Feline Gingivostomatitis

Gingivostomatitis (GS) is a painful chronic inflammatory condition affecting canine and feline patients. GS is not an infection but rather an inflammatory disease thought to be the result of a highly reactive immune response to a variety of antigens that include bacterial and environmental.

Clinical signs of this condition include partial to complete anorexia, halitosis, drooling, weight loss, abnormal swallowing, and oral pain. On examination the oral inflammation is often extensive, affecting oral tissues other than the gingival margin, such as the lip commissures, palatoglossal folds, and sublingual mucosa. See arrows

The differential diagnosis for severe oral inflammation in a feline patient includes: gingivostomatitis, periodontal disease, resorptive lesions (RL's), viral disease (FELV, FIV, herpes, calicivirus), bartonella, eosinophlic granuloma, and neoplasia.

A patient's initial evaluation should include physical examination, CBC/Chemistry, serologic testing for FELV/FIV and a Bartonella test. Next, a dental prophylaxis is performed that includes dental radiographs. Root anatomy is evaluated and all teeth exhibiting RL's are extracted including any root fragments. Finally, tissue biopsies are collected using a 4mm biopsy punch and submitted for histologic examination.

A diagnosis of GS is confirmed by lymphoplasmocytic infiltration on histology. The preferred treatment for GS is surgical extraction of all teeth distal (caudal) to the canine teeth. Medical management alone initially offers a fair clinical response but this diminishes over time.

Extraction therapy is performed in two procedures. A patient will receive regional nerve blocks and mucogingival flap approach of the ipsilateral mandibular/maxillary quadrant to completely remove tooth and root structure. Extraction therapy has shown a cure in 60% of patients and significant improvement in 20%. Refractory causes that have received extraction therapy are managed with cyclosporine or azathioprine to improve patient comfort.