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Stomatitis and Dental Disease

Mouth Inflammation

Unfortunately, little is known about the causes of stomatitis (mouth inflammation). Treatment focuses on ruling out potential causes, and managing symptoms.

Causes and Symptoms

Stomatitis is inflammation of the mouth tissue. While gingivitis is limited to inflammation along the gum line, stomatitis often includes ulcerated tissue in the back of the mouth, inside the cheek pouches, and even back in the throat.

Cats with stomatitis may drool and express discomfort while eating. They may cry out, run or walk away from their food bowl, and/or refuse to eat. Upon examination of the mouth, there may be bright red tissue along the gums, in the cheek pouches, and/or in the back of the mouth.

Stomatitis may be more accurately described as a symptom rather than a disease. Some cases seem caused by viruses such as bartonella and calici. Food allergies could be the culprit. In other cases, the cause is unknown. Some believe many cases are caused by an autoimmune condition, where the cat’s body attacks what it perceives as a foreign substance – perhaps the enamel of their own teeth. Others feel the acidic coating on dry cat food causes many cases.

As symptoms for stomatitis are similar to those of dental disease, the best place to start may be a thorough dental examination and cleaning under anesthesia. Your veterinarian may wish to biopsy any nodules or other tissue he finds suspicious, to rule out mouth cancer.

Treatment Options

As the causes of stomatitis are often unknown, treatment often consists of trying various remedies to see what works.

A limited-ingredient grain-free poultry or rabbit diet, canned or raw, could rule out food allergies. An all-wet diet may be more comfortable for a cat’s inflamed mouth, and may reduce the chance of developing diabetes. If making your own food, use a reputable recipe such as those found on catinfo.org or catnutrition.org.

Supplements such as agaricus blazei, lactoferrin, omega fatty acids, or Coenzyme Q10 may be helpful. Interferron has reportedly been used with success with some cats. Chlorhexadine rinses or water additives may help.

In other cases, antibiotics such as metronidazole (Flagyl), clindamycin (Antirobe or CliniDrops), amoxicillin (Clavamox) or Zithromax may work. Sometimes, the only option is to suppress the symptoms of pain or inflammation with anti-inflammatories (such as Metacam), immuno-suppressants (such as cyclosporine), or steroids (such as dexamethasone or prednisolone). Steroids should be utilized with care, as undesirable side effects can occur (such as diabetes). In some cases steroids have been reported to improve symptoms temporarily, but the symptoms later resume even worse than before.

In half or more of cases, full mouth extractions or removing all teeth behind the canines has met with success.

Finally

There is much unknown about the cause and treatment of stomatitis. Therefore, it can be a frustrating disease to work with. However, there are many options to explore to enhance the comfort and quality of life of your cat.

Case Studies

Omaha struggles with a mild case of stomatitis, or inflammation of the mouth tissue. This is one of the most frustrating conditions Lynette has dealt with, as no one seems to know what causes it, or alleviates it. She has had the best luck using:

  • Lactoferrin - Syringing lactoferrin, mixed with water (she uses the Nutricology brand, freeze-dried types tend to clump and not dissolve as well) into his mouth twice a day, attempting to "wash" the mouth tissue and allow him to swallow some, coating the throat. Lactoferrin has microbial properties and is supposed to modulate the immune system.
  • Agaricus blazei mushroom extract - 0.5 cc (or one capsule) orally or in food daily (Lynette prefers the Atlas World USA bio liquid)
  • Dentals - performed every six months to remove tartar build-up

Prior treatments also included:

  • Chlorhexadine rinse - Omaha hated the mint taste, so Lynette just put some on gauze or cotton and wiped it across the gums daily
  • Steroids helped temporarily, then stopped. In some cases, it can make the situation worse. The side effects were bothersome (weight gain, chronic infections...) so she weaned him off of it.
  • Pulse therapy with antibiotics (Clavamox and Antirobe) was attempted, but they were unsuccessful.

Latifah struggled with a more severe case of stomatitis. Latifah had a full-mouth extraction to remove all remaining teeth, but her symptoms prevailed. Various antibiotics were tried without success. She was fed a limited-ingredient poultry canned or raw diet, lactoferrin, and agaricus blazei which helped, but her mouth still caused her a great deal of pain. Lynette had to resort to using cyclosporine (Atopica, 25 mg given daily on an empty stomach) and Metacam (0.2 mL of the 0.5 mg/mL strength given every other day). These medications controlled her symptoms well and while her mouth would never be "normal" she could eat with enthusiasm and her mouth was significantly less red and raw.

Cost Saving Ideas

Generic drugs may save cost. Shop around, including online sources, for cost savings on various medications.

For futher information, visit:

Lymphoplasmacytic gingivitis in a cat

Boot's Story: Lymphocytic-Plasmacytic Stomatitis

Plasma Cell Stomatitis by Mar Vista Animal Medical Center

Treatment and Procedures by Vet Dentistry

Feline Stomatitis by All Pets Dental

Feline chronic gingivostomatitis by Dr. Addie

Feline Odontoclastic Resorptive Lesions

Does Dry Food Clean Teeth? by Dr. Hofve

Feline Future - A Predator's Teeth (this is a commercial site, so the information needs to be evaluated in light of the product being sold and other available information)

The Relation Between Dental Disease and Canned Food by Shawn Messonnier DVM

Treating the Inflamed Mouth - WSAVA 2001 WSAVA 2001

Oral administration of bovine lactoferrin for treatment of intractable stomatitis in feline immunodeficiency virus (FIV)-positive and FIV-negative cats. - Am J Vet Res. 1996 Oct

Date last updated: 8/11/2008

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