Stomatitis

Stomatitis is a chronic disease that can be very painful for your cat, but there are things that we can do to make your cat more comfortable, and there is a potential cure.

Cause:

No one knows for sure what causes stomatitis in cats.  The current thought is that it is a mutation or variant of calici virus, but that has not been definitively proven.  What we do know, is that whatever causes this, it is contagious, but only selectively.  Most cats that are exposed to this will not develop it, but some cats will, and a depressed immune system does seem to make them more likely to develop it.

We do know that it seems to be an overreaction of the immune system to plaque in the mouth.  By suppressing the immune system, we can suppress the disease, or by removing plaque in the mouth, we can also suppress the disease.

Symptoms:

The primary symptom that we see is very swollen red inflamed gums and tissues in the mouth.  The affected areas can be just around the gums, but it can also be found in the back of the mouth, and in some cases, down the back of the throat.

We do know that this is extremely painful in cats.  While cats tend to be very stoic and not show signs of pain, this is one of the few diseases that can cause cats to stop eating because their mouth is just so painful.

You may also notice an odor coming from your cat's mouth ? in some cases we can also see secondary infection in the inflamed tissues.

Treatments:

There are a variety of treatments for stomatitis in cats.  There is only one potential cure, but it is not a guarantee, and it is very drastic and costly.

• Full mouth dental extractions:
  • Since plaque is a known trigger for stomatitis, and since plaque builds up on teeth, in about 90% of cases, we can cure the disease by surgically removing all of the remaining teeth in the mouth, both crowns and roots in their entirety.
  • This is costly, and drastic, but it is the only known potential cure for stomatitis.  Most owners who have gone this route, usually after battling stomatitis for years, are glad they did, and wish they had done so sooner.
  • Cats can still continue to eat just fine without teeth, and in fact most cats who have had stomatitis will eat better, because the pain is gone.  Many of these cats had long since stopped chewing their food anyway, and were already swallowing it whole.
  • But, this is not a guarantee of a cure, and some cats have had all of their teeth removed, and still continue to have stomatitis.
• Steroids:
  • These are effective at suppressing the immune system and eliminating the inflammation in the mouth.  However, these are a short term fix, and it will reoccur, and eventually after several years, your cat will develop steroid resistance.
  • We will also tend to see a high rate of diabetes as a side effect in long term high dose steroids, which is what we have to do with stomatitis.
  • We will usually treat with long lasting injectable steroids, as these tend to be more powerful and more effective, but we can also treat with daily steroids.
    • Depo medrol is a steroid injection that will stay in your cats system for a month, but can have effects up to 2-3 months for some cats.
    • Triple steroid injection.  This is a triple injection, consisting of two very high dose but short acting steroids, dexamethasone and triamcinolone, and a high dose of an antibiotic, penicillin, given once a week for three weeks.  The idea behind this is to suppress your cat's immune system so far down, that it will take a long time to come back up enough for the stomatitis to return.  We have had several cats get relief up to a year with this combination, but each time we have to repeat it, the length of time that the cat is stomatitis free shortens.
    • Daily steroids.  These will generally consist of prednisolone, dexamethasone, or triamcinolone.  We do not use daily steroids commonly for cats with stomatitis, as we will generally have to give such a high dose consistently to achieve the desired effect, that diabetes is a high likelihood as a side effect.
• Immunosuppressants:
  • Cyclosporine.  This has been shown to be effective in some cats, but not all, and this is a more costly drug that can have undesired side effects such as anorexia, or even bone marrow suppression.  This is a daily or twice daily drug.
  • Chlorambucil.  This is not used very commonly in cats for stomatitis, but there are some vets who have used it with some success.  This is also a more costly drug that can have undesirable side effects similar to cyclosporine.
• Antibiotics:
  • Azithromycin is a drug that has been used commonly to treat secondary infections such as bartonellae hensalae, which has been linked with stomatitis, and while it has not been shown to be the causative agent, it may complicate the treatment of stomatitis.
  • Doxycycline.  This antibiotic has some anti-inflammatory effects, and can help treat most secondary infections that may arise in the mouth.
• Other treatments:
  • Pentoxifylline.  This drug increases red blood cell elasticity, which can have an anti-inflammatory effect.  This drug does not work for most cats with stomatitis, but it can help significantly with a small percentage.
  • Pain medications.  We will commonly also treat painful flare ups with either a narcotic, Buprenex, or as long as the cat is not on steroids, with a pain medication called Metacam.
  • High dose interferon.  We have just started trying this as a treatment, for the possible calici virus link, but initial results have not been promising.

If you have any questions or concerns regarding any of the above, please contact us at All Feline Hospital at info@allfelinehospital.com.

This handout was written by Dr. Shelley Knudsen, DVM

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