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.
