Hello Dr. Barchas,

My female cat, Elli, has had feline stomatitis for several years. Initially, I believe she contracted it shortly after getting the virulent form of calicivirus that several of my cats also got. She is FeLV and FIV negative.

She had a full-mouth extraction (except for front fangs), which reduced the severity, but did not cure it. She gets a Depo shot once a month.

Her main symptoms are gingivitis (bleeding and drooling from the mouth, with occasional diarrhea). I read an article suggesting you have experience with this issue. I was wondering if I could try the cyclosporine treatment. I also have used Metacam as a bridge between her symptoms reappearing and when I can get her to the vet.

What is your experience working with this condition? I am worried that her lifespan is extremely short and nearing its course.

Lauri

Stomatitis is a condition in which a cat’s immune system inappropriately rejects the animal’s teeth. Cats appear to react to the tooth roots themselves. However, many experts believe that a reaction to bacterial plaque may be a significant trigger. Some cases are linked to the feline leukemia virus, the feline immunodeficiency virus (FIV, or feline AIDS), or calicivirus. Many cases, however, occur in cats not infected with any of these, and in most instances the cause is not determined. Lauri, Elli’s stomatitis may have been triggered by the calicivirus, or it may be unrelated. Either way, treatment options are the same.

Cats with stomatitis develop severe inflammation of the mouth, usually most pronounced in the back. Stomatitis is horribly painful. It can lead to weight loss, drooling, halitosis, and increased breathing noises. It also generally tends to be progressive, socats that are treated rapidly tend to have better outcomes.

The most successful way to treat stomatitis is to remove the teeth, tooth roots, and bacterial plaque that trigger the inflammation. This is of course more aggressive and invasive than any pet owner (or veterinarian) would like, but there is no better option at this time, and it has by far the best chance of eliminating the severe pain and suffering. Cats with no teeth and no stomatitis live much better lives than cats with stomatitis.

Lauri, if you can muster the resources, I would recommend as a first step to have Elli treated by a veterinarian who can take dental X-rays. The previous extraction sites should be checked to confirm that no tooth root fragments remain, since cats with stomatitis will continue to suffer until they are removed. At the same time, all of her remaining teeth should be extracted. Many vets do not remove the canine teeth (fangs) in cats with stomatitis because they are located some distance from the worst inflammation. However, many reputable experts in veterinary dentistry believe that the canines and their associated plaque can contribute significantly to ongoing problems.

Complete removal of every tooth leads to complete remission or reduction of inflammation to a satisfactory level in a majority (perhaps 70 to 80 percent) of cases — although Elli seems like she’s a more difficult case, so she has a significant chance of being in the minority.

For cats in that unfortunate group, steroids and cyclosporine are drugs that modify the activity of the immune system and may be beneficial. Depo-medrol injections are steroid shots that are convenient because they last for several weeks, but they are not an especially elegant way to treat the condition. You have already begun to see diminishing returns, and in the long run they could place Elli at risk of serious complications such as diabetes.

In my experience, cyclosporine usually is a better option than steroids. However, for some cats, steroids seem to work better. In those cases, I recommend oral dosing with prednisolone instead of depo-medrol injections, because the dose can be adjusted to the minimum effective one. Prednisolone also is less expensive.

Metacam is a painkiller, but it isn’t very safe in cats, and it can cause huge problems when combined with depo-medrol or prednisolone. I recommend that you use buprenorphine, which is a mild narcotic. It is fairly easy to administer, and much safer. Ask for it specifically. Doxycycline, an antibiotic, also appears to have anti-inflammatory effects, so it works in two ways — by reducing inflammation directly, and by reducing inflammation caused by bacteria. Azithromycin, a different antibiotic, appears to be similarly useful.