Stomatitis or Gingivitis

Gingivitis is an inflammation of the gums, with or without infection.  Stomatitis means that the inflammation involves the entire mouth.  Cats have a disease that causes severe gum irritation that may involve almost all of the mouth.  The tissues are infiltrated with plasmacytes and lymphocytes, cells of the immune system.  Therefore, this disease is called lymphocytic-plasmacytic gingivitis, lymphoplasmacytic gingivitis, lymphocytic-plasmacytic stomatitis, or lymphoplasmacytic stomatitis.

Contributing Factors

Tartar formation on the teeth and accompanying bacteria around the teeth and gums are usually present.  Although these factors do not cause this disease, they contribute to its severity and must be controlled as part of the overall treatment protocol.  Many of these cats develop tartar at a very rapid rate and need dental cleaning every 4-6 months.

Prevalence

This is one of the more common diseases of the mouth of cats.

Causes

The cause of this disease is not known.  Various theories exist, most of which revolve around the immune system.  Some affected cats seem to be immune compromised; others seemed to have an over-reaction to the immune system.  Another theory is that these cats are having an immune reaction or allergy to the teeth or to the bacteria that often reside around the teeth.

Gingivitis/stomatitis in cats may be the end result of more than one disease that causes the same response by the gum tissue.  This theory exists because the response to treatment varies widely from cat to cat.

Clinical Signs

The clinical signs are due to the inflammation and pain in the mouth.  Some cats only exhibit a decrease in appetite due to the oral pain.  Those that are severely affected do not eat at all, drool excessively, sometimes with bloody saliva, and exhibit severe pain when the mouth is opened.

Diagnosis

Because the inflammation in the mouth is so unique and severe, most diagnoses are made from an oral examination.  However, confirmation requires biopsy of the gums.  This is especially important if the gums do not have the typical appearance or if there is poor response to treatment.  Some forms of cancer can look like this disease; those cases require biopsy for differentiation.

Therapy

Various treatment approaches have been tried, but there is no treatment that is successful for all cats.  Thorough teeth cleaning and one to two weeks of an antibiotic are appropriate for almost all cats.  Cortisone (“steroids) is beneficial to most cats.  Drugs in this category (prednisolone, prednisone, dexamethasone, triamcinolone, etc.) suppress the immune system so many consider this response to confirm that an exaggerated immune response is all or part of the cause.

Some cats respond to immune stimulating drugs (Interferon, Immunoregulin, etc.)  This further confuses our understanding of the disease because these drugs have the opposite effect of cortisone.  It probably indicates that there is more than one cause of this disease.

Laser surgery can be very helpful or virtually curative in some cats.  The laser obliterates the abnormal tissue.  However, most cats require more than one treatment and many require periodic treatments for months to years.  However, this form of therapy may be the only one that really helps many cats.

Another approach to treatment is to extract all or almost all of the teeth.  For some cats, the response is dramatic.  However, this is not true for all cats.  Therefore, this approach is generally reserved for cats that have failed to respond to the other treatments.

Prognosis

Most cats that are treated aggressively have good to excellent response so their short-term prognosis is good.  However, many cats become resistant to many treatments that formerly were successful.  Many cats can be managed for years; others become so painful that euthanasia must be considered.