What is stomatitis?
Stomatitis in cats is inflammation of the mucosal tissues of the mouth. (It is closely related to gingivitis, which is inflammation of the gums along the base of the teeth.) It shows up as red and proliferative tissue in the mouth and often in the back corners of the mouth. Because stomatitis is an extremely painful condition, cats who have it will often not eat, may paw at their mouths, and might have personality changes. They can also have bloody saliva and may lose weight.
What causes stomatitis?
There is no single cause of stomatitis. The most prevalent belief is that it is caused by chronic viral infections such as calicivirus and herpesvirus. Cats with weak immune systems — which can be the result of FIV and FeLV infection — are prone to having chronic viral infections. Other things that can lead to stomatitis include immune-mediated diseases, ingestion of irritants, foreign bodies (such as plant debris) and systemic diseases such as kidney failure. One reported cause of stomatitis is the bacterium Bartonella henselae, which is certainly present in some cats with stomatitis, but is also present in a lot of cats without stomatitis.
What are the treatment options?
There are many ways to manage a cat with stomatitis. The ideal way, in most cases, is extraction of all teeth that are associated with the inflammation. Often, this is all of the teeth in the cat’s mouth. Surprisingly, cats do very well without any teeth. Many cats without teeth can eat both dry and canned food without any problems.
The reason for extraction of the teeth is that it removes the sites to which plaque can attach. Plaque harbors bacteria that can lead to the immune response and inflammation. Scaling and polishing the teeth is often not enough because the plaque comes back very quickly. However, if one is unable to have all of the cat’s teeth removed, scaling and polishing is an alternative as long as it is followed up with extensive home care. Brushing the cat’s teeth can decrease plaque formation, but it is nearly impossible to brush the teeth of a cat with stomatitis because they are so painful.
Along with teeth extraction, long-term antibiotics are often important to get rid of bacteria that help contribute to the inflammation. These antibiotics may need to be given for up to six weeks. This is also an important step if someone is unable to have all of the cat’s teeth removed.
Often, extractions and long-term antibiotics are not enough. In this situation, an anti-inflammatory (typically, prednisone) is often needed. Prednisone can be given in oral form or as a long-acting injection. Many veterinarians actually have more success with the long-acting injection. Unfortunately, there are significant side effects to long-term prednisone administration in cats, including predisposing the cat to diabetes and congestive heart disease. Cyclosporine is another medication that can decrease the inflammation caused by the body’s response to the gum tissue. With either medication, frequent follow-ups are required to make sure the medication is not causing any problems.
Sometimes, this treatment is still not enough and the stomatitis persists. In this case, some veterinarians have had success with oral antiseptic rinses, with the antiseptic chlorhexidine in a 0.12 percent solution. Also, some veterinary dentists will perform laser surgery on the inflamed tissue. Mixed success has been reported with the laser procedure and it is very expensive, but some veterinarians do report success with it.
In short, stomatitis in cats can be a very frustrating disease for both people who have cats and veterinarians. It is often expensive to treat and often will not go away completely. With that said, for people who cannot afford full-mouth extractions, there are options such as frequent antibiotic and prednisone administration that can provide a good quality of life for a cat for several years.