Dear Dr. Barchas,
My 13-year-old cat, Darwin, had dental surgery two weeks ago after showing signs of periodontal disease (drooling, bad breath, difficulty eating dry food). He had two extractions, lower and upper teeth in the back of his mouth. He was sent home with no pain meds or other specific instructions, other than to withhold food for about 12 hours due to anesthesia.
About a week after the surgery he still wasn’t eating well and seemed to be in pain, so I took him back to the vet. They noticed a ball or knotlike area on the jaw. It is hard and does not move (like a cyst), and seems tender or painful. I’m not trying to be smart when I say this, but he looks like he’s got a wad of chewing tobacco in his mouth. They kept him overnight, gave him electrolytes, fluids, and pain meds, and got him eating again.
They sent him home with prednisolone and buprenorphine for pain for five days and Clavamox for seven days in case there was infection. They provided no explanation as to what the knot or ball area is or what might have caused it.
After about five days, he still seemed lethargic, still had the knot on the side of his face and stopped eating again. He also developed upper respiratory infection symptoms, but all nasal and eye discharge fluids are clear.
I took him to a different vet and they gave him Science Diet A/D, which he seems to like and eats with some coaxing. They gave him a Covenia injection, which they said was an antibiotic that will stay in his system for up to two weeks, but no additional medicine for pain.
Today he is still very lethargic, still needs coaxing to eat, and seems uncomfortable and in pain. Can you give me some advice as to what is going on with him?
Is the swollen area centered at a site where a tooth was extracted? If it is, I am very strongly suspicious that a residual tooth root fragment may be causing infection and irritation.
Teeth that are extracted due to periodontal disease inevitably are infected. Pulling these can be very tricky business. Teeth are attached to the bones of the face through roots, which must be fully removed as well. However, especially when teeth are compromised by advanced periodontal disease and infection, it can be nearly impossible to differentiate the tooth root from the tissue that surrounds it. As a result, a fragment of root can be left behind, and can then serve as a chronic source (called a nidus) of infection and swelling. The infection in turn can cause lethargy and pain, as well as suppress appetite.
Antibiotics such as Clavamox and Convenia may have limited effect when a nidus of infection is present. The roots abut the eye and nose, so infections can cause symptoms of upper respiratory infections.
If a tooth root fragment is the cause of the problem, the solution is to remove it. This will require another anesthetic procedure. I recommend that this procedure be performed at a facility that can take dental X-rays, which will help to identify any residual tooth fragments that might be causing problems. It will also be helpful in identifying other possible causes for your cat’s symptoms, such as a fractured bone in the area of the swelling (fractured facial or jawbones are common complications of dental extractions).
Finally, although I don’t like to bring it up, there is a chance that neither an infection nor a fracture is the cause of your cat’s issues. Sadly, it is possible that an oral tumor may have caused the intial symptoms of drooling, bad breath, and poor appetite that Darwin displayed prior to his dental work. In that case, the swelling might represent a normal progression of the tumor. I hope this is not the case, but X-rays should be very useful in determining whether a tumor is playing any role in the problem.
Regardless of what happens, if you suspect that your cat is in pain, you should get him back on painkillers immediately. Buprenorphine and tramadol are two comonly used feline painkillers.
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