• OVERVIEW

    (For more information or questions, contact Dr. Hewitt at 702.395.1800, or by e-mail at: dr.hewitt@cheyennewest.com)

    Introduction:
    Gingivostomatitis (also called stomatitis, lymphocytic-plasmacytic gingivostomatitis, or LPGS) is an inflammatory condition that can affect the gums, throat, and even the tongue of afflicted cats. The condition can develop at almost any age, and gets progressively worse with time. It has been proposed that certain breeds (Siamese, Abyssinian, Persian, Himalayan, Burmese, and Somali) are more predisposed to these conditions, and/or generally get more severe signs.
    Gingivostomatitis is a condition that is extremely complex, and most cats have multiple factors involved in the development of the condition. It is also important to note that there is no single treatment that is effective for all cats with this condition. The treatments that will be discussed have all been shown to have potential benefits, but the right treatment for an individual cat with this disorder must be based on a careful assessment of the cat’s health, as well as an individual cat’s response to any given treatment.

    Symptoms:
    Gingivostomatitis is a condition that presents as a mild to severe inflammation of one or more of the following areas: the gums, cheeks, throat, and tongue. The symptoms include: red/inflamed tissues that often will bleed easily when touched and are painful. The affected cat may have a rough, dry coat, sometimes with mats, because the cats with this condition often will stop grooming themselves due to the pain in their mouths. These cats may also have drooling, halitosis (bad breath), grinding of the teeth, pawing at the mouth, weight loss, and will refuse to eat certain foods. In severe cases, the affected cats will refuse food almost entirely, due to the pain associated with eating, and will have significant weight loss. Some affected cats may also have chronic or recurrent sneezing, nasal discharge, or discharge from the eyes.

    gingivostomatitis in cats

    Causes:
    Gingivostomatitis is an inflammatory condition that is often essentially a reaction to plaque (which is a combination of salivary proteins and bacterial products/bacteria). However, this is, in most cases, not simply a bacterial infection. Routine dental cleaning and anti-inflammatory medications do not cure this problem. However, these are often an important part of the treatment of this disorder.
    Gingivostomatitis is often a spontaneous onset condition, with no apparent underlying cause. This is called “Idiopathic gingivostomatitis”. However, there are many underlying conditions that have the potential to be associated with this disorder. Many of these conditions do not cause gingivostomatitis, per se, but can cause symptoms that can appear the same as gingivostomatitis. These include:
    Infectious diseases:
    – Bartonella (a specific bacterial infection)
    – Feline Leukemia virus (FeLV)
    – Feline AIDS virus (FIV)
    – Herpesvirus (a feline respiratory infection)
    – Calicivirus (a feline respiratory infection)
    – Feline Infectious Peritonitis virus (FIP)
    – Toxoplasmosis
    – Fungal infections
    Metabolic disease:
    – Uremia (kidney disease)
    – Liver disease
    – Pancreatitis
    – Diabetes
    Physical injury:
    – Trauma to the face/mouth
    – Electric shock
    – Chemical burns
    – Thermal (heat) burns
    Toxic causes:
    – Snake bite
    – Toxic plant exposure
    Immune-mediated diseases:
    – Pemphigus foliaceus or vulgaris
    – Bullous pemphigoid
    – Lupus erythematosus
    Miscellaneous causes:
    – Hyper-immune response or Idiopathic (cause unknown)
    – Drug reaction
    – Neoplasia
    – Eosinophilic Granuloma Complex

    Viral infections (primarily Herpesvirus and Calicivirus) and idiopathic inflammation (spontaneous inflammation with no apparent underlying cause) appear to be very common causes of this disorder.

    One additional note: There are certain forms of oral cancer (lymphoma, squamous cell carcinoma) that can appear very similar to gingivostomatitis, so they must also be considered when planning diagnosis and treatment of this disorder.
    Some of the more significant underlying causes noted above include:
    – Idiopathic
    – Retroviruses: Feline Leukemia (FeLV) and Feline AIDS (FIV)
    – Respiratory virus infection, specifically Calicivirus and/or Herpesvirus

    A quick note on Bartonella. It was previously thought that this bacteria was a significant cause of gingivostomatitis in cats. However, additional research has made the relationship between Bartonella and gingivostomatitis more questionable. Bartonella does, however, cause other potentially significant health problems and should be treated if it is present.

    The majority of cats with gingivostomatitis fall into the category of “idiopathic” or cause undetermined. These may include cats with hyperactive immune system function or other unknown disorders. Further definition of the type of inflammation can be determined by getting a biopsy of the affected tissue, which also helps to rule out oral tumors.

    Testing Recommendations:
    All cats with gingivostomatitis should have the following basic laboratory work done:
    – Complete Blood Count (CBC)
    – Chemistry panel
    – Thyroid screen
    – Urinalysis
    – FeLV/FIV testing
    In addition, it is highly recommended that cats also receive the following tests:
    – Bartonella testing
    – Feline Respiratory PCR Panel
    – Urine culture
    – Biopsy of the affected tissue in the mouth
    In certain specific cases, additional testing may be recommended. This may include Toxoplasmosis titer, TLI/PLI testing (to rule out pancreatitis), or radiographs (x-rays) of the body.

    Treatment options:
    There is no single treatment that works for all cats that have this disorder. However, some treatments are generally effective for the majority of cats with this disease. We will discuss treatments for specific causes of gingivostomatitis first, and will then discuss some treatment options that apply to all cats with this disease.

    Bartonella-positive cats are treated with an antibiotic, generally azithromycin or one of the tetracycline derivatives (tetracycline or doxycycline).

    FeLV/FIV-positive cats: Broad-spectrum antibiotics are used to treat secondary bacterial infections in the mouth.
    In addition, it has been shown that symptoms in these cats can be reduced by administration of interferon, either recombinant form of human interferon (given orally) or a recombinant feline interferon (given by injection).

    Calicivirus positive cats: These cats will also respond to treatment with interferon, as discussed in the above paragraph on FeLV/FIV positive cats.

    Herpesvirus positive cats: These cats will also respond to treatment with interferon, as discussed in the above paragraph on FeLV/FIV positive cats. In addition, these cats benefit from an amino acid supplement called L-Lysine and from treatment with certain antiviral drugs, like famcyclovir.

    General treatments that have potential benefit for all cats with gingivostomatitis:
    – Frequent dental cleaning and assessment of underlying oral health, 1-4 times yearly, depending upon the severity of the disease. Any teeth that have a significant amount of periodontal disease or bone loss will be extracted, because they will be a continued source of inflammation if left in place.
    – OraVet sealant. This product is a wax-like sealant that is applied to the teeth after a dental cleaning, followed by weekly application of a home-care version of the product.
    – Sanos dental sealant. This product is a biologic varnish that is applied to the teeth after professional dental cleaning, and does not require re-application at home.
    – Antibiotics may be given in association with the dental cleaning and assessment noted above, if bacterial involvement is suspected.
    – Home dental care. Home dental care can include antiseptic rinses (CET Rinse, Biotene (DO NOT USE the human version of Biotene available over the counter), Healthy Mouth water additive), dental diets (Hill’s prescription t/d diet), chews (CET Chews, Greenies), and other products made for oral health, such as Maxiguard (a combination of zinc, vitamin C, and amino acids that improves the health of the gum tissues).
    – Extraction of all of an affected cat’s “cheek teeth” (all of the teeth behind the canines, or “fangs”) was shown to have approximately an 80% success rate, to the point where no additional treatment was needed to keep these cats comfortable. However, if there is any inflammation associated with the canine teeth (fangs) or incisors, these teeth are extracted as well.
    – Lactoferrin is a natural product that can help to reduce the excessive response of the immune system that is associated with the inflammation in the mouth. Lactoferrin is present in a product called Biotene (DO NOT USE the human version of Biotene available over the counter), and is also available in certain over the counter products.
    – Steroids such as prednisolone or prednisone will often result in a positive response, temporarily. Cats with gingivostomatitis that respond to steroids will almost always have a progressively decreased response over time. Therefore, steroids may be beneficial for the short term, but for most cats are not long-term treatments. In addition, there is evidence that cats that have been treated long term with steroids tend to have a poorer response to other treatments that are tried later.
    – Immunosuppressive and/or chemotherapy drugs such as azathioprine, cyclosporine, chlorambucil, gold salts, and cyclophosphamide have been used with limited success in some patients.
    – Laser therapy, using a carbon dioxide (CO2) laser has been shown to be beneficial for some cats with this condition.
    – Metronidazole is a specific antibiotic that has activity against the primary types bacteria associated with oral disease, and may decrease certain types of inflammation.
    – Hypoallergenic diets have potential benefits in the rare cases that this condition is related to a food allergy. However, dietary therapy is rarely beneficial for cats with this condition.
    – Dietary supplements, including CoQ10, Vitamins A, C, B complex, E, zinc, and omega-3 fatty acid supplementation. These can potentially help to maintain the health of the oral soft tissues. There is a product specifically designed for this called EFAC (Esterified Fatty Acid Complex) that is both easy to administer and potentially of significant benefit.

    In summary, it is important to repeat that gingivostomatitis is a condition that is extremely complex, and that most cats have multiple factors involved in the development of the condition. It is also important to note that there is no single treatment that is effective for all cats with this condition. The treatments noted above have all been shown to have potential benefits, but the right treatment for an individual cat with this disorder must be based on a careful assessment of the cat’s health, as well as an individual cat’s response to any given treatment. In many cases, treatments are on a trial basis, in order to find out which treatment(s) will be best for each cat.

    Additional information and handouts can be found online at the web sites of:
    The American Veterinary Dental Society – http://www.avds-online.org/resources.htm
    The American Veterinary Dental College – http://www.avdc.org/?q=node/2
    Veterinary Partner web site – http://www.veterinarypartner.com
    Veterinary Oral Health Council – http://www.vohc.org

    Updated December 2011

    CHEYENNE WEST ANIMAL HOSPITAL
    3650 N. Buffalo Dr.
    Las Vegas, NV 89129
    702-395-1800
    Brian Hewitt, DVM