Cats, just like humans, dogs and other animals, are susceptible to plaque and calculus accumulation on the tooth surfaces. Along with with the uncomfortable gingivitis (inflammation of the gums) that comes with them. This often occurs over time, with severe disease only really becoming apparent after many years.

However, some unfortunate felines are susceptible to a chronic inflammation of the gums and parts of the pharynx (known as gingivostomatitis). This can start at a very young age and can be the cause of significant pain. It’s a disease that can markedly reduce their quality of life and be very frustrating to manage. 

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Is feline chronic gingivostomatitis just poor dental care?

Well, we will often see aged cats with severe dental disease who need multiple teeth to be removed because they’re loose or severely diseased. These cats will have gingivitis related to their dental disease. This is a common consequence of poor oral hygiene over many years but responds well to appropriate dental treatment with extractions and cleaning as needed. 

By comparison, chronic gingivostomatitis may first appear even in very young cats whose adult teeth have recently erupted. In these cases, it often goes unnoticed until the lesions are sufficient to cause clinical signs including;

  • Discomfort when eating
  • Weight loss
  • Pawing at the mouth
  • A bad smell from the mouth or oral bleeding
  • A change in attitude owing to pain

Often, we will first see these cats as young adults, not uncommonly between 2 and 8 years of age. The lesions can range from reddened, inflamed gums, to thickened, friable oral tissues that bleed easily, and right through to severe ulceration of parts of the pharynx. It’s not uncommon to see affected cats with large, bleeding sores – these cats are obviously in a lot of pain. 

A multifactorial problem

Feline chronic gingivostomatitis occurs in part because of the local gum reaction to bacterial film and plaque on the tooth surfaces. But this isn’t the whole story.

We still don’t fully understand the cause of this disease. Although, in many cases, it appears to be a combination of plaque reaction, in addition to the body’s own immune responses, diet and often a viral component (perhaps as a trigger). These lead to friability and inflammation of the gums and, in some cases, parts of the pharynx, close to the palate. 

Since we still don’t fully understand the disease, we always take a thorough history documenting the cat’s diet, eating habits, temperament, access to the outdoors, access to other cats and the history of the clinical signs or symptoms. This helps build a picture of possible factors that could be involved, and we follow this with further testing to try and identify viruses like feline leukaemia virus (FeLV), feline immunodeficiency virus (FIV), feline calicivirus (FCV) or feline herpes virus (FHV), that could be complicating the disease. 

How can feline chronic gingivostomatitis be managed?

Managing the condition starts with good, regular oral care. 

The first thing we advise is a dental examination under general anaesthetic to properly clean the teeth. Here we remove any bacteria and plaque from the dental surfaces and subgingival pockets, before polishing the teeth smooth. The reduction in plaque helps minimise the gingival reaction. For some cats, regular dentals like this, in combination with a good oral hygiene routine at home (brushing and using an antibacterial mouthwash) are all that is needed to manage the inflammation. 

Next step, extractions.

For more severely affected cats, or for whom the gingivitis progresses despite adequate oral hygiene, extraction of the premolar and molar teeth where the gums are affected may be the next step. This could mean removing all of the teeth apart from the canines and incisors (or even these in occasional cases).

The idea here is to remove the cause of plaque accumulation, the teeth. This is often very successful and can allow the condition to resolve. We find that, actually, cats will cope remarkably well without the extracted teeth. Owners often note a marked increase in appetite and improvement in demeanour. 

Medical options to try.

In between these two stages, and with unresolved gingivostomatitis despite extractions, painkillers and antibiotics might be used to try and alleviate the inflammation. However, it must be recognised that bacteria are only a component of the disease. Often, the body’s own immune response plays a large part, so these can’t be expected to cure the cat.

Where we are dealing with severe cases that don’t respond to any of the above treatments, we may add in an immunomodulatory drug known as feline interferon. Some cats will respond favourably to this medication, perhaps even showing full resolution of the inflammation.  

The results of virus testing can also impact the cat’s future routine. 

Those identified as having FeLV, FIV, FCV and FHV benefit from good all-round healthcare. Keeping up-to-date with vaccinations, worming and avoiding stress is important. To reduce the risk of transmission by mixing with cats outdoors, you may be advised to keep your cat indoors.

What is the prognosis for a cat with chronic gingivostomatitis?

Many cats with gingivostomatitis can be successfully managed with intensive management and good long-term oral and general care. Sadly, there are occasional cases which are refractory to treatment. In these situations, we must consider the cat’s welfare, if we can’t get their pain under control and help them maintain a good weight, we must consider that euthanasia might be the kindest option. 

It’s possible that with future research, we will obtain a deeper understanding of this condition, and will find new methods to treat it successfully. Regardless, it’s better to try and catch it sooner rather than later, so make sure your cat doesn’t miss his yearly check-ups, the next time he has a booster make sure to ask your vet if his mouth is healthy.  

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