[00:00:02] Introduction: Welcome to All Cats Considered, a podcast from the Feline Veterinary Medical Association.
Here we interview professionals from across the veterinary world and take deep dives into the latest evidence-based research, developments, studies and guidelines that improve feline health and well-being.
We are the home for veterinary professionals seeking to enhance the care of cats through high standards of practice, continuing education and evidence-based medicine. In each episode you'll hear interviews with a variety of experts in our field covering a wide range of topics and the latest developments in feline health. We'll share the key points you need to know to improve your patients' care.
Let's dive in and listen to this week's experts.
[00:00:44] Dr. St. Denis: Well welcome everyone to this month's Clinical Spotlight interview. I am Dr. Kelly St. Denis, co-editor of the Journal of Feline Medicine and Surgery and Journal of Feline Medicine and Surgery Open reports. Today we have a really exciting interview for you today because we're going to be talking about the 2025 Feline VMA Oral Health and Dental Care Guidelines, the first feline only oral health and dental care guidelines. And I was very privileged to have the opportunity to be a co-chair on the task force. And today I have my co-chair with me, Dr. Heidi Lobprise, veterinary dentist and we're going to chat about the guidelines and discuss some of the content.
Dr. Lobprise, welcome and thank you for all the great work over the past year. It's really been a pleasure working with you on these guidelines.
[00:01:35] Dr. Lobprise: Well, thank you Kelly. We had a great team of some other veterinary dental specialists and a technician specialist as well.
And I really like how this focused on supporting the practitioner with feline dental care.
[00:01:53] Dr. St. Denis: Yeah, that was really one of the really good parts and we're going to talk some more about that too. But I wondered if you could just take a minute to tell us about yourself and how you got into veterinary dentistry.
[00:02:05] Dr. Lobprise: Well, I consider an act of God basically because I'm a Texas A&M graduate, 1983. Yes, they were still graduating us back then and I actually started doing relief work, met Dr. Robert Wiggs, who was one of the founding fathers of veterinary dentistry. And it literally, it was something that I had not planned on, but has been a huge part of my life ever since.
[00:02:32] Dr. St. Denis: Yeah, and you have been prolific in writing, co-authoring and authoring different textbooks.
And so it's been really amazing to see your career and you and I have worked in other capacities as well. So it's been great working with you and learning from you as well. And honestly one of the reasons that I ended up being a co-chair on the dental guidelines is just from my own love of dentistry. I'm not a veterinary dental specialist, but I am a feline specialist. And as any of us know who are feline-only practices, dentistry takes up a lot of your time. I can remember when I had my own practice that probably 70-75% of the surgeries that I did were veterinary dental surgeries. So really important part of our career, especially when we're working with cats. And so really happy to have these guidelines out and to be able to chat about them today.
[00:03:20] Dr. Lobprise: Absolutely. I mean, you can only spay or neuter once typically, but it's important to get cat caregivers the information that a lifetime of dental care is absolutely essential.
[00:03:34] Dr. St. Denis: Yeah and on, sort of on that note, that's one of the things that we open up the guidelines with, is just talking about the caregiver and their role in veterinary care and dental care, specifically oral and dental care for their cat. And so I wondered if we wanted to just chat about that a little bit, what, what we're guiding people with in terms of how do we get that caregiver involved.
[00:03:56] Dr. Lobprise: Right. So I've always considered dentistry a team sport.
You have to have everybody working together, not just in the clinic with the, with the veterinarians and the technical staff and the front office staff, but also that collaboration, that advocacy with the caregiver.
[00:04:13] Dr. St. Denis: Yes.
[00:04:13] Dr. Lobprise: Because we know it can be a challenge to get these cats into the clinic sometimes.
So that's why we have a lot of ancillary tools that for some reason I think FelineVMA has been good at providing to help encouraging getting that cat in and how to make it better for the cat and the caregiver both.
[00:04:33] Dr. St. Denis: Yeah, and I feel like that cat friendly experience is really something that does make a difference for caregivers in, like you said, getting them to the clinic full stop, but also in interacting with their cats at home. I certainly spend a lot more time helping caregivers understand how to interact with their cats and even cooperative care training for getting them to let us handle their mouths, to do an awake oral exam, but also in how to do some home care.
And our listeners will find in the guidelines we have a lot of information about home care with a lot of good supplemental links to some resources, as you've said, from FelineVMA, for example for those purposes.
[00:05:07] Dr. Lobprise: I was going to say it's very important to start talking about it at kittenhood. And you mentioned that cooperative training, they can do home care with wipes, getting them used to it early on and then they'll notice problems early.
[00:05:25] Dr. St. Denis: That is so true. And yeah, getting that kitten used to being handled, with having the handling of their mouth. And one of the key things that you and I have talked about during the process of developing these guidelines is how we've kind of moved away from the concept of two toothbrushing for cats as opposed to using something like wipes or gauze. And I certainly try to show caregivers in my appointments how to take a gauze on their finger and just get, get onto the canine and then work their way back to the upper premolars even to get that plaque off on a daily basis.
So it, it seems to be something that people are more comfortable with. It takes less time than brushing teeth and it, it does pull plaque off those teeth. So it can be really helpful to show caregivers that trick.
[00:06:09] Dr. Lobprise: There's even a video in the toolbox.
[00:06:13] Dr. St. Denis Yes, we talk about caregivers and what they are willing or able to do, and that kind of dives into something else that we spoke about early in the guidelines, and that is the spectrum of care in feline oral and dental health.
So we have a figure in the guidelines that really shows how we have different factors associated with clients or our caregivers, factors associated with the veterinarian and the veterinary team and also the patient. All of those different factors will contribute to how that cat receives their prevention and their oral health and dental care.
And so for caregivers, a lot of us will sometimes think, oh, well, it's probably about finances, right. Especially if we're talking about anesthesia and dentistry. But what are some of the other things that you kind of consider when you're talking about caregiver factors in terms of how that impacts whether they or how they move about with dental care?
[00:07:03] Dr. Lobprise: Well, to begin with, Kelly, it's a good thing we had you on board. I mean, even though you've got the ABVP boarding, it was boarded veterinary dentists, and except for me, I'll take that back, some of them have had some general practice experience, but we're talking about some university-associated people.
And I think as specialists, we sometimes really focus on what's the best, the optimal, the most intense treatment we can give for the highest level of treatment.
And we have to be aware at every step, both at the general practitioner. True, if they're coming to us for a referral, we might have a different category of clients, but we have to realize what's going to be the best combination for that pet and for that caregiver.
Sometimes it is the cost. But just like when we talk about senior care, there's other wallets as well. You know, their time, can they get off work, their human companion animal bond. If they have to do a lot to that cat and give them a lot of different medications and do different things, is that going to impact that bond?
So we have to be empathetic to the owner and look at these different burdens and make sure that spectrum of care falls within their wheelhouse.
[00:08:23] Dt. St. Denis: Yeah, that's a really good point. Those budgets are really important to consider.
And then of course, that cat's budget's about how much they're used to being handled. And what they will accept also affects it as well, right?
[00:08:36] Dr. Lobprise: Absolutely.
[00:08:37] Dr. St. Denis: And I think we have veterinary factors will include things like how much experience they have within their veterinary practice, doing dental surgeries, if they have dental radiography.
And so we do talk about referral in the guidelines, when to refer. And as being someone who sees dentistry patients primarily in your practice, Heidi, what are your thoughts about referral and when general practitioners like myself should be referring?
[00:09:02] Dr. Lobprise: Well, you got yourself your own training probably by going out and getting additional CE. A lot of students graduating don't necessarily have all the skills and knowledge they need to do great dentistry.
That's. We've realized this. And in fact, a lot of the courses are again, dog-centric, you know, the extraction classes.
So as we look at what's going on with the patient, you have to be comfortable being able to say, I am confident in doing this procedure, or if that's not the case and you have the ability to refer, offer that ability to refer. If the owner declines it, then record it.
But we generally would get anything from cases that are a little bit more advanced. I mean, I may not be seeing as many full mouth referrals as we used to because I think general practitioners, some of them are getting more comfortable with that, even staging them into two parts.
But certain like oral tumors and anesthetic cases, that may be tricky. We get those.
And can I be a little flippant here?
I think there's a group of clients that get referred a little bit earlier in the process, some of our special clients, and that's okay, we handle a lot of those. But be aware of what you can do.
Get additional training, get the right equipment, the right size equipment, keep it sharpened. And dentistry can be a whole lot happier in a general practice.
[00:10:35] Dr. St. Denis: It can. And I found that even in the practice that I work in as a feline specialist. We do have other practices that refer in partly if that practice doesn't have dental radiography. But I've also had cases sent to me that were more complex cases like cats with comorbidities or cats that were higher anesthesia risk and they're just not comfortable with that aspect of the care. So there are those things to consider too, when referring how comfortable you are also with the anesthesia portion of it and the cat's comorbidity.
[00:11:06] Dr. Lobprise: Absolutely, absolutely.
[00:11:09] Dr. St. Denis: And we do have a really good section on anesthesia and analgesia in the guidelines. And so since we're talking about that, I just wanted to kind of roll into that a little bit. You know, we hear a lot of things about anesthesia free dentistry and we don't always think about cats as being painful when they have oral or dental disease.
So I don't know if you want to pipe in about what your thoughts are with regards to pain management for these patients as at diagnosis and through the perioperative period.
[00:11:38] Dr. Lobprise: Absolutely. So a big part of oral and dental disease is the discomfort. All right. And in fact, there's going to be a level of pain that cats will hide. You know, they're good at hiding things.
[00:11:50] Dr. St. Denis: They are so good.
[00:11:51] Dr. Lobprise: But whenever we see inflammation or ulceration, we know there is pain. So managing that pain with good analgesic protocols before, during and after dental surgery can be very important for these patients.
As we look at that too, we can help speed up the healing, help their quality of life.
It's just so critical. And again, a lot of dental guidelines, anesthesia guidelines are more general, but the feline anesthesia guidelines and analgesic guidelines are extremely helpful. In fact, we, we have some good information in the veterinary, in the dental guidelines, dental oral guidelines, but we also ref to those feline anesthesia and pain guidelines.
[00:12:37] Dr. St. Denis: Yes. And that's such a good resource for people when they're using the dental guidelines to go to for further information.
And I know, even for myself, from day to day, I diagnose tooth resorption in probably 1, 2, maybe 3 of my patients per day that I see. It's so common and it's painful. And it's hard to convince caregivers that things are painful because they don't see anything because cats are so good at hiding it.
So it can be challenging to get caregivers to get started on pain management before they even book a dentistry.
Do you have any tips or tricks for us when we're talking about getting caregivers to get on board with analgesia at diagnosis.
[00:13:18] Dr. Lobprise: Well, if you've ever had one of those cases where you did do the analgesia ahead of time or even finally got them into the procedure and the cat felt better.
Yeah, that's a key way. Using a testimonial, even giving the pain medication prior to the owner will likely see a difference.
[00:13:43] Dr. St. Denis: Yes.
[00:13:43] Dr. Lobprise: In that cat. And hopefully that won't mean, oh, well, I'll just give it pain medication, not do the dental procedure. We educate them to do all the steps that are necessary, but it can really be impactful.
[00:13:55] Dr. St. Denis: Yeah. And I've seen that quite often in my own practice, either after the dental surgery or just from starting analgesia. Well, someone will come back to me and say, you know, I had, they used to do such and such and such a thing. Like I had a patient who used to fetch and the client hadn't really noticed, but the cat had stopped fetching. And then as soon as we put the cat on analgesia for the oral and dental disease, they start. They went home like two days later after starting, when the cat was fetching again. So they were like, yes, we need to do this dentistry right away.
[00:14:23] Dr. Lobprise: When you hurt, you're not happy and sometimes you can't hide it.
[00:14:26] Dr. St. Denis: But they just have very subtle ways of hiding it for sure.
I think when we're talking about perioperative and specifically intraoperative. I know one of the big things that you teach people about is dental blocks, and I want us to talk about those a little bit because they have so many benefits to our patients. So did you want to kind of tell us a little bit about dental blocks?
[00:14:49] Dr. Lobprise: And again, this is another. The guidelines are another resource. In fact, we have. I usually joke when we have 10 dentists in the room, there'll be 12 different opinions. And there were different opinions about the types of blocks, but we all agree that by using the regional and local blocks, we can use less general anesthetic.
They're going to wake up more comfortable and they're going to recover better as well. So it's really critical for extractions.
We do some periodontal work in kitty cats, making sure that that area has been blocked to maximize our efforts and to maximize their analgesia.
[00:15:30] Dr. St. Denis: Yeah, and there was a lot of discussion too, around something that I hadn't really thought about in a longer procedure that depending on the dosages, we may even be able to top up those dental blocks before the cat is recovered from anesthesia, so that they have a longer lasting effect into the recovery period.
[00:15:46] Dr. Lobprise: Correct. At the end of the procedure, depending on how long it is. Still watching total dose or using some of the potentiated methods, too?
[00:15:57] Dr. St. Denis: Yes, if there's access to those, they can be really amazing, too. With our cats under anesthesia flowing through this, we're talking about workflow and feline dental procedures under anesthesia. We have a lot of really good charts that were provided by the veterinary dentist in the group. I think a lot of them came from you, so some really good supplemental material there. And we just really talk about what's important for the patient and for the people that are involved in the dental procedure.
And I just wanted to talk a little bit about this because we have such a tendency as veterinarians to not really pay attention to what we need. But operator safety and comfort is such an important part of this, especially when we're talking about procedures that can take two or three hours, right?
[00:16:42] Dr. Lobprise: Yes. And we have a combination of things working, what we call four handed with the technician, the veterinarian, again, that team sport concept.
We even developed a really cool dental chart that's going to be available as a toolkit, but part of the personal protection. We've got all into PPE with COVID, but anytime you have dentistry, make sure your team is wearing eye protection masks, gloves. There's some nasty stuff in there. So let's keep them safe for sure. Let's keep them safe from radiation.
[00:17:15] Dr. St. Denis: Yes.
[00:17:16] Dr. Lobprise: And one concept that I think we really need to pay attention to is ergonomics, because the way we sit, the way we crunch over everything else, we really need to look at how we're treating ourselves during these procedures. The use of loops, magnification and light, the correct kind of table and even the correct kind of chair can make a big difference. And the older I get, the more I appreciate the things that keep me comfortable.
[00:17:45] Dr. St. Denis: Agreed, Agreed. And you're like, you're sitting there for such a. You're doing stuff for such a long time. So really planning ahead and making sure you have all the equipment that you need to keep yourself safe and comfortable are so important.
So, you know, we're working with our patient again. We have a lot of information about keeping them comfortable as well while they're under anesthesia in terms of monitoring and warmth.
And some people may notice when you're looking at the guidelines, that we are not really delving into specifically extraction techniques in detail or radiographic positioning in detail. And that is because there are resources that are already available and easily accessible to us and to everyone. So we do refer out to those from the guidelines.
[00:18:32] Dr. Lobprise: Right.
[00:18:33] Dr. St. Denis: But you do have some information in there about extractions and the tools that are needed for extractions. I wondered if you could just talk about the tools that we use as well.
[00:18:44] Dr. Lobprise: Absolutely. One size does not fit all.
If we use the large dog elevators, luxators can be so important. Using the right size dental elevators, using the right size bur the smaller round burs, the 699, for sectioning teeth, making sure that, yes, these elevators and luxators are going to be more delicate. You do need to keep them sharpened, and if you're a little too aggressive, you can bend or break them. Even with sharpening, they may need replacement on a regular basis. But having the right tools, the right size is absolutely critical for these patients. Being able to handle these extractions well. And even some little nuances, like doing a good, smooth alveoloplasty after extraction, say, with the diamond bur. Hints like that are in the guidelines as well.
[00:19:36] Dr. St. Denis: Yep. And the suturing, too. Your techniques are so amazing with burying your knots.
[00:19:42] Dr. Lobprise: I like to bury the knots, especially on my full mouth, my stomatitis kitty cats, the bury knot cruciates. And just years of experience.
[00:19:53] Dr. St. Denis: Yeah and it's so amazing that all of us were able to get together and have all this shared into this document. And we also had the pleasure of having a veterinary technician in our task force. And, you know, this person is specialized in veterinary dentistry as a technician. So, you know, one of the reasons that we wanted to have a veterinary technician as part of the task force was to emphasize the role of the technician. You spoke earlier about the four hands approach, and obviously, technicians play a really important role in our practice regardless. But do you want to delve into that a little bit, too with me?
[00:20:27] Dr. Lobprise: Absolutely. I mean, in the field of dentistry, I think it's probably the most impactful area for technicians. Now, true, I'm biased. They do help out many different areas, but outside of the diagnosis and actual surgery, they're providing the great majority of the cleaning, the radiographs, the, you know, monitoring everything else. And absolutely important for some of those techs out there who really love dentistry, there's a specialty.
You can really delve into it if you want to. Also knowing that this is really an area that we can all make our patients feel better, which is so critical.
[00:21:09] Dr. St. Denis: Yes, And having that second person who's been directly involved in the surgery makes it helpful, too, when we're interacting with caregivers, I think, before and after the surgical procedures, so that we have that other person that's there to support the caregiver during the recovery process, which can be really quick or take a long period of time, depending on how sick the cat is and how bad the oral disease was.
[00:21:32] Dr. Lobprise: Very true.
[00:21:33] Dr. St. Denis: They're a very important part of our team in terms of follow up as well.
[00:21:36] Dr. Lobprise: Oh, I, I couldn't, I couldn't practice without my Vanessa.
[00:21:42] Dr. St. Denis: It's perfect, right? Yes, exactly. And that, that team approach, one of the things that we also talk about, and it's kind of getting back up to the top of our intro of our guidelines, is the veterinary team being on the same page. So I've worked in a lot of different clinics over the years and not everyone's aware of certain things about dentistry and cats.
And if we're not conveying that message, the same message across to the caregivers, then it can be very confusing. Right. This is already a confusing time for that caregiver.
And so what are your thoughts on how we can educate our team as a whole so that they are on the same page about dentistry and cats and oral and dental disease?
[00:22:22] Dr. Lobprise: And you've hit it on the head that education, because if you just hand a new technician the ultrasonic scaler, yes, they may have had some training or whatnot, but it really does need the same approach from the front office staff - understanding the value. Maybe they can shadow you in the back sometimes. Maybe they can come in or help or listen to how that post operative visit goes when that cat is doing so much better. But having good training with your front office staff, with your technical staff, and how important, like you mentioned, the communication with helping to provide additional education for the caregiver.
I mean, it is an advocacy that takes everybody.
[00:23:08] Dr. St. Denis: Yeah. And we're reinforcing those messages so that we know people when, when they hear things more than once from multiple people around them, they're more likely to say, hey, wait, this, I'm hearing this a lot. This, this must be something to consider.
So it's nice if we can get everybody, maybe if there's a way to train everyone, maybe we'll have some webinar. We're gonna have a webinar associated with these guidelines, might be a good place to start. But as you mentioned, we have a lot of supplemental material coming from the FelineVMA as well, including the caregiver brochure, which I think is going to be really helpful.
So from the perspective of the team and then just looking at the guidelines in general, just kind of thinking about other things that we talked about, and I don't know if there's anything that specifically that comes to mind for you.
[00:23:57] Dr. Lobprise: Well, I'd like to make sure we cover antibiotic use.
[00:24:01] Dr. St. Denis: Yes, that's another one.
And that was a fun conversation that we had, wasn't it?
[00:24:08] Dr. Lobprise: Yes, yes. As a team. And even the AVDC guidelines on antibiotic use, I think is a little generalized and it's a few years older. These days it's tough to think of cases where antibiotics, preoperative, perioperative or postoperative are even warranted. I mean, if we're extracting some teeth, we're removing the source of the infection a lot of times.
[00:24:34] Dr. St. Denis: Yes, exactly.
[00:24:35] Dr. Lobprise: If we had a very active osteomyelitis or compromised patient, immunocompromised patient, that may lend the use the antibiotics. And even at that level, possibly an intraoperative dose intravenously may be sufficient because it's not just about the back bacteria in the mouth. In fact, we're used to saying, oh, that bacteria gets in the bloodstream and does this, this and this. It's the chronic inflammation. And this is where cats can be so much fun. They may have very little bacteria in that mouth and their inflammation causes the disease. Like in stomatitis.
[00:25:14] Dr. St. Denis: Yes, exactly.
[00:25:16] Dr. Lobprise: Yeah. It's an important part. We want to be good stewards.
[00:25:21] Dr. St. Denis: We do, yeah. And it's such a knee jerk reaction. I think over the years, like I said, I've worked in a lot of practices. We see this commonly, that dentistry tends to go with antibiotic use. And so hopefully when people are reading the guidelines, if they're leaning towards using an antibiotic, they'll rethink about it and maybe skip it when it's not really necessary. So there's some really good guidelines inside of the guidelines on when we think it might be necessary.
[00:25:49] Dr. Lobprise: Absolutely.
[00:25:50] Dr. St. Denis: And on that topic, Heidi, I find it interesting because you mentioned chronic gingivostomatitis and that's a condition that we cover in detail in the guidelines. Along with multiple other common oral and dental conditions in cats, that's one that is often associated with antibiotic use at the outset at diagnosis.
And so I thought maybe we should chat a little bit about feline chronic gingivostomatitis, because I think it's one of the things we see.
I don't know if it's more commonly seeing it, but we're seeing more advances in research and treatment. So I wonder if we could chat a little bit about FCDs.
[00:26:24] Dr. Lobprise: How much time do you have?
[00:26:26] Dr. St. Denis: Exactly right. So as the journal editor, I see all these research papers coming through and it's so exciting, all the stuff that's going on.
[00:26:32] Dr. Lobprise: It's amazing. So one of the points that I'm glad was made that not to over diagnose it in younger cats that might have a more transitory juvenile inflammation, but once we start seeing that caudal mouth inflammation, then we usually start talking.
We don't have anything really medically that can cure it.
So we generally go to extractions at the get go as soon as possible. And I think more and more we're going to full mouth extractions fairly early. Although sometimes we can stage these procedures by doing the caudal mouth extractions, premolars and molars at one stage and the canine teeth on another. Or some people do the right side and then a few weeks later do the left side to help that workflow. But even as we see the full mouth extractions, we'll also have some patients that have ongoing inflammation.
Now, we generally don't call it refractory until about six months because sometimes these individuals take a while to get that, that immune system calm down a bit.
But as we're looking into it, everything from cyclosporine to different medications, but on the horizon, the possibility of stem cell therapy is becoming more reasonable and even reachable.
[00:27:59] Dr. St. Denis: Yeah. And we're seeing some promising data coming out and potentially a product that will be accessible probably, not in Canada, but maybe in the U.S. at least initially.
[00:28:10] Dr. Lobprise: Right. The research about, it's, it's, you know, and it's not really about just the bacteria. Yes, they may play a part, an antigenic part, the Now, we generally don't call it refractory until about six months because sometimes these individuals take a while to get that, that immune system calm down a bit.
But as we're looking into it, everything from cyclosporine to different medications, but on the horizon, the possibility of stem cell therapy is becoming more reasonable and even reachable.
[00:27:59] Dr. St. Denis: Yeah. And we're seeing some promising data coming out and potentially a product that will be accessible probably, not in Canada, but maybe in the U.S. at least initially.
[00:28:10] Dr. Lobprise: Right. The research about, it's, it's, you know, and it's not really about just the bacteria. Yes, they may play a part, an antigenic part, the feline calicivirus intercellular we're learning more about. But the body's own immune system is where this data is really being driven. we're learning more about. But the body's own immune system is where this data is really being driven.
[00:28:30] Dr. St. Denis: Yep. So watch out for that. Everyone in the research literature, but when you're treating those FCGs, chronic gingivostomatitis, make sure you're not just running to antibiotic use. We're really going to try and get to that extraction procedure as soon as possible.
So I could talk to you all day about this. I mean, we spent a year working on this. It was a really long process, but a really rewarding process. It was such a pleasure again to work with you and with all of the dentists and the dental technician or technician, veterinary dental specialist.
And I really appreciate you coming on today to have a chat with me about all of this. And I'd just like to say to everyone, please check out the 2025 Feline VMA Oral Health and Dental Care Guidelines.
As Dr. Loprise has noted, it's the first feline only oral Health and Dental Care Guidelines. So this is going to be our go to space for all of us that are working with cats.
[00:29:29] Dr. Sr. Denis: Thanks, Heidi
Dr. Lobprise: Oh thank you, Kelly.
[00:29:32] Conclusion: Thank you for listening to this episode of All Cats Considered. We hope you enjoyed this interview. For more information on the topics discussed in this episode, please head over to catvets.com podcasts and explore the links in the show notes. Don't forget to subscribe to this podcast on your platform of choice so you won't miss any episodes as we release them. Have thoughts or ideas about the interview you heard today? Share them with us by leaving a comment on our Facebook page or shoot us an email
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