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Dental disease is a problem for cats of any age, but especially for older cats. Tartar build-up, gum disease, and bad breath are bad enough, but they bring with them other serious problems. Infected teeth are swarming with harmful bacteria that have direct access to your cat's bloodstream through the blood vessels in and around the roots of his teeth. These bacteria travel throughout your cat's body, and their two favorite places to do damage are the kidneys and the heart valves. When damaged, kidneys become unable to eliminate toxic waste from the body through the urine, and your cat begins to suffer from kidney failure. Eventually, this will prove fatal. Infected heart valves become shriveled and gnarled and no longer close properly when the heart contracts. The heart becomes unable to pump blood throughout the body properly. Then other body systems begin to malfunction.
Anesthesia is never without risk, even for a young and healthy cat, but modern anesthetics, machines, and monitoring equipment make the procedure much safer. Your veterinarian may recommended a pre-anesthetic evaluation of your cat, which should include a thorough examination to detect other health problems; an electrocardiogram (ECG), which might detect abnormalities of the heart; and analysis of a blood sample (both a complete blood count, or CBC, and serum biochemistry panel, often just called a panel) to determine whether other internal organs are functioning normally. Analysis of a urine sample (urinalysis) will also help your doctor evaluate the kidneys.
All of these tests should be performed at least every two years on cats older than 10 years of age. The tests will tell your veterinarian how well your cat will respond to anesthesia and which anesthetic procedures might be safest for him. Just because he doesn't pass these tests with flying colors doesn't mean he shouldn't be anesthetized: Those teeth still need to be thoroughly cleaned (even under the gums, which is impossible without anesthesia), and many cats with some malfunction of the heart, kidneys, liver, or other organs can be safely anesthetized as long as special precautions are taken.
One last bit of advice: Don't make the mistake of not taking good care of your older cat's teeth (or any other health problem he may have) just because he's an old cat. With modern veterinary care, many cats now live to be at least 20 years old, and withholding care now could rob you of several wonderful years with your feline buddy.