Chronic Stomatitis in cats – what are the options?

Chronic stomatitis, or Chronic Gingivo-Stomatitis Syndrome (CGSS, also known as Lymphocytic-Plasmacytic Gingivostomatitis Complex, LPGS) is a disease of the cat’s mouth caused by severe inflammation of the gums and mucous membranes. To understand the treatment options, we need to look at the disease in more detail…

What causes Chronic Stomatitis?

This is a really complicated question, because although we understand the mechanism, the exact underlying causes are still something of a mystery. However, although this disease looks superficially similar to normal gingivitis/periodontal disease (caused by dirty and infected teeth and gums), it is actually quite different in origin. The underlying problem is an abnormal response by their immune system. A cat’s mouth is a really dirty environment – it’s full of bacteria (many hundreds of different types), and scraps of food. Normally, the immune system doesn’t respond to low levels of stimulation in the mouth; however, in Chronic Stomatitis it responds violently to even the normal mouth contents.

cat teethTriggers are thought to include normal bacteria in the mouth, mild (often invisible) plaque on the teeth, and sometimes an abnormal reaction to food proteins (like a food allergy). It is also thought that other disease conditions may make the stomatitis worse – particularly infection with cat flu (calicivirus and possibly herpesvirus), FIV (feline AIDS) and FeLV. Trauma to the lips or gums can also be a predisposing factor, as it breaks down the protective barrier between mouth contents and immune cells. However, while in a normal cat this may lead to some mild, localised inflammation, in the cat with Chronic Stomatitis the inflammatory response is disproportionate and involves even unaffected areas of the mouth.

OK, so what does all this lead to?

Immune cells migrate into the gums and mucous membranes (mainly lymphocytes and plasmacytes, hence the old fashioned name for the disease!) and cause inflammation – increased blood flow, swelling, and pain. Over time, this swelling may become so marked that the teeth are almost invisible under the reddened, swollen gums.

What are the symptoms?

The key thing to remember is that this is a very painful condition, and its really isn’t fair to leave a cat in this state. Unfortunately, cats are often very good at hiding signs of pain, so it may be that the first symptom is a “sudden” loss of appetite. However, in most cases an observant owner will notice other symptoms first:

  • Drooling
  • Slower than usual eating, often with extreme care when chewing or biting.
  • Rubbing at the mouth, typically with a front paw.
  • Reduced appetite.
  • Weight loss.
  • Refusal to eat, and sometimes even drink.

How is it diagnosed?

Well, it’s important to realise that these symptoms are the same as periodontal disease – only after a thorough mouth exam (under anaesthetic, and ideally including dental X-rays) is is possible to definitively diagnose Chronic Stomatitis.

So, what are the treatment options?

dental machineThe first and most important treatment is a thorough dental scale and polish – removal of all the plaque and tartar on the teeth to minimise the immune stimulation. Only after that is done do tooth brushing and water additives have a chance of working – unlike periodontal disease which can sometimes be controlled with brushing in the absence of dental surgery. Once the mouth is clean, it MUST be kept that way – plaque starts to form again within hours, so home dental care in the form of twice-daily tooth brushing and anti-plaque water additives or tablets are vital.

Antibiotics are sometimes useful to reduce the bacterial load in the mouth; however, these are not a long term solution – they will rapidly become ineffective and will drive the development of drug-resistant bacteria which are a threat to your cat and to you.

Anti-inflammatory drugs such as steroids are widely used and are often the mainstay of medical treatment, to reduce the immune system’s response. However, they are unlikely to be effective on their own in a dirty mouth.

In severe or unresponsive cases, the best treatment option may well be radical dental extraction – removal of the chewing teeth, or possibly even all of the cat’s teeth. Once the teeth are removed, the gums will heal over, and the problem almost always disappears.

Isn’t that cruel, leaving a cat with no teeth?

No – what’s cruel is leaving a cat in pain and not doing something about it. A cat living in a house with a human to look after him or her doesn’t actually need teeth – there are healthy modern wet diets available that don’t need biting or chewing, and modern cats do not need to hunt down their prey (we do that for them, across the endless waste of the supermarket…). In advanced cases, radical extraction gives by far the best outcome – a happy and comfortable cat.

If you are concerned about your cat’s mouth or teeth, make an appointment to see one of our vets as soon as possible.

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