What Every Cat Owner Should Know About Periodontal Disease

If your cat has bad breath that could clear a room, red or puffy gums, or a vet who just flagged dental disease on their chart, here’s what’s likely going on: periodontal disease, or gum disease caused by plaque and tartar that works its way below the gumline and quietly damages the teeth and surrounding tissue. It’s one of the most common health issues vets see in cats, and most show signs by age three or four.

The good news? Caught early, it’s very manageable.

What is periodontal disease in cats?

Periodontal disease is an infection and inflammation of everything that holds your cat’s teeth in place: the gums, the ligaments connecting teeth to the jaw, and the jawbone itself. It starts simply enough. Bacteria in your cat’s mouth form a soft, sticky film on the teeth called plaque. Leave that plaque alone long enough and it hardens into tartar, which is much tougher to remove and starts working its way below the gumline where you can’t see it.

Once bacteria get into that space under the gums, the body tries to fight back, and it’s actually that immune response, that ongoing inflammation, that does most of the damage over time. It gradually breaks down the gum tissue, bone, and ligaments that keep teeth anchored and stable. In more advanced cases, it can also trigger something called tooth resorption, a painful process where the tooth structure itself starts to break down from the inside out. It’s as uncomfortable as it sounds, and cats are notoriously good at hiding it.

Stages and symptoms of periodontal disease in cats

Periodontal disease moves through four stages, each progressively harder to reverse. Here’s what you might actually notice at home at each one:

• Stage 1 (Gingivitis): The gums look red or swollen along the tooth edge. Breath may start smelling off. This stage is fully reversible with a professional cleaning.
• Stage 2 (Early periodontitis): Mild bone loss is beginning (visible only on dental X-rays). Gums may bleed when touched. Your cat probably isn’t showing obvious pain yet.
• Stage 3 (Moderate periodontitis): More significant bone and tissue loss. Teeth may feel loose. Bad breath (halitosis) is usually noticeable. Some cats start eating differently or favoring one side of their mouth.
• Stage 4 (Advanced periodontitis): Severe bone loss, loose or missing teeth, exposed roots, and significant pain. Cats at this stage may stop eating, drool excessively, paw at their mouth, or become withdrawn. Tooth extraction is often necessary.

One thing worth knowing: cats are remarkably good at hiding discomfort. Even with severe periodontal disease, many cats keep eating and grooming as if everything is fine. Visible signs alone aren’t always a reliable way to gauge how serious things have gotten, which is why regular vet checkups matter so much.

What causes periodontal disease in cats?

Plaque is the root cause, and honestly, plaque is just a fact of life for most cats. It starts forming the moment bacteria meet teeth, and without regular removal it hardens into tartar and the cycle begins. That said, some cats are more vulnerable than others:

• Age: Buildup accumulates over time, which is why older cats tend to have more advanced disease.
• Breed: Flat-faced cats like Persians have more crowded teeth, giving plaque more places to hide and making cleaning harder.
• Diet: Wet food is great for hydration, but it doesn’t mechanically scrub the teeth the way chewing harder food or toys can.
• Genetics and mouth anatomy: Some cats are just more prone to rapid buildup regardless of what their owners do.
• Infrequent or no professional dental cleanings: There’s simply no way to address what’s happening below the gumline at home without professional help.

How to prevent periodontal disease in cats

You can’t eliminate plaque entirely, but you can slow its buildup significantly, and that makes a real difference in how quickly the disease progresses. The most effective habits to build:

• Daily teeth brushing: This is the single most impactful thing you can do at home. Use a cat-safe toothbrush and enzymatic toothpaste (never human toothpaste, which is toxic to cats). Even a few times a week is better than nothing, but daily is the goal.
• Annual professional dental cleanings: No amount of home care can address what’s happening below the gumline. A professional cleaning once a year is what keeps early disease from quietly advancing between visits.
• Dental treats and water additives: These can help slow plaque buildup as a supplement to brushing, but they’re not a replacement for it or for professional care.
• Regular vet checkups: Your vet can spot early gingivitis before you’d ever notice it at home, and flagging it early is what keeps stage 1 from becoming stage 3.

Prevention is always easier than treatment. A cat whose teeth are cleaned professionally every year and brushed regularly at home is far less likely to need extractions down the road. It’s one of those areas where a small consistent effort genuinely pays off.

What a professional dental cleaning actually involves

A professional dental cleaning for cats, sometimes called a COHAT (comprehensive oral health assessment and treatment), is a much bigger deal than a human teeth cleaning. Here’s what actually happens:

Anesthesia

Your cat goes under general anesthesia for the entire procedure. This isn’t optional, and it’s not a shortcut. It’s the only way to safely examine every tooth, probe below the gumline, and take full-mouth X-rays. Anesthesia-free dental cleanings only clean visible surfaces and miss the damage happening below the gumline, which is exactly where the disease lives.

Dental X-rays

Full-mouth dental X-rays let the vet see bone loss, tooth root problems, and tooth resorption that are completely invisible to the naked eye. More than half of dental disease findings in cats are only detectable on X-ray, which is why skipping this step means a lot of the real damage goes undetected.

Scaling and polishing

The vet uses an ultrasonic scaler, essentially a very precise vibrating tool, to break up and remove tartar above and below the gumline. After scaling, the tooth surfaces are polished to smooth out any microscopic scratches that could let plaque reattach faster.

Extractions, if needed

If any teeth are too damaged to save, the vet will extract them during the same procedure. This sounds alarming, but cats adapt remarkably well to missing teeth. Removing a painful, infected tooth almost always improves their quality of life significantly.

What does it cost?

Costs vary depending on your location, your vet, and the severity of disease. As a general range in 2026, a routine COHAT with anesthesia and X-rays typically runs $400 to $800. If extractions are needed, costs can climb to $1,000 to $2,500 or more, especially for multiple teeth or surgical extractions. Stage 3 and 4 cases with significant bone loss sit at the higher end of that range.

Does pet insurance cover periodontal disease in cats?

Yes, but the right coverage depends on which dental add-on you have. A base accident and illness policy alone won’t cover dental illness, so adding dental coverage is worth thinking about sooner rather than later.

Lemonade offers two dental coverage options depending on your location:

Dental Care add-on: The most comprehensive option. Covers dental illness treatment and routine cleanings, has no deductible, and uniquely, covers pre-existing dental conditions. Only available to add while your cat is between 0 and 3 years old.

Dental Illness add-on: Covers treatments, diagnostics, and medications related to dental illness, including extractions and periodontal disease treatment. Doesn’t include routine cleanings on its own. To cover routine dental cleanings, you’d need to pair this with the Preventative+ add-on. Pre-existing dental conditions are not covered, and a deductible applies.

The earlier you enroll and add dental coverage, the more it can do for you.

Before we go

Periodontal disease is one of the most common things vets find in cats, and one of the most underdiscussed by owners, partly because it develops quietly and cats rarely complain. But it’s also one of the most preventable conditions with the right routine. If your cat’s breath has been telling you something is off, or if their last vet visit flagged early dental disease, now’s the time to ask about a professional cleaning and talk to your vet about a home care plan.

And if they’re still young and healthy, that’s actually the best time to look into pet insurance coverage, so you’re prepared if things change.

Frequently Asked Questions

A few quick words, because we <3 our lawyers: This post is general in nature, and any statement in it doesn’t alter the terms, conditions, exclusions, or limitations of the policies issued, which differ according to your state of residence. You’re encouraged to discuss your specific circumstances with your own professional advisors. The purpose of this post is merely to provide you with info and insights you can use to make such discussions more productive! Naturally, all comments by, or references to, third parties represent their own views, and Lemonade assumes no responsibility for them. Coverage may not be available in all states. Please note that statements about coverages, policy management, claims processes, Giveback, and customer support apply to policies underwritten by Lemonade Insurance Company or Metromile Insurance Company, a Lemonade company, sold by Lemonade Insurance Agency, LLC.  The statements do not apply to policies underwritten by other carriers.