Asher is an 18 month old cat who as a kitten had bad gums.  During examination some time after he was adopted from a rescue group, I noticed significant inflammation of his gums, especially over his back teeth.  He was treated with antibiotics and with a dental cleaning in hopes of stopping the gingivitis from progressing further.  On rechecks I observed the gum disease moving deeper in his mouth.  I tried treating him with anti-inflammatory medications but the gum disease moved into the tissue at the back of his mouth and towards his throat.  His gingivitis advanced into stomatitis.

Veterinarians don’t truly know what causes feline gingivostomatitis.  Viruses, bacterial infections, food allergies, and an abnormal response to plaque on the teeth have all been implicated as factors triggering the disease.  If the diseased gum or oral mucosa tissue is biopsied, the most common cells found are inflammatory cells called plasma cells and lymphocytes.  Lymphocytic-plasmacytic gingivitis stomatitis (LPGS) is the official name of this condition.

Cats that have LPGS often have painful mouths, bad breath, and trouble chewing.  Some cats drool and stop grooming.  Early intervention stops stomatitis from developing in many cats but unfortunately not in Asher’s case.  His disease had started before he was adopted.

When dental cleaning, antibiotics and anti-inflammatory medications do not get LPGS under control, aggressive dental surgery is the next step.  Extraction of all of the teeth behind the canine fang teeth is needed.  It is crucial to remove each entire tooth and root and to confirm that the extractions are complete with dental x-rays.  This is a drastic measure, but one that cures many cats.  Once the stomatitis moves into the back of the mouth and into the pharynx, extractions are still needed, but most of these cats require long term treatment with a drug called cyclosporine to control inflammation.

Asher had the extraction surgery and all of his premolar and molar teeth were extracted.  When he was under anesthesia I could see that the inflammation extended into his tonsils and pharynx.

Laser treatment to remove the painful, inflamed tissue is an option for some cats.  Typically laser therapy is required at least once a year to keep the disease under control.  The laser is not a curative treatment.

I was disappointed when Asher came back in a month after his extractions because the stomatitis was still present.  The inflammation had improved and he was less painful, but I was hoping that he would be better.  He was put back on anti-inflammatory medication and we will see how his mouth looks in another month.

LPGS can be frustrating to both owners and veterinarians and painful to cats.  Early recognition of gingivitis and treatment with professional dental cleaning, antibiotics, anti-inflammatory medications, and home dental care can stop the disease in many patients.  If initial treatments are unsuccessful, it is important to proceed with dental extractions at an early stage in order to prevent the inflammation from traveling deeper in the mouth and throat.  Later stage disease still has treatment but may not be cured.

Written by Dr. Wexler-Mitchell of The Cat Care Clinic in Orange, CA
Copyright © 2011 The Cat Care Clinic