Date Published: March 1, 2019
Publisher: Public Library of Science
Author(s): Ryota Watanabe, Graeme Doodnaught, Caroline Proulx, Jean-Philippe Auger, Beatriz Monteiro, Yvan Dumais, Guy Beauchamp, Mariela Segura, Paulo Steagall, Francesco Staffieri.
This study aimed to evaluate pain scores, analgesic requirements, food intake and serum inflammatory cytokines in cats before and after clinically recommended dental treatment. Twenty-four cats were included in a prospective, blinded clinical trial. Cats were equally divided into minimal (minimal dental treatment) or severe (multiple dental extractions) oral disease groups. They were admitted (day 0) and underwent oral examination/radiographs/treatment under general anesthesia (day 1; acepromazine-hydromorphone-propofol-isoflurane-meloxicam-local anesthetic blocks). Serum inflammatory cytokines were measured on days 0 and 6. Pain was scored using the Glasgow composite measure pain scale-feline (CMPS-F). Rescue analgesia was administered with hydromorphone if CMPS-F ≥ 5/20. Dry and soft food intake (%) during 3 minutes and 2 hours, and daily soft food were calculated. The Cochran-Mantel-Haenszel and Chi-square tests, Spearman’s rank correlation and linear mixed models were used for statistical analysis (alpha = 0.05). Pain scores were significantly increased in cats with severe disease when compared with baseline (up to day 4) and minimal disease (all postoperative time points). Prevalence of rescue analgesia was significantly higher in severe (91.7%) than minimal disease (0%); analgesics were required up to day 3. Pain scores and frequency of rescue analgesia were significantly correlated with the number of tooth extractions, gingival and calculus index. Prevalence of rescue analgesia was significantly correlated with the number of missing teeth, teeth extractions and gingival index. Dry and soft food intake during 3 minutes, and dry food intake during 2 hours were significantly lower in the severe than minimal disease group throughout the study. Some cytokines differed between groups between day 0 and day 6 and were associated with the presence of tooth resorption and number of missing tooth and tooth fractures. Long-term analgesia is required after dental extractions in cats with severe oral disease. This condition reduces food intake and influences serum inflammatory cytokines.
Pain is a serious welfare issue that produces long-term distress with significant deleterious effects affecting quality of life (QoL) in humans [1–4]. Periodontal disease including gingivitis and periodontitis, is one of the most commonly reported diseases in humans and companion animals [3,5–8]. In cats, it produces pain, inflammation, dysphagia, halitosis, weight loss and oral hemorrhage; aggressive full-mouth extractions are commonly required as treatment [9,10]. Nevertheless, pain scores and analgesic requirements have not been systematically investigated in cats with oral disease undergoing dental extractions. It is unknown how oral treatment can affect soft and dry food intake perioperatively which could significantly impact the nutritional status of these patients.
Descriptive statistics for age, body weight, body condition score, surgery (time elapsed from the first scaling until the end of scaling or placement of the last suture) and anesthesia (time elapsed from induction of propofol to turning off the vaporizer dial) times, and dental score and number of extracted teeth are presented in Table 1. Cats in the minimal disease group were typically younger and lighter and required less time for surgery and anesthesia than those in the severe group (Table 1). One cat from the minimal disease group was excluded because of wound dehiscence in the postoperative period requiring further treatment. Therefore, only preoperative data of this cat was included in the analysis.
This study showed that cats with severe oral disease undergoing dental treatment had significantly higher postoperative pain scores and analgesic requirements, and significantly lower soft and dry food intake when compared with those with minimal oral disease. Additionally, pain scores and frequency and prevalence of rescue analgesia were correlated with some dental parameters and specific serum inflammatory cytokines.
This study showed that severe oral disease and multiple dental extractions produce severe pain and inflammation that require long-term analgesic treatment. Opioids were often required for up to 2 days after surgery. This condition affects food intake with an ultimate consequence for the welfare and nutritional status of these patients. Pain scores and inflammatory biomarkers were associated with dental parameters and could predict postoperative analgesic requirements. The concentrations of serum inflammatory biomarkers after dental extractions and between severity groups were described and could provide future insights into the pathogenesis of oral disease in cats.