Stomatitis in Cats

Laurie Anne Walden, DVM

Photo by TJH1976 on Flickr

Stomatitis is severe inflammation of the inside of the mouth. In cats, this painful condition is caused by an abnormal immune system response. Most cats with stomatitis need to have many or all of their teeth extracted to have a good quality of life.
 
Stomatitis is more severe than gingivitis (inflammation of the gums) and periodontal disease (inflammation of the structures around the tooth roots). In cats, stomatitis starts at the gums and tooth roots but eventually extends to the back of the mouth, the roof of the mouth, the tongue, and the area under the tongue.
 
Causes
The exact reason for the abnormal immune response isn’t known. Plaque—a biofilm produced by bacteria in the mouth—triggers stomatitis in most affected cats. Viruses (especially feline immunodeficiency virus and feline calicivirus) and various oral bacteria are also involved in many cases.
 
Signs
Cats with stomatitis can’t eat, groom themselves, or even yawn without pain. Because cats by nature hide their signs of pain, we humans often don’t notice the signs of stomatitis until it’s severe and significantly affecting a cat’s behavior. These are some of the signs of stomatitis in cats:

• Bright red gums, possibly bleeding gums with ulcers or a cobblestone appearance
• Bad breath
• Difficulty eating
• Pawing at the mouth
• Drooling
• Hiding, being less active than usual, or playing less than usual
• Weight loss (because eating hurts)
• Scruffy coat (because grooming hurts)

 
Diagnosis
Stomatitis can usually be diagnosed just by the appearance of the mouth during a physical examination. However, oral examination can be very painful for an affected cat, so the extent of disease might not be known until the cat is sedated or under anesthesia.
 
Cats with stomatitis have laboratory tests (baseline bloodwork, tests for feline leukemia virus and feline immunodeficiency virus, and urinalysis) to assess their overall health and look for other problems that might be causing—or caused by—the immune system disorder. Dental radiographs taken under anesthesia show which tooth roots are affected by the disease.  
 
Treatment
The goals of treatment are to manage pain and reduce inflammation. Medical treatments might include pain medications, antibiotics, and immunosuppressive or anti-inflammatory medications. Cats often need nutrition support. Because plaque is a trigger, affected cats need a complete dental cleaning under general anesthesia, followed by home dental care once the cat’s mouth is comfortable enough to allow it. Some cats have laser therapy to remove inflammatory tissue in the mouth.
 
For most cats with stomatitis, medical treatment and dental cleaning aren’t enough to manage the disease. The prognosis is best if plaque-collecting surfaces are removed from the mouth, which means surgically removing teeth. Some cats do well with only the back teeth extracted (leaving the incisors and fang-like canine teeth at the front of the mouth in place), but many cats need to have all of their teeth removed. Some cats need to continue medical treatments even after all of their teeth are extracted.
 
Cats that have had full-mouth tooth extractions can eat cat food; they just can’t disembowel a wildebeest anymore. These cats are much happier once their teeth are out and their mouths have stopped hurting.
 
Image source: https://www.flickr.com/photos/57764574@N03/26233750210/

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