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A healthy mouth is the result of the balance between disease and the patient’s immune system. An inappropriate immune response can upset this delicate balance and result in
stomatitis. Chronic stomatitis is inflammation of the oral cavity that goes beyond common gingivitis. Lesions range from swollen, inflamed gingiva
(gums) to severe mucosal
ulcerations and granulomatous lesions. The gingiva around the molars and premolars is most commonly affected, but severe cases often include the mucosa of the cheeks,
tongue, lips, palate, and floor of the mouth. This is a painful condition and affected cats may present for drooling, signs of pain when eating, unkempt hair coat, or
weight loss. Other signs include aggressive behavior, pawing at the face, bad breath, general malaise and mandibular lymphadenopathy.
The exact etiology of stomatitis is unknown. Most cases of gingivitis are thought to result from an exaggerated immune response to bacterial antigens in plaque or to the tissues
of gingival attachment to the teeth. This excessive immune response can be related to allergies, drug sensitivities, calicivirus,
Bartonella bacteria, plaque bacteria and food
proteins. Other possible causes include immunosuppression that can be caused by diabetes, immunosuppressive medications, cancer
,and infection with feline leukemia virus (Felv) or
feline immunodeficiency virus (FIV). Cats infected with FIV or calicivirus often have more severe lesions.
Treatment must be preceded by routine blood tests including testing for Felv and FIV. Other tests may be indicated in some patients. Testing enables the selection of
the most appropriate therapy and helps establish the patient’s prognosis.
Treatment
- Professional
dental prophylaxis performed under general anesthesia to remove
plaque and tartar
- Dental radiographs are taken to evaluate for retained roots and resorptive
lesions below the gum line
- All compromised teeth, including those affected by severe periodontal disease and those with resorptive
lesions, should be extracted. This may be done in two stages if many
teeth are involved
- A biopsy of the affected gingiva will be sent for histopathology to rule out other possible diagnoses such as oral tumors
and eosinophilic ulcerations
- Medications
to control infection and pain are sent home with each patient
- Replace all
plastic food/water dishes with stainless steel or ceramic
- Hypoallergenic diets may be prescribed
Chronic gingivostomatitis can often be controlled, but it is seldom cured. Long-term management is required and varying degrees of remission may be reached with the available
therapies. Even after all teeth are extracted, approximately 20% of patients will continue to have lesions. The goal of therapy is to provide pain relief so the patient can eat,
drink, groom and enjoy the wonderful life of a feline companion.
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