Stomatitis in Cats: Deep Welfare and Treatment Guide
What Is Feline Stomatitis?
Feline chronic gingivostomatitis (FCGS, or stomatitis) is a severe, debilitating inflammatory condition affecting the gingiva (gum tissue) and oral mucosa. It extends beyond the gingivae to involve the fauces, tongue, and pharynx in severe cases. The inflammation is characterised by intense, proliferative, and often haemorrhagic tissue. It causes severe, persistent oral pain. Prevalence estimates suggest 0.7-12% of cats are affected; it is the most common cause of severe oral pain in cats.
Aetiology and Immune Response
FCGS has a multifactorial aetiology involving an exaggerated, dysregulated immune response to oral antigens (bacteria, viral antigens). FCV (feline calicivirus) and FHV-1 are associated; Bartonella species have also been implicated. The fundamental problem appears to be an excessive inflammatory response to normal oral bacteria in the context of viral-induced immune dysregulation. This explains why standard periodontal treatment (cleaning) alone is usually insufficient.
Welfare Impact of Untreated Stomatitis
Untreated stomatitis causes unremitting severe oral pain. Affected cats drool, have halitosis, refuse food (causing weight loss and potentially hepatic lipidosis), resent oral examination, become unkempt (inability to groom), and may show behavioural changes including hiding, aggression, or depression. Many owners describe dramatic improvements in demeanour, activity, and grooming after successful treatment — indicating the pre-treatment level of chronic suffering was extreme.
Full-Mouth Extraction
Full-mouth extraction (FME, removing all premolar and molar teeth, and often all remaining teeth) is the most effective treatment for FCGS. Resolution rates of 60% (complete resolution) and a further 20% significant improvement are reported in the literature. Surgery requires meticulous technique (complete root removal; dental radiography essential to confirm complete extraction). Post-operative pain management is essential. Recovery takes 2-8 weeks; cats do well without teeth using gums to manage wet food.
Medical Management and Refractory Cases
Medical management (immunosuppressants, antibiotics, interferon) may provide temporary improvement but rarely achieves sustained resolution. Ciclosporin (Atopica) shows the best evidence among medical options and can be used as a primary treatment or in post-extraction cats that do not fully resolve. Stem cell therapy and laser therapy are under investigation. Cats failing to respond to FME and ciclosporin represent a challenging welfare problem requiring specialist referral and innovative approaches.