Feline stomatitis is an exqui- sitely painful condition, and it
can be a frustrating condition for
pet owners and feline caregivers.
When I see a stomatitis patient for the first time, I try to
set pet owners’ expectations
early: stomatitis is a disease
that we sometimes control rather than cure. However, with aggressive treatment, cures can
Gingivitis or Stomatitis?
Sometimes it is difficult to
discern whether a cat has stomatitis or merely gingivitis.
Clinical signs will often be a
good indicator, even before you
take a look in the mouth. Gingivitis is generally well tolerated
by cats. However, cats with stomatitis will show signs of hyp-orexia progressing to anorexia,
preference for canned vs. dry
food, crying when yawning or
eating, ptyalism and occasionally bloody oral discharge.
When trying to distinguish
gingivitis from stomatitis, the
key is the mucogingival line.
Routine gingivitis never ex-
tends beyond the gingiva,
whereas stomatitis always ex-
tends beyond the mucogingival
line into the alveolar
and buccal mucosa.
the gingiva to the
alveolar mucosa is
referred to as rostral stomatitis or
Cats with stomatitis also often show
to the palatoglossal
folds in the caudal
oral cavity (referred to as caudal
stomatitis or caudal mucositis).
Inflammation associated with
true gingivitis tends to be worst
at the free gingival margin, with
minimally inflamed gingiva toward to the mucogingival line.
In cats with stomatitis, the full
height of the gingiva is equally
red, ulcerated and bleeding.
Juvenile cats sometimes develop severe inflammation of
the gingiva that occurs shortly after the permanent teeth
erupt, referred to as juvenile
hyperplastic gingivitis. It is unclear what percentage of cats
with juvenile gingivitis progress to full-blown stomatitis.
Juvenile gingivitis can be
painful and can result in loss
of attachment and
mobility, especially of
the incisor teeth.
Stomatitis may be
due to a variety of
causes, including ingestion of a caustic
The cause of immune-medi-ated stomatitis is not clear, but
it appears that cats develop inappropriate inflammation in the
presence of even small amount of
plaque accumulation. Many cats
with stomatitis concurrently shed
both herpesvirus and calicivirus. 1
FeLV rarely plays a role in stomatitis (0-17 percent of cats with
stomatitis have FeLV), but FIV
may play a role (10-81 percent
of stomatitis cats are positive
for FIV), and FIV-positive stomatitis patients can be some of
the more challenging stomatitis
cases to get under control. Bartonella has received recognition
as a possible etiologic agent, 2
but a more recent manuscript
showed no association between
Bartonella and stomatitis. 3
In my experience, azithro-mycin treatment of Bartonel-la-positive stomatitis cats does
not usually resolve chronic oral
Evidence suggests that cali-
civirus exposure may have long-
term effects on the immune sys-
tem, resulting in an aberrant
immune response in some cats
to bacterial antigens that ac-
cumulate in plaque. FCV-PCR
is positive in 97 percent of cats
with caudal stomatitis. 4 There-
fore, plaque control is very im-
portant in cats with stomatitis.
cats are so painful that daily
plaque control at home is not
feasible. A professional den-
tal cleaning will transient-
ly remove plaque, but tooth
brushing to prevent daily accu-
mulation is not feasible in most
cats due to severe pain.
Antibiotics provide transient
improvements by decreasing
bacterial plaque burden, but
long-term use promotes bacterial resistance. Ultimate plaque
control is removing the plaque
retentive surfaces, i.e., the teeth.
Tooth extraction is the gold
standard for stomatitis treatment due to its potential for
a cure and due to possible
long-term side effects of medical therapy. In one study that
looked at outcomes, full-mouth
extractions or partial-mouth extractions have been shown to
provide the following outcomes:
n 60 percent of cats were
n 20 percent of cats were so
improved that no further medications were needed.
n 13 percent of cats were
improved but required continued long-term medication.
n 7 percent of cats did not
By John Lewis, VMD,
FAVD, Dipl. AVDC
Figure 1: Severe rostral and caudal stomatitis in a 10-year-old male neutered
Teeth removal is best
cat. Biopsy of proliferative tissue would be warranted. I’d recommend full-mouth
extractions in this cat due to the severity of disease, even with no apparent inflam-
mation around the canine and incisor teeth.
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PHOTO © 2012, JOHN R. LEWIS.