removed and lived another six or seven very happy years after. Her quality of life was so much better after the surgery because her mouth didn't hurt anymore! So, as long as the pre-surgical blood work comes back okay, I think you can probably anticipate a good recovery and happy life afterward.

Can't help with the vet choice, sorry.
posted by cooker girl at 5:56 PM on February 23, 2016

Any chance you can get a pre-op and post op xray elsewhere, and stick with vet one for the actual surgery?
posted by studioaudience at 6:12 PM on February 23, 2016

When you say healthy you mean that kitty's liver and kidneys are working well?
Have you already done the bloodwork that they usually do before putting kitty under?
In older cats vets want to minimize the number of time they are put under especially if they have any issues with kidney function for example. My old cat had most of his teeth except for those tiny front ones and 1 fang pulled by a vet who was a lot like your description of vet 1. Cost was an issue for us but there wasn't the question of hidden damage. FWIW my cat recovered very well despite other health issues and seemed happy to gum his wet food.

Is there anyway you can get referred for a radiograph somewhere else and then get vet 1 to do the dental work?
posted by oneear at 6:14 PM on February 23, 2016

Response by poster: His bloodwork is normal, kidneys are very slightly on the low end but ok.

The pre-op radiograph could be done elsewhere, but the post-op radiograph needs to be done while the cat is still anaesthetized, so any missing fragments can be removed in the same surgery. Yes, I guess I could trust Vet One to check the pre-xray and then just extract diligently with no post-xray... that's an option, thanks.
posted by pseudostrabismus at 6:39 PM on February 23, 2016

I would go with vet one, given the choices. You obviously aren't comfortable with two, and I wouldn't be either. Three is a specialist, and while specialists have value, $3000 is extremely a lot for dental unless there are very very severe issues. Your cat does not sound that seriously screwed up. (As one vet told me when I was considering trying surgery to save a beloved elderly dog, he said best case it would get her six months, would cost $3000, and he closed with this: "You can help a LOT of dogs for $3000.")

Your cat is 14. This is a quality of life issue. Go talk with that vet again, or check with others. But do get those teeth done (likely they're just gonna pull all six since it's easier on the cat being proactive and doing it while it's already under instead of having to put it under again later.)
posted by azpenguin at 6:40 PM on February 23, 2016

My kitty just went in for oral surgery last week and had almost all of her teef pulled. She was a street cat in Bushwick before I got her and we don't actually know how old she is. I've had two vets warn me she would need dental work and we scheduled it after her last visit with my current vet. I paid under $500 in NYC which is absurdly cheap. But my vet only operates out of a van and has no fixed facility costs. She did the bloodwork and the X-rays in the van. So - the surgery was done in a mobile facility and everything went great for me and my kitty.

She had most of her teeth removed - she's only got about three left now. I dropped her off in the morning and picked her up in the evening. I'd asked for the pain patch after reading some other descriptions here in Mefi but when I picked her up my vet told me that she doesn't have enough volume to go through all the hassle of getting the restricted meds so I was given an oral painkiller to put on her food. This worked out fine.

When I got her home - she actually wanted to eat that night. So I fed her her favorite canned food and she ate it fine even with the stitches in. The first night was a bit rough because I didn't know what she would want and she wasn't acting herself. I assumed she'd want to get up on the human bed where she usually sleeps but she did not want that - she wanted to stick to the floor. The next morning I went out and got her a heated cat bed and set this up on the floor near her wet food, water and the litter box and this was good. She liked not having to go far for her needs.

The pain meds on her food was just fine. She ate her wet food, ingested the meds and was mellow on her heated bed for the next 8 hours until I could redose her. I used up the whole prescription for meds and she was fine when they ran out. I was worried about my other cat not having his dry food at his disposal but everyone's been very understanding.

Anyhoo - she can start eating her dry food on Saturday and she has snapped back to her normal self and she is incredibly spry and happy now. She has no problems eating, lords her heated cat bet over the other cat, and is getting back up on the human bed with me when I go to sleep like she used to. I can tell that she feels great. I personally think that 3K sounds egregious - but it's your cat.

My vet also saved her teeth for me to keep after her surgery! I asked my vet what people do with the teeth and she said - they make crafts and things! Is it a Brooklyn thing? I don't know. I have no idea if this is typical - but be prepared for some bloody evidence!
posted by rdnnyc at 6:41 PM on February 23, 2016 [3 favorites]

In your place, I'd choose conscientious and detail-oriented Vet One. Have the pre-op x-rays done elsewhere and ask her to be aggressive in the OR when deciding which teeth to remove.

My experience, as cooker girl and rdnnyc suggest, is that an older cat can be happy and healthy with virtually no teeth. Careful attention and an aggressive stance toward taking any tooth that looks even slightly compromised should reduce the overall risk to Kitty nearly as well as having post-surgical radiography. Vet One's proven track record is evidence.

That this option will also leave you with more cash on hand (for spoiling Kitty) is a bonus.
posted by peakcomm at 6:56 PM on February 23, 2016 [1 favorite]

My cat (5 years old) had every single one of his teeth removed last month, also because of resorptive lesions. I would emphasize that you definitely do want to find all of the teeth with damage, since you really don't want to do this twice. Going with Vet #1 and having x-rays done elsewhere sounds like a reasonable approach.

We got a Fentanyl patch that stayed on for a couple of days after the procedure, and was easier than administering anything orally. My cat was eating wet food immediately upon getting home. He was definitely a little worse for wear for a day or two, but has recovered quickly and fully. His quality of life is clearly so much higher now. He doesn't seem to realize that there are no teeth left anywhere in his mouth, and plays/bites as normal.

I can get pretty anxious about these things, and everything I read online (and boy, did I read a lot) emphasized that cats are Totally Okay with some or all of their teeth gone. This has proven to be 100% true in my case.

And I too was given the teeth in a little jar! Very strange. Someone should open an Etsy shop making things from all these loose cat teeth people apparently have floating around.
posted by apricity at 7:04 PM on February 23, 2016 [1 favorite]

I'd also go with vet 1 and ask her to be super aggressive in tooth pulling -- better to pull an extra tooth than to have to go back.

My then 11-year old cat had a bunch of teeth pulled for a different reason, and though her appetite didn't improve, she's never been a big eater so it wasn't likely that a new tooth problem would have fixed it. She is doing fine without her teeth and the only issue she had was weak bladder control for a few hours after I took her home. Your cat, unless you are feeding it live prey, does not need its teeth and will eat fine without it for the rest of its life.

I wasn't given her teeth, thankfully.
posted by jeather at 7:38 PM on February 23, 2016 [1 favorite]

My cat nearly died of starvation with a single resorptive lesion before a sharp eyed substitute vet spotted it and pulled the tooth. She thrived for several years afterward. There were a couple of other teeth with early lesions that didn't bother her and were not pulled. I do not recall any X-rays. The tooth they pulled had a crescent moon chunk out of it, poor thing. I am still unhappy with the vet who told us she probably had cancer because she was losing weight so quickly. We were very close to putting her down rather than let her waste away.

Short story- it was a very simple procedure and had an excellent outcome. Even though she was very frail. And at least for my kitty, the early lesions did not need treatment.

Best wishes to your beloved friend.
posted by SLC Mom at 8:23 PM on February 23, 2016

I also vote for vet #1. You'll never trust #2 at this point, so I wouldn't even consider her.

I currently have two(!) cats who needed full mouth extractions - one has all her teeth out, the other only has 2 canines left. This was for some insanely bad stomatitis however. The more expensive of the two cost me $2500 (CDN) for everything from a clinic that only does dental work (and did it well!). That $3000 sounds nutty -- even for an older cat.

I feel that even if vet #1 missed some teeth, you could also go back in again for the same price, and still come up ahead, price wise. But yes, it is stressful for the cat, but you could luck out, or it may not even even be necessary to remove the missed teeth.

Do your quotes cover pain killers for after the procedure? Antibiotics?

For me, the worst part was trying to force post-surgery antibiotics on my cats. Forcing open their very tender mouths to squirt liquids in seemed cruel. The second cat also had forced-liquid painkillers, but those really worked - she was loopy as could be. The other one had painkillers I had to glove up for and rub into her ears, which was a ton easier for both me and cat, but more expensive.

I will say having all those teeth out was the second-best thing to ever happen to both my cats. (The first was being rescued by me!) They suffer absolutely no side effects now, and actually prefer dry food. Given how much grief teeth seem to give cats, i'm starting to believe they're optional in today's indoor-only spoiled rotten house cat. Mine are certainly better off, anyway.
posted by cgg at 8:29 PM on February 23, 2016 [1 favorite]

Missed the edit window: Got a couple of the intact teeth from the first cat. Declined the offer on the second!
posted by cgg at 8:34 PM on February 23, 2016

I think it's worth getting as many teeth out as needed on this round; I had a cat who went through a few rounds of teeth-pulling and while she recuperated just fine, I regret that we didn't get it all done right just once. I would either go with Vet #3 or with Vet #1 and ask her to err on the side of taking out any questionable teeth.

Comfort-wise, the only thing I noted about recovery was that one time there were oral painkillers and the other time a stick-on patch, and I think the patch was a lot better. Obviously, holding on to a kitty's sore jaw to get meds down her throat to help with her sore jaw is...suboptimal. If I were doing it again, I'd specifically ask if post-surgery painkillers could be transdermal.

Really, though, I've been through this three times (one kitty twice, one once) and it was a lot harder on me than it was on the cats. They both bounced back quickly, were clearly much more comfortable, were eating regularly and regaining lost weight quickly, and I wish I'd done it sooner.
posted by Stacey at 6:00 AM on February 24, 2016

I'd go with vet #1 and pull any suspect teeth. More is better, really. I've got a 15 year old toothless cat (due to resporptive lesions) and he's fine, no trouble eating. I've also got another, younger, toothless guy due to a different issue and he is also fine. Teeth seem to be optional for cats! I have an *excellent* vet about an hour outside Toronto - please message me if you want more info.
Have you looked at the vetratingz website for the vets you've seen already? It might help you decide.
posted by strega_bianca at 6:27 AM on February 24, 2016

Response by poster: Argh- I loved the plan of getting radiographs wherever they're affordable, then having the vet I like best do the surgery, but it turns out the cat has to be sedated for the radiographs, which means same surgeon must do the x-ray and the extractions at the same time.
posted by pseudostrabismus at 1:19 PM on February 24, 2016

Best answer: As you now know, you cannot have the radiographs done elsewhere, they require general anesthesia, in which case you will be spending more than you need to.

Having ANY dentistry done without full mouth x-rays is a waste of time and money, painstaking piecing teeth together is, well...bizarre. Vet 1's method is scarily outdated and likely to leave your cat with root fragments that will abscess.

I would go with 2 or 3 or find another vet. There is a lot of good information about the whys and wherefores of animal dentistry here. And remember that anesthetic protocols are even more important than skill at dentistry (all anesthetized pets should have pre-op bloodwork, IV fluids running, have pulse oximetry, blood pressure, EKG, end-tidal CO2 AND staff monitoring them who know what to do, having emergency drugs already drawn up is also a sign of excellent anesthetic protocols).
posted by biscotti at 4:55 PM on February 24, 2016

My 12 year old cat had almost all of his teeth pulled for this reason a few months ago. The recovery was much easier and faster than I had hoped!

One thing you might want to consider in a vet is whether they have someone available for questions or help late and on weekends. My cat was doing great for a few days and then suddenly stopped eating and got very lethargic. Fortunately, our vet had a 24-hour line and someone was able to talk to us when we got worried (it was a reaction to the pain relief patch. He perked up immediately after we took the narcotic patch off).

Overall, my cat is much happier (and fatter) and the recovery didn't seem to be too stressful or painful.
posted by forkisbetter at 6:38 PM on February 24, 2016

Best answer: I have two cats with teeth problems. They've both had multiple extractions, and next week one is going in for her second round of serious dental work in five-ish years. I have a small collection of weird little cat teeth in plastic containers that I can't make myself throw out.

Personally, if x-rays weren't possible I would find another vet. Like biscotti said above, paying a little more/going somewhere new for better and more precise work is totally worth it for both your cat's recovery and your peace of mind.

My cats have bounced back from dental work really quickly and with zero problems. Your little buddy will seem really strange and loopy while he comes down from the anaesthetic and while he's on pain killers. One of my cats paced around the house all wild-eyed for an entire day, but the other was a lot more lethargic and spaced out.

The vet prescribed a liquid pain killer dosed out in tiny syringes that we were instructed to squirt into their mouths between their lips and their gums. It was a lot easier than it sounds. They also both got a shot of antibiotics a week before the procedure. We've always used the same vet so I don't know how this varies in different practices. (My vet is in mid-town-ish Toronto if you're interested.)

Good luck! Your cat won't be bothered by having fewer teeth, and will be so much happier to be free of his mouth pain!
posted by 1UP at 7:13 AM on February 25, 2016

Response by poster: Thanks so much to all who gave advice. I ended up calling around some more and finding another vet with great attention to detail and an in-house radiograph.
It cost $1400 to get 4 teeth out, including cleaning, x-rays, and liquid oral pain medication, and he was home that night, groggy and swollen with his little tongue poking out, but already eating greedily just 5 hours after the surgery. He was totally back to normal within 3 days, and he eats much more enthusiastically now that those teeth are sitting in a tiny jar in my dresser. I'm so glad I got this done and very grateful for the reassurance and advice!
posted by pseudostrabismus at 10:16 AM on March 18, 2016 [1 favorite]

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