Cats Stomatitis Signs & Treatment

Article at a Glance:

Feline Stomatitis is also known as Feline Chronic Gingivostomatitis (FCGS). It is a severe inflammation that affects the gums and is thought to be influenced by plaque levels.

• One of the most striking features of this condition is the extreme pain experienced by those affected.
• Signs to watch out for include a refusal to eat, reluctance to let owners go near the mouth and visibly red and swollen gums.
• While antibiotics and steroids can help in the short-term, most patients will need to have dental extractions to control their signs.

What is Stomatitis? 

Feline stomatitis is a painful and often debilitating condition. It should not be confused with periodontal disease. Those affected can suffer extreme pain and find it very difficult to eat and drink. There is severe inflammation of the tissue within the mouth which will be bright red and may bleed.

For some individuals, the inflammation is focused at the back of their mouth. This is known as ‘caudal stomatitis’. About 0.7% of all cats are thought to be affected, as discussed in this article.

What Causes Stomatitis in Cats? 

Frustratingly, it isn’t clear what causes stomatitis in cats and why some are affected but others are not. Potential triggers include:

• Pre-existing periodontal disease
• Viral infections such as Calicivirus, FIV and FeLV. Read more about the link here.
• An autoimmune disorder
• Bacterial infections
• Genetics

What are the Signs? 

Those with stomatitis will typically show more obvious signs than cats who only suffer with periodontal disease. This is because the pain is so intense that it is difficult for even the most stoic cat to mask what they are experiencing.

Within the mouth, we will be able to see red and bleeding gums which are swollen. There will be foul breath and cats may produce excessive, thick and smelly saliva. Cats may paw at their mouth or rub it along the ground in an attempt to relieve pain. Many refuse their meals (especially dry food) and may run away from their bowl or growl and yelp when trying to eat. Due to the difficult relationship with food, weight loss is common. 

As their mouth is so painful, many stop grooming altogether and develop mats in their fur and greasy skin. Most affected cats start to hide away more and more and no longer enjoy being social.

How is It Diagnosed?

Frustratingly, there is not a standalone test for stomatitis. It is not easy to diagnose in its early stages or when advanced periodontal disease or oral cancer is also present.

Vets need to rely on their experience when examining a cat’s mouth. Basic diagnostic tests such as blood tests (including tests to check for viral disease) can be helpful. Oral x-rays can be useful and need to be performed under a general anaesthetic. Vets may swab the mouth to check for localised infection and a biopsy may be taken of any abnormal looking gum. This is especially true if the disease seems to be localised to just one or two spots.

What is the Role of Nutrition in Managing Stomatitis in Cats?

As stomatitis causes such intense oral pain, it is little wonder that cats decline their kibble. We need to offer them tempting food that is easy to eat. This usually means high calorie soft food that has been warmed up to make it even more palatable. Warm water can be added to ensure it is very mushy.

Stick to a high-quality food that is easy to digest such as Hill’s A/D. Short term, we can also offer mashed chicken, white fish and scrambled egg. It is often a fight to get enough calories into our cats to ensure they aren’t wasting away, especially when their pain is not well managed with pain relief. Steer well clear of crunchy treats or other food items that may be hard to eat.

How Can Stomatitis Be Treated? 

For very mild stomatitis, it may be an option to manage the inflammation. This is done by cleaning away the calculus and implementing an at-home tooth cleaning regime. Feline toothpaste and mouthwash can help to keep bacteria levels to a minimum. We can also offer a prescription diet aimed at maintaining good oral health. Frustratingly, this rarely works to keep the signs at bay and stomatitis will proceed in most cases. Also, if cats are in discomfort, they aren’t likely to tolerate dental cleaning.

More advanced cases of stomatitis will require more drastic action. Medical management may be trialled. This is likely to include oral antibiotics and corticosteroids to reduce inflammation and pain. For those who won’t accept oral medicine (even when mixed with food), injectable medicine is an option.

The sad truth is, that medical management is not effective in a large number of individuals. Long term, we have to be aggressive with our treatment plan. While it sounds extreme, extracting the affected teeth has been proven to provide resolution and dramatically improve quality of life. Veterinary dentists may remove all teeth (a full mouth extraction) or may leave the canines and/or incisors. Dental radiographs need to be taken to assess the dental roots. Removing teeth ensures plaque cannot build up and allows the gums to heal. 

Owners sometimes worry about the effects of dental extractions on their cats and their ability to eat. Cats with no teeth will be able to eat with ease compared to when they had active stomatitis!

For some, additional therapies will be trialled. These can include laser therapy and strong immune-suppressants, as well as nutritional supplements.

The Bottom Line

Stomatitis in cats can be a debilitating condition that causes chronic pain and food refusal. Signs can include weight loss and bad breath. While several treatment options are available, many will require dental extractions to control the disease.

Dr. Linda Simon, BVMS, MRCVS