Management of the Stomatitis Patient

Introduction

Stomatitis is recognized mainly in the adult cat characterized by persistent inflammation of the oral mucosa. Purebred cats and cats living in a multi-cat household tend to develop stomatitis at a younger age. Primary differential diagnoses include autoimmune diseases, erythema multiforme, eosinophilic granuloma complex, foreign body reactions, and chemical and thermal burns.

Etiological Considerations

A recent investigation found that 88% of cats with stomatitis were shedding both feline calicivirus (FCV) and feline herpesvirus-1 (FHV-1) in saliva, making these two viruses highly suspicious in playing a role in feline stomatitis. Feline immunodeficiency virus (FIV) and feline leukemia virus (FeLV), however, do not appear to play a role. It has also been suggested that acute and chronic oral inflammation may develop due to a deficient or excessive host response to the presence of plaque bacteria and their toxins. Evidence for a causeeffect relationship between Bartonella and feline stomatitis has not been provided.

Pathogenesis

The presence of polyclonal gammopathy and lymphocytic-plasmacytic infiltrates within stomatitis lesions in cats is indicative of an immune-mediated disease. Serum concentrations of immunoglobulins (IgG, IgM and IgA) are elevated in cats with stomatitis. About onethird of affected cats also have elevated serum IgE levels. In saliva, IgG and IgM concentrations are increased, but IgA levels are decreased which may contribute to the development and/or persistence of stomatitis by reducing the effectiveness of local oral defense mechanisms.

History, Clinical Signs and Oral Examination

Cats with stomatitis often have a long history of inappetence, weight loss, pawing at the face, and oral pain. Clinical signs include mandibular lymphadenopathy, oral, nasal and ocular discharge, focal ulceration of the lips, focal or diffuse oral inflammation involving the gingiva, alveolar mucosa, buccal mucosa, and mucosa of sublingual tissues, tongue, and the area of or lateral to the palatoglossal folds. In severe cases, the inflamed tissues become proliferative, ulcerated and bleed readily. Various degrees of dental and periodontal disease may be present (tooth resorption, gingival recession, periodontal pockets, mobile or missing teeth). [...]