Recognizing Pain in Cats After Dental Extractions

Dental disease can be overlooked as a source of patient morbidity when patients are eating and drinking normally. Education in identifying behaviors specific to oral pain could lead to more prompt treatment of dental disease and help pet owners evaluate their pets in the postoperative period.

In this prospective, blinded, randomized clinical trial,* 24 cats were divided into minimal (group 1, minimal dental treatment) or severe (group 2, multiple dental extractions) oral disease groups. Both groups underwent oral examination, radiography, scaling, and dental extractions while under general anesthesia. Cats were filmed remotely for 10 minutes before surgery (baseline) and throughout the study at different time points over a 36-hour period. The videos consisted of 4 groups of behaviors, including general demeanor, playing, feeding, and postfeeding. A board-certified behaviorist evaluated the duration and frequency of different behaviors.

All cats received premedication with acepromazine and hydromorphone and local anesthetic blocks using bupivacaine. Meloxicam was administered SC at the end of the dental procedure, and 3 subsequent doses were administered PO at 24, 48, and 72 hours after the first dose. Cats received rescue analgesia (ie, hydromorphone) when Glasgow Feline Composite Measure Pain Scale scores were ≥5 out of 20 at any time during the study. Based on the duration of action of hydromorphone in cats, videos obtained within 2 hours of rescue analgesia were excluded from statistical analysis to avoid bias.

Results showed that cats in group 2 exhibited more signs consistent with pain than did cats in group 1. Group 2 cats were generally less active both before and after surgery and exhibited fewer play behaviors. Group 2 cats also had more difficulty grasping dry food postoperatively, although no significant difference in feeding behaviors for soft food was found between the groups. Frequency of postfeeding headshaking was significantly higher in both groups at day 6 as compared with baseline. The study concluded that cats with oral pain require longer periods of time to eat both dry and soft food than those with minimal pain. Despite some study limitations, including the need to extrapolate the Glasgow Feline Composite Measure Pain Scale scores for evaluation of oral pain, the authors also concluded this study identified some pain-induced behaviors in cats undergoing treatment of oral disease and these behaviors may be used to differentiate painful versus pain-free cats in clinical practice.

Key pearls to put into practice:

Cats that were determined to have significant dental disease were noted to be less active in the pre- and postoperative observation periods; these cats were also less playful. These observations support that dental disease can cause patient morbidity; however, these behaviors may be subtle and challenging for owners to recognize.^1-3

Grasping of dry food in the postoperative period was more difficult for patients that had multiple extractions. It is generally recommended to feed patients that have had extractions a soft diet for patient comfort.²

Cats that had more extractions required rescue analgesia more frequently in this study. Appropriate multimodal pain management is essential for patient comfort after dental extractions.^2-5

Recognition of specific behavioral signs of oral pain in cats could be useful to owners and clinicians in identifying the need for dental treatment. These signs could also be useful for evaluation of pain in the postoperative period after dental treatment.^6-8