21 Jan Treating Cats with Stomatitis in Colorado Springs
What is Feline Stomatitis?
Stomatitis in cats is a frequent condition seen in our feline patients that can have many manifestations. The term is most appropriately used when there is widespread inflammation throughout the mouth of a cat.
Inflammation of the gum tissue in contact with the crown of a tooth is referred to as gingivitis. When gingivitis extends beyond the gumline into surrounding tissues it is called periodontitis. Inflammation that involves more widespread areas, particularly into the tissues in the back of the mouth, is likely the most frequent usage of the phrase stomatitis. However, the most appropriate name for this inflammation is caudal oral mucositis. The most frequently given name for this condition is Feline Chronic Gingivostomatitis (FCGS). For this blog we will refer to FCGS as simply stomatitis.
Clinical Signs of Stomatitis
Regardless of the name given to this condition, it is very painful for cats afflicted with this disease. They often present with a decreased appetite, weight loss, poor coat quality, drooling, painful swallowing and reluctance to have their mouth handled. Sometimes the oral inflammation can be so severe a cat will present with bleeding from the mouth
Figure 1 – A cat with severe FCGS. Notice the areas of intense inflammation in the back of the mouth.
What Are The Causes and Risk Factors of Stomatitis?
Studies have estimated that 5.5% of the domestic cat population has stomatitis. Many veterinary dentists feel that the prevalence and intensity of the lesions is much higher in North America and southern Europe. Perhaps there is an environmental component to stomatitis in cats—the exact reason for this correlation is unknown.
Why do cats get stomatitis? There are many potential causes, but it has not been shown to result from one particular factor. While the clinical signs are typical, determining the underlying etiology (causative factor) has been elusive for the veterinary dental community.
Oral bacteria and the plaque accumulation they cause have been consistent findings in cats, but they are present in the vast majority of the feline population that is not having daily at home dental care by their owners and at least annual dental cleanings under anesthesia by their veterinarian.
It has long been suspected that cats with stomatitis have an excessive immune response to plaque bacteria that results in severe oral inflammation extending into the surrounding oral tissues. Certain types of bacteria have been shown to play a more prominent role in stomatitis cases, but treating them with antibiotics alone has not been shown to be efficacious.
Other potential causes, such as feline respiratory viral diseases, have been shown to have a higher association in cats diagnosed with stomatitis. Feline calicivirus and feline herpes virus have been. Studies have shown that as many as 70% of cats with stomatitis test positive for feline calicivirus.
Pre-existing dental disease, such as periodontal disease and tooth resorption, only exacerbate oral inflammation and the already exuberant immune response seen in stomatitis cats.
Some stomatitis cases start when cats are kittens, but the condition can start at any age.
Treating Feline Stomatitis in Colorado Springs
How are cats with stomatitis treated? The first goal is to minimize all plaque bacteria in the oral cavity. This starts with a complete evaluation and dental cleaning under anesthesia. In order to fully evaluate the feline patient some form of dental imaging with either dental radiographs or cone beam CT scanning is required.
Manage Oral Bacteria and Plaque
Barrier sealants, such as Oravet, can be applied to the teeth after the dental cleaning and while the cat is still under anesthesia. This will inhibit plaque accumulation on the teeth for the first two weeks after the dental cleaning. Cat owners can start daily dental care at home with dental rinses. chlorhexidine rinses are the best oral antiseptics available for pets and are highly effective in decreasing bacterial growth in the mouth. Unfortunately, cats often react poorly to these rinses— however, newer chlorhexidine rinses are showing better palatability for our feline friends.
Brushing a cats teeth becomes more practical as the oral inflammation hopefully decreases over the following weeks, but is still a challenge for many cat owners.
Surgical Tooth Extraction
It is often necessary for the veterinary dentist to surgically extract teeth at the time of the dental cleaning that are affected by periodontitis and/or tooth resorption. If home care efforts combined with dental cleanings and strategic surgical extractions do not resolve stomatitis, near- or full-mouth extractions is often indicated. It can be an emotionally disturbing thing for a cat owner to think about their cat going through life without teeth, but these feline patients live and thrive more often without these diseased and painful teeth.
Figure 2 – A cat who previously had FCGS and was treated with full mouth dental extractions. Notice the complete resolution of intense inflammation in the back of the mouth.
The majority of cats with stomatitis that require full-mouth tooth extractions have their oral inflammation resolve. However, 20-40% of full mouth extraction cases do not have their signs of stomatitis resolve over the first few months after surgery. These cats often require additional medical treatments, such as anti-viral drugs, immunosuppressive medications, and antibiotics, for a period of time. Most of these cats can be slowly weaned off medications over a number of months.
Advanced treatments are becoming more available as we learn about this troubling disease. Interferon is an ant-iviral medication that has shown promise for cases that may be dealing with a viral component, such as calicivirus. Essential fatty acids have shown promising anti-inflammatory properties and may benefit stomatitis cats. Stem cell therapy is in the early stages of promising research and may become available in the near future. Stem cells are harvested from a cat’s fat or bone marrow and injected intravenously.
Certified Veterinary Dentists in Colorado
Remember, stomatitis can have many names, but the most appropriate name is feline chronic gingivostomatitis (FCGS). While it is a painful disease for the afflicted cat and often challenging for the veterinary dentist to treat, most cats respond well to aggressive and early treatment with more and more promising therapies on the horizon.
If you or your regular veterinarian are concerned that your cat may be dealing with signs of stomatitis, please call Animal Dental Care and Oral Surgery at (719)270-3076 and schedule a consultation with one of our veterinary dentists or residents in Colorado Springs, Castle Pines or Loveland.