5 Sources of oral and dental pain that demand serious attention

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According to Heidi Lobprise, DVM, DADVC, pain interferes with healing; pain interferes with function; pain interferes with behavior. While giving her session talk at the New York Vet Show 2021, in New York, New York, Lobprise highlighted the most common sources of oral pain and shared her experiences with pain management in her practice. Here are the 5 issues she targeted for discussion.

1. The silent progression of periodontal disease

Periodontal disease is the infection and inflammation of tissues that support the teeth in the mouth. Lobprise advised the audience: “The progression of periodontal disease in itself is not terribly painful, because it’s slow and gradual…It’s somewhat of a hidden disease until you get a loose tooth or ulcer or something like that.”

In her material, Lobprise shared some signs to look for in catching periodontal disease early, including bad breath, not eating hard food or treats like before, not eating well, and weight loss. She stressed that it can be tough to spot early, because until there is inflammation, the patient may not be experiencing any pain. She noted, “The thing about periodontal disease…it’s not just the infection…it’s the chronic inflammation and that metastatic inflammatory response that causes most of the problems.”

2. Broken teeth and pain that comes and goes

Next, Lobprise pivoted to fractured teeth and what to think about when dealing with those patients. She cautioned that pain might not be evident right away. She said that this is because the nerve may only be very sensitive initially. However, she added, “Once that pulp dies…there’s no acute pain.”

“Once we get that dead pulp, bacteria colonies in there leading to an abscess…then we get pressure with chronic inflammation,” continued Lobprise, adding that this will reintroduce oral pain.

3. Tooth resorption and secondary infections

The ensuing topic revolved around tooth resorption. She characterized tooth resorption as occurring when bone cells next to the tooth get through periodontal ligament, which then resorbs the root and transforms it into bone.

“When we see the tooth resorption, when it’s still in the root, there tends not to be a lot of discomfort at that point in time as long as there’s no infection and inflammation," explained Lobprise. "When that…resorption gets into the crown, we start seeing loss of the crown substance. We start getting gum tissue growing into the grown. That’s where it becomes uncomfortable and painful, and that’s where we can get the secondary infections.”

4. Stomatitis in cats and ulcerative disease in general

Lobprise then spoke on ulcerative disease, which she explained arises in the form of severe inflammation and ulceration, even with mild plaque and tartar, due to the immune system overreacting. Simply put, “It’s the immune system and the inflammation causing the disease,” she said.

She put her focus on stomatitis in cats, adding, “Everybody’s frustrated by stomatitis in cats. If somebody could find a cure for it, that would be amazing, but there’s just too much complication.” She noted that she prefers to recommend a full-mouth extraction in these cases, due to other treatment options often only being temporary solutions.

5. Oral tumors and the importance of early detection

Lobprise mentioned that the key to dealing with oral tumors is early detection, which can be challenging unless the tumor is very large or near the front of the mouth. She advised that they can often grow quite large because they are hidden, with the first signs of a tumor being oral odor and bleeding. She added that pain typically isn’t present until the tumors are large. She recommended regular oral examinations to help spot tumors before they reach that stage.