Cats are prone to chronic diseases of the mouth including gingivitis (inflammation of the gums) and stomatitis (inflammation of the oral mucous membranes, including the back of the mouth). The disease may also be known as 'oropharyngeal inflammation'. The primary feature of this disease is severe inflammation of the gums where they touch the teeth, as well as inflammation of other oral tissues.
What causes gingivitis and stomatitis in cats?
There are probably a number of factors that contribute to the development of this chronic inflammation in the mouth and gums. Although the exact cause is unknown, it is primarily thought that some cats may have a hypersensitivity or allergic reaction to bacterial plaque and are called 'plaque-intolerant.' All we know is that cats with this disease have an abnormal immune response.
It has been speculated that other diseases such as feline leukemia virus (FeLV), feline immunodeficiency virus (FIV), calicivirus and feline herpes virus, and Bartonella henselae and other bacteria can play a role.
What are the signs of chronic gingivitis and stomatitis?
Chronic gingivitis and stomatitis causes severe pain. The cat's behavior may change - irritability, aggressiveness, depression or reclusiveness may be seen. The cat may drool excessively, have difficulty eating or not eat at all. Some cats will go up to the dish as though they are very hungry (which they are) and then run from the food dish because eating is so painful. They will often have bad breath (halitosis) and may not be grooming themselves adequately. Their gums bleed very easily. An affected cat may paw at the mouth and grind the teeth.
How is this disease diagnosed?
During the oral exam, which needs to be done under anesthesia to do it well, multiple lesions are seen with stomatitis. There may be ulcers or proliferative lesions. The lesions can be on the gums, roof of the mouth, back of the mouth, tongue, or lips. The lesions at the gumline surround the whole tooth. Usually, the area around the back teeth, is most affected. Sometimes tooth resorption is seen.
What is the treatment for chronic stomatitis/gingivitis?
Cats with juvenile onset gingivostomatitis may respond to a very intense program of oral hygiene. It has been found that it is imperative to eliminate plaque in these cats. To do this requires:
- frequent dental cleaning and polishing (2 - 3 times per year)
- daily home care, including daily brushing and oral disinfectants.
- good nutrition, using a diet designed to control plaque.
- oral antibiotic therapy to reduce bacteria in the mouth.
Unfortunately, even with this intensive care, in some young cats the disease often progresses and the only way to cure the disease and eliminate the very painful lesions is to extract all of the teeth. This may appear drastic, but in almost all cases it is the only alternative. The use of antibiotics, steroids (eg.,methyl prednisolone), or other medications have some short term benefit at reducing the redness and pain, but there are no long-lasting results in the treatment of this disease.
Mature cats with gingivostomatitis are less likely to respond to conservative treatment, although the above program plus removing all diseased teeth, may be successful in a minority of cats with mild disease. In cats with more extensive disease the best treatment is extraction of all teeth. In a few cases, it may be possible to leave the canine teeth (fangs) and the incisors. Often, though, in time, it becomes necessary to remove these as well. Cats can manage fine with no teeth, and it is much preferred to leaving the cat in severe pain for the remainder of her life.
Some veterinary dentists believe the longer the cat is on the medical management to control plaque as described above, the more likely the extractions will not be as successful or the response as fast. They therefore recommend extractions earlier in the course of disease versus later.