By Dr. I Elizabeth Borgmann. Gingivitis and stomatitis of the cat mouth is a very frustrating condition to try and manage. Gingivitis refers to inflammation of the gums. Stomatitis refers to inflammation of the mouth (often the back of the mouth but it can advance onto the roof of the mouth or the tongue). In severe cases cats cannot eat and blood tinged saliva drips from their mouths. Pain and discomfort is severe.

So why does this develop? We don’t know! The types of cells present suggest it might be an immune response. The speculation is that the body has an excessive response to the bacteria in the mouth. (The type of cells present gives this form of gingivitis its full name – lymphocytic plasmacytic gingivitis and stomatitis. For the sake of simplicity in this article, I’ll simply call it gingivitis.) It is a disease that tends to affect the younger cat.

This disease is managed, not cured. That’s the first thing to understand or you’ll be very frustrated.

What are the first steps your vet will take when trying to manage this disorder? They will probably test for the viruses Feline Leukemia Virus and Feline Immunodeficiency Virus. They will also do a full general health screen to detect and correct any underlying health issues. They may test for Calicivirus or the bacterium Bartonella. Underlying problems need to be corrected first.

The next step is to start the cat on antibiotics. Azithromycin is a favourite choice of antibiotic because Bartonella is associated with so many cases of gingivitis. (And obviously, azithromycin kills Bartonella.) Unfortunately, the infection with Bartonella is not the full answer.

Then the teeth need to be cleaned. Hygiene is extremely important. Remember, this seems to be a reaction to the bacteria in the mouth. Bacteria adhere to plaque and calculus. In the early stages dental home care (minimally done once daily, preferably twice daily) may slow the progression of the disease. But this is difficult to do for most cat owners. And later on, as the gingivitis worsens, it is too painful. Veterinary dental cleanings every six months may slow the progress.

Cortisone injections & oral steroids are often attempted because of the belief that this may be an immune based problem. These treatments initially are effective but their value tends to wane and within 6 months to 2 years the steroids do little to reduce inflammation in the mouth.

As the disease progresses it becomes necessary to extract healthy teeth to reduce the bacteria in the mouth. Many cats will improve adequately and have a good quality of life with the extraction of the all but the canine teeth and incisors. Sometimes these need to come out as well if the gingivitis is extending towards these teeth.

Dental radiographs need to be taken to ensure all the roots are removed in cases of gingivitis unless root resorption to bone is occurring. In these cases, it has been advised to ‘atomize’ the root. This can only be done with monitoring using dental radiographs to ensure all the roots are gone and not too much other damage has been done. (In other words, it gets a bit tricky.)

The majority of cats do well with full mouth extractions. A few will still have problems. These problem cats need to be tested for shedding of the calicivirus. If this is found,
treatment with interferon may help.

Ultimately, this painful disease can be managed but it will be a long journey. Cats never make our jobs easy!

Dr. I Elizabeth Borgmann

Dr. Borgmann has been practicing in the Fraser Valley for over 11 years and can be reached at the Whatcom Road Veterinary Clinic