Cat teeth: how do you brush them, and what about tartar?

A cat gets two sets of teeth. Kittens are born without teeth and get 26 baby (milk) teeth. An adult cat has 30 permanent teeth: 12 small incisors at the front, 4 long canines (the fangs), 10 premolars and 4 molars. The baby set has no molars.

Permanent teeth do not grow back. If an adult cat loses a tooth, have a vet find out why.

Cats cope very well with few teeth, or none. A cat with no teeth and no pain is better off than a cat with many painful, unhealthy teeth.

Baby teeth come through from about 3 weeks and are usually all in by about 6 to 8 weeks. From about 3 months the adult teeth push through and the baby teeth fall out. Most kittens have all 30 adult teeth by 6 to 7 months.

Kittens chew most between about 3 and 7 months. Some extra chewing, eating a bit less, slightly red gums, a little drool and changed breath are part of teething. A baby tooth on the floor is normal, and most kittens simply swallow them, which does no harm. Never pull a loose baby tooth: it falls out by itself.

Give soft or rubber chew toys, not hard plastic or wood, because baby teeth are fragile. Do not let a kitten chew hands and feet: it becomes a habit. Soft or wet food helps if crunching hurts.

Sometimes a baby tooth stays in place while the adult tooth comes through beside it, most often an upper canine. Food and bacteria get trapped between them, leading to tartar, gum disease and a painful bite. Vets usually remove such a retained tooth under anaesthesia once the adult tooth is coming through, without waiting for neutering. Look in the kitten's mouth weekly until about 7 to 8 months.

Plaque is a soft, sticky film of bacteria, saliva and food that forms on the teeth within hours of a meal, and keeps coming back. If it is not brushed off, it hardens into tartar within about a day: the rough, brown-yellow crust, usually first on the outer side of the back teeth.

Tartar itself does not cause the inflammation; the bacteria that stick to its rough surface do. Inflamed gums (gingivitis) are red, swollen and sore and may bleed. This is usually reversible once plaque and tartar are removed. If it goes on, the bone that holds the tooth is destroyed too (periodontitis). That cannot be reversed and leads to receding gums, loose teeth and tooth loss.

Gum inflammation can have other causes too: cat flu viruses (calicivirus, herpesvirus), FeLV, FIV, kidney disease, diabetes, or a grass blade or other object stuck in the gum. It can happen at any age, kittens included.

Dental disease is very common: studies find it in 50 to 90 percent of cats over four. The chance rises with age and is higher in some breeds (Persian, Maine Coon, Burmese, Siamese, Abyssinian, Somali), in cats that keep baby teeth and in cats whose teeth are never brushed. Soft diets and lots of sweet treats are also named.

No. Hard tartar does not come off with brushing. Only a vet removes it properly, with an ultrasonic scaler above and below the gum line, and then polishes the teeth smooth.

Do not scrape tartar off at home. It is hard, you can hurt the gums, and tartar often hides damage that only shows once it is gone.

Tartar alone is not an emergency. Mention it at the next check-up, or sooner if it keeps coming back, the gums are inflamed or your cat eats less. With heavy tartar and inflamed gums the vet may also suggest a blood test (for example for FIV and FeLV) or X-rays.

After a professional clean, plaque and tartar build up quickly again without home care. Daily brushing is what slows new tartar.

Daily brushing is the best home care and prevents most dental disease. Three times a week is the least that is advised. A minute or two at a time is enough.

Start young if you can, but older cats can learn too, with more patience. Build it up slowly over about four weeks. During teething, just get a kitten used to having its mouth handled and the taste, without scrubbing.

Look at the gums first. Healthy gums are light pink, the teeth white to off-white, with no smell. If the gums are red, sore or bleeding, ask the vet first. Brushing a painful mouth hurts and teaches your cat to refuse.

Brush the outer surfaces of the teeth along the gum line, where plaque and tartar build up fastest. The tongue keeps the inside clean. Start with the big back teeth and the canines, with the brush angled (about 45 degrees) towards the gum and light pressure. Small circles and short back-and-forth strokes are both advised.

Brushing works best. Dental treats, dental food and water additives are extras, and a second best for a cat that will not accept brushing. Nothing in a bottle or a treat dissolves existing tartar.

Vets point to the seal of the VOHC (Veterinary Oral Health Council). A product gets it when trials showed it reduced plaque or tartar by a set amount. It does not mean your cat will not get gum disease. Check the exact product name on the list, because only one version of a brand may carry the seal.

Dental treats only clean where they touch the tooth; give them now and then and cut back other food. Dental diets only work if fed all the time, and the vet can say whether one suits your cat. Ordinary dry food is not a toothbrush: the evidence that biscuits keep teeth clean in the long term is thin.

Water additives may reduce plaque and bad breath above the gum line, but cannot reach below it. Most of the research is in dogs. Choose one made for cats, keep a bowl of plain water next to it and check that your cat keeps drinking. A chlorhexidine gel is something vets commonly use; ask first. Chews that are too hard (bones, antlers, nylon, hard plastic) can break teeth.

Dental disease hurts, even when your cat keeps eating. Cats hide pain, so the signs are often small changes in eating, grooming or mood, not crying out.

Watch for bad breath, red or bleeding gums, drooling, eating less or only soft food, chewing on one side, dropping food, pawing at the mouth, tilting the head while chewing, and weight loss. A cat that goes to its bowl, hisses and walks away, or leaves hard food, may be telling you eating hurts. Hiding, no longer wanting to play or sudden aggression can be part of it too.

Bad breath in a cat is not normal and is often the first sign of toothache. Mostly it comes from plaque, tartar or inflamed gums, but kidney disease, diabetes, something stuck or a growth in the mouth can cause it too. Treat the cause, not the smell. Only in a teething kitten is changed breath normal.

A tooth root abscess is a painful infection around a root and often shows as swelling on one side of the face, just under the eye. Teeth weakened by disease, a knock or a hard chew can break, which is very painful. Left untreated, a cat can stop eating and lose weight, and bacteria from the mouth can get into the bloodstream.

In tooth resorption, also called FORL or neck lesions, the cat's own cells dissolve the tooth, starting at the gum line. It is not a sugar cavity like human tooth decay. It is one of the most common dental problems in cats: studies find it in roughly 20 to 70 percent, depending on which cats were checked and whether X-rays were used. It becomes more common with age.

The cause is unknown and there is no known way to prevent it. The lower premolars are most often affected, often on both sides. Early on you usually see nothing, because it sits below the gum. A pink spot on the tooth at the gum line can be a sign. Once the lesion opens into the mouth, it hurts.

Looking and probing only finds late lesions. The vet needs a tooth-by-tooth exam and X-rays under anaesthesia. Treatment is aimed at pain: usually the whole tooth comes out, sometimes only the crown when the X-ray shows that is possible. Fillings are no longer advised, because resorption carries on underneath, and fluoride has not been shown to stop it. After a diagnosis, a yearly check with X-rays is advised.

Chronic gingivostomatitis, usually just called stomatitis, is a painful, long-lasting inflammation that spreads from the gums to the cheeks, tongue and back of the mouth. It is much less common than tartar. The immune system probably overreacts, perhaps to plaque, and viruses such as calicivirus, FIV and FeLV may play a part. Vets usually test for FIV and FeLV.

Signs are bad breath, drooling, a very painful mouth, eating less, weight loss and a scruffy coat because the cat stops grooming. Medicines and cleanings alone often do not solve it. Removing teeth (the back teeth or the whole mouth) is the standard treatment for cats that do not improve. Results vary from cat to cat, and it can come back, so follow-up visits matter.

A cat will not sit still with its mouth open. A proper look at every tooth, probing and X-rays are only possible under anaesthesia. The vet removes plaque and tartar above and below the gum line and polishes the teeth. X-rays matter, because root disease and resorption sit under the gum. Teeth that need to come out are usually removed in the same anaesthesia.

Anaesthesia-free dental cleaning is advised against by vet bodies. It cannot clean below the gum, cannot take X-rays or control pain, and gives a false sense of security: the teeth look clean while the disease stays.

Anaesthesia always carries some risk, higher in cats with kidney or thyroid disease, high blood pressure or old age. Vets run a blood test first and monitor heart, oxygen and breathing. With modern monitoring it usually goes well, even in older cats. Fear of anaesthesia is the most common reason a needed procedure is put off. Your cat gets pain relief and usually goes home the same day. Follow the practice's rules on food and water beforehand, and ask whether another procedure, such as neutering, can be done in the same anaesthesia.

AAHA guidelines advise a first anaesthetised dental assessment with X-rays by about one year of age. For cats that build up tartar fast, many vets suggest a cleaning every 6 to 12 months. Your own vet may advise differently.

A tooth comes out when it is loose, broken with the nerve exposed, resorbed or infected, or part of gum disease or stomatitis that cannot be treated another way. The aim is a healthy mouth without pain. The vet loosens the tooth, checks with an X-ray that the whole root is out, and closes the gum with dissolving stitches.

Afterwards your cat gets pain relief from the vet, sometimes antibiotics, and soft or wet food for a while. Most cats eat better afterwards because the pain is gone, even after several teeth are removed. Never give human painkillers yourself: paracetamol is toxic to cats.