Severely Limits Ability to Eat and Can Quickly Progress to Starvation

Story at-a-glance -

  • Feline stomatitis is a very serious, very painful, chronic oral condition that occurs in cats, and 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 multimodal approach
  • Advanced stomatitis is often best resolved with a full mouth extraction, which delivers immediate, dramatic relief to the cat and restores his or her quality of life

By Dr. Karen Shaw Becker

Feline stomatitis is a chronic, serious and very painful oral condition that occurs in cats. “Stoma” is Latin for “mouth,” and “itis" means “inflammation.” There are several other names for the condition, including lymphocytic-plasmacytic stomatitis, feline chronic gingivostomatitis, immune-mediated feline refractory stomatitis and feline generalized oral inflammatory disease.

Stomatitis inflammation appears in the mouth as angry red swollen tissue. It can be localized, but it usually involves the whole mouth and often the back of the throat. Even the underlying bone in the mouth can become inflamed or infected.

Risk Factors for Feline Stomatitis

Stomatitis is thought to be an autoimmune disease in which the affected cat's immune system overreacts to dental plaque around the teeth, triggering a massive inflammatory response in the mouth. 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 to develop the condition. 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 behaviors 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.

Medical and Lifestyle Management of Cats With Stomatitis

In juvenile onset stomatitis, which is hopefully when you'll proactively notice the disease, some kitties respond to intensive medical management. This includes really good oral home care (brushing your cat’s teeth and gently disinfecting the mouth twice daily), regular professional cleanings, and aggressive plaque and tartar control.

I’ve had pretty good success treating mild to moderate feline stomatitis using a multimodal approach. First, I address the diet. Although food allergies haven’t been definitively linked to this condition, I consistently see improvement in inflammation levels when I convert these cats to an anti-inflammatory diet that eliminates all potential sources of food allergens.

I stop feeding anything with seafood or poultry in it, because they are the two most common food allergens for cats. I also discontinue all foods that are biologically unnecessary for felines. That means no potato, no rice, no wheat and no corn. All carbohydrates need to go. Feeding an anti-inflammatory diet, which means a carb-free diet, is sometimes enough to naturally control the amount of inflammation occurring in the kitty's mouth.

Next, we begin an at-home oral disinfecting protocol. If a cat has a significant amount of plaque and tartar buildup, then we need to have a deep cleaning performed under anesthesia to remove all the infection along and under the gum line. Third, I prescribe natural anti-inflammatories. I use an esterified fatty acid complex for periodontal health. I also use plant-derived sterols and sterolins, as well as proteolytic enzymes, all of which help control the systemic mediators of inflammation.

The fourth step is to use a variety of nutraceuticals to improve gum health. These include ubiquinol (the reduced form of CoQ10), which I use both orally and topically on the gum line. I also use a product from Standard Process called VF Bio-Dent for Pets, as well as probiotics, both orally and topically.

Lastly, I recommend the cat's owner focus on removing environmental sources of toxins that can negatively impact the immune system. We stop vaccinating and start titering. If your cat goes outside, you definitely want to make sure his titers show he’s protected. However, kitties with an autoimmune disorder and indoor cats with no exposure shouldn’t receive unnecessary vaccines. You also can consider a vaccine detoxification protocol. We also evaluate air and water quality, as well as household chemical use.

With early intervention and an aggressive integrative protocol, cats with mild to moderate feline stomatitis have a chance to reclaim their oral health without aggressive dental surgery.

The Full-Mouth Extraction Option

Unfortunately, most cases of feline stomatitis are diagnosed very late in the game, when kitty's breath has become unbearable or he’s not eating well, and is taken to the vet. By this time, the whole mouth is typically swollen. There can be ulcerations on the roof of the mouth, the tongue, the lips and throat. It’s a bad situation all the way around.

At this stage, there are no consistently successful long-term medical management options available. Veterinarians treating feline stomatitis 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.

Believe it or not, the kindest option for treatment of advanced feline stomatitis is a full mouth extraction, which means removing all your cat’s teeth. It’s an aggressive form of treatment, but unfortunately, 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.

To avoid chronic complications from full mouth extractions, I believe 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 postsurgical discomfort is resolved and healing has occurred.

I can’t tell you the number of patients I’ve seen who’ve experienced a complete quality of life transformation and a return to their normal lives after their infected, inflamed teeth were removed.