Dental Pain and Anesthesia Concerns - 16y CKD / diabetes in remission currently

Tilda

Active Member
Hi everyone,

I've been watching quietly here since Tilda went into remission over a year ago-- we are still so thankful for all of your help. I posted this today in the CKD Facebook group but trust you all so much that I'd love any advice.

We're trying to make the right decision for our girl but I think we know the answer is doing the dental ASAP if it's possible.

Last weekend Tilda (16 years old) had sudden bad mouth pain and after watching her for a few hours decided to take her to the emergency vet since she was reluctant to eat. I caught it because I heard her gag after eating and saw her frantically pawing at her mouth, using her tongue to push food bits out.

Two vets looked in her mouth and we all didn't see anything (but the usual tartar). In hindsight I noticed she ate less 48 hours before the pain started, her breath has smelled bad for the last 6 months, and she has been dropping food more often. She has had off and on soft stool for a few weeks (we balance constipation with miralax and psyllium). Her kidneys are currently 3.9 creatinine and 54.9 BUN -- creatinine was 3.4 in November, 3.0 in April, 3.4 the prior year...so up and down a little and the vet says "stable". BG has been under 100 except once at the vet during stress.

She's now on bupe every 12 hours and is eating very thinned food which I'm tracking closely-- I believe she's getting enough calories but a little less than she usually eats. Other than the occasional pain when eating (she tilts her head, moves her tongue as if she's moving food away from her molars, grinds her teeth) she is acting herself-- no loafing, chirping, grooming.

We were fortunate to see a dental specialist for a consult on Thursday and are waiting to hear back from the Dr. and anesthesiologist to see if she's a candidate for anesthesia. They are ok with us waiting a little longer to monitor her and I feel she would be in good hands there. We cannot let her be in pain or not eat. But I'm obviously terrified.

She had a dental two years ago (and one prior) and has a history of needing teeth removed. She did well last time.

Pending approval for anesthesia, we have a few options:

Do the dental ASAP and hope it resolves the pain and hope that it doesn't damage her kidneys further.
Postpone the dental (months? they said 6 months would be OK) with pain management and watch her closely. We'd redo bloodwork then. Obviously we risk her kidneys getting worse with this option.
Do a sedated CT as a low risk option to see what's happening before jumping into anesthesia.


Thank you all
 
Hi everyone,

I've been watching quietly here since Tilda went into remission over a year ago-- we are still so thankful for all of your help. I posted this today in the CKD Facebook group but trust you all so much that I'd love any advice.

We're trying to make the right decision for our girl but I think we know the answer is doing the dental ASAP if it's possible.

Last weekend Tilda (16 years old) had sudden bad mouth pain and after watching her for a few hours decided to take her to the emergency vet since she was reluctant to eat. I caught it because I heard her gag after eating and saw her frantically pawing at her mouth, using her tongue to push food bits out.

Two vets looked in her mouth and we all didn't see anything (but the usual tartar). In hindsight I noticed she ate less 48 hours before the pain started, her breath has smelled bad for the last 6 months, and she has been dropping food more often. She has had off and on soft stool for a few weeks (we balance constipation with miralax and psyllium). Her kidneys are currently 3.9 creatinine and 54.9 BUN -- creatinine was 3.4 in November, 3.0 in April, 3.4 the prior year...so up and down a little and the vet says "stable". BG has been under 100 except once at the vet during stress.

She's now on bupe every 12 hours and is eating very thinned food which I'm tracking closely-- I believe she's getting enough calories but a little less than she usually eats. Other than the occasional pain when eating (she tilts her head, moves her tongue as if she's moving food away from her molars, grinds her teeth) she is acting herself-- no loafing, chirping, grooming.

We were fortunate to see a dental specialist for a consult on Thursday and are waiting to hear back from the Dr. and anesthesiologist to see if she's a candidate for anesthesia. They are ok with us waiting a little longer to monitor her and I feel she would be in good hands there. We cannot let her be in pain or not eat. But I'm obviously terrified.

She had a dental two years ago (and one prior) and has a history of needing teeth removed. She did well last time.

Pending approval for anesthesia, we have a few options:

Do the dental ASAP and hope it resolves the pain and hope that it doesn't damage her kidneys further.
Postpone the dental (months? they said 6 months would be OK) with pain management and watch her closely. We'd redo bloodwork then. Obviously we risk her kidneys getting worse with this option.
Do a sedated CT as a low risk option to see what's happening before jumping into anesthesia.


Thank you all
@Bandit's Mom
@Bron and Sheba (GA)
@Sienne and Gabby (GA)
 
Many of my old cats have had dentals, one at the age of 19 (he's now 22). Cats are very good at hiding pain so if it's noticeable to you, it's already bad. Mouth pain can be excruciating and the bad breath may be an abscessed tooth, which my Finn had. Bacteria from dental disease can spread to other organs and cause life-threatening infections in the heart, kidneys and liver so it's important to take care of it sooner rather than later. With Finn who also has CKD, my choices were euthanize or risk the dental, but letting him suffer was not an option. I would not wait 6 months.
 
Gabby had dentals at +16yo. It wasn't a problem. I agree with what Deborah posted. A dental infection can cause other systemic problems. Veterinary dentists are typically far better than having a dental at your usual vet's office especially if there are other medical issues that are of concern.

One word about a CT -- they are very expensive. I'd get a quote on the cost before you make a decision. It may make a difference if the vet feels that the problem isn't dental.
 
Many of my old cats have had dentals, one at the age of 19 (he's now 22). Cats are very good at hiding pain so if it's noticeable to you, it's already bad. Mouth pain can be excruciating and the bad breath may be an abscessed tooth, which my Finn had. Bacteria from dental disease can spread to other organs and cause life-threatening infections in the heart, kidneys and liver so it's important to take care of it sooner rather than later. With Finn who also has CKD, my choices were euthanize or risk the dental, but letting him suffer was not an option. I would not wait 6 months.
Thank you for sharing about your kitties! I agree, it's got to be terrible for me to see it. Our girl is so tough and it makes me feel terrible that she's likely had some pain for months that I didn't notice.
 
Gabby had dentals at +16yo. It wasn't a problem. I agree with what Deborah posted. A dental infection can cause other systemic problems. Veterinary dentists are typically far better than having a dental at your usual vet's office especially if there are other medical issues that are of concern.

One word about a CT -- they are very expensive. I'd get a quote on the cost before you make a decision. It may make a difference if the vet feels that the problem isn't dental.

Thank you! The quote we've received is bonkers but I was glad they offered options and didn't push us into anything even if we all know the right option is doing the dental ASAP. If they clear her for anesthesia we'll likely set up the dental without the CT and hope that they are able to find the source of her pain. Since we can't see what's bothering her, it's a bit scary.
 
Did the dental specialist see infections in the mouth? Just wondering if a short course of antibiotics will help before the surgery. If yes, might indicate a dental is needed.
 
Did the dental specialist see infections in the mouth? Just wondering if a short course of antibiotics will help before the surgery. If yes, might indicate a dental is needed.

Unfortunately I don’t think any of the vets saw anything super concerning— just tartar and her chart says “moderate” dental disease. That’s a good thought about the antibiotics… I’d have trouble getting them in her right now— I'm chasing her around with food and I can’t pill her. I hope to hear from the dentist tomorrow and can ask a bunch more questions.
 
For next time, maybe some tips for you: Pilling Your Cat

After Neko's major dental, I got the antibiotic in liquid form. It was easier to squirt a liquid than pill her.

Liquid can work! I have had so many cats I now spend time making sure I can touch/pill/pick up/hold anything by working with them overtime but Tilda draws the line at pills haha
 
Keep in mind that there are some medications that can be compounded into topical form, as well. You put the goop on your cat's ear. There may be issues with dosing since the absorption may be different, though. Lots of meds can be compounded into liquid. (Unfortunately, they may taste terrible.)
 
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