That's something only you and your vet would know is best for your kitty. If her values are ~kinda~ elevated (BUN /CREAT) and she has no heart issues she'd probably be OK with anesthesia and some 0.9% NaCl IV during her dental. She probably would benefit from antibiotics for a week PRIOR TO having the procedure as well as having the antibiotics for a week or so afterwards.

If her values are very high or you don't want to risk the anesthesia, perhaps ~pulse dosing~ with an antibiotic for one week each month will help your kitty. This is often used in human and veterinary medicine. The theory is to bombard the system with a broad spectrum antibiotic once a month and decrease the systemic bacterial load that results from the bacterial shower.

A bacterial shower is the chronic result of severe gingivitis. The bacteria normally in the mouth find their way into the general circulation thereby causing a low grade infection of the kidneys, liver ... ___________(insert body part of your choice). These bacteria get into the system and continuously infect the body.

Just as in people, chronic dental disease can result in something called bacterial endocarditis where bacteria set up housekeeping on the heart valves and the result is an ever changing heart murmur. The pulse dosing will decrease the chances or severity of this condition as well.

If you have any reservations about the safety of your kitty going under anesthesia which your vet cannot alleviate ... do what YOU think is right! Only you can decide what is best for your kitty.

I 100% agree with everything that chickadeedeedee said. Just wanted to add that dental disease is extremely painful- if you've ever had a toothache you know it hurts. Getting the bad teeth out will help him feel *so* much better. You may not even be aware of the changes caused by pain- decreased activity level, chewing on one side of the mouth, reluctance to eat, and eventually refusal to eat. You don't want to wait for that stage. Can you imagine being in so much pain that you won't even eat?

There are analgesics that are safe even for CRF cats that he should receive after the procedure for a couple of days. Even if you choose not to have the dental done, he would benefit greatly from some sort of pain control. You need to be sure the vet provides all the best monitoring- pulse oximeter, blood pressure ESPECIALLY important (low BP causes kidney damage), temperature, etc. He also need IV fluids for the procedure to help maintain blood pressure and hydration. Most anesthetic risks can be managed with excellent care. I've anesthetized patients in all sorts of horrible condition successfully (we get the worst of the worst at the vet school), a little CRF is certainly manageable.

Good luck with your kitty. I know the decision is never easy. But honestly a lifetime of pain vs risk of anesthesia- I know what I would choose.

Thank you both for the feedback. It has helped a great deal with just getting some thoughts straight. I'll pick the vet's brain again next time she goes in for blood work- debate where she stands from an overall health standpoint compared to the risks. Last year her teeth looked like they could use some work, but this year they have gone to horrendous IMO. I keep figuring that at some point it will go from an issue that the vet throws out there as something that we could do for her to something that the vet strongly recommends we do for her. I wish this were an easier decision to make.

Thanks again.