Inflammation of the Mouth in Cats

Chronic ulcerative paradental stomatitis (CUPS), also known as gingivostomatitis, and oral ulceration are both severe, painful oral diseases that affect cats. The conditions cause the development of inflammation and painful ulcers on the cat's lips, tongue, back of the throat and gums. The condition occurs when the immune system becomes hypersensitive to the oral plaque and bacteria in the mouth. Though poor dental hygiene can cause the condition to occur, it can occur after a routine dental cleaning that loosens the plaque and bacteria from the teeth.

The condition may evolve into lymphocytic plasmacytic stomatitis (LPS), which causes inflammation of the cat's entire mouth. Himalayans, Somalis and Persians are more likely to develop inflammation of the mouth than other breeds of cats.

Stomatitis, or inflammation of the tissues of the mouth, can be caused or influenced by a number of diseases, infections, and injuries and creates a painful condition for cats.

Symptoms may be mild at first before progressing to a more severe form. These symptoms include:

• Frequent drooling with or without blood
• Bad breath (halitosis)
• Red gums
• Swollen gums (gingivitis)
• Inflammation of the fauces in the back of the mouth (faucitis)
• Inflammation of the back of the throat (pharyngitis)
• Ulcers in the inner cheeks (buccal/buccitis mucosal ulceration)
• Loss of appetite
• Weight loss
• Swallowing difficulties
• Thick saliva
• Plaque on teeth
• Pain
• Exposed necrotic bone
• Tongue scarring
• Unkempt coat due to lack of grooming
• Pawing at face or mouth

There are a variety of diseases, viruses, and conditions that trigger the strong immune response that causes the mouth inflammation to occur. These causes include:

• Hypothyroidism
• Hypoparathyroidism
• Diabetes
• Uremic syndrome due to advanced kidney disease
• Squamous cell carcinoma
• Malignant melanoma
• Fibrosarcoma
• Lack of food resulting in protein-calorie malnutrition
• Deficiency of riboflavin
• Retrovirus
• Feline leukemia virus
• Calicivirus
• Feline immunodeficiency virus
• Periodontal disease
• Herpes virus
• Bartonellosis
• Consuming chemicals, acids or thallium
• Wood or bone fragments in mouth
• Malocclusion
• Electric cord shock
• Foreign body

Diagnosing a cat with stomatitis can be difficult due to the pain the cat is experiencing. It's important to take the cat to a veterinarian if any symptoms of CUPS or LPS are present. The veterinarian will ask for the cat's health history, when symptoms first began and a detailed list of all symptoms. If the cat had any accidents, illnesses or injuries that could have caused the inflammation to occur, it's important to include these in the health history. 

The veterinarian will physically examine the cat, carefully examining its mouth and noting any dental problems, such as plaque, that are present. The veterinarian will run several tests, which will include a complete blood count, a biochemical profile, an electrolyte panel and a urinalysis. These tests will help the veterinarian determine the cause of the inflammation. X-rays of the mouth will also be performed. An X-ray can show if any bone involvement is present that can complicate treatment and healing. A small sample of tissue may be removed from the cat's mouth and sent to an outside lab for analysis.

Nutritional and Fluid Therapy

Because the ulcers often prevent cats from eating normally, the cat may need to be hospitalized in order to receive intravenous fluid therapy and nutritional therapy through a feeding tube. These will continue until the ulcerations have healed and the cat is able to eat and drink on its own.

Medication

Corticosteroids will be prescribed to the cat in order to reduce inflammation and reduce the immune system's reaction. Painkillers will also be given to the cat in order to decrease pain levels. Antibiotics and antimicrobials may be prescribed if an underlying infection is causing the inflammation to occur.

Surgery

If the death of bone tissue has occurred, the necrotic bone will need to be removed with surgery. The cat will be placed under general anesthesia during surgery and will be prescribed broad-spectrum antibiotics to prevent infection from occurring. Because the surface of the teeth provides a surface for bacteria to attach, the veterinarian may recommend that cats with chronic ulcerations have their teeth removed to reduce the immune system's response to the bacteria.

The prognosis of cats with CUPS and oral ulceration is guarded as recovery will depend on the successful treatment of the primary condition. The cat will need to follow up with the veterinarian on a regular basis in order to check on recovery and responsiveness to treatment. Cats who have had surgery will need to be on a soft food diet. Preventative treatment will need to occur twice a day in order to prevent bacteria from growing in the mouth and causing the ulcers to form again. Cats will need to have their teeth cleaned regularly by the dentist in addition to at-home care.