Feline Gingivitis 

Like any animal, cats are prone to tooth decay.

A large majority of tooth decay is caused by diet, especially consumption of large amounts of low fibre food (e.g. tinned). Providing adequate amounts of raw chicken necks or beef chunks will ensure the teeth are kept clean. Alternatively, a prescription diet food will suffice. Gingivitis is a common problem in certain pure bred cats, including British Blues, Siamese, Bengals and Abyssinians. Gingivitis occurs from 12-18 months of age and normally progresses in spite of treatment. Dental extractions are common by 2 years of age. There are two types of results from gingivitis in cats; resorptive lesions (shrinking tooth roots) and stomatitis (inflammation of the mouth) and these are discussed below.

The images (Fig 1-6) show the various stages of gum disease or gingivitis.

1) Feline Dental Resorptive Lesions (FDRL) 

This is a very painful condition afflicting cats. The gum around the tooth becomes inflamed and looks as if it grows into the neck of the tooth so weakening it. It is possible to ‘fill’ these holes, but it is often necessary to remove the tooth. This is apparently a modern disease of cat teeth and is not seen as commonly in feral or wild cats in their natural environment. No one knows why this should occur, but one theory was that some cat food manufacturers put up to 10 times the recommended allowance of certain salts in food to make it more appealing. This can lead to the production of bladder stones resulting in lower urinary tract disease. To counter this, they add urinary acidifiers to prevent the salts from crystallising in the urine. It is possible that it is the acidifier damaging teeth and causing the neck lesions. This was only a theory, and is probably not correct, but if it were true, then using a diet that didn’t carry excess salt and therefore had no need for urinary acidifiers would help prevent these lesions. Vomiting which will result in stomach acid attacking teeth may also have a role in the development of resorptive lesions. The causes of this are obviously complicated, and it is a condition which requires more research.

Varying stages of resorptive lesions (Grades 2 to 4 left to right)

 

2) Feline Chronic Lymphocytic Stomatitis

Gingivitis is an inflammation of the gum and can become very painful in cats. It can occur for a variety of reasons but most commonly due to:

- Over-reactive immune system i.e. due to a hypersensitivity to plaque bacteria by the cat
- Under-active immune system i.e. immunosuppression due to viral infections such as those caused by calicivirus, feline leukaemia or feline aids.

Where the immune system is hypersensitive to bacteria, the gingivitis can be controlled by reducing plaque bacteria numbers on teeth either by using a dry diet that reduces plaque or by using antibiotics to reduce plaque bacteria number. Alternatively , tooth extraction would not enable plaque bacteria to gain a foothold in the mouth. Another approach is to calm down the body’s hypersensitive response to the bacteria by using steroids. Some complementary therapies claim they can modulate the immune system by calming a hypersensitivity. In immunosuppression, plaque bacteria are able to invade much further into the gums resulting in gingivitis. Antibiotics will help redress the balance, but there is often a sinister underlying cause to immunosuppression such as feline leukaemia or feline AIDS. Again, foods which reduce plaque bacteria on teeth will help to control the extent of the gingivitis.

Stomatitis in cats (mild to severe) 

Treatment

First line therapy involves teeth cleaning above and below the gingiva as well as strict home care and treatment (extraction) for those teeth affected with grades 3 and 4 periodontal disease and/or feline odontoclastic resorptive lesions.

Currently, the only treatment that will deliver consistent results of 70% cure without the use of follow up medications, are extractions of all the teeth distal to the canines. In addition to extraction, all quadrants are flapped and a bur is used to remove a trough of bone where the roots were, thus removing most of the keratinised gingiva, periodontal ligament and periradicular alveolar bone. In those non-responding, all teeth are removed. When extracting the teeth meticulous attention must be paid that, all tooth substance is removed. Intraoral radiographs should be taken before and after surgery. Additionally, the alveolar socket should be "smoothed down" with a high-speed drill bur before resuturing the gingiva. Postoperative application of flucinonide 0.05% (Lidex Gel) to the gingival margin helps in the healing process.

Drugs - Antibiotics (clindamycin 5mg/kg q12hrs), Metronidazole, amoxicillin, ampicillin, enrofloxacin, tetracycline, Corticosteroids: Prednisone 2mg/kg initially daily followed by every other day. Methylpredinsolone acetate 2mg/kg q 7-30 days may also help control inflammation. Gold Salts (Solganol: Shering 1mg/kg im every week until improvement (up to four months) then every 14-35 days), megestrol acetate 1mg/kg, levamisole, cyclophosphamide, Cyclosporin-A, chlorambucil 2mg/m2 orally every other day or 20 mg/m2 every other week, vitamin therapy, aspirin, megestrol acetate, Bovine Lactoferrin (40mg/kg) applied to the oral mucus membranes, and CO2 laser therapy have been used with inconsistent long term results. Lack of permanent response to conventional oral hygiene, antibiotics, anti-inflammatory drugs, and immunosupressives is typical. Cases of gingivitis are readily treated with a broad-spectrum antibiotic. Antirobe^® is recommended and is available in liquid form for oral administration.

In cases of stomatitis, treatment is aimed at restoring normal mouth flora (healthy cat's mouths have predominantly Pasteurella multocida, 50% of cats with stomatitis have spirochaetes), trying to eliminate FCV, and shifting the immune response back to type 1. For the latter, it is not a good idea to use corticosteroids, but a non-steroidal anti-inflammatory safe for use in the cat (e.g. Metacam^®). In cases of gingivitis with an hereditary cause, palliative treatment with Depo-medrol injections may alleviate some of the symptoms in the short term. In cases which don't respond to medication, surgery is usually required.