Updated August 16, 2021
Possibly the most frustrating disease of cats is stomatitis. It can cause terrible suffering, and for a third of affected cats, nothing seems to work well. For the other two thirds, the only good option is an extreme one.
New treatments have made the control of stomatitis within the reach of more cats, and we may be on the cusp of even greater things.
What Is Stomatitis?
Stomatitis, or more correctly gingivostomatitis, is inflammation of the mouth not directly associated with the teeth. The definition is important: many cats who are said to have stomatitis really have gingivitis and periodontitis. While still severe, these cats will respond to standard dental treatments and subsequent good oral hygiene.
Stomatitis on the other hand, is a poorly understood disease which likely represents malfunction of the immune system. It is said to affect anywhere between 0.7 and 12% of cats depending on how you define it.
The most common locations for stomatitis are at the back of the mouth at the opening to the throat (often called the fauces) and on the inside of the cheeks. Sometimes the tongue or oesophagus are also affected.
The Causes Of Stomatitis
Here is what we know about feline gingivostomatitis:
- Cats with stomatitis almost always also have regular tooth and gum disease, but not vice versa
- The risk of it developing goes up by 70% with each additional cat in the house (but removing them afterwards will not help)
- Affected cats are more likely to carry the calicivirus cat flu virus, and if they cure they will clear the virus
- The gums of affected cats contain more cytotoxic (killer) T cells than normal cats
- The risk increases with age
The best theory is that long-term immune stimulation in the mouth leads to the development of an abnormal, runaway immune response. This is certainly what I see: cats who develop stomatitis often have had more regular gum disease for years before it starts.
The Signs Of Stomatitis
Most of the signs of gingivostomatitis are due to severe pain. These include:
- Drooling, excess salivation and a dirty face
- Hissing or backing away during eating
- Extreme pain on opening the mouth
- Reluctance to eat hard food (though it is amazing how some cats will manage to keep eating)
Cats will also have a foul smell from the mouth, but this is true for all oral diseases. Diagnosis is usually straightforward but if the lesions are not symmetrical, a biopsy is a good idea to rule out cancers.
Treatment Of Stomatitis In Cats
Due to the slowly developing nature of the disease, most cats have tried some or all of the following by the time stomatitis develops:
- Regular dental cleaning
- Corticosteroids, especially prednisolone
These will all help to some extent, often quite well at the beginning but the effect reduces with time. Most cats end up needing a lot more treatment. The most important of these is pain control.
No matter what else we do, we need these cats to be comfortable, both for welfare reasons and so they look after themselves better. Drugs used are a combination of meloxicam, buprenorphine and gabapentin. In particular, buprenorphine (which is normally an injectable) works very well just by dripping it in the mouth.
However, even this is usually not enough.
Tooth Removal For Stomatitis
The best hope for a cat is that removal of their teeth will help. This is such a major hurdle to cat owners that I can spend six months trying to convince some to do it. But just look at these figures:
- 28.4% of cats are cured
- 39% are substantially improved
- 26.3% have minor improvement
- 6.3% do not respond at all
To the question of “how will they eat?” I answer that the pain is what is stopping them, not whether they have teeth or not. Commercial foods mean that cats don’t really need teeth anyway. All they need is to be happy.
Only the teeth at the back (premolars and molars) need removing in most cases. Leaving the canines and incisors means cats look and act much the same, and the procedure is shorter. However, at Walkerville we still often do only one side of the mouth at a time.
Close to 70% of cats who have their teeth removed will still need some form of medical treatment at least in the short term.
Newer Stomatitis Treatments
The real problem comes for the few cats who don’t respond to tooth extraction. If this happens to you, please don’t regret having the teeth removed; the next treatments are very unlikely to work on their own.
Cyclosporine is an immunosuppressant that helps in around a half of these cases, especially if blood levels are measured. Those that cure can usually be weaned off the drug, whereas others may need to stay on it for life. You can learn more about cyclosporine here.
Interferon Omega injections have a lower response rate (similar to prednisolone) but give a small chance of complete cure.
Mesenchymal Stem Cells given intravenously are the newest hope, and are showing good results in early trials. A seemingly effective product is close to release in the USA.
If no other treatments work, you should never feel guilty about choosing euthanasia. It’s a terrible choice, but also sometimes the only humane and kind thing for the worst of cases. But I hope I’ve helped you see that there’s a lot more than just cortisone and antibiotics, and a real chance of cure for many cats.
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By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. These help topics are from a series regularly posted on email and Twitter. Subscribe via email here to never miss a story! The information provided here is not intended to be used as a substitute for going to the vet. If your pet is unwell, please seek veterinary attention.
Jennings, M. W., Lewis, J. R., Soltero-Rivera, M. M., Brown, D. C., & Reiter, A. M. (2015). Effect of tooth extraction on stomatitis in cats: 95 cases (2000–2013). Journal of the American Veterinary Medical Association, 246(6), 654-660
Lommer, M. J. (2013). Efficacy of cyclosporine for chronic, refractory stomatitis in cats: a randomized, placebo-controlled, double-blinded clinical study. Journal of veterinary dentistry, 30(1), 8-17