Chronic Feline Gingivitis-Stomatitis
General information
Other common/scientific names: plasmacell gingivitis-stomatitis, lymphocytic-plasmocytic gingivitis-stomatits, gingivostomatitis, gingivostomatitis-pharyngitis, gingivostomatitis-oropharyngitis, GSO, stomatitis with gingivitis-faucitis
This disease involves severe, chronic inflammation of one or more of the following tissues: the gingiva, or gums (gingivitis); the stoma, or mouth (stomatitis); and/or the oropharynx, or throat (oropharyngitis or pharyngitis). The inflammation seen is far greater than what would be expected as a response to periodontal disease alone. If biopsies of the affected areas are taken, they typically show that the tissues are infiltrated with plasma cells and lymphocytes, both of which are types of white blood cells. Chronic feline gingivitis-stomatits is usually very painful and can be difficult to treat.
Causes
The exact cause of chronic feline gingivitis-stomatitis is not known, although it is suspected that cats with the disease have a deficiency of their immune systems. It is also thought that several other causes or contributing factors may be involved, including viruses, bacteria and allergies. Viruses, such as FeLV, FIV, feline herpesvirus, and calicivirus, may put cats at a greater risk of developing the disease, as may various bacteria, such as Bartonella. One study has shown that cats with chronic feline gingivitis-stomatitis that are also FIV- or calicivirus-positive tend to have a more severe presentation of the disease relative to cats that do not test positive.
Infection
Because the cause of the disease is not yet understood, it is unclear as to whether there is truly an infectious component to the disease. If viruses or bacteria are involved, however, these organisms may be spread between cats.
Cardinal symptom
• Inflammation of gums, mouth or throat
• Mouth pain
• Bad breath
Symptoms
Cats with chronic feline gingivitis-stomatitis typically have bright red lesions of their gums, mouth or throat. Inflammation of the gums of the back teeth is often particularly dramatic, although the gum tissue of all teeth may be affected. The inner lips may also be severely inflamed, as may the tongue, roof of the mouth, and back of the mouth leading to the throat. Often these bright red lesions are ulcerated or thickened. The lesions frequently bleed spontaneously, or when gently touched. Cats with chronic feline gingivitis-stomatitis also often have teeth with feline odontoclastic resorptive lesions.
Bad breath, increased salivation, and a decrease in grooming are frequently noticed. Also, because the lesions cause severe mouth pain, changes in eating habits often occur. Affected cats may cry out when eating or drinking, and they are sometimes observed picking up their food only to let it drop from their mouths. They may even become aggressive to their food and water bowls. As less food is eaten, weight loss may be seen. As the lesions progress, cats often completely stop eating.
Diagnosis
A complete physical exam, including a thorough dental examination, will be necessary to diagnose chronic feline gingivitis-stomatitis. Bloodwork (including a complete blood cell count, a serum chemistry profile, FeLV and FIV tests, and urinalysis) is often recommended to eliminate other causes of severe oral inflammation and to help with the diagnosis. Dental x-rays may be performed, and biopsy of the lesions may be recommended.
Treatment
Chronic feline gingivitis-stomatitis cannot be cured and can be challenging to treat. Chronic, lifelong treatment is often needed. The goals of treatment are to decrease the extent and severity of the lesions so the cat may comfortably eat, drink and groom itself.
Medications such as antibiotics, anti-inflammatories, pain relievers, and immunosuppressives are often used to help treat chronic feline gingivitis-stomatitis. Some of these medications may be needed for the life of the cat. In some cases, a hypo-allergenic diet may also be recommended.
Scaling and polishing of the cat’s teeth, as well as extraction of loose teeth or teeth affected by FORL, will be needed to maintain good oral hygiene in these cats. If the cat can tolerate it, oral hygiene regimens at home may be recommended as well. These may include mouth gels or rinses, and possibly brushing of the teeth. Multiple laser treatments of lesions may also be recommended.
Many cats with chronic feline gingivitis-stomatitis will require extraction of all their teeth. Cats can do quite well with no teeth, and this would certainly be preferable to the pain of chronic feline gingivitis-stomatitis. However, even when this is done, the lesions will continue in about 20-40% of the cats. Medical therapy may still be required, and some cats may still respond poorly.
Prognosis
The prognosis for this disease is rather variable. Keep in mind that this is a chronic disease that cannot be cured. Many cats, however, can have the extent and severity of their lesions decreased to a level where they can comfortably eat, drink, and groom.
Prevention
Because we do not yet understand the causes of this disease, prevention can be difficult. Good dental hygiene from an early age and the prevention of periodontal disease may be beneficial.
Tips
Get your cat used to having its mouth opened and examined by you at home so that your cat will be more likely to let your veterinarian do a good oral exam on it when it is at the clinic! This may also allow you to catch a problem in your cat’s mouth early on, before it becomes too serious.