Written by Dr. Gawen Thompson
Gingivostomatitis literally means inflammation of the mouth and gums. Among some cats there is a predisposition to an excessive and inappropriate inflammatory reaction to the plaque on the teeth. Plaque is a combination of bacteria and saliva that creates a film on the surface of the teeth. All animals have plaque in varying degrees, and in the normal process of dental disease, the plaque goes on to form tartar on the teeth.
In cats with gingivostomatitis, there is such an exaggerated reaction to the plaque that the mouth becomes painful. Owners will note a cat that has foul breath and sensitivity around the mouth. There is a great deal of variation amongst cats with the condition, varying from mild gingivitis affecting a few teeth to marked reaction of the entire mouth including the tissue around the base of the tongue and the tonsils as well as the reaction around the teeth.
Prevention is difficult because there are many potential causes and contributing factors, some of which, like genetics, are beyond our control. Systemic infectious and metabolic diseases are known to influence oral health and are contributing factors. Owners should keep in mind that in a significant number of the cases of gingivostomatitis, the cause may be undetermined. The reaction is not an infection, so it won’t resolve with antibiotics and dental scaling (although they can help temporarily).
Management is focused on awareness of the disease process and extraction of teeth as needed. Blood tests are performed to assess the health of the pet and to rule out systemic infectious and metabolic diseases. As mentioned above, treatment with antibiotics may provide some improvement and steroids can suppress the immune reaction. However, these measures usually only provide a temporary relief. The simplest and most effective therapy (with an 80% success rate) is extraction of the cheek teeth (all teeth behind the canines).
Although this may sound radical and invasive, the cats tend to respond extremely well. Once the teeth have been removed the source of the reaction (plaque) is gone and the inflammation gradually resolves. The fact is that if the teeth are a source of pain, then extraction removes that pain. When cats eat canned food and some dry foods, the teeth are rarely used. Most cats return to normal activity and eating within 2 days of the procedure, although some require additional pain medication. Typically by 2 weeks after the procedure the gums are red but healed. By 4 months after the procedure the gums should be normal. A percentage of cats may require additional medication (e.g. steroids) to manage the condition long-term.