"Mimi" was a wonderful, friendly, long-haired tabby cat. She was a regular visitor to the surgery as she had a condition called: gingivitis-stomatitis complex.
"Mimi" was a wee rescued cat and she had had this condition from her kittenhood, likely secondary to a calicivirus viral infection she may have had as a kitten.
She was always so tolerant of her examinations of her mouth, and she had responded well to advised, radical dental surgery. However, "Mimi" did require regular check-ups and treatments for the occasional flare-ups of her painful condition.
Gingivitis-stomatitis complex in cats is a debilitating dental disease causing severe, painful inflammation of a cat’s gums and oral mucosae, the moist tissues that line the oral cavity.
The condition is most frequently diagnosed among cats with certain diseases; Feline calicivirus infection, Feline Bartonellosis, and cats with the Feline immunodeficiency virus and Feline Leukaemia virus. As well as cats with other bacterial infections and health problems, for example Kidney disease, and Feline Diabetes.
These underlying conditions can then cause an abnormal immune response to "plaque", which is the thin coating of bacteria that normally accumulates on the surface of teeth. The immune system becomes overly reactive to normal plaque and this causes severe inflammation in the gingiva, initially around an affected tooth and then quickly progressing to the tissues in the surrounding area. Normally, the immune system doesn’t respond to low levels of stimulation in the mouth, however with this condition it responds violently, even towards normal plaque levels. Immune cells migrate into the gums and mucous membranes causing severe inflammation, swelling, and pain. By the time an owner has noticed the inflammation, it is likely to have spread well beyond the tissue immediately around the affected tooth, also potentially involving the tissues in the back of the mouth too.
Clinical signs and symptoms include oral pain; swollen, ulcerated, and bleeding gums; excessive salivation; blood in the saliva; bad breath; pawing at the mouth; lack of appetite or inability to eat and consequent weight loss.
The condition can occur in juvenile cats as well as in older animals. The age range seems to be from three to 10 years, but you can see the disease in young kittens and in older cats as well.
Pain is obviously an issue, but cats can show their pain in various ways. Affected cats may avoid food or prefer canned food over kibble. Some cats drool or paw at their face and others may stop grooming their coat, resulting in an unkempt appearance. Pain can cause some cats to become aggressive and generally agitated. If the condition remains untreated, the mouth can become so painful that an affected cat will eventually be unable to eat at all, due to oral pain.
Any underlying suspect causes such as Feline calicivirus, Bartonella and feline immunodeficiency virus, feline leukaemia virus and feline diabetes should be checked for, which will require some blood tests. And a biopsy for a confirmed diagnosis along with Dental work may be advised.
Treatment of this debilitating condition will typically involve either one or both of two options depending on the extent of the disease: medical management using drugs to suppress the immune system and control the proliferation of bacteria in an affected animal’s mouth; and /or dental surgery, which is likely to entail removal of teeth, to get rid of the source of bacteria in the mouth. The first and most important treatment generally advised is a thorough dental scale and polish, removal of all the plaque and tartar on the teeth to minimise the immune stimulation. Once the mouth is clean, it must be kept that way, plaque starts to form again within hours, so good on-going dental hygiene is essential. Antibiotics are sometimes useful to reduce the bacterial load in the mouth; however, these are not long-term solution. Anti-inflammatory drugs such as steroids are used to reduce the immune system’s response. In severe or unresponsive cases, the best treatment option may well be dental extractions, removal of the chewing teeth, or possibly even all the cat’s teeth. Once the teeth are removed, the gums will heal, and the mouth will be much more comfortable.
If you are concerned about your cat’s mouth or teeth, do make an appointment to see your Vet as soon as possible. For painful cases requiring treatments, we can still assist you during these difficult times.
Alison Laurie-Chalmers,
Senior Consultant,
Crown Vet