Tooth resorption in cats (FORL) and feline gingivitis
Tooth resorption is one of the most common and most painful diseases in cats, and is often invisible without X-rays. We diagnose it under anaesthesia and treat it by removing the affected teeth.
What it involves
Tooth resorption (FORL, today more often called simply feline tooth resorption) is a process in which the cat's own cells gradually dissolve the hard tissues of the tooth — from the root towards the crown. Once the defect reaches the pulp, the tooth hurts at every touch, including when eating. The disease affects as many as one in three adult cats, and its cause is still unknown.
Gingivitis in cats can be associated with it, but it is a broader group: from ordinary inflammation caused by tartar to severe, chronic inflammation of the mouth (stomatitis), in which the inflammation involves the cheeks and throat, and the cat suffers so much that it stops eating.
There is no medicine that reverses resorption. The effective treatment is removal of the affected teeth — a cat without painful teeth eats normally, often better than before. In stomatitis, extensive extractions are also the most effective method, although some cats later need further anti-inflammatory treatment.
When it is used
We recommend testing for resorption in every cat with signs of oral pain, drooling, a change in the way it eats, or visible redness of the gums at the level of the necks of the teeth. It is also worth checking the teeth whenever the cat is under anaesthesia for another reason, because the disease often gives no clear signs until it is advanced.
Gingivitis in young cats (under 2 years) or gingivitis that does not respond to dental treatment requires extended diagnostics, including tests for FIV, FeLV and calicivirus.
Indications: symptoms that should prompt a visit
- The cat starts to eat and suddenly jumps away from the bowl, drops food or miaows while eating.
- The cat's jaw trembles or it “chatters its teeth” when biting.
- Drooling, sometimes with blood; the cat rubs its muzzle against objects or paws at its cheek.
- The cat has stopped eating dry food, but eagerly eats wet food or licks the gravy.
- The gum at the neck of the tooth is bright red and seems to grow into the tooth.
- Unpleasant mouth odour, weight loss, an unkempt coat because the cat has stopped grooming itself.
- The cat clearly has fewer teeth than it should, although none have been removed.
Conditions for which we use it in particular
Diagnostics beforehand
At the consultation we assess the mouth as far as the cat allows, and take a history. Before anaesthesia we do a blood count and biochemistry (STD-01), and in stomatitis or in outdoor cats we suggest FIV/FeLV tests and — when important for the plan — a PCR test for calicivirus (sent away to an external laboratory).
Proper diagnosis means dental X-rays of all the teeth under anaesthesia. Resorptive changes under the gum and the type of resorption can be seen only on the image, and the type determines whether the roots must be removed or the crown can be amputated. Without X-rays this disease cannot be treated properly.
How it proceeds
The cat arrives fasted. After premedication and placement of an IV cannula, we induce general anaesthesia with intubation; throughout the procedure we monitor ECG, oxygen saturation, capnography, blood pressure and temperature (STD-02), and the patient lies on a heated surface, which is particularly important in cats. Before extractions we perform nerve blocks to keep pain after waking to a minimum (STD-04).
After X-rays of the whole dentition and probing, we remove the teeth affected by resorption: in type 1 the whole tooth, with its roots, after incising the gum and dividing the roots; in type 2, if the X-ray allows, we amputate the crown and close the gum over the resorbing root. The remaining teeth are cleaned with a scaler and polished. In stomatitis we agree the scope beforehand: removal of the cheek teeth or of all the teeth. We finish each extraction with a check X-ray, and close the wounds with an absorbable suture.
Duration of the procedure: from 45 minutes for single teeth to 2–3 hours for full extractions. The cat wakes up in the hospital, in warmth, and goes home the same day or — after extensive procedures — after a night of observation, as decided by the lead veterinarian.
Aftercare
For 10–14 days give only wet food, pain relief as set out in the discharge notes, and any antibiotic. Cats often eat better after just 1–2 days than before the procedure. We book a check-up after 7–10 days; in stomatitis, further check-ups every few weeks, because some cats need additional anti-inflammatory treatment.
Resorption can appear in further teeth, so we recommend an oral examination every 6–12 months and a check X-ray at the next anaesthetic. Call us if the cat does not eat for more than a day, drools blood-stained saliva, or has swelling of the mouth or fever.
Frequently asked questions
Will a cat eat normally after all its teeth have been removed?
Yes. Cats without teeth eat wet food, and many of them return to dry food once healed — they swallow the kibble whole. Being free of pain is a greater relief to them than the loss of teeth.
Can resorption be prevented?
We do not know the cause, so there is no proven prevention. What can be done is to detect it early: regular oral examinations and X-rays at every anaesthetic.
Does the cat really suffer if it is eating?
Cats hide pain very effectively and eat because they have to. A resorptive defect reaching the pulp hurts at every touch — during the examination this can be seen, even in a deeply anaesthetised cat, as a jaw-trembling reflex.
Is stomatitis the same as FORL?
No. Resorption is a disease of the tooth, stomatitis is extensive inflammation of the mucous membrane. They can occur together, and treatment of both often relies on extractions, but stomatitis additionally requires anti-inflammatory treatment and monitoring.
We manage every case individually. The scope, indications and course described above are indicative; we agree the exact diagnostic and treatment plan during the consultation. This content is for information only and does not replace a veterinary consultation.
Do you have questions about tooth resorption in cats?
Call us or book a consultation. We will set out the diagnostic and treatment plan in writing, before you decide.