Stomatitis in Cats

Stomatitis is a common condition seen in cats. It causes severe inflammation to the inside of the mouth, gums, and tongue, resulting in pain and reluctance to eat.

Any condition that causes cats to avoid eating can be dangerous. Let’s review the signs and symptoms of stomatitis in cats and what you can do to help your feline feel better.

What is Stomatitis?

Stomatitis, also known as Feline Chronic Gingivostomatitis (FCGS), is a condition where the inside of a cat’s mouth becomes severely inflamed. Unlike gingivitis, which usually affects the gums near diseased teeth, stomatitis affects all of the soft tissues in the mouth including the gums, the back of the throat, the tongue, and even the roof of the mouth.

It’s one of the more unusual cat mouth problems that veterinarians come across, but still affects a significant proportion of cats. The inflammation is painful, and it may lead to a cat not eating due to the intense discomfort.

Is Stomatitis in Cats Deadly?

Stomatitis in cats is rarely fatal. But it is serious and causes problems when not treated due to the pain associated with the disease and the resulting inappetence that arises when cats find their mouth too painful to eat.

It’s theoretically possible that cats could eventually die from not eating, but the vast majority of cats get treatment before the problem becomes this serious.

What Causes Stomatitis in Cats?

Veterinarians do not know the exact cause of stomatitis in cats. There are, however, several things that can make a cat more likely to suffer with it. The most common theory is that cats have an over-reactive immune response to something, and it is this immune reaction that causes the ulcers and inflammation in the mouth.

We do know that infection with Feline Calicivirus makes a cat more likely to get stomatitis. Infection with Feline Immunodeficiency Virus (FIV) or Feline Leukemia Virus (FeLV) may also make a cat more likely to suffer with stomatitis, but the relationship is much less clear than with calicivirus.

It also seems that cats in multi-cat households or outdoor cats that live in colonies may be more predisposed to suffering from stomatitis, but it is not clear if this is because of chronic, low levels of stress, or because these cats are more likely to have and carry viruses.

Although cats often get flare-ups in their mouths as kittens, especially during tooth eruption, most cases of stomatitis occur in cats older than one year old.

Oral hygiene definitely comes into play with cats suffering from stomatitis. Many of these cats seem to have an excessive immune response to the bacterial plaque on their teeth, and reducing the amount of bacterial plaque can make vast improvements to the inflammation in their mouths. In addition, any dental disease that could be increasing inflammation and pain will make it worse, so dental problems in general can complicate stomatitis in cats.

In short, cats are more likely to suffer from stomatitis if they:

• Live in a house with more than one cat
• Are over 1 year old
• Carry calicivirus, FeLV or FIV
• Have dental disease

Symptoms of Feline Stomatitis

Since cats rarely let us look inside their mouths, the first symptom of feline stomatitis is often drooling or pawing at the mouth—which are signs of mouth inflammation and pain. Pet parents often also report a change in the cats eating preferences. Some will start avoiding hard food, some will avoid food altogether. Some may go over to the bowl, take one bite, and walk away.

Sometimes, cats show very few signs of pain, and cat mouth sores are only picked up on a regular physical examination, at a booster vaccination or as part of a routine dental cleaning, when the severe inflammation and ulcers are seen. Cats can put up with a lot of pain without showing symptoms.

It’s rare to see your cat bleeding from the mouth, but severe stomatitis in cats may cause slightly bloody saliva, and if your cat is drooling more than usual you may notice this as patches of blood left behind on bedding, toys, or food bowls.

Other symptoms of stomatitis in cats include:

• Inappetence, or eating only part of a meal
• A reluctance to eat kibble
• Drooling
• Weight loss
• Halitosis (bad breath)
• Poor fur coat due to not grooming
• Pawing at the mouth
• Painful and swollen lymph nodes in the neck

Diagnosing Stomatitis in Cats

If your veterinarian suspects your cat has stomatitis, they will want to do a full physical exam. A veterinarian will need to look inside your cat’s mouth, examine their head and neck, and check over the rest of them to make sure there is nothing else amiss, especially as these cases often present with vague signs.

Stomatitis diagnosis is often made presumptively on the basis of lesions in the mouth and compatible symptoms, but it’s important to look at the teeth to rule out other dental issues.

Sometimes, biopsies of the mouth—taken under general anesthetic—may be necessary to confirm that the lesions are stomatitis and not cancerous. Vets will also want to investigate underlying causes of the stomatitis, such as viral disease.

In addition to a physical exam, most vets will do the following tests:

Blood tests: These tests screen for other conditions and make sure medicines are safe to use. Blood tests also help veterinarians detect FIV or FeLV.

Mouth swabs: A veterinarian may conduct a mouth swab to test for feline calicivirus. They may also take a bacterial swab of the mouth.

Dental imaging: This includes X-rays of a cat’s mouth, gums, and teeth, which will be done while a cat is under anesthesia.

Mouth biopsy: If your cat is placed under a general anesthetic, a veterinarian may choose to conduct a biopsy to test for cancer.

How to Treat Cat Stomatitis

Treating cat stomatitis can be frustrating, and some cats will never fully recover. However, many cats will have some improvement with some simple solutions. Once your vet has diagnosed your cat with stomatitis, treatment usually starts with these simple solutions and works up to more complex treatment processes.

The first step is usually to perform a full dental cleaning and remove any diseased teeth. Once your cat’s mouth is clean, home care with a suitable product is the next step. Your vet will recommend a chlorhexidine-based antiseptic paste that will need to be brushed or wiped onto your cat’s gums and teeth twice daily for life. In some cases, this, along with a full dental cleaning a few times a year, is all that is required to treat stomatitis in cats.

Tooth Extraction for Stomatitis

Unfortunately, some cats are not so lucky. If your veterinarian is not satisfied with your pet’s response to a routine cleaning, they may recommend extraction of all the cheek teeth. This means your cat will keep all the teeth at the font, including the canines, but will lose everything else. This seems like a drastic step to a lot of owners, but nearly 90 percent of cats will improve with this step, with 50 percent being cured and not needing long-term medication.

Rest assured, cats will still eat with their teeth missing—in fact most cats will eat far better once their mouths have settled back down again and they are more comfortable. Depending on the state of your cat’s teeth and the experience of your veterinarian, they may recommend you visit a veterinary dentist for removal of the teeth, as this surgery can be long and complicated.

Medications to Treat Stomatitis in Cats

Lots of medications have been suggested to treat stomatitis in cats, but many of them are a bit hit-and-miss as to whether they work or not.

The most promising is Feline Recombinant Interferon Omega (usually just called ‘interferon’) which helps the body to fight viruses like feline calicivirus. Interferon is an antiviral medication given by injection or a liquid directly into the mouth.

Other possible medications used to treat and manage stomatitis in cats include:

Corticosteroids: Steroids work as an anti-inflammatory. They are usually given in pill form. They have significant side effects and veterinarians try to use the lowest effective dose for the shortest time possible to control the condition.

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): These are either oral liquids or pills given to reduce inflammation in the mouth. They are good pain relief, but shouldn’t be used long-term unless there is no other option.

Cyclosporine: This has historically been recommended but is falling out of favor as it isn’t very effective and has many side effects. It is usually given in oral liquid form.

General Cost to Treat Stomatitis in Cats

The cost of treating stomatitis in cats is variable, as it depends on the individual cat’s response to treatment. On average, simple cases treated without referral to a specialist may cost around $800 each year for repeated dental operations. More complex cases may cost more, up to $1,500 per year.

How to Prevent Stomatitis in Cats

Since it isn’t clear what causes stomatitis in cats, there’s no proven way to prevent it. Good dental hygiene from kittenhood is probably the most effective prevention method.

In addition, keeping your cat up to date with their vaccinations will reduce the chance of them getting feline calicivirus or feline leukemia virus. Reducing cat fights by neutering your pet, and therefore the chance of your pet catching FeLV or FIV, is a good idea, too.

Related Conditions

• Feline Calicivirus
• Feline Leukemia Virus
• Feline Immunodeficiency Virus