Bad breath: Sign of illness?

Go nose-to-nose with your sleeping cat and give her a loving sniff. If it's not sweet kitty breath that you know and love, but a stench that makes you wince, something may not be right.
Just as the eyes may be windows into the soul, a kitty's breath may hint to her health.

"A healthy cat's breath should not be offensive," says Eric Davis, DVM, a fellow of the Academy of Veterinary Dentistry and director of the Dental Referral Service at Cornell University's College of Veterinary Medicine.

Many Different CausesBad breath, in fact, may indicate conditions from periodontal, kidney, respiratory or liver disease to diabetes, skin disease (involving tissue around the lips) or oral trauma, such as electric cord injury."However, by far, the most common problem associated with bad breath is periodontal disease," says Dr. Davis. "Just think how your breath would smell if you didn't brush your teeth for a week, months or even years."

Without good dental care, this preventable disease is likely to cause pain, tooth loss, and infection that, in some cases, can spread to other organs. Without tooth brushing, a film called plaque adheres to the teeth. Over time, this film thickens and hardens, attracting even more plaque. The gums will swell with gingivitis, eventually leading to tissue and bone loss.
Early stages of periodontal disease can be remedied with professional teeth cleaning, which would give your cat a fresh start, but plaque will build up again within days without regular tooth brushing.

Another common cause of bad breath, however, is something caught in your cat's teeth or under her gums," says Dr. Davis. "Food or a strand of hair or string, for example, can get lodged in the little nooks and crannies between teeth and can decompose, soon infecting the surrounding tissue."
Bad breath can also be a sign of diabetes if the breath is sweet, kidney disease if it's urine-like, or liver disease or an intestinal blockage if it's foul (see sidebar). Bad breath can also be the result of a mouth ulcer, mouth sores or even cancer.

To prevent most cases of bad breath, brush your cat's teeth - ideally, every day - using tooth gel for felines. "Link the brushing to a treat, such as drinking water from a dripping faucet or a favorite canned food," advises Dr. Davis. "Just before the treat, you can apply a tiny amount of the gel onto a finger and gently apply it to the cat's teeth. Most cats will forgive your foolish human behavior to savor their desired food or beverage.

Repeat this procedure every day for the first week to establish the new routine. Then, apply the gel a little further back in the mouth, but still without stressing the cat."
If you grip your cat and jam a toothbrush down her throat, the battle is lost. Once the cat is tolerant of the gel on the finger prior to receiving the cherished item, try the same routine with the gel on the brush rather than the finger.

Because cats hate having their mouths forcefully opened, simply stretch back the lips without opening the mouth. Don't bother the tongue side of the teeth or focus too much on the motion. You simply want to disrupt the plaque buildup at the margin between the tooth and the gumline.

The younger your cat, the easier it will be to brush her teeth. Never use toothpaste for humans because some of its components can upset a cat's stomach. And never force the issue; it's not worth putting yourself at risk. Some veterinarians believe that dry food is also better than canned food to prevent plaque buildup.

Occasional Halitosis is OkayNot all cases of bad breath, however, indicate a health problem. Food smells that are repulsive to you - but gusty to your cat - can be harmless. Your cat's breath may be pretty pungent, for example, after she chows down some smoked oysters or canned tuna.

"Nevertheless, consistent bad breath should be checked by a veterinarian," Dr. Davis advises. "Halitosis is a common complaint of cat owners and veterinary examination is usually necessary to identify the cause.

Your cat may need a professional tooth cleaning, an antibiotic to clear up an infection, or other medication for a serious disorder that could jeopardize your cat's health, such as kidney or liver disease."

By Susan Lang

IBD (Inflammatory Bowel Disease)

Feline Inflammatory Bowel Disease

By Margaret Muns, DVM

In cats, inflammatory bowel disease (IBD) is the most common cause of chronic vomiting and diarrhea. The term actually refers to a group of diseases that are characterized by the invasion of inflammatory cells into the cat's intestinal wall.

Symptoms of IBD

One or many of the following symptoms can be found in a cat with inflammatory bowel disease (IBD):

Weight loss
Normal/increased appetite
Stomach rumbling
Black, tarry stools
Flatulence (from digested blood)
Increased thirst
Abdominal pain
Weight loss

In severe cases, weight loss can be extreme. Vomiting cats will seldom produce food in a cat's vomit. Instead, the vomit usually consists of bile-stained mucus. The presence of hair or partially digested food in the vomit indicates that the disease also involves the cat's stomach.
The most common form of inflammatory bowel disease in cats is the presence of lymphocytes and plasma cells, which produce a diagnosis of lymphocytic-plasmacytic enteritis (LPE).

Causes of LPE

This disease can develop in one of two ways. The inflammatory cells can enter the intestinal wall in response to an injury or infection. Or, parasites, food intolerance, bacteria, fungi, or cancer can cause activation of the immune system and subsequent inflammation.
Cats that are affected with LPE may have a defective intestinal wall barrier. This defect allows normal intestinal bacteria to leak into the deeper layers of the intestinal wall, and the body mounts an immune response to remove them. Subsequent inflammation damages the gut wall even further, allowing more bacteria to enter the deeper tissues.

History and Clinical Signs

The most consistent clinical signs associated with feline lymphocytic-plasmacytic enteritis are those consistent with a small-bowel diarrhea syndrome.

LPE can occur in cats of any age, but most commonly appears in older cats. LPE can affect any area of the intestinal tract, and can also be very localized. Consequently, the symptoms of an affected cat are quite variable.

For example, clinical signs in some cats can appear suddenly, while in others, the signs can be more subtle and intermittent. Many cats experience exacerbation of symptoms only during times of stress, while others experience constant problems.

Vomiting may be the only symptom of LPE. Often, cats with chronic vomiting are misdiagnosed and treated symptomatically for stomach or pancreatic disease, when the disease is actually located in the small intestine.

Diagnosis and Treatment

Appropriate tests must be chosen by your veterinarian to rule out infectious disease, parasites, obstructions and cancer. Metabolic disease (especially, hyperthyroidism), concurrent large bowel disease, and pancreatic insufficiency must be eliminated, since each can closely mimic the symptoms of LPE. It is also important that your cat is screened for the viral infections feline leukemia and feline immunodeficiency because both diseases can be associated with IBD.

In severe cases of LPE, cats may have one or more abnormal test results that indicate advanced intestinal wall damage. In these cases, protein leaks into the intestinal tract and subsequently, cats can have abnormally low serum protein levels.

Definitive diagnosis of feline LPE can only be made by examining biopsy samples from the intestinal tract. Lymphocytic-plasmacytic enteritis lesions can be very localized, leaving the surface of the intestinal wall normal. If only grossly abnormal tissues are sampled, the diagnosis may be missed.

The pathologist will usually report cases of LPE as mild, moderate, or severe. A diagnosis of mild lymphocytic-plasmacytic enteritis may just indicate a reaction to an underlying parasitic or infectious disease, and the underlying causes should be addressed. A diagnosis of moderate to severe LPE tells the veterinarian that more aggressive therapy should be considered.

Dietary Therapy

Dietary therapy for feline LPE may or may not help, but it is certainly worth trying. Inflammatory response can be triggered by an abnormal immune reaction to normal intestinal components. Therefore, it may be possible that one or more ingredients in the cat's food may be one of the underlying causes.

Even if dietary therapy alone doesn't resolve the cat's symptoms, it can allow other treatments to be more effective. Occasionally, a cat can be completely weaned off oral medication and maintained on dietary therapy alone. One possible explanation for the efficacy of dietary therapy is that it helps the intestinal tract to compensate better, despite ongoing inflammation.

Effective dietary therapy for feline LPE involves feeding the cat a diet that is unlikely to trigger an immune response within the intestinal tract. To accomplish this, the cat must be fed a home-cooked elimination diet composed of a protein and carbohydrate source. Commercial hypoallergenic diets are not effective.

A careful dietary history should be obtained to find out which ingredients the cat has eaten over its lifetime. Once known, a food can be formulated consisting of a protein and carbohydrate source that the cat has never had. During the dietary trial (ideally five to six weeks), nothing but that special diet and water must be ingested by the cat, including treats, chewable vitamins, or chewable medications. If the cat has improved by the time the trial period ends, you can try switching to a commercial diet based on the protein source used.

Some cases of feline LPE may benefit from additional dietary manipulation. Adding extra fiber into the diet may help cats with large bowel involvement. Although the increased fiber doesn't have any anti-inflammatory effect, it can help to improve fluid balance inside the intestine and relieve diarrhea. Severe cases may benefit from additional vitamin and mineral supplementation.

A severely inflamed small intestine cannot absorb vitamins and minerals efficiently, which can result in a deficiency. Vitamin deficiencies can adversely affect the course of the disease. For example, folic acid and cobalamin may contribute to the small intestine's ability to repair itself. Therefore, supplementation of these important vitamins should be considered.

Drug Therapy

There is no set treatment regimen for every case of lymphocytic-plasmacytic enteritis in the cat. The appropriate choice of immune-suppressing drugs for treating feline LPE is up to your veterinarian. Treatment must be tailored to each cat's needs.

Prednisone (a potent corticosteroid) is usually the initial drug of choice for treating feline LPE. As a class, the corticosteroids are powerful immune suppressive and anti- inflammatory agents. In addition, treatment with corticosteroids may improve the fluid and electrolyte balance within the intestine. This can have a significant role in decreasing diarrhea.

If prednisone alone is given, then improvement should be noted within the first one to two weeks of therapy.Most cats with lymphocytic-plasmacytic enteritis will require life-long prednisone therapy to avoid a relapse.

In severe cases of LPE, azathioprine can be useful as a very potent immunosuppressive drug. Adding this drug to the treatment should be considered in cats that are not responsive to prednisone alone. Also, azathioprine can be used in cats that just cannot tolerate the adverse effects of prednisone. However, cat owners must wait three to four weeks before azathioprine will take effect.

Several other drugs can be tried for treating feline LPE. There is evidence that metronidazole may have a direct immune suppressing effect. Cyclophosphamide is a chemotherapy drug that also has potent immune suppressing qualities. Again, it is important that your veterinarian choose the appropriate treatment for your cat.


Most cases of feline lymphocytic-plasmacytic enteritis cannot be cured, although the disease is not usually life threatening. With aggressive therapy, many cases can be adequately controlled.