The Silent Epidemic: Dental Disease in Senior Cats

At a Glance

Dental disease is one of the most common health conditions veterinarians diagnose in cats. Banfield Pet Hospital’s 2024 report found that 64 per cent of cats seen that year had dental-related issues. The UK’s largest feline dental study — analysing over 18,000 cats, confirmed that age is the single strongest predictor. What makes this particularly complex is that cats face not one but three distinct dental diseases: periodontal disease, tooth resorption, and feline chronic gingivostomatitis. Your senior cat may be living with one, two, or all three — silently.

If your cat is drooling more than usual, has an unkempt coat, approaches the food bowl and walks away, prefers soft food over kibble, or has bad breath that was not there a year ago — these may not be signs of a “finicky eater” or “just getting old.” They may be signs of dental pain that cats are biologically wired to hide from you. A normal appetite does not guarantee a healthy mouth.

This guide covers what dental disease actually looks like in senior cats, the three conditions every cat parent should know about (including tooth resorption — a disease where the body destroys its own teeth from the inside), which breeds face the highest risk, the home prevention options ranked by evidence, the honest conversation about anaesthesia safety, and the emerging therapies offering new hope for cats with the most severe form of oral disease.

Whether you have noticed drooling, a matted coat, bad breath, a reluctance to eat hard food, or a sudden change in your cat’s personality — whether you are searching for cat teeth cleaning, cat drooling causes, or why is my cat losing teeth — start here.

The Full Guide

Why Cats Are Even Better at Hiding It

Pet parents often say: “He’s always been a fussy eater” or “She just grooms less now that she’s older.” Here is what those observations may actually mean.

Cats have been domesticated for only about 10,000 years. That comparatively short history means cats have retained more of their wild survival instinct, including a profound ability to conceal pain. A cat with an abscessed tooth, dissolving roots, or inflamed gums will continue eating, grooming, and purring on your lap. By the time the signs become visible to you, the disease has often progressed beyond the point where early intervention would have made the biggest difference.

The numbers are stark. Banfield Pet Hospital’s 2024 report, drawing on data from over three million pets, found that 64 per cent of cats seen that year had dental-related issues. A landmark UK study of more than 18,000 cats under primary veterinary care found a 15.2 per cent periodontal disease prevalence on conscious examination alone — but here is the catch. When cats are examined under anaesthesia with dental X-rays, the detection rate rises dramatically. A study of cats receiving full-mouth X-rays found clinically important findings in 41.7 per cent of teeth that appeared normal on visual inspection. X-rays detected 2.4 times more root disease than clinical exam alone.

The 2025 FelineVMA Feline Oral Health and Dental Care Guidelines — the most authoritative set of feline dental recommendations published to date, make a point that every cat parent needs to hear: a normal appetite does not mean a healthy mouth. Cats’ survival instinct to eat is so strong that they will continue eating through significant oral pain. This is not resilience. It is masking.

Only four per cent of cat owners brush their cat’s teeth daily, and 73 per cent have never brushed at all. This article is not here to add guilt to that statistic. It is here to give you the information you need — the three diseases, the signs you may be misreading, the evidence-ranked options that work in real life, so you and your vet can build a plan that fits your cat’s temperament and your reality.

The Cat Triad — Three Diseases, Not One

Searching for “why are my cat’s teeth falling out” or “holes in cat teeth”? You may be looking at one of three distinct conditions — and your cat could have more than one at the same time.

What makes feline dental health uniquely complex is that cats face three distinct dental diseases. Understanding which one your cat has (or which combination) changes everything about prevention, treatment, and what to expect. These three conditions have different causes, different progressions, and different treatment paths. Your vet needs dental X-rays (radiographs) under anaesthesia to tell them apart. Here is what each one looks like from your side.

Periodontal Disease — The Familiar One

Periodontal disease follows a familiar progression: plaque forms within hours of eating, mineralises into calculus within two to three days, and drives progressive destruction of the gum and bone structures anchoring each tooth. The disease moves through four stages, and only Stage 1 (gingivitis) is fully reversible.

But there is a critical anatomical difference. Cat teeth are short, and the healthy gingival sulcus (the tiny gap between gum and tooth) measures just 0.5 millimetres. A probing depth of just one millimetre already signals periodontitis. This means cats lose supporting structure quickly, and the window between “reversible” and “irreversible” is narrower than most cat parents realise.

Cats have 30 permanent teeth, and every one of them matters for eating, grooming, and quality of life in the senior years. Two-thirds of each tooth sits below the gumline, invisible to you and to your vet during a routine wellness check without anaesthesia.

Tooth Resorption — The Disease That Comes from Inside

Tooth resorption occurs when specialised cells called odontoclasts begin attacking healthy adult teeth. These are the same cells that normally dissolve baby teeth to make way for permanent ones, but for reasons science has not yet explained, they turn on healthy tooth structure. The tooth breaks down from the inside, eventually destroying the root and crown. It is, in effect, the body consuming its own teeth.

The prevalence is staggering. Studies report that 28.5 to 67 per cent of cats are affected, depending on the population studied and the diagnostic method used. Cornell University’s Feline Health Center estimates that close to three-quarters of cats aged five and older have some degree of tooth resorption. In one study, 53 percent of cats had a visible lesion; where no lesion was visible clinically, X-rays revealed one almost 50 per cent of the time.

Veterinarians classify tooth resorption into three types based on what X-rays reveal. Type 1 (inflammatory) retains normal root density and is associated with periodontal disease; the entire tooth must be surgically extracted. Type 2 (replacement) is the most common form: the root is gradually replaced by bone-like material and effectively merges with the jawbone. Treatment involves removing the diseased crown while leaving the resorbing roots in place. Type 3 is a combination of both types in different roots of the same tooth.

The mandibular third premolar is often called the “sentinel tooth” because it is the most commonly affected; if resorption appears here, it is likely developing elsewhere. Pain from tooth resorption produces a characteristic sign: jaw chattering or quivering when the lesion is touched. This involuntary spasm occurs because exposed dentin triggers a sharp nociceptive reflex.

The cause of tooth resorption remains unknown. Hypotheses include excessive dietary vitamin D (cats cannot synthesise vitamin D through their skin and are entirely diet-dependent), changes in commercial diets since the 1970s (when prevalence began rising markedly), and individual immune responses. Despite decades of research, no method of prevention has been identified. Once a cat has been diagnosed with tooth resorption, it is likely that more lesions will develop in currently unaffected teeth. Annual X-ray screening is the best available strategy.

Feline Chronic Gingivostomatitis — When the Immune System Overreacts

Feline chronic gingivostomatitis (FCGS), also referred to simply as stomatitis, is the most severe and emotionally devastating of the three conditions. It is an immune-mediated disease in which the cat’s own immune system launches a disproportionate inflammatory response to the bacteria in dental plaque. The result is widespread, painful inflammation that extends beyond the gums to the cheek lining and the back of the mouth. Cats with FCGS experience moderate to severe oral pain, decreased appetite, poor grooming, and reduced social interaction.

Prevalence estimates range from 0.7 to 12 per cent of the general cat population, with some studies reporting up to 26 per cent. Feline calicivirus (FCV) is the most consistently associated infectious agent, found in 60 per cent of FCGS cats versus 24 per cent of controls, though a direct causal relationship has not been established. Cats living in multicat households are at higher risk; one study found that each additional cat in the household increased the odds of FCGS by more than 70 per cent.

The gold standard treatment is partial or full mouth extraction. A study of 95 cats found that 28 per cent achieved complete resolution and 39 per cent showed substantial improvement, a combined positive outcome of 67 per cent. Earlier studies reported cure rates of up to 60 per cent. Many cats eat normally (including dry food) within two to three weeks of full mouth extraction. For the 30 to 40 per cent of cats who do not respond fully, ongoing medical management (immunosuppressive or immunomodulatory therapy) is required.

Stem cell therapy is the most promising emerging treatment for refractory cases. Multiple studies at the University of California, Davis have shown response rates of 65 to 79 per cent in cats who failed to improve after extraction. A pivotal field study published in 2025 found that 78.8 per cent of owners reported meaningful quality-of-life improvement after stem cell treatment. This therapy is approaching regulatory approval but is not yet standard of care.

If your vet recommends full mouth extraction, this is not a failure. It is the most effective treatment available for a disease that causes daily suffering. Cats are remarkably adaptable. Your vet is your partner in navigating this decision.

Breeds at Higher Risk — And Why It’s Genetics, Not Size

Searching for “are Siamese cats prone to dental disease” or “do Persian cats have bad teeth”? The answer is yes.

Unlike many health conditions where body size plays a role, feline dental disease is driven primarily by breed-specific genetics and immune response.

The UK’s largest feline dental study (VetCompass, 18,249 cats) found that Siamese cats had the highest periodontal disease prevalence at 18.7 per cent, followed by Maine Coons at 16.7 per cent. Siamese cats are also predisposed to tooth resorption, narrow-jaw malocclusion, and an aggressive form of juvenile periodontitis that can begin before the age of one. A large Finnish study of over 8,000 cats confirmed breed-specific predispositions to tooth resorption: Siamese, Abyssinian, and Oriental Shorthair were at highest risk.

Persian and Himalayan cats face a different burden: their brachycephalic (flat-faced) skull structure creates tooth overcrowding, making plaque accumulation harder to prevent and oral examination more difficult. They are also predisposed to juvenile hyperplastic gingivitis — an overgrowth of gum tissue that begins as early as six months of age.

Abyssinian cats have a documented genetic predisposition to sensitive gums and tooth resorption. Maine Coons are prone to early-onset periodontitis. Burmese cats tend toward resorptive lesions and have small mouths that trap food and debris.

For domestic shorthair and longhair cats — including Indie cats, no breed-specific dental research exists. What we do know is that dental disease affects cats of every breed and background. One important finding: being purebred is not itself a risk factor. The associations are breed-specific, not purebred-versus-mixed. Diet, home care, and individual genetics all play a role.

Age is the multiplier across all breeds. The VetCompass data showed that cats aged nine to twelve were 6.7 times more likely to have periodontal disease compared with cats under three. By the time your cat reaches senior status, the cumulative burden of years of low-grade dental disease may have already done significant damage below the gumline.

The Signs Your Cat Is Hiding Pain

When pet parents search for “why is my cat drooling,” “my old cat won’t eat,” or “senior cat won’t eat hard food,” they are often describing dental pain without knowing it.

The following signs may seem unrelated to dental health, and that is exactly what makes dental disease in cats so easy to miss. Many of these behaviours are attributed to “just getting old” or “being a fussy cat” when they actually indicate treatable oral pain.

Drooling or hypersalivation. Cats are not natural droolers. Excessive saliva, especially if blood-tinged, is one of the most reliable indicators of oral pain or disease in cats. Drooling is the alarm signal that warrants immediate veterinary attention.

An unkempt coat. Cats spend 10 to 15 per cent of their waking hours grooming. When oral pain makes grooming hurt, cats stop — and the result is a matted, dull, or unkempt coat, particularly along the back and rump. This sign is unique to cats because of their grooming habits. If your previously well-groomed cat’s coat has deteriorated, their mouth may be the reason.

“Finicky” eating that is actually pain. Approaching the food bowl and walking away. Licking the gravy but leaving the chunks. Choosing soft food over kibble. Carrying food away from the bowl. Chewing on one side. These are not personality traits. They are pain-avoidance behaviours. A cat who once ate enthusiastically but now seems “picky” may be a cat whose every meal hurts.

Jaw chattering or quivering. This involuntary spasm is highly characteristic of tooth resorption. It occurs when exposed dentin is contacted: by food, by the tongue, or during a dental examination. Pet parents often mistake it for excitement, cold, or even a reaction to watching birds.

Swallowing food whole, head tilting, or dropping food. A cat that tilts its head while eating, consistently chews on one side, or swallows kibble without chewing is likely compensating for pain in a specific area of the mouth.

Personality changes. Withdrawal, hiding, irritability, snapping when touched near the face, or a general loss of interest in interaction. Chronic pain changes behaviour. A “grumpy old cat” may be a cat in pain.

Weight loss. Gradual weight loss from reduced eating is common in cats with advanced dental disease. In cats, this carries a specific danger: hepatic lipidosis (fatty liver disease) can develop when a cat stops eating for as little as two to three days. If your cat has not eaten for 24 to 48 hours, contact your vet — this is not a “wait and see” situation.

The Feline Grimace Scale (a validated pain assessment tool developed at the Université de Montréal) uses five facial action units (ear position, orbital tightening, muzzle tension, whisker changes, and head position) to detect pain in cats. A study validating this scale in cats undergoing dental extractions confirmed its reliability for dental pain assessment. While designed for clinical use, learning to read your cat’s facial expressions can help you spot discomfort earlier.

You can make a habit of checking your cat’s mouth weekly by gently lifting the lips from the side and looking at the gums and outer tooth surfaces. Redness, swelling, pinkish defects at the gumline, and bleeding on gentle touch are all flags. But remember: the majority of feline dental disease — especially tooth resorption, hides below the gumline and can only be detected with X-rays under anaesthesia.

What Dental Disease Does to the Rest of the Body

You may have heard that “bad teeth can cause kidney problems in cats.” The reality is more nuanced, and for senior cats, more important than the headline suggests.

The kidney connection is the most important link for cats, because chronic kidney disease (CKD) is the leading health concern for senior cats, affecting 30 to 40 per cent of cats aged ten and older. The largest study on this question (a retrospective analysis of 169,242 cats across 829 veterinary hospitals) found that periodontal disease was associated with a significantly increased risk of developing CKD. The risk was highest for cats with Stage 3 or 4 periodontal disease. Banfield’s 2024 data confirmed that cats with advanced periodontal disease were 1.5 times more likely to develop chronic kidney disease. Cats with more than 25 per cent alveolar bone loss showed the greatest risk.

The overwhelming systemic concern for cats with dental disease is the kidney. The cardiac association is less well established. The UK’s VetCompass study found that cats with periodontal disease had higher odds of cardiac dysrhythmia and heart murmur, but these are associations, not proven causal links.

A unique feline vulnerability adds another layer. Cats cannot synthesise vitamin D through their skin — they are entirely dependent on dietary sources. Research has found significantly lower vitamin D levels in cats with gingivostomatitis compared with healthy cats, and increased vitamin D receptor expression in tooth resorption lesions. Because dental pain reduces food intake, and reduced food intake means less dietary vitamin D, a vicious cycle may develop in which dental disease worsens the very deficiency that may contribute to it.

Feline immunodeficiency virus (FIV) and feline leukaemia virus (FeLV) compound dental disease significantly. Cats with FIV are more prone to severe gingivitis and periodontal disease, and cats with FeLV who develop stomatitis have a substantially worse prognosis after dental treatment. If your cat’s retroviral status is unknown, testing before a dental procedure gives your vet critical information for planning.

Why does this matter? Because an educated cat parent deserves evidence grades, not scare tactics. The kidney link is strong enough to justify dental care on systemic grounds alone. Protecting your cat’s mouth is protecting your cat’s kidneys.

The Food Question — Wet, Dry, and What Actually Helps

Searching for “does dry food clean cats’ teeth” or “best dental food for senior cats”? The answer involves a genuine tension that every senior cat parent needs to understand.

The idea that standard dry kibble provides meaningful dental protection for cats is a myth. Most kibble shatters on first bite; many cats swallow it whole. There is little evidence that standard dry cat food reduces plaque or calculus compared with wet food.

The exception is purpose-designed dental diets. These use oversized kibble with interlocking fibre matrices that force the tooth to push through the surface, creating a mechanical scrubbing action. Several feline dental diets carry the Veterinary Oral Health Council (VOHC) Seal of Acceptance, meaning they have met a minimum 20 per cent reduction in plaque or calculus in controlled trials.

Here is the tension for senior cat parents: wet food is widely recommended for cats with chronic kidney disease because of its higher moisture content, which supports hydration and kidney function. Yet some evidence suggests cats on exclusively wet diets may develop slightly more plaque. For a senior cat with CKD, the answer is clear — prioritise kidney management. The difference between standard dry and wet food for dental health is marginal at best. Only VOHC-accepted dental diets provide meaningful benefit, and even these are best used as a partial ration alongside wet food.

The practical approach: if your senior cat is on a wet food diet for kidney health, compensate with non-diet dental products (a seaweed-based food topper, a water additive, or an oral gel) rather than switching to a dry diet that may compromise hydration.

The Home Prevention Playbook — Ranked by Evidence

Searching for “how to clean cat teeth at home” or “best dental products for cats”? Here is every home option for cats, ranked by what the research actually supports.

Home dental care for cats presents unique challenges. There are no VOHC-accepted dental chews for cats, a notable gap in the available product landscape. Cats also have lower tolerance for oral handling, making brushing more challenging. What follows is a tiered ranking based on the evidence available specifically for cats.

Tier 1: Daily Toothbrushing — The Gold Standard

Brushing remains the single most effective home prevention method for cats. The mechanics are the same: mechanical disruption of plaque before it mineralises into calculus. The benefits are dose-dependent — daily is ideal, but even three times a week provides meaningful protection.

The compliance reality is sobering. Only four per cent of cat owners brush daily, and 73 per cent have never brushed at all. A majority of cat owners describe brushing as “difficult and an inconvenience.” If you can build the habit, use a veterinary toothpaste or a safe carrier such as coconut oil. A finger brush is often better tolerated than a handled brush. Start with brief gumline contact and build gradually.

A cat showing signs of dental pain may prompt you to look in your own medicine cabinet. This is a critical mistake. Common human pain medications are toxic or lethal to cats. Cats metabolise these drugs differently from humans, and doses that are safe for people can be fatal for a cat. If your cat is in pain, contact your vet rather than attempting to manage it at home.

Tier 2: VOHC-Accepted Dental Diets

Several cat-specific dental diets have earned the VOHC Seal of Acceptance, including formulations from Hill’s, Purina, and Royal Canin. These use engineered kibble size and texture to mechanically reduce plaque. They can be fed as a full ration or as a partial component; even feeding a dental diet as 25 per cent of the daily ration has shown meaningful plaque reduction in studies.

Look for the VOHC Seal of Acceptance. Products carrying this seal have passed independent clinical trials reviewed by a board of veterinary dental scientists.

Tier 3: Water Additives, Oral Gels, and Sprays

VOHC-accepted water additives and oral gels exist for cats, primarily from the HealthyMouth range. These provide a passive antimicrobial layer without requiring oral handling — you add the product to drinking water or apply gel along the outer gumline. They work best as part of a layered approach alongside other methods.

One important consideration for senior cats: if a water additive causes your cat to drink less, the dehydration risk (especially in cats with CKD) outweighs the dental benefit. Monitor water intake when introducing any additive and discontinue if consumption drops.

Tier 4: Ascophyllum Nodosum (Seaweed Food Topper)

Ascophyllum nodosum is a North Atlantic brown seaweed that works through an unusual systemic mechanism: bioactive compounds are absorbed in the gut, enter the bloodstream, and are secreted into saliva, where they modify the oral environment to inhibit plaque mineralisation. The cat-specific product (ProDen PlaqueOff Powder for Cats) carries the VOHC Seal of Acceptance for both plaque and tartar, making it the only VOHC-accepted food topper for cats.

Because it is sprinkled on food, it requires no oral handling whatsoever. For cats who will not tolerate brushing, mouth gels, or even dental diets, this may be the single most practical daily intervention available.

One ingredient commonly found in human dental products requires a specific warning.

Tier 5: Emerging Science

Oral probiotics represent a growing area of research. Early studies show that specific bacterial strains can modify the oral microbiome, increasing beneficial bacteria and reducing pathogenic species. No robust clinical trials in cats have been published yet, but the mechanistic evidence is promising.

Lactoferrin, an antimicrobial protein naturally present in saliva, has the strongest preliminary evidence among emerging feline-specific approaches. A small trial found improvement in cats with caudal stomatitis treated with bovine lactoferrin spray. The evidence is encouraging but the sample sizes remain small.

Professional Cleaning and Anaesthesia — An Honest Word

The most common reason cat parents avoid professional dental cleaning is fear of anaesthesia. Here is what the numbers actually say.

A professional dental procedure under general anaesthesia is not cosmetic. It is the only way to take full-mouth X-rays (radiographs), scale below the gumline, probe every tooth, and diagnose tooth resorption and stomatitis, conditions that are invisible on the surface. For cats, this is not optional. Without radiographs, the majority of feline dental disease cannot be detected at all.

Anaesthesia in cats carries a measurable risk, and it is important to be honest about this. The largest UK study (the Confidential Enquiry into Perioperative Small Animal Fatalities, or CEPSAF, covering more than 79,000 cats) found an overall perioperative mortality rate of 0.24 per cent and a rate of 0.11 per cent in healthy cats. A 2024 worldwide study of nearly 15,000 cats reported an overall rate of 0.63 per cent. In healthy cats, the risk is approximately 1 in 900.

What drives the risk? Cats have a more sensitive upper respiratory tract, making intubation more challenging. Laryngeal spasm can occur rapidly. Their lower blood volume (50 to 60 millilitres per kilogram) means even small fluid imbalances have proportionally larger effects. Their smaller body mass leads to faster heat loss under anaesthesia.

Critically, approximately 75 per cent of feline anaesthetic deaths occur in the postoperative recovery period, not during the procedure itself. This means the quality of post-anaesthetic monitoring is the single most important safety factor. Studies show that pulse oximetry combined with peripheral pulse monitoring reduces the risk of anaesthetic death by 80 per cent. Ask your vet about their recovery monitoring protocol.

Age is a risk factor in cats, independent of health status. Cats over 12 years are approximately twice as likely to have anaesthetic complications compared with younger cats, even when overall health is equivalent. But age is not a contraindication; it is a reason for more careful planning. Pre-anaesthetic screening (bloodwork, blood pressure, and sometimes chest radiographs) is essential. For cats with chronic kidney disease, your vet will adjust the protocol based on International Renal Interest Society (IRIS) staging, including preoperative fluid therapy and avoidance of drugs that reduce kidney blood flow.

Cats do not have well-documented breed-specific drug metabolism sensitivities. The primary breed-associated risk is brachycephalic conformation. Persian and Himalayan cats require careful airway management under anaesthesia.

Local nerve blocks are a critical component of modern feline dental anaesthesia. A controlled study found that cats receiving nerve blocks during dental extractions required significantly less general anaesthetic, had lower heart rates and blood pressure during the procedure, and showed lower pain scores for hours after surgery. Three nerve blocks are routinely used in cats: infraorbital, middle mental, and inferior alveolar.

Avoid “anaesthesia-free” dental services. For cats, whose most significant dental diseases are invisible without X-rays, a cleaning that cannot look below the surface is not just inadequate. It is actively misleading, creating a cosmetically improved appearance while the disease progresses beneath it.

Putting It All Together — A Practical Daily Routine

Searching for “senior cat dental care routine” or “how to start brushing an old cat’s teeth”? Here is a realistic plan built for real life — not a textbook.

The best dental care routine is the one you will actually follow. Because cats present unique challenges — lower tolerance for oral handling, no VOHC-accepted dental chews, and higher rates of tooth resorption that cannot be prevented by home care

— the approach must be adapted to your cat’s temperament.

Protocol A: Zero Touch (for Handling-Intolerant Cats)

Dental diet as at least 50 per cent of daily calories (or mixed into wet food). Add a seaweed-based food topper (Ascophyllum nodosum) daily. Add a VOHC-accepted water additive to drinking water (monitor intake). Offer dental treats daily. This protocol requires no oral handling whatsoever and provides three to four passive layers of protection.

Protocol B: Minimal Touch (Cat Tolerates Brief Oral Contact)

Everything in Protocol A, plus: apply a VOHC-accepted oral gel or use dental wipes along the outer gumline three times a week. If tolerated, progress to finger-brush desensitisation — start with brief gumline contact while offering a treat, and build gradually. Even twice a week adds meaningful protection on top of the passive layers.

Protocol C: The CKD Cat (Wet Food Required)

Wet food as the primary diet (kidney management takes priority). Add the seaweed food topper to wet food daily. Use a water additive (monitor consumption carefully). Offer dental treats as tolerated. More frequent professional cleanings (every six to twelve months rather than annually) compensate for the reduced mechanical benefit of an all-wet diet.

Make it a weekly habit: a brief home dental check. Gently lift your cat’s lips from the side. Look at the gums and outer tooth surfaces on both sides. Note any changes: redness, swelling, pinkish defects, or bleeding. Early detection is the entire difference between a reversible Stage 1 problem and an irreversible Stage 3 one.

When to call your vet: persistent drooling, blood-tinged saliva, visible loose teeth, facial swelling, an unkempt coat that was not there a month ago, refusal to eat for

more than 24 hours, or any sudden change in eating behaviour or personality. These are not “wait and see” situations.

Your vet is your partner in this. This guide gives you the evidence to do more at home, and to have better conversations with your vet about your senior cat’s mouth.

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