This chronic feline oral disease is a commonly occurring, complex syndrome. It is characterised by often severe, debilitating and protracted oral inflammation in cats. The cause of the condition remains unknown and may be multifactorial. It is clear that cats with gingivostomatitis have an inappropriate immune response to an inciting trigger. The specific trigger or triggers may be different amongst cats.
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A number of potential causes or triggers have been suggested including: Viruses (feline calicivirus, herpesvirus, leukemia virus, immunodeficiency virus); bacteria (bartonella); dental disease (tooth resorption, periodontal disease) and hypersensitivity reactions (overreaction to plaque bacteria, food allergies). It may be that some or all of these act as triggers to the immune system in individual cats.
Cats with gingivostomatitis suffer with moderate to severe oral pain, they may have a reduced appetite or changed food preferences, preferring softer food items; resent being handled especially around the mouth; paw at their mouth; salivate or drool; have difficulty swallowing; be irritable or withdrawn and suffer weight loss. They will resent oral examination and can be virtually impossible to give oral medications to. This will have an impact on possible treatment regimens for the condition if the treatment involves administration of medication by mouth.
Gingivostomatitis is differentiated from gingivitis (inflammation of the gums) when the inflammation also affects the buccal mucosa (cheeks) and soft tissue at the back of the mouth lateral to the palatoglossal folds – often incorrectly referred to as the “fauces”. This means that not only the gums are inflamed as in gingivitis but also the mucosa (mouth tissue) next to it. The tissue is friable and bleeds readily on palpation, there are classically proliferative and/or ulcerative mucosal lesions present.
Gingivostomatitis appears to be more prevalent in purebred cats, cats from multiple cat households and those kept in shelter facilities.
Gingivostomatitis is VERY painful!
Apart from cancer, this is by far the most horrendous disease we deal with in the mouths of animals. They can be so painful they stop eating.
Extractions offer a potential cure
As scary as the prospect is of your cat having many extractions, this is the only pathway to a potential cure.
Medications are useful, but they do not fix the problem
Medications can be used to control the symptoms we see in our cats, but they will never give long term relief.
A consistently successful treatment option is yet to be determined. Numerous different approaches to treatment have been trialled over many years with surgical treatment being considered the most consistently successful and appropriate at the present time.
Surgical treatment involves either full mouth extractions or extraction of all premolar and molar teeth (those behind the canine teeth). The precise reason aggressive extraction of teeth is successful in so many patients is not entirely understood but is thought to have its basis in reducing the number of plaque retentive surfaces in the mouth. Our expectation is that approximately 60% of patients treated with caudal or full mouth extractions will have complete resolution of their gingivostomatitis symptoms, 20% of patients will experience improvement of their signs and symptoms with the remaining 20% of patients unfortunately failing to show any improvement following surgical treatment. It is imperative that extractions are performed by skilled individuals with the aid of dental radiology to ensure all tooth material is removed, leaving any tooth material is a common cause of failure to respond to surgical treatment.
Many forms of medical therapy have been pursued, the majority involve suppression of the immune system. Medications such as corticosteroids and cyclosporine are the most commonly employed. These are not without potential significant side effects and often reduced efficacy over time, furthermore these medications have not been shown to offer long term resolution for patients with gingivostomatitis. We recommend that medical management only be employed as an adjunct to treatment for those patients that have failed to completely respond to surgical management.
Patients testing positive to feline immunodeficiency virus (FIV) have been shown to be less likely to respond favourably to treatment and for this reason we recommend all feline patients with gingivostomatitis be tested for FIV as this can provide valuable information as to prognosis. We have however seen a number of FIV positive patients respond well to treatment.
Supportive care is essential for patients with gingivostomatitis as many patients experience moderate to severe oral pain. Provision of suitable pain control, nutritional support, assistance with grooming and occasionally antibiotic therapy can aid in managing patients pre and post operatively for those undergoing extractions and controlling clinical signs in those that have failed to completely respond to treatment.
Unfortunately, despite our best efforts some patients fail to respond adequately to treatment and in these instances some pets are put to sleep due to the drastic impact this disease can have on their quality of life.
Until the cause of gingivostomatitis is clearly understood, no prevention is possible. Research is ongoing into potential causes and more effective treatment options. There have been some positive results from recent trials being conducted with stem cell therapy, this may offer hope for a more reliable and less invasive treatment options to patients in the future.