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Issue number 22.3 Dental

Epidemiology of periodontal disease in older cats

Published 06/04/2021

Written by Elizabeth Lund

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Oral cavity disease is the most prevalent diagnosis in both dogs and cats. Not only are many of these disorders preventable, the reported associations between periodontal disease and systemic illness in both animals and humans...

Epidemiology of periodontal disease in older cats

Oral cavity disease is the most prevalent diagnosis in both dogs and cats 1. Not only are many of these disorders preventable, the reported associations between periodontal disease and systemic illness in both animals 2 3 4 and humans 5 6 should motivate the clinician towards proactive measures which will positively impact the overall quality of life for both pet and owner.

Methods of analysis 

For this population analysis, feline in-patients seen in 2006 that were ≥ 5 years of age and had received one or more diagnoses in the oral disease category were selected. These cases were compared to a sample of 5,000 feline in-patients with a similar age distribution but with no oral disease diagnosis. Overall prevalence rates for all oral diseases, including periodontal disease diagnoses, were generated from the Banfield in-patient population. Prevalence of the clinical signs reported for the population with periodontal disease (dental calculus; gingivitis; gingival recession; periodontal pockets and/or subgingival calculus) were also estimated. Logistic regression was used to determine risk factors important in predicting which cats are most likely to be diagnosed with periodontal disease. Potential risk factors included in the model were age, breed, gender, region and concurrent diagnosis (i.e. overweight, obesity, heart murmur, chronic kidney disease, aggressive behavior, diabetes mellitus, dermatitis, feline immunodeficiency virus [FIV], acute renal injury, hypertrophic cardiomyopathy or feline leukemia virus [FeLV]). To quantify risk, the relative risk (RR) was estimated using the odds ratio (OR) 7 for the association between age, breed, gender and the concurrent diseases of interest.
For the analysis, we used a p-value of .05 to determine statistical significance. 


There were 103,934 in-patient cats aged ≥ 5 years identified from Banfield hospital records during 2006, of which 55,455 (53.4%) were diagnosed with oral disease; 16,374 (15.8%) of cats were diagnosed with periodontal disease. Of this group, the following clinical signs were reported: tartar (94.2%)*, swelling or inflammation of gums (69.5%), infected pockets in gums (18.1%), gum recession (17.7%) and halitosis (13.0%). The mean age of the case group was 9.8 years, while the mean age of the control population was 9.7 years.

Table 1 details prevalence in the periodontal disease case group for selected oral and periodontal conditions, whilst Table 2 lists the prevalence for diseases hypothesized to be associated with periodontal disease for the case group vs. the control population. Statistically significant results from the multivariate analysis can be found in Table 3. 

Table 1. Prevalence of specific oral and/or periodontal disease diagnoses for cats with periodontal problems.
Disease Case Population (n=16,374)
Dental calculus * 39.7%
Gingivitis  28.6%
Periodontal disease, grade 2 **  25.1%
Periodontal disease, grade 1 **  20.6%
Periodontal disease (unspecified) ** 16.2%
Periodontal disease, grade 3 **  15.9%
Periodontal disease, grade 4 **  4.6%
Gingival recession 1.7%
Periodontal pockets  0.4%
Subgingival calculus 0.04%



Table 2. Prevalence of selected diagnoses for cats with and without periodontal disease. 
Disease/condition Cases (n=16,374)  Controls (n=5,000)
Overweight 15.6% 3.5%
Obesity 5.0%  1.1%
Heart murmur 5.0%  1.2%
Chronic renal failure 3.3%  3.1%
Aggressive behavior 2.1%  0.8%
Diabetes mellitus 1.9% 1.1%
Dermatitis 1.8% 1.3%
FIV  0.7% 0.3%
Acute renal failure 0.5% 0.4%
Hypertrophic cardiomyopathy 0.3% 0.1%
FeLV  0.2%  0.2%


Table 3. Multivariate results: predictors of periodontal disease in cats ≥ 5 years of age.
Variable in model Relative risk***  Confidence interval
Overweight 5.0 4.3-5.9
Heart murmur 4.5 3.5-5.9
Obesity 4.5 3.4-5.9
FIV  2.8 1.6-4.9
Aggressive behavior 2.2 1.5-3.0
Himalayan  1.6 1.3-2.0
Diabetes mellitus 1.5 1.1-2.0
Spayed/neutered 1.5 1.2-1.8
Persian 1.3 1.1-1.6
Siamese 1.3 1.1-1.5

* Note that the figures for calculus and tartar vary because dental calculus is a diagnosis and tartar is an examination finding - if tartar was noted on examination but wasn’t severe enough to warrant an intervention, calculus was not diagnosed.

** Periodontal disease was graded as follows: grade 1: inflammation; grade 2: inflammation, swollen gums and early bone loss; grade 3: inflammation, swelling, bone loss and loose teeth; grade 4: inflammation, swelling, pus, bone loss and loose teeth.

*** Estimated using the odds ratio. A relative risk (RR) > 1 suggests a positive association between an outcome and a factor; whereas RR < 1 suggests an inverse relationship between a factor and disease outcome; RR = 1 reflects no association.


Based on the multivariate analysis, older cats with periodontal disease are more likely to be spayed or neutered than those without periodontal disease, and are more likely to be Himalayan, Siamese or Persian. They are also more likely to be concurrently diagnosed as overweight or obese and to have a heart murmur, aggression, diabetes mellitus or FIV recorded in their medical record. The odds of being diagnosed as overweight or obese or with a heart murmur were about five times greater for cats with periodontal disease as compared with those without. The concurrent diagnosis of aggressive behavior is an interesting finding and may reflect a behavioral response to the pain that can accompany severe periodontal disease.


  1. Lund EM, Armstrong PJ, Kolar LM, et al. Health status and population characteristics of dogs and cats examined at private veterinary practices in the United States. J Am Med Vet Assoc 214;1999:1336-1341.
  2. Logan EI. Dietary influences on periodontal health in dogs and cats. Vet Clin North Am Small Anim Pract 2006;36:1385-401.
  3. Glickman LT, Glickman NW, Moore GE, et al. Evaluation of the risk of endocarditis and other cardiovascular events on the basis of the severity of periodontal disease in dogs. J Am Vet Med Assoc 2009;234(4):486-94.
  4. Glickman LT, Glickman NW, Moore GE, et al. Association between chronic azotemic kidney disease and the severity of periodontal disease in dogs. Prev Vet Med 2011;99(2-4):193-200.
  5. Iacopino AM. Periodontitis and diabetes interrelationships: role of inflammation. Ann Periodontol 2001;6:125-137.
  6. Beck JD, Offenbacher S. The association between periodontal diseases and cardiovascular diseases: A state-of-the-science review. Ann Periodontol 2001;6:9-15.
  7. Odds ratio and Relative risk. Wikipedia. Available at: Relative_risk. Accessed June 8, 2012.

Elizabeth Lund

Elizabeth Lund

Elizabeth Lund, Banfield Pet Hospital, Portland, Oregon, USA Read more

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