Cat peeing outside litter box: Can broken tooth be the problem?

We recently took our 12 year old female fixed cat to the vet because she started peeing outside the litter box - normally in laundry baskets, boxes, any pile of clothes or bags left on the floor, newspaper and plastic. She has never had a litter box problem and is usually very particular and neat when using the bathroom.

Our cat’s urinalysis and blood work came back normal, except there was a higher than normal white blood cell count, which the doctor said was indicative of an inflammatory condition. He prescribed prednisone but wants to take more tests. Our cat lost a little bit of weight since her last appointment, so he's concerned.

Some of the changes that have been going on that I think may be causing/contributing to this new litter box behavior:

1. Our cat has a chipped tooth. The vet said that it is chipped, but not infected. He says that it is purely coincidental and is not the root of the problem. For me, however, I feel like this might certainly be the problem, because we noticed the chipped tooth right around the time this cat behavior started. Sometimes, our cat licks her mouth and has it open in a weird position, and while I'm not sure if she's eating much less (we don't really monitor her food intake), it would make sense to me that she's eating less because her tooth hurts. And, it would also make sense that her white blood cell count would be higher because of an infection in her tooth or mouth.

2. Another cat in the house has recently become an outdoor cat. We have three cats, and the one that's now outside has had a very bad peeing/pooping outside the box problem since we took him in. Ten years later, we have finally had enough. He is now outside. We also started giving the other two kitties, including the one with the new litter box problem, monitored outdoor time. Our cat with the tooth problem kept jumping the fence, so we don't let her out anymore. Ever since, our cat howls at the windows/doors a lot. I feel like she's really mad at us for not letting her out.

My question is, should I just let the vet run his course? Or do you think I should get a second opinion because the tooth might be the problem, and my current vet has dismissed it? Thanks!

Dear concerned cat owner,

Any pain anywhere in a cat’s body can cause a change in the cat’s behavior, so it certainly is possible that your cat’s tooth is bothering her and causing her litter box behavior. It is also possible that her new behavior is a result of the environmental change of having her house brother be moved outside, and the stress or anxiety associated with that change. It also may be because she liked it outside and now that you won't let her out, she is alleviating her stress in the other way she knows how.

A high white cell count can indicate an inflammatory condition but can also be from a bacterial infection. I'm also not sure if you meant the high white cell count was in the urine or the blood. If it was in the blood, then it could indeed be from a tooth problem.

Taking your cat to another vet for a second opinion sounds like a good idea. It is important that you feel confident that your cat is in good hands medically, and that you can trust that your vet has adequately explored all possible causes for your cat’s behavior. Unfortunately, all vets are not created equally and not all are as knowledgeable about cats as others or about feline dentistry.

Best wishes,
Dr. Neely

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