Feline Stomatitis

By Teresa Garden, DVM

Feline stomatitis is defined as inflammation of the mucous membranes of the mouth. It is a painful and frequent problem in cats. Treating stomatitis is frustrating for veterinarians as well as pet owners. It is believed the immune system of affected cats overreacts to plaque, causing severe inflammation in the mouth. Symptoms of stomatitis are decreased appetite, refusal to eat, “chattering” teeth, bad breath, salivation, bleeding from the mouth or gums, trouble swallowing, vomiting, retching, gagging, face rubbing, head shaking, nasal discharge, sneezing, fever, and depression. Your veterinarian may discover enlarged lymph nodes, tooth resorption, and ulcers in the mouth during a physical exam. Sometimes sedation is needed to do a thorough oral exam due to the painful nature of this disease.

There are other maladies that can lead to stomatitis besides a faulty immune system. This disease has been associated with viruses such as Calicivirus, Herpes virus, FIV, and Feline Leukemia. Fungal diseases such as Blastomycosis and Cryptococcus have been implicated. Stomatitis has been associated with diabetes, hypothyroidism, and uremia from renal failure. Certain cancers can cause stomatitis as well as trauma, plant ingestion, and electric cord burns. The majority of cases we see in clinical practice are thought to be immune-mediated or idiopathic…meaning “we don’t know the cause”. Sometimes a biopsy of affected tissue can tell us if cancer or the immune system may be the cause.

The objective of treatment is to identify, remove, and treat the underlying cause of stomatitis. The mainstays of conventional western medical treatment are frequent dental cleanings every 3 to 6 months to remove the offending plaque. Antibiotics are employed to treat concurrent infection, and steroids such as Prednisolone can reduce the painful inflammation. Sometimes full mouth extraction is performed in those cats suspected of having immune-mediated stomattis. Multiple studies have shown this procedure to be effective in only about 50% to 70% of cases. This stat has lead some researchers to ask, “could these cats be reacting to something besides or instead of plaque”?

Ongoing studies are pointing to the likelihood that feline stomatitis is a disease of the bone. “Guided Bone Regeneration” is a procedure that is currently being developed as a treatment alternative for feline stomatitis. The procedure uses oral digital radiography to identify areas of pathology in the bones of the mouth. Once the pathology is identified, radiowave radiosurgery is used to cut soft tissue and expose all the bone pathology. The pathologic bone is then removed. This is followed by a guided tissue regeneration procedure consisting of harvesting the patients own stem cells from fat and then injecting them IV back into the patient. The GBR surgical technique allows abnormal soft tissue to normalize again after pathologic bone is removed. Antibiotics, pain control and a feeding tube are used for 2 weeks post op to help the mouth to heal. Research trials are ongoing at the University of California–Davis. Cornell University is now joining the research project.

Homeopathy and Traditional Chinese Medicine are holistic treatment modalities that can help treat stomatitis. The goal of homeopathy is to prescribe the medicine or remedy that is most similar to the totality of the patient’s symptoms. Symptoms are physical, emotional, and behavioral. It is the homeopathic veterinarian’s duty to take a very careful and thorough history of the patient to obtain current and previous symptoms of the patient. A homeopathic remedy is then chosen which best fits the individual patient.

Remedies are made from natural substances and, if chosen correctly, can produce healing throughout all levels of the patient. Even a well chosen remedy may help to palliate the symptoms if not produce a total cure. And a palliative homeopathic remedy is safer and gentler on the body than antibiotics and steroids which are also only palliative measures.

Traditional Chinese Medicine (TCM) is a system in which the patient is examined and treated based on the knowledge of energy channels in the body (meridians) and points along those channels associated with internal organs. The Qi, or life force, along with blood, flow along the channels to keep the entire individual healthy. Blockages or weaknesses in the channels will cause illness and pain. TCM uses acupuncture and Chinese herbal medicine to treat the patient based on their individual needs. The patient’s diagnosis is determined by doing a complete history, examination of the entire body and by feeling the pulse and looking at the tongue.

Tellington T touch can be useful in improving the quality of life of kitties with stomatitis. T Touch can help relieve pain, promote circulation and improve appetite. T Touch should begin on the top of the head in front of the ears on the midline and then is slowly moved down to the mouth area. One or two fingers move very gently in a clockwise direction in small circles. T Touch can be learned by pet owners and performed daily at home as an adjunct to any other treatments for stomatitis.

Nutritional support is very important for cats afflicted with stomatitis… Pet owners are encouraged to feed high quality canned food that has been blenderized. Foods with “cooling” ingredients are preferred since they can help decrease inflammation in the body and moisten the gums. Cooling foods are turkey, rabbit, clams, salmon, mackerel, kelp, algae, eggs, and seaweed. Foods can be cooked and pureed to increase palatability.

Feline stomatitis has historically been a very challenging disease. It is difficult to discern the underlying cause. Various treatments are employed with less than satisfactory results. It is my hope that new research will shed light on the true cause of stomatitis and, thus, more successful treatment outcomes in the future.

Dr. Teresa Garden is chief veterinarian /owner of Animal Health & Healing, a full-service holistic and conventional veterinary practice in the Maplewood/Richmond Heights area. 314-781-1738.