As cats are seldom hugged by owners in Singapore as compared to dogs, bad breath can be present for many years. Bacteria multiply and attack the roots. In this unusual case, the cat owner was advised to do dental in 2012 but she did not want to do it. Blood test did show a slight increase in urea and creatinine levels indicating abnormalities in the kidney.

In early 2013, I saw the cat with a swollen left eye with the conjunctiva much swollen. I had taken an image. I treated the conjunctivitis. Then in Sep 2013,  Dr Daniel was handling the case and advised X-ray.

I got the cat X-rayed on Sep 10, 2013 at 9 am, on behalf of Dr Daniel who starts work in the afternoon. The young vet at the other practice used xylazine (1.1 mg/kg)  and reversin to sedate the cat to get good X-rays done. I had told her that there was no point struggling with the cat to open the painful mouth to X-ray in the rostro-caudal position. "It is better to give a light sedation and get a clear view rather than no sedation and get a blurred X-ray," I advised.

 "I would say that this cat has an abscess in the sinus," the slim young lady vet told me. "Her teeth are all rotten too." I thanked her for her X-ray interpretation. It is always good to have opinions from other vets too.

"It was a tooth root abscess, lanced," Dr Daniel reported to me. "The facial swelling you saw in April was due to this problem." I reviewed the medical records. If only the owner had accepted dental scaling in 2012, there would not have been this left eye conjunctivitis in April 2013 and the recent lancing of the oro-nasal abscess.

In April 2013, the cat could have felt the painful infected molar tooth root and rubbed her left eye to relieve the pain. For the owner and for me, it was an eye problem. Actually, in retrospect, it could be a decayed tooth root abscess.  It is easy to be wise on hindsight.

This case could be the feline equivalent of the dental fistula of dogs with carnaissal tooth abscess. Only that in the cat, it is rare and it was in the early stage such that I missed its presence. Time and space leads to correct diagnosis by Dr Daniel.  

Regular dental checkup and scaling when advised by the vet would have saved this owner much time and money.

Only one molar tooth was extracted but root has blood and no obvious pus. Pus accumulated mainly inside the left maxillary sinus. An incision into the facial skin over and into the sinus was made and the pus was drained by Dr Daniel. The skin was stitched and the cat went home feeling much better.