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@bothwell
They're fine without them. Cats with FIV are prone to getting gingivostomatitis which causes massive, painful inflammation in response to tiny amounts of plaque. The most successful treatment is complete extraction of every single tooth in their mouth, and they live happy and pain-free lives as a result. They just crunch through stuff with their iron gums. It sounds like Patch has resorptive lesions.
Also, I hear the "dry food cleans teeth" theory a lot but cats teeth aren't built for chewing like ours are, and house cats don't typically sit and gnaw on bones like dogs do. If you watch a cat eating dry food, it doesn't chew it into pieces before swallowing, it just swallows it whole. If they do bite down on dry food, it just shatters in their mouth - can't see them getting much tooth cleaning from that. It seems to me that it's more of a plausible-sounding homily that originates from manufacturers of kibble than an actual evidence-based recommendation ¯_(ツ)_/¯ (I just had a little google and found this article talking about teh same thing: https://thecatsite.com/ams/does-dry-food-actually-clean-your-cats-teeth.30205/) (ETA: yay, I found a better one, with citations from actual studies! http://www.catbehaviourist.com/blog/6-reasons-dry-food-clean-cats-teeth/ )
I used to give mine Plaque-Off as well, but I didn't find the research for it very compelling. I could only find one study that claimed it was efficacious, and that was a small scale study in humans, that was done by the same dentist who patented and sells the product itself. It's possible that high quality studies into Plaque-Off do exist and I just wasn't able to find them ofc. But lots of feline dentists swear by it, the cat seemed to like it, and it didn't seem to do him any harm. He still had to get all his teeth removed, though. (Mine had FIV and gingivostomatitis, not what Patch has)