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Ask a Vet: How Can Severe Mouth Disease in Cats Be Treated or Prevented?

Vets don't know what causes stomatitis, a painful syndrome, but sometimes they can treat it.

Dr. Eric Barchas  |  Aug 4th 2015


Dental disease is by far the most common health problem suffered by cats. The best way to prevent dental disease is to brush the teeth. Brushing physically removes food particles and bacteria from the surface of the teeth.

Cats are incapable of brushing their teeth, and, let’s face it, few cat owners brush their pets’ teeth for them. Because of this, bacteria grow on the teeth, and then spread into the gums. This leads to a gum infection called gingivitis. As the infection spreads deeper along the tooth surface and then the tooth-root surface, gingivitis morphs into a more severe condition called periodontitis in which the bones and structures that surround the teeth become degraded. As the disease progresses, tooth loss and dental abscesses can occur.

Dental disease is painful. However, it is relatively preventable with tooth brushing. And it is treatable with anesthetic dental procedures that remove infection from the mouth, and that often involve extractions of multiple teeth.

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Photo of Dr. Eric Barchas by Liz Acosta

Some unfortunate cats — an estimated 1 percent to 12 percent of the feline population (see source below) — suffer from a much more severe dental problem. This condition, called stomatitis, is a severe affliction.

Stomatitis is a condition of oral pathology that goes far beyond ordinary dental disease. Affected cats suffer from extreme inflammation of the gums and mouth. They suffer intense and incessant pain. Symptoms of the condition may include bad breath, drooling, poor appetite, weight loss, a rough and malodorous hair coat, and behavior changes. The pain of stomatitis can make some cats so miserable that they lash out — one of the most fractious cats I ever met became an absolute sweetheart after her stomatitis was successfully treated.

The cause of stomatitis is not known, but the condition appears to have a multifactorial etiology (which is a fancy way of saying that numerous factors usually combine to create the condition). The immune system plays a significant role in the condition — an aberrant response to dental plaque, or perhaps even to the teeth themselves, causes the immune system aggressively to react to the point of attempting to reject the teeth from the mouth.

Certain viruses appear to be linked to stomatitis. Feline leukemia virus, also known as FeLV, and feline immunodeficiency virus, or FIV, may cause a predisposition to the syndrome. Another virus, feline calicivirus, is suspected to play a role in many cases.

Vets have explored a large number of treatments. Home treatment with regular tooth brushing may help to prevent the condition in some cases, but it’s sufficiently aggressive that such management usually fails in the long run.

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Kitten with a toothbrush by Shutterstock

Veterinarians have treated the condition with antibiotics, pain killers, and drugs that modify the activity of the immune system. These therapies have some limited benefit for some patients. However, again, in most cases they are not sufficient to truly address the problem.

There is, however, one treatment that historically has had a good track record of bringing relief to cats suffering from stomatitis. That treatment is called full mouth extraction.

Make no mistake: Full mouth extraction is a less than perfect solution. It involves, as the name implies, removal of all of a cat’s teeth. Veterinarians and technicians cringe when they see a full mouth extraction on the appointment schedule. The procedure takes a long time and is a recipe for carpal tunnel syndrome.

And let’s not forget the cat involved. It’s not fun to have a tooth, let alone all of them, pulled. The recovery from the procedure can involve significant pain.

However, once recovery is complete, most cats experience significant relief. (Some cats do not — this may be related to residual tooth root fragments or to a pathological process that is exceptionally severe.)

There has been debate regarding dental extractions in cats with stomatitis. Although it is clear that extractions lead to clinical improvement, many clinicians have questioned whether it is necessary to remove all of the teeth in the mouth. The inflammation associated with stomatitis usually is focused in the back of the mouth. Might it therefore be possible to spare the teeth in the front?

Enter researchers from the University of Pennsylvania, who recently published a paper in the Journal of the American Veterinary Medical Association.

The paper reached three core conclusions. First, dental extractions do help with the condition in a majority of cases. Also, the good news is that full mouth extraction does not appear to have a clinical benefit over partial mouth extraction. In other words, it is not necessary to remove all of the teeth — those in the front can be spared. Finally, unfortunately, long term medical management is necessary in most cases. Or, as the authors stated in the conclusions of their abstract:

Extraction of teeth in areas of oral inflammation provided substantial improvement or complete resolution of stomatitis in more than two-thirds of affected cats. Full-mouth extraction did not appear to provide additional benefit over [partial mouth extraction]. Most cats with stomatitis may require [extended medical management] to achieve substantial clinical improvement or complete resolution.

Partial mouth extraction is still an imperfect treatment, but it is better than full mouth extraction. Until a more sophisticated effective treatment is developed, it will by necessity be the mainstay of treatment for cats with stomatitis.

The paper cited in this post is J Am Vet Med Assoc 2015;246:654-660.

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