Feline Stomatitis Frequently Asked Questions
What is feline stomatitis (FS)?
Feline stomatitis is a painful, debilitating, inflammatory, and ulcerative condition of the oral cavity. Feline stomatitis is characterized by an immune-mediated bilateral inflammation of the gingiva and oral mucosa. Inflammation can extend around the dentition and in the caudal region of the oral cavity.
What causes feline stomatitis?
There is no exact cause that has been identified. Various infectious and non-infectious agents have been suspected, however, there is no single identified causative agent. It has long been agreed that feline stomatitis is an underlying immune abnormality, and that the presence of plaque (bacterial film) and calculus are thought to be major contributing factors. Other contributing factors that have been shown to have a causal relationship to feline stomatitis are feline calicivirus and living in a multi-cat environment without outdoor access. Feline stomatitis is also known to be associated with cats that suffer from severe widespread periodontitis and those with retained tooth roots and inflammatory-type tooth root resorption.
How do we treat feline stomatitis?
Medical treatment alone is considered unrewarding and will only show temporary improvement. Depending on the severity of the disease and individual patient factors, the accepted standard of care is the removal of all premolar and molar teeth (partial mouth extraction therapy) or the removal of all teeth (full mouth extraction therapy). Remember, any teeth left remaining will need to be maintained for the remainder of your cat's lifetime.
How long does it take to recover from surgery?
Partial or full mouth extractions are not an overnight cure. Absorbable sutures will be placed that may last approximately three weeks. These sutures also collect plaque bacteria that, in turn, can cause an immune response. However, this "suture-induced" immune response is to a much lesser degree than having normal or diseased teeth present. Post-operatively, medications will help tremendously with the anti-inflammatory response and pain response. Typically, we do not start to see optimal resolution of stomatitis-associated inflammation until the sutures exfoliate and are gone. For this reason, we typically do rechecks at 4-6 weeks post-operatively to see the response after the sutures are gone.
What type of medications can help?
Medications are selected accordingly for every individual case depending on the severity of the disease, age of the patient, other health concerns, patient temperament, and ease of medicating.
Anti-inflammatories: Anti-inflammatories are almost always prescribed whether it be a non-steroidal anti-inflammatory (NSAID) or a steroidal anti-inflammatory. Steroids, such as prednisolone, have the advantage of being faster onset and more effective at reducing inflammation. However, steroids should be used with caution as long-term use is not recommended due to the potential build-up of resistance over time and other common side effects.
Pain control: Pain control will always be used. Multimodal pain management will begin on the day of surgery and will continue with at-home pain control that is chosen on an individual patient basis. Gabapentinoids are readily accepted by most cats when mixed with food. Opioids such as buprenorphine have excellent absorption properties through the oral mucosa. Newer formulations of opioids are now available as transdermal preparations and also come in long-acting 24-hour injections labeled for felines. Fentanyl patches can also be utilized for some cats depending on the ability to medicate them at home.
Antibiotics: Antibiotics are sometimes used on a case-to-case basis. Recall that although the exact cause of feline stomatitis is not known, it is the immune response we are battling and not a bacterial origin. For cats that may have other underlying infections or secondary infections, antibiotic use may be considered.
Immunomodulating medications: Immunomodulating drugs will occasionally be used initially but are the first choice if medications need to be continued after your pet's initial anti-inflammatory therapy is completed. One option is Cyclosporine (Atopica), which is labeled for cats as a once-a-day oral dosing. Another available option is compounded cyclosporine which is made with a different base with chicken flavoring. However, compounded cyclosporine needs to be administered twice a day. Cyclosporine takes longer to have a clinical response and is started with the notion of continuing this medication for a minimum of 90 days to see the optimal response. This is not an overnight cure and requires a longer time commitment, but cyclosporine can provide excellent control and is safer for long-term use when compared to steroids. Recombinant feline interferon has also been used as a helpful medication for our feline patients, however, it is not currently available in the United States. Since the COVID-19 pandemic, the importation of recombinant feline interferon has been difficult and inconsistent.
Other medications: Appetite stimulants, such as mirtazapine, have been very helpful at initially keeping our feline friends eating. Other supplements such as CBD have anecdotally been shown to have a positive effect on overall well-being.
Clinical Trials: Promising results have been shown with the use of feline stem cells as a long-term control or even possibly cure for feline stomatitis. More research is needed at this time, and clinical trials are underway. This therapy is not yet commercially available, but may be possible in the near future!
