STORY AT-A-GLANCE
- Feline stomatitis is a very serious and very painful chronic oral condition that occurs in cats; the disease is characterized by angry, red, swollen tissue in the mouth and the back of the throat
- Stomatitis is assumed to be an autoimmune disease in which the immune system overreacts to dental plaque around the teeth, triggering a massive inflammatory response
- Stomatitis causes intense pain for the cat, and can severely limit her ability to eat, which can rapidly progress to a life-threatening situation
- Mild cases of feline stomatitis can sometimes be managed with an early and aggressive multi-modal approach; however, advanced stomatitis is often best resolved with a full mouth extraction, which can deliver immediate, dramatic relief
- To avoid chronic complications from full mouth extractions, it’s best to partner with a veterinary dentist
Editor's Note: This article is a reprint. It was originally published July 23, 2024.
Estimates are that from 1 in 71 to 26%2 of cats develop inflammation of the entire mouth, a very painful condition called feline gingivostomatitis (FGS), or simply stomatitis. Characteristic signs include redness in the throat area, severe inflammation where the teeth and gums meet, and in some cases, tooth resorption. Even the underlying bone in the mouth can become inflamed or infected.
Risk Factors for Feline Stomatitis
According to experts, including board-certified veterinary dentist Dr. Jan Bellows, the cause of feline stomatitis is thought to be an exaggerated immune response to plaque, meaning affected cats actually become allergic to their own teeth.3
The condition is often found in kitties with diseases of the immune system like feline immunodeficiency virus (FIV) or feline leukemia virus (FeLV). Many cats with stomatitis also have gum disease.
There might be more of a tendency for certain breeds like the Siamese, Abyssinians, Persians, Himalayans, and Burmese, to develop the condition.4 There's also a juvenile onset form of the disease that occurs in kittens between 3 and 5 months of age, as their permanent teeth erupt. By 9 months, these kittens have full-blown and very serious oral inflammation and, sometimes, infection.
Symptoms to Watch For
This condition starts as gum disease (gingivitis), which appears as redness at the gum line. Often the entire gum becomes red and inflamed, but it starts with a red ring around the teeth, usually at the premolars, and molars. You may not see any plaque or tartar on the teeth, yet the gum is an angry red, especially at the junction of the tooth and gum.
Stomatitis causes such intense pain that it can demolish your cat’s quality of life. If your kitty has the condition, you might notice behavior changes such as depression, irritability, aggression, or hiding. Excessive drooling is also a common symptom, along with gums that bleed easily.
Because the condition is so painful, many cats have trouble eating. Some simply give up after trying for several days or weeks because it's just too painful. If you have a cat who cries for her dinner and runs to her bowl, then is hesitant about putting food in her mouth, she may have stomatitis.
Dehydration, weight loss and muscle wasting are not uncommon in cats with the disease because they aren’t able to eat enough calories to maintain their body weight.
Breath that goes from bad to unbearable is another common symptom, and so is lack of grooming because the mouth becomes too sore for any self-cleaning behaviors. Many cats with stomatitis also paw at their mouths in an attempt to relieve the pain and irritation.
Treatment Options
Cats with juvenile onset stomatitis sometimes respond to intensive medical management, delivered early in the process and primarily by very dedicated owners. It involves excellent oral home care (i.e., brushing your cat’s teeth and gently disinfecting the mouth twice daily), regular professional cleanings, and aggressive plaque and tartar control.
Cats with this condition often improve when fed an anti-inflammatory diet that eliminates all potential sources of food allergens, including seafood and poultry, as well as biologically inappropriate ingredients such as potato, rice, wheat, and corn. It’s important to remove all carbs from the diet.
Natural anti-inflammatories can be beneficial, and include esterified fatty acid complex, plant-derived sterols and sterolins, and proteolytic enzymes — all of which help control the systemic mediators of inflammation.
A variety of nutraceuticals can also improve gum health, including ubiquinol and probiotics, both of which can be used both orally and topically at the gum line. Finally, it’s important to remove environmental sources of toxins that can negatively impact the immune system, including unnecessary vaccines.
The Full-Mouth Extraction Option
Unfortunately, for most kitties with stomatitis, there are no consistently successful long-term medical management options available. Veterinarians treating the condition have tried steroids, immunosuppressive drugs, long-term antibiotic therapy, laser therapy and topical anesthetic options — all with generally unimpressive results. And of course, there are significant side effects with all those drugs.
The most important thing to remember about a cat with stomatitis is that she’s in a tremendous amount of pain all the time. A kitty in that much pain, for that long, who isn’t eating well, is in serious danger.
That’s why the treatment of choice and the kindest option is a full mouth extraction, which means removing most or all of the cat’s teeth. It’s an aggressive approach, but stomatitis is an aggressive disease, and things will quickly progress to a point where kitty is no longer eating, which is a life-threatening situation.
The good news is that many cats who undergo full mouth extractions experience dramatic relief and have significantly improved quality of life after their teeth — which were the source of all the inflammation, infection and pain — have been completely removed.
According to the board-certified veterinary dentists at the Veterinary Dental Center, full mouth extractions are commonly performed in one surgical procedure, quadrant by quadrant, to completely remove tooth and root structures.
“Extraction therapy has shown a cure in 60% of patients and significant improvement in 20%. Twenty percent remain refractory (inflammation remains) but fortunately, most can now be managed with cyclosporine to improve patient comfort.”5
For cats who don’t achieve complete resolution of the condition after a full mouth extraction, researchers at the University of California, Davis, offered this advice in a 2023 study:
“For cats that do not respond to surgical management, medical management, in the form of immunosuppressive or immunomodulatory therapy, remains an option. Analgesia is of fundamental importance. Immunomodulation utilizing mesenchymal stromal cell therapy provides an alternative treatment avenue for refractory patients and likely targets the chronic viral infection present in this disease.
The potential for treatment stratification and use of novel systemic treatment options may be revealed as the molecular pathways involved in this disease are better described.”6
To avoid chronic complications from full mouth extractions, it’s best to partner with a veterinary dentist. Digital X-rays should be taken after extraction to make sure all of the tooth roots have been successfully removed. Pain management must be instituted and maintained until post-surgical discomfort is resolved and healing has occurred.
