#stomatitis

My friend @last-laments has a cat, Sassy, who has been diagnosed with stomatitis, an autoimmune disease. Her body is attacking her teeth, so she will need most if not all of her teeth pulled. This surgery alone will cost around $1150. She also will need medicine.

My understanding from the vet was just extractions of the teeth that are inflamed if it is what he thinks it is (not full mouth extractions), but that may have been a misinterpretation. Further research into it, and I think I'm going to ask about full mouth extractions if it isn't ruled out as something else. From what I'm seeing, trying to manage it long-term without them can backfire at any time. But I am guessing I won't even know for sure until he has already been put under anesthesia. (2/?)

How do I politely go about ensuring that the person doing the procedure is experienced enough? I was seeing a lot about how you need to make sure they get the root. My clinic is great, & there is a vet there that has special interests in feline medicine & dentistry. Her credentials look good & it says she primarily does surgeries there. Should I ask about it before the cleaning/XRay/extraction appointment, or should I wait to ask about full mouth extractions? I'm lost on the logistics. (3/3)

gettingvetted here.

Every cat is an individual regarding stomatitis. Some cats only need the inflamed teeth removed and they never have another issue especially if strict medical management (immunosuppressants, superb at-home dental care) is used. Some cats will eventually need all of the teeth removed (although the canine teeth are typically left behind, since for some reason they don’t tend to be as problematic).

In general it is much more difficult to remove a healthy tooth than a diseased tooth, so it is debated whether removal of all the teeth, even if some of them are still healthy, is a good idea in stomatitis patients. I don’t think it’s wrong to do that, but it’s not my approach. Why would I lengthen the anesthesia time, cause more pain, and prolong the healing of my patient for a set of problems that may never happen?

If a clinic is offering the dental procedure, their staff is experienced enough to perform it. Why would we offer something we cannot do? It is important to remove the entire root during every extraction, not just full mouth extractions or extractions in stomatitis patients, so making sure to remove the entire root would not be something unusual surrounding stomatitis cases. It sounds like your vet knows what she’s doing. If you wanted to ask *something*, you could say that you were reading about full mouth extractions and wanted to know if it was a good idea for your cat. You could also ask how many stomatitis patients does your doctor see that end up needing full mouth extractions over time?

So Trooper, the special needs kitten who is deaf, cross-eyed, clumsy, and neurologically impaired, has a new issue to add to his repertoire: stomatitis. Stomatitis is an extremely painful oral disease in which ulcerations form on the gums and in some cases on the throat or tongue. It is more commonly observed in senior cats with periodontal disease, but can occur in cats of any age.

Cats with stomatitis find it painful to eat, groom, and open their mouths in general. Trooper has always had difficulty chewing, which we thought was part of an old jaw injury he suffered as a kitten, but his extremely foul breath and reluctance to groom himself suggested more was going on.

One of the most effective ways to manage stomatitis, in addition to anti-inflammatory and antibiotic treatment, is the removal of the molars are premolars, which often harbor bacteria that can worsen symptoms. So, two days ago, Trooper had all but his canines and a few incisors removed. He is already finding it much easier to eat soft food, and overall seems more comfortable.

Mate, if I could tell you exactly why autoimmune disease develops, I’d probably have a Nobel prize and a million dollars.

Best we can tell in cats, is that it’s one of the quirks of the species that some cats, and it may be up to 50% of cats if they live long enough, have an immune system that overreacts to antigenic stimulus (infection, calculus etc) on the teeth and at the gum line. You can get very exaggerated immune responses (eg plasmacytic-lymphocytic gingivitis) and even Feline Odontoclastic Resorptive Lesions (FORLs), where cells are stimulated to dissolve the tooth, or the ligament holding the tooth in place.

Sometimes removing the antigenic stimulus (regular teeth cleaning, low allergen diets) and cortisone or immunosuppresants help, but a lot of the time we end up removing most or all of the teeth. Then there’s nothing for the immune system to bother with, and the cats live happily ever after.

gettingvetted here.

gettingvetted here.

Stomatitis is a non-specific term meaning inflammation of the mouth, and there are lots of things that can cause it to various extents. In cats this includes but is not limited to:

trauma (chewing pointy or caustic things)

Renal failure (uremia)

Immune mediated disease

Respiratory viruses

Immune system suppressing viruses

infection in the mouth (tooth root abscesses, gingivitis)

severe peridontitis

osteomyelitis

certain toxins

So there’s a bit of a list for why your cat might have stomatitis. Renal failure requires blood tests to detect, but then to figure it out you’re left working down the list with one test after another. You can’t be certain why a cat has stomatitis until you’ve ruled everything out, which may ultimately include biopsy of the gums.

It might be that a lower antigen load in the mouth has reduced symptoms, but I can only speculate. Some cats end up being treated with long term steroids, and some end up having all their teeth extracted to fix teh problem.