Feline and canine stomatitis are very different diseases with differing etiology, presentation and outcomes.
Several pathogens have been suggested as a cause or factor in the development of feline stomatitis (lymphoplasmacytic gingivostomatitis, feline chronic gingivitis and stomatitis) including calicivirus, FIV, feline leukemia, and Bartonella hensleae. More in depth investigation has shown that feline calcivirus infection is often present in cats with feline chronic gingivitis and stomatitis (FCGS) but other pathogens are not significantly associated with FCGS.
Clinically affected cats may demonstrate severe gingivitis, caudal stomatitis near the palatoglossal folds (previously called faucitis), mandibular lymphadenopathy, anorexia and bad breath. Serum biochemical profiles may show an increase in globulin but little else.
The current working theory of the etiology of FCGS is the patient has an overzealous inflammatory response to plaque. It is unclear how feline calicivirus is involved in this. Regardless, the strategies for treating FCGS are often centered on plaque control through preventative measures or extraction.
Extraction of all teeth associated with inflammation can improve or resolve oral inflammation in 2/3 to 3/4 of cats with FCGS. Cats which do not respond to extractions may respond to post-surgical medical therapy. Cyclosporine has been shown to decrease the severity of about 3/4 of cats with stomatitis. It is possible that cats who have received corticosteroids before extraction and cyclosporine respond less favorably. Feline recombinant omega interferon may help decrease caudal inflammation and improve pain scores in calcivirus positive cats who are refractory to extractions.
Dogs with stomatitis present very differently. Although the clinical signs are often similar (pain, mucositis, gingivitis, enlarged lymph nodes) and serum testing is similar in that the globulin level is often elevated, these diseases behave differently and likely have different etiologies. Although there is no known cause for canine stomatitis, it is clinically accepted that often diligent plaque control can help control the clinical signs. Because of this, there is opinion that the patient is having an overzealous response to plaque bacteria, and may be why contact ulcers of the mucosa are seen and this is often called chronic ulcerative paradental stomatitis (CUPS).
If daily plaque control with brushing can be provided and periodontal therapy has been performed, these patients may be controlled with good oral hygiene. Immunomodulation with doxycycline may also help. In cases that brushing cannot or will not be provided, selective or whole mouth extractions may be required.
With both feline and canine stomatitis, rarely is the disease successfully treated with one simple cleaning. Therapy may be very involved and there are cases in which control cannot be achieved. However many patients will respond positively to more specialized therapy.
Tips for Treatment of Stomatitis
- Client counseling is important to lay out expectations and prognosis
- Begin with a dental cleaning and extraction of teeth with gingival recession and bone loss
- Biopsy is recommended if the appearance is atypical or the patient does not respond to treatment
- Viral cultures may be helpful in cats with FCGS to assess if calcivirus is present
- Steroid use alone often is not effective