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Severe Gingivitis-Stomatitis Complex


Stomatitis is a general term used to describe any inflammatory change in the mouth. This inflammation can be caused by infections, chemicals, or foreign material.  In cats, a syndrome of stomatitis that has become increasingly common is called Feline Lymphocytic Plasmacytic Stomatitis/Gingivitis. This condition can be mild or severe. In a severe case it is extremely painful and debilitating.

 

Most veterinary dentists have generally agreed that this type of feline gingivitis and stomatitis is due to an abnormal reaction of the immune system. Therapy has been aimed at controlling the inflammatory reaction because the immune response is more aggravating than beneficial.  The intensely red, swollen, and ulcerated tissues cause considerable pain when touched or when the mouth is stretched open to chew or yawn. The problem may also lead to dental complications, scarring on the inside of the cheeks, and may transform into cancer. Although infections of Feline Leukemia Virus and Feline AIDS Virus may worsen this condition, they do not act as a cause. In the past, the only direct association has been with plaque and periodontal disease.

 

Diagnosis can usually be made on the clinical appearance of the mouth and gums, but occasionally biopsy specimens are necessary for confirmation. Biopsies also help rule out other conditions.

 

Treatment of this condition has and still can be very frustrating.  In many cases our only realistic goal is successful management; complete resolution of the symptoms may not be possible. The teeth must first be cleaned of all plaque and tartar accumulation both above and below the gum line.  This can be accomplished only under anesthesia.  While under the anesthetic, every surface of each tooth is examined and x-rays are routinely taken to detect any hidden pathology that could harbor plaque or infection. Therapy has to be aggressive! Any abnormalities must be properly treated, or the affected tooth extracted. Often, erosive resorptive lesions or broken tooth roots are found to be significant contributing factors.  Antibiotics may be necessary from time to time but are not indicated for long-term management. Anti-inflammatory drugs are very useful in most cases in controlling the inflammation and pain.

 

Since plaque begins to reform in just a few hours after the cleaning, diligent home care is essential to the control of inflammation. Ideally, the teeth are brushed with a solution of an anti-plaque germicide such as chlorhexidine. This product can also be used as a rinse for those cats that will not allow brushing. The chlorhexidine should be applied daily.

 

Following the aggressive cleaning and periodontal treatments, most cats show dramatic improvement. Conservative therapy combines home care of the mouth with brushing and germicides along with frequent dental cleanings under anesthesia. In addition, moderate doses of anti-inflammatory medication and occasional antibiotics have a role in conservative therapy.

 

An association has been established between Feline Stomatitis and a specific bacterial organism called Bartonella. In a large study 70% of cats with severe gingivitis/ stomatitis syndrome tested positive for this organism. Antibiotics in routine veterinary use have no effect on Bartonella organisms but there is an antibiotic called azithromycin that is effective. We are now recommending that all cats with symptoms of stomatitis or severe gingivitis should be tested and those that are strongly positive be treated. In the same large study, more than 70% responded favorably to treatment. Bartonella is unlikely to be a causative organism but one that contributes to the problem. Some cats do not test positive and some that are positive do not improve, but the link to Bartonella is promising and most cats that we have treated have improved substantially.


For those cats that are not positive for Bartonella or do not respond to treatment, an aggressive approach in which all the teeth behind the canines (fangs) are extracted usually helps. Some cats will still not be comfortable enough and all teeth (including the fangs) must be removed. The majority of cats improve substantially following the extractions. Fortunately pet cats adjust very well to the loss of their teeth and can even eat dry food with no problem. A very small number of cats will still have enough discomfort to warrant medications to assist in controlling the inflammation and pain.



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