PAIN SCORES, ANALGESIC REQUIREMENTS AND FOOD INTAKE IN CATS

WITH ORAL DISEASE UNDERGOING DENTAL TREATMENT

WATANABE R, DOODNAUGHT G, PROULX C, MONTEIRO B, BEAUCHAMP G, DUMAIS Y, STEAGALL P
Département de sciences cliniques, Faculté de médecine vétérinaire, Université de Montréal, Canada

INTRODUCTION RESULTS
l Periodontal disease (PD) is common and produces pain with potential impact l Demographic data, prevalence and frequency of rescue analgesia and results
on nutritional status and quality of life of cats.1,2 of CMPS-F are shown in Tables 1 and 2, and Figure 3, respectively.
l This study aimed to evaluate pain scores, analgesic requirements and food l CMPS-F scores were positively correlated with number of tooth extractions,
intake between cats with minimal or severe PD before and after treatment. gingival index, and calculus index (r = 0.80, 0.70 and 0.48, respectively).8
l The hypotheses were: 1) cats with severe PD would have higher pain scores l The severe disease group had lower wet food intake during 3 minutes at 2
and analgesic requirements than those with minimal PD, 2) pain scores and 6 hours post-operative (day 1), evening of day 3 and morning and
would correlate with dental parameters and 3) cats with severe PD would evening of days 4 and 5 when compared to the minimal group (p ≤ 0.0004,
have less food intake than those with minimal PD. respectively). Wet food intake was higher in the minimal group at 6 hours
post-operative and lower in the severe group on the morning of day 4 (p =
0.001 and 0.0003, respectively) when compared with baseline.
MATERIALS & METHODS l Results of wet food intake during 3 minutes and 2 hours/day and dry food
intake during 3 minutes and 2 hours are shown in Figure 4.
l Ethics committee: 17-Rech-1890
Table 1 – Demographic data for cats with minimal or severe oral disease undergoing
l Study design: Prospective, blinded clinical trial treatment for oral disease
l Animals: Twenty-four cats (11 males and 13 females) from local shelters were Variable Minimal disease (n = 12) Severe disease (n =12) p value

divided into two groups (minimal or severe PD) based on a scoring system Median (range) dental score 1 (0-4) 17 (8-28) < 0.0001
Mean (SD) Age (years) 3.6 (2) 8.5 (2.2) < 0.0001
(Figure 1). Mean (SD) Body weight (Kg) 4.0 (0.6) 5.8 (1.9) 0.007

l Treatment of oral disease: Cats were admitted on day 0. They underwent Median (range) Body condition score (1-9) 5 (5-6) 6 (4-6) 0.078

general anesthesia (acepromazine, hydromorphone, propofol, isoflurane, Table 2 – Number of cats receiving rescue analgesia at each time point during the study
meloxicam and dental nerve blocks with bupivacaine) on day 1 for treatment Group
Day 1 (Postoperative)
Day 2 Day 3
Days
Total p value
4, 5, 6
of oral disease. Cats were discharged on day 6; meloxicam was administered 0.5h 1h 2h 3h 4h 6h 8h
Minimal disease 0 0 0 0 0 0 0 0 0 0 0 (0%)
up to day 4 (0.05 mg/kg PO at day 2-4). Severe disease 0 2 1 2 5 2 2 5 2 0 21 (91.7%)
< 0.0001

l Pain assessment: Pain assessment was performed by an observed who was Figure 3 – CMPS-F scores in cats with minimal and severe oral disease
5
blinded to disease severity using the Glasgow composite measure pain scale- before and after treatment
feline (CMPS-F)3 (Figure 2). Rescue analgesia was administered if scores ≥ *†
4
*† Minimal disease
5/20 using hydromorphone either at 0.05 mg/kg (IV) or 0.1 mg/kg (IM). *† Severe disease

l Food intake evaluation: Cats were fed drya and wetb food according to Figure 3 *† *†
CMPS-F

*† *† *†
2. Total amount (100%) of food/day was calculated based on the following *†
equation (kcal): 70 body weight (kg)0.75.4 Cats were offered 33.3% of their 2
* * *†
* *† *
daily total amount at each time point. Food intake (%) during 3 minutes and *
* * *
2 hours were calculated for each time point and each day/cat. Any remaining
1
*
food was removed after 2 hours. 0
100

Statistical analysis:
Evening

Evening
0.5 h

1 h

2 h

3 h

4 h

6 h

8 h

Morning

Noon

Morning

Noon

Evening

Morning

Noon

Morning

Noon

Evening

Morning
Baseline

l
80
u26 CMPS-F scores were compared between baseline and each time point and
Atlas of Normal Radiographic Anatomy and Anatomic Variants in the Dog and Cat Day 1 (Postoperative) Day 2 Day 3 Day 4 Day 5 Day 6
Time point
between groups at each time point using the Cochran-Mantel-Haenszel test for
Food intake (%)

Upper jaw Incisors Figure 4 – Food intake (%) in cats with minimal and severe oral disease
repeated measures. 101 201 60
103
102 202
203 before and after treatment
Right upper Left upper
Figure 4a – Wet food Figure 4b – Dry food
u Correlations
permanent
between 2CMPS-F scores on the morning of day 2 and dental
permanent Canine 104 204
*
1 40 *
parameters were evaluated using Spearman’s correlation.
Right upper Left upper
100
105 205 100

*
106 206
Premolars
* *
u Prevalence and frequency of rescue analgesia were compared using the exact
Right upper
deciduous
Left upper
deciduous
107 207
80
* * *
*
*
20 80
5 6 108 208

chi-square test.
Food intake (%)

Food intake (%)

109 209 60 60

Food intake was compared using a linear mixed model with Benjamini-Hochberg
Molars
u 110 210
0
Right Left Baseline Day 1 Day 2 Day 3 Day 4 Day 5
sequential adjustment procedure for multiple comparisons (p < 0.05). Molars 410
411 311
310
40
Time point
40

CMPS-F scores and food intake obtained within 2 hours of IV and within 6 hours
Right lower Left lower
Minimal disease (3 min)
u permanent permanent
Right lower
409 309
Left lower 20
Severe disease (3 min)
20
4 3
of IM injection after rescue analgesia were excluded from the statistical 408

407
308

307
Minimal disease (2 h)
Severe disease (2 h)
analysis.5,6
Premolars 0 0
406 306 Baseline Day 1 Day 2 Day 3 Day 4 Day 5 Baseline Day 6
Right lower Left lower
deciduous deciduous 405 305 Time point Time point
8 7
Minimal disease (3 min)

Figure 1 – Dental scores based on number of dental

Canine 404 304
extractions7 Figure 3 and 4 - The bars and error bars represent least-squares means and standard errors, respectively.
Severe disease (3 min)
Minimal disease (2 h)
A Lower jaw
403 303
402 302
401 301
* and † indicate a significant difference
Severe disease (2 h)between groups and between baseline and each time point,
B Incisors
Figure 1-a respectively (p < 0.05).
Incisors
• If ≥ 7 incisive teeth
101 201
103
102 202
203 and/or first premolars
Canine 104 204
Right upper Left upper of the mandible were

Premolars
106
3 206 extracted, they were
counted as 2 points,
CONCLUSIONS
108
107
1 207

208 otherwise if ≤ 6 teeth

were extracted, they l Long-term analgesia is required after treatment of severe oral disease in cats.
2
Molar
109 209
were counted as 1 point. This conditions impacts food intake before and after treatment.
l Total score was
2 Figure 1-b
calculated.

ACKNOWLEDGEMENTS
Molar 409 309
Cats were allocated to
l 2-7. The modified Triadan system of dental identification. In
Figure

Premolars
408 1 308 A, eachanatomy
(Atlas of normal radiographic
& anatomic variants in the dog and cat) the minimal (Figure 1-a)
quadrant of the mouth is designated by a number; this is the
first digit in identification. With respect to permanent teeth, the right

3
407 307
or severe (Figure 1-b)
maxilla is designated 1, the left maxilla 2, the left mandible 3, and the

This study was funded by Hill’s Pet Nutrition and a

right mandible 4. When describing deciduous teeth, the right maxilla
Right lower
Canine 404 304
Left lower
oral disease group if
is designated 5, the left maxilla 6, the left mandible 7, and the right l
mandible 8. B, Schematic model of a canine jaw with each permanent
403
402
303
302
dental scores were ≤ 7
tooth identified. The numbering always begins on midline; the central Discovery Grant by the Natural Sciences and Engineering
401 301 Figure 2 - Time points for pain assessment and feeding evaluaGon
incisor is designated 01, the canine 04, and the first molar 09.
or ≥ 8, respectively.
C Incisors C, Schematic model of a feline jaw, showing tooth identification.
Research Council of Canada (RGPIN-2018-03831).

Figure 2 – Time points for pain assessment and food intake evaluation
D
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