Gingivo-Stomatitis Syndrome

Gingivo-stomatitis of cats

This chronic feline oral disease is a commonly occurring, complex syndrome. Numerous terms such as plasmocytic-lymphocytic stomatitis (PLS), ulcerative gingivo-stomatitis, chronic oral inflammatory disease and others are used synonymously to describe it. It is often difficult to treat, and currently there is no specific treatment available. Dental treatment options will be discussed.

This disease has some very classical signs, which are:

 

•     Halitosis (bad breath).
•     Grossly inflamed gums especially in premolar and molar areas.
•     Gums bleed easily.
•     Very painful and cats often bad tempered.

 

The cause of the condition is unknown at this time.  Suggested causes have been bacterial, viral (especially calicivirus) and immunological (possible hypersensitivity to plaque proteins).  The condition may be the result of chronic immune-mediated processes.

 

Cats with gingivo-stomatitis exhibit intense oral pain (and are often bad tempered cats).  They will resent oral examination and are virtually impossible for the owner to give tablets to.  This will have an impact on possible treatment regimes for the condition if the treatment involves administration of medication by mouth.  The cats present with bad breath and sometimes with difficulty in swallowing, can salivate excessively and, in severe cases, suffer weight loss.

 

Proliferation of gingiva (gum tissue) with extensive inflammation is characteristic. The tissue is friable and bleeds readily on palpation.  It most frequently involves the gingiva (gums) caudal to (behind) the canine teeth and the fauces (angles of the jaw) but can occur associated with the incisors as well.  A characteristic of the condition is that it is a gingivo-stomatitis.  This means that not only the gingiva is inflamed but also the mucosa (mouth tissue) next to it.  In cats, gingivitis presents as a well demarcated thin line of inflamed tissue.  When this inflammation spreads past the muco-gingival line into the mucosa as a diffuse region of severely inflamed tissue, it has become gingivo-stomatitis.

 

Gingivitis in cats
Inflammation spread past the gingiva = gingivo-stomatitis

A thorough history of affected cats often reveals that they had mild cat flu as kittens (usually reported as sneezing episodes).  This may be an indication of calicivirus infection.  This early calicivirus infection may play some role in the sensitization of the oral tissues to an immune-mediated disease. 

 

Gingivo-stomatitis appears to be more prevalent in purebred cats.  This may be associated with their early development in catteries and possible exposure to calicivirus if it is implicated.  A large number of purebred kittens come from larger catteries where calicivirus infection is endemic.  No individual breed seems to have a higher incidence than other breeds.

 

Treatment

Initially, a careful and thorough dental clean, scale and polish and appropriate antibiotic therapy may be attempted and this may give relief (although only temporary).  Corticosteroid therapy will often produce improvement whilst used but long term immune suppressive doses are not in the best interests of the cats.

 

Permanent resolution is common following extraction of all teeth caudal to the canines (but these teeth must be extracted completely including all of the roots) if performed early enough in the disease.  The remaining teeth need to be brushed daily to prevent plaque build-up and development of the condition involving these teeth.  If these teeth are involved at the initial examination, they must also be extracted.



Cat with gingivo-stomatitis


Cat from previous photo at examination 12 months later

The prognosis is guarded for those treated without extraction.  With complete extraction, the prognosis is fair to good.  In cats treated by extraction most will get complete resolution of clinical signs and all will have improved to some degree.  Those cats with residual lesions are often eating normally and have improved demeanour according to their owners even though some lesions are still present.

 

A low percentage of cats treated by complete extraction still have residual lesions.  For this reason, trials of alternative treatments are always underway.  A trial using omega interferon intra-lesional injections was performed based at Melbourne and Brisbane but affected cats showed no improvement

 

Prevention

Until the cause of the disease is clearly understood, no prevention is possible.

 

 

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Some Photographs copyright and courtesy of Dean Saffron.

 

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