Decision to make about dental work

My cat brian is approx 12 years old. He needs dental surgery for at least 3 teeth.

Vet says it is a likely contributor to his diabetes BUT she also said we need to be very cautious about anesthesia due to his age, low weight, and diabetes.

The vet said we can avoid the risk of surgery as the teeth will rott fall out eventually?, and there is not significant infection /we can manage with antibiotics as needed.

BUT one of the teeth likely causes him some pain.

It's not something I would want to do without his diabetes regulated at least, but I'm also unsure what do here? The vet seems really cautious about the surgery all together

 

Age, low weight and diabetes are good reasons to be cautious about anesthesia. Just like in humans a bad tooth will make a cat very miserable but he has no way of telling you that. It's not just likely to cause him pain, it will and it will get worse every day.
Making a new member feel guilt or shame is a sure way to have them never come back and that's not what I'm doing. Then there's criticizing someone's vet which never goes over well so ask yourself this, if your dentist said not to worry because these teeth would just fall out eventually what would you think?
You can always see a vet who specializes in dental work but there's a chance your vet won't like that. That's another story about pride we don't need to go into. What's important is Brian's health.
I've been through all this before. Our last diabetic cat had rotten teeth but because of an enlarged heart he wouldn't survive anesthesia so he lived for two+ years getting transdermal BUPE, a heavy duty pain killer. Just yesterday I took one of our cats in for a nail trim and a quick look at his perfect teeth. He's almost ten and has all his teeth. Sure enough he needs one pulled, it's quite painful to touch and it's only getting worse. Best of luck.

 

I think you should see a vet that specializes in dental work for a second opinion. Since they may be more experienced with dealing high risk patients, they may have alternatives for treatment or able to use different procedures to reduce the risks for anesthesia.

 

Your Brian seems to be on a mission, lately. Knock On Wood

Have you read the Stickeys at the top of the Lantus forum? I found this one for you by doing a Search on "Dental" posted by Sienne and Gabby (GA). I really like the Search feature.

 

My girl was at least 15 when I took her to get her teeth done. I picked a place that specialized in vet dental work and anesthesia.

 

I wrote a whole bunch yesterday, but I erased it, because I thought it was too much about me and not about helping you. I'll start again:

This disturbed me a lot.

My thoughts are: Then do what you can, now. He's not getting younger.
I do not consider 12 to be old, but maybe middle aged.

I kept asking my regular vet about my kitty Ginger, with kidney disease, about a dental, and she kept putting it off. Last year Ginger was off in her eating, and I asked again. The vet finally agreed and she just had a dental last August, when she was 16. I just made sure to read all that I could on kidney disease and dentals and to relay what I wanted.. to the vet.
My kitty J.D., who was diabetic for his last 9 years (and lived to be 20) and the reason why I came to this forum, had his first dental at 14. I had to ask my regular vet about a dental for him regularly, and he finally (after years) agreed. The vet kept saying something about his diabetes not being controlled. Well, it hasn't been controlled for years. And my thoughts were, he's not getting any younger. I was worried, because what if my vet was right and something went wrong and it would all be my fault. When I went to pick him up after his dental, I asked the vet tech that was handing him to me, "How many teeth did he have removed?" She replied "Oh, I don't think he has any teeth left." He had 8 teeth removed.
When J.D. was 18, when asked repeatedly about another dental, my regular vet kept saying "No, not at this time". I felt like he wasn't eating right, so I took him to a board certified veterinary dental specialist, one that does x-rays before and after the procedure (and was well known for his expertise in the field) and I had J.D. go through a cardiologist appointment and an echocardiogram first to make sure he was okay for the anesthesia. I also talked to the anesthesiologist beforehand to make sure she knew about his kidney disease, diabetes, age, and what not. She helped to relieve my worries. During his procedure, this wonderful dentist/doctor sent someone out to where I was waiting outside in my car to tell me that J.D. had a majorly infected canine, and to ask my permission to remove it. Of course! Upon discharge, he showed me the before and after pictures of J.D.'s mouth (photos and x-rays and tried to explain everything to me), and he gave me the canine tooth in a little vial. It was almost an inch long (so, maybe 1/3 is below the gums, and 2/3s is above). J.D. had to have strong antibiotics and pain meds afterwards, but I was happy to help my J.D. not have to have that pain anymore. My only next worry was telling my regular vet what I had done.

 

Let it rot out? Yikes. If you’ve ever had an abscessed tooth, you know the pain can be extraordinary. Cats mask things really, really well at times.

If concerned about concurrent medical issues or risks, I second the idea of taking him to a dental specialist. They have expertise and tools that an average vet might not have. I once took an FIV rescue cat to a specialist because he was older, higher risk, and had a suspected mouthful of issues despite looking “not that bad.” He had 23 teeth pulled and was a mess for awhile, but his quality of life was so much better after he recovered. I had another younger FIV rescue who had obvious problems but was overall healthier and the regular vet did the dental and all went very well (and that cat quit being such a bully to one of the other cats once his mouth quit hurting so much — I had no idea that’s why he was being such a jerk).

So it depends on the situation of course. But dental specialists can be worth it — even just a consultation might be enlightening.

 

There is a cat dental disease, called FORL, feline odontoclastic resorptive lesion. Our cat has had this. At about 9-10 years old our former vet told us our cat needed dental work, and it ended up with 3 teeth being pulled. This was a vet of very few words, so he didn't explain further. Life and cross-country moves happened, and we forgot that this cat should have his teeth attended to. We did not know he had a dental disease.

This past year, new vet in new area looked at his teeth and said they were really bad, and he needed a cleaning. He's 14 now. Vet tech pulled back his cheek just a little to show us the massive tartar, and a big chunk fell off in his hand. So, we had him go for a dental cleaning, etc.
We got charged full price for a dental cleaning (which is a whole 'nother discussion, as you will understand as soon as you read the next part), but the vet reported that the cat had FORL, which is where their teeth basically crumble/rot and reabsorb into their jawbone (or something like that, I'm probably way oversimplifying). Basically, the teeth disintegrate and their jaw/gums heal over where teeth used to be, all on their own.
Our cat has only one molar, not in good shape, 3 of his four canines (the fang teeth) and a few of the tiny little front incisor teeth. That's all. All the others crumbled/disintegrated away due to FORL. We had no idea he had practically no teeth left. We had no idea his teeth had gone so bad, fallen out, crumbled, disappeared. He never appeared to be in pain. He never had trouble eating, stopped eating, anything. No drooling, no swelling, no nothing.

So, it IS possible for a cat to have rotting teeth and not be in distress. It isn't always painful, or a problem. We had switched him off of dry food when he tested borderline diabetic, so with an all-canned food diet, he's never had any problem eating, in fact, he's fat because he was eating not only his food, but a good share of the other cats' food before they could finish it.

So, if the vet judges that bad teeth are not a problem, and to let it be unless the cat exhibits gum inflammation/infection, or distress, it IS possible that this is a valid choice. We had no idea that our cat was losing almost all his teeth, and he's an inside-only cat who gets thyroid medicine twice daily, so he is not ignored or forgotten. Perhaps something to discuss with a cat-dental specialist to make sure the cat is doing okay with the way things are, but just know that it is a valid possibility.