Feline oral disease – a pain in the mouth

When we look at the reasons why a cat may be presented to us at the vets, dental disease is certainly one of those conditions that ranks high on our list of complaints. In fact, as many as 80% of cats over 4 years of age have tooth and gum disease. In this article, we look at two common presentations, gingivitis and feline chronic gingivostomatitis, and discuss the clinical signs, causes and treatments available.

Posted: 22 September 2020

Feline oral disease – a pain in the mouth

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1. Feline gingivitis

Gingivitis is the term we use to describe inflammation of the gums in the mouth. It’s most often seen on the gum line where the gums meet the teeth, where you might see a red line or even some bleeding. For many cats and their owners, gingivitis can be quite a frustrating disease to manage and is generally difficult to cure.

What are the signs?

Depending on the severity of the disease, cats will show one or more of the following;

  • Bad breath – we normally refer to this as halitosis. You might notice a particularly unpleasant smell from both the mouth and the coat.
  • Drooling saliva – a cat with gingivitis will be in pain and reluctant to swallow. Saliva may then starts dribbling out of the mouth.
  • Pain – be aware that the cat may react to the pain when being examined or touched. They may often growl or scratch as a result.
  • Reduced appetite – owners may notice their pet avoiding food, despite appearing to be hungry. They can jump back suddenly or growl when eating.
  • Weight loss – if they can’t eat properly, they’ll soon start to lose condition.
  • Dull coat – the fur may appear uncared for if they stop grooming themselves properly.

Five common causes of gingivitis

A. Dental disease

If dental hygiene is poor, plaque soon starts to build up, with tartar and mineral deposits following. Bacteria will start to damage the enamel of the teeth causing the gums to recede. Within a relatively short period of time, the teeth will become damaged and diseased.

B. Feline chronic gingivostomatitis (FCGS)

This is a particularly aggressive form of gingivitis, caused by a hypersensitivity to the bacteria in the mouth (see below).

C. Viral infections

There are several virus infections that can trigger gingivitis, including;

  • Feline Immunodeficiency Virus (FIV)
  • Feline Leukaemia virus (Felv)
  • Feline Calici virus

D. Diabetes

Diabetic cats are more prone to gingivitis due to the high levels of sugar in their bloodstream. The bacteria that form plaque and cause gingivitis thrive on glucose.

E. Genetic predisposition

Certain breeds of cat are more prone to developing gingivitis than others. Some examples include the oriental breeds such as the Siamese, Persian and Somali cats.

What treatments do we recommend?

The golden rule to remember is, the sooner gingivitis is treated, the quicker it will be controlled. Even with feline chronic gingivostomatitis (FCGS), it has a better chance of being managed well if treated in the early stages.

  • Scale and polish – this is often our first recommendation.
  • Dental surgery - if damage is detected, such as cavities, caries, deep gingival pockets, abscesses or loose teeth, you might advise that some teeth are removed.
  • Dental health checks - follow up checks are always recommended.
  • Brushing – the most effective way to keep their teeth free from plaque and gingivitis is to brush them with a soft toothbrush. Don’t forget to recommend a pet toothpaste made for animals.
  • Dry food - diet can have a significant impact on a cat’s dental health. Dry foods tend to be best, and there are some dry foods that have been specially made to help with cleaning teeth. Did you know that at Burgess Pet Care we produce a range of high-quality cat food with Dental Defence Technology? Find out about our range of feline diets here.

2. Feline Chronic Gingivostomatitis

What is stomatitis?

Feline Chronic Gingivostomatitis (FCGS), also known as lymphocytic plasmacytic gingivitis-stomatitis, will cause ulceration of the gums. The inflammation can extend to the back of the mouth, onto the tongue and down into the pharynx. The inflammation persists despite antibiotics, steroids and dental cleaning. It’s an oral syndrome characterised by some classic clinical signs;

  • Pain – especially when eating or opening the mouth. This can be expressed by the animal pawing at the mouth.
  • Dysphagia – affected animals will often have difficulty or discomfort in swallowing. Cats presenting with the most severe and frustrating condition show caudal stomatitis which may extend more caudally in the oropharyngeal area (oropharyngitis).
  • Weight loss – the condition is usually chronic in nature, and animals will tend to lose weight over several weeks.
  • Poor coat and body condition – most cats presented with this condition look debilitated, with their coat unkempt from lack of grooming.
  • Ptyalism – animals will frequently drool saliva.
  • Bleeding – look for evidence of blood in the saliva and around the gums.
  • Oral ulceration – check for ulcerative mucosal lesions located around the teeth, caudally towards the dental arch and lateral to the glossopalatine arches (caudal stomatitis).

What are the causes?

The truth is that FCGS is a multifactorial condition. Chronic oral calicivirus is often present, and there also seems to be an inadequate immune response towards oral antigens of bacterial and viral origin. Chronic oral inflammatory processes are also involved.

A thorough examination of the oral cavity needs to be performed. In most cases this can only be completed if carried out;

  • Under general anaesthesia
  • With radiography – used to determine the extent of periodontitis and the presence of dental resorptions
  • With biopsy of the mucosa – this is primarily to eliminate neoplasia
  • PCR – this is used to identify the presence of calicivirus

How is FCGS treated?

A. Dental Extractions

There is often a debate on which teeth need to be extracted. Some vets recommend a full-mouth extraction, whilst others prefer a more selective approach, and only choose to remove the premolar and molar teeth. Some studies have shown that;

  • 50–60% of cats are cured
  • 25–30% have a markedly improvement
  • 15% do not show any improvement

B. Control inflammation

Around 80% of cats will show some improvement with the use of anti-inflammatory drugs, including long-acting steroids. There is however no evidence that cats can be cured of FCGS with steroids alone. When using this as a long-term treatment, owners should be warned of possible side effects, including diabetes.

C. Control secondary infections

Antibiotics are frequently used and may be prescribed in a pulse therapy form. Some of the common antibiotics of choice include;

  • Amoxicillin-clavulanic acid
  • Clindamycin
  • Doxycycline

D. Analgesia

Typically, NSAIDs and opioids are prescribed, as the condition can be extremely painful. For stubborn cases, gabapentin and amantadine are also used.

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