Feline stomatitis, aka feline lymphoplasmacytic stomatitis, is severe inflammation of the mucous lining of the mouth. Stomatitis isn’t the mild inflammation that is present in the overwhelming majority of adult cats’ mouths, it goes far beyond gingivitis or even periodontitis. Stomatitis is a painful problem that leads to weight loss, lack of eating, drooling, “hidden cat syndrome,” aggression, and a generally miserable feline. Stomatitis hurts in a big way.
What causes stomatitis in cats?
The cause of stomatitis is not completely understood, but the disease is believed to be multi-factorial. Viral causes have been seen, as well as chronic immune stimulation and autoimmune components. In some affected cats, the plaque that forms on their teeth daily causes an allergic reaction and the cat essentially becomes allergic to their own teeth.
Although any cat (or dog for that matter) can develop stomatitis, mature cats and certain purebreds such as Siamese, Persian, and Abyssinians are more likely to develop this condition than others. Cats that suffer from kidney disease or diabetes mellitus are also more prone to feline stomatitis.
Symptoms of Stomatitis in Cats
The cat’s breath will likely have a strong smell due to infected gums. In most cases, the gums are bright cherry red and may be bleeding. There may be missing teeth already. Many patients will appear unthrifty, with poorly groomed coats and progressive weight loss, all traceable to oral pain and discomfort. Stomatitis in cats is not contagious between cats or other animals.
A complete oral examination is necessary to diagnose feline stomatitis. While many cats have to be under general anesthesia for a complete oral examination due to the painful nature of the disease, your veterinarian may be able to tell based on symptoms and behaviors of your cat, including guarding their mouth.
A blood workup including something called viral assays is necessary to rule out FIV, FeLV, and other possible causes. Examination of cells at the cellular level, either by fine needle aspirate, cytology, or biopsy is needed to definitively diagnose the condition as it can resemble squamous cell carcinoma and eosinophilic granuloma complex.
Typically, cats with stomatitis show a widespread and dramatic inflammation of the oral tissue, often spreading into the oropharynx and along the mucosa of the hard palate. This is somewhat unique, but with treatment protocols for these diseases varying vastly, a confirmed diagnosis is wise.
How to Treat Stomatitis in Cats
There is no one treatment for stomatitis that is effective on its own. Because cats with stomatitis become severely allergic to the plaque on their teeth, professional teeth scaling and cleaning above and below the gum line is often a starting point. To decrease the plaque load, teeth extraction is often recommended. Antibiotics are helpful in some patients to control oral infections. Meticulous home dental care is also needed.
Unfortunately, maintaining perfect oral hygiene is not possible in cats even with daily brushing as plaque will inevitably return (I’ve yet to meet a cat who tolerates daily flossing). In many cases, anti-inflammatory medications such as glucocorticosteroids may be helpful. Intermittent antibiotic therapy known as pulse therapy helps some patients. Hypoallergenic diets may even prove helpful.
Persistent cases often require premolar/molar extractions, if not all the teeth. Removing all the teeth affected by inflammation, tooth resorption, or periodontal disease currently shows the highest success rates. The removal of the periodontal ligament lining, the alveolus, is also advisable. Special care is taken to control pain and to suppress any remaining inflammation after dental extractions.
Some patients that fail to improve after surgical treatment are sometimes treated with carbon dioxide laser therapy on the remaining lesions. This laser therapy may need to be repeated monthly in an attempt to remove the plaque-retentive surfaces that are thought to be part of this plaque hypersensitivity. If all attempts fail, then immune-suppressing drugs can be used as the final medical step to try to control this painful condition.
How to Prevent Stomatitis
Unfortunately, we do not currently know of a way to prevent this terrible condition. Impeccable teeth brushing may help deter the onset in milder cases but the hyperimmune response to plaque cannot be prevented. Excellent dental hygiene at home may delay its onset or decrease its severity.
Remember, feline stomatitis can sometimes be confused with types of oral cancer so if you suspect your feline suffers from stomatitis, have your pet evaluated by your veterinarian as soon as possible. It's a general rule that the longer these cats go without treatment, the longer it will take to get their pain under control.
Studies show success in most felines after full mouth extractions (removing all the teeth). Cats are able to eat quite well, and many prefer hard food even with no teeth. Most pet parents see a marked improvement in six weeks or less post-surgery.
Some severely affected cats can take up to a few months to show what is considered adequate improvement. No matter what treatments are done, a small percentage of treated cats don't really improve significantly with full mouth extractions. Sadly, some pet parents choose humane euthanasia when pain continues despite exhausting all treatment options.