Feline Stomatitis – how to stop the pain

As I write this, my cat Raven is zipping around the living room playing and talking to himself. I know cats often do that, but Raven hasn’t been lately. This is made even more remarkable when you consider that he had a major surgery to remove all his molars and premolars and the connecting periodontal ligaments a little over a week ago. Raven feels good, better than he has felt in over a year. It warms my heart to see him happy again.

Feline stomatitis is the most painful disease in cats. Cats with stomatitis have severe inflammation in their mouths and sometimes back into their throats, far beyond normal dental disease. What makes it even worse is that because it effects the mouth, many cats with stomatitis don’t want to eat.

There are three main types of stomatitis.

  1. Juvenile stomatitis effects kittens and very young (less than a year and a half) cats. It is usually inflammation around the molars and premolars. This form of stomatitis can usually be cleared up by daily brushing and care of your cat’s teeth. It often times can be resolved by the time they are two years old with good care and never come back again.
  2. Rostral stomatitis effects mostly the front of the mouth and teeth. There is severe inflammation in this form of the disease, which seems to be more of a reaction to the bacteria and plaque on the teeth. This form of disease can be quite painful and lead to secondary infections as well. Rostral stomatitis can be completely cleared up if all the teeth are pulled. I have another cat, Melody, who had this form of disease. I had all her teeth pulled ten years ago when she was two and she has done great. She has no pain or inflammation. Rostral stomatitis can also be managed with very good dental care and antibiotics. This usually involves professional dental cleanings every six months, daily brushing and occasional antibiotics. In many of these cats it makes more sense to pull the teeth.
  3. Caudal stomatitis is the last type of this disease and the most severe. This is the form Raven has. It involves severe inflammation and ulceration around the molars, premolars and usually the oropharynx and throat behind the teeth. This form of stomatitis is chronic and usually impossible to completely resolve. With no treatment many cats will stop eating and die from the severe pain and inflammation.

Here is a link to an article with some great photos of stomatitis (warning – somewhat graphic)
Feline Stomatitis

So how do you treat caudal feline stomatitis?

I tried to treat this disease just holistically in Raven and while I feel like I bought some time I do believe that this disease needs to be treated with extraction. By the time I scheduled Raven to have his teeth pulled, he would often scream while eating if he was not on pain meds. He did better once I started making my own cat food for him but clearly he needed something that would permanently remove the pain. The best prognosis is in pulling the teeth early in the disease process.

  1. The best thing you can do is to see a veterinary dentist. These professionals really know what they are doing. The procedure being done by most of these dentists is to remove all the premolars and molars and the periodontal ligaments. I know it sounds like a big surgery but these poor cats are in so much pain and they immediately feel better. Raven went home the day of surgery on pain meds and was already playing again. It is very important to make sure that no roots are left when the teeth are pulled. If you go to a dentist they will make sure that no roots are left and remove the ligaments as well. This gives the best prognosis for a pain free life. Raven’s dentist, Dr. DuPont, gave a 80% chance that once Raven recovered he would be able to live a normal life with no medication even though he would still have some inflammation in the mouth. This can vary on the severity of disease, how long it has been going on and if steroids have been given or not.
  2. Get the teeth pulled as soon as possible. The sooner the teeth are removed, the better the prognosis. Really! They do so much better without the teeth.
  3. Avoid giving steroids. Many vets recommend steroid injections for this disease and the steroid will clear up the symptoms for awhile. However Dr. DuPont told me he has found that the prognosis gets worse for every steroid injection that is given. It may be that cats with more severe disease get more steroid injections so it is hard to put a direct cause and effect on this. The cats with the best prognosis have not had steroids. Raven had only had one steroid injection so his prognosis was still pretty good but it would have been even better without that one shot.
  4. Follow the protocol given by the dentist after the teeth are removed. This often is a few weeks of antibiotics. I know it is hard to get drugs down a cat but it is important to get proper healing and clear up any infection
  5. Get your cat on a grain free canned food diet. This helps to decrease the inflammation in their body and can help to reduce the inflammation in the mouth. I have Raven on a mix of mostly my homemade cat food – see Making Crazy Awesome Homemade Cat Food, and occasional Instinct canned cat food, and Rad Cat raw food. Avoid anything with bone bits as they can irritate the tissue in the mouth of these cats.
  6. Consider herbal treatments if there is still severe inflammation after the teeth are pulled. I was able to control the inflammation in Raven’s mouth successfully with Hoxsey like formula with Agrimony and Yellow Dock Root for about six months. This formula helps to pull blood away from inflammation, decreasing the inflammation, and heal mouth ulcerations. I hope I do not need to use it now that Raven’s teeth are gone but I am hopeful that if he has any flare ups I can get it under control with these herbs.
  7. Use pain medication if needed. The most common pain medication given is buprenorphine. Some vets use Metacam but usually given long term it will start to destroy the kidneys and is not a good choice for long term use.

Why does this disease occur?

We don’t know. It is more common in certain breeds of cats like the Siamese and Abbyssinians. It is more common in cats who had rough starts to life as kittens.

There may be viral factors involved but we don’t know for sure. Cats with FIV and FeLV have more problems with it. Cats with stomatitis are more likely to test positive to herpes and calici viruses then normal cats.

It does seem to have an autoimmune component. The immune system is overreacting to the plaque and bacteria or fighting against the teeth or ligaments holding the teeth themselves. Is there an allergy component to it? Maybe. I found Raven’s inflammation would flare up with any grain in his diet.

Someday we may have the answers and in finding them a better way to treat this disease. In the meantime, pulling the teeth is the best we have and well worth it for our cat companions’ comfort.

Update 11/16/13 – A reader recently asked me how Raven was doing and I realized it would be good to add an update. Raven is now five years old – it has been about 2 1/2 years since his teeth were pulled. His mouth looks great and he has shown no symptoms of any pain ever. He is a happy, energetic boy! We are lucky.

12 Responses to “Feline Stomatitis – how to stop the pain”

  1. Jennifer Says:

    That does not sound like fun for the poor guy. I’m so glad Raven is feeling better!

  2. Michelle S Says:

    Having had two cats come down with sudden onset caudal stomatitis within a few months of each other (one had just had a dental less than a year prior), I’m constantly searching for more information/answers. Both cats are long term fosters (guess that the term foster no longer applies now), and the 5 year old FIV+ cat responded very well to extraction of all but the canine teeth. The senior (NOT FIV+), has not. He only has the upper canine teeth remaining. In fact, we were back at the Vet today for another sterioid injection and round of meds.

    We’ve been grain free for some time (also eliminated all but a few ingredients), so I can’t help but start to look at other additives such as vitamin/minerals, etc. as possible culprits. I’ve accidentally learned that antihistamines have provided some relief (used to stimulate appetite), so to me it looks like a reaction to SOMETHING that I could eliminate if I knew what it was. This particular cat actually had two acute pancreatitis attacks after being treated with Revolution when he first came to me a few years ago, so there’s no doubt that he is sensitive to chemicals.

    I’d love to hear more about your experiences, because quite frankly, I’ve already decided that this is the last time I will put this sweet boy through this if I can’t come up with a solution that truly returns his quality of life.

    I’d love to learn more about your experiences

  3. Lena McCullough, DVM Says:

    Hi Michelle,
    I think the fact that the antihistamines helped doesn’t necessarily mean that there is something he is allergic to that is being blocked but more about their actions on tissues and appetite. If you are concerned about something he is reacting to you could try home cooking for a month, perhaps with a meat source that you normally don’t feed and see if he does better. I found that a homemade raw really helped Raven when he was bad. Raw food can help to reduce inflammation. If you have access to a holistic vet you may also want to consider some of the possible herbals for this disease such as Hoxsey like formula. Also if you aren’t addressing pain that would be something else to treat. I’m found that the earlier you can get the teeth and ligaments if possible the better they do. I have two stomatitis cats and both had all or almost all teeth removed before three years of age. They are both asymptomatic now. The dentists I have talked to also say that the prognosis gets quite poor for resolution if many steroid shots are given. Unfortunately with a rescue or foster you don’t always have control over this. Sometimes all we can do is supportive care for infection and pain. This is a bad disease and I hope someday we have more answers.
    best wishes,

  4. April Williams Says:

    I’ve been searching for a while for a treatment for my cat, Waldo’s stomatitis. He has the more severe type. He’s had his teeth extracted and it only helped temporarily. He’s been getting steroid injections for several years now. I have spent so much money on his comfort and I’ve grown disillusioned. Now I’ve gone through a divorce and have no income and can’t afford the injections anymore. I am considering having him put down. I hate to do it as he really is a sweet cat, but I don’t know what else can help him. We have tried so much and nothing seems to help. I have 6 cats in all , all rescues and none of them have this except him. He’s around 10 years old now. I’m so depressed about losing him, but I don’t want him to suffer. I know how painful this condition is.

  5. Lena McCullough, DVM Says:

    I’m sorry April. As you know even with money this is a very hard disease to treat. In our area we have some non-profits that help people with medical care for their animals until they can get a job again. There may be something in your area that can help with that. You may also want to talk to your vet about letting you do the injections yourself. Sometimes that is a cheaper option. I wish I had more to offer.
    best wishes,

  6. Sally Horvath Says:

    I really appreciate this excellent and informative article on feline stomatitis. I have two cats (mother and son) who both had to have full mouth extractions five years ago. Yes, it was very expensive (over five thousand for two) but I would do it again in a minute because they began to eat almost as soon as they got home and were pain free. I would caution on who you choose to do this procedure however. My local vet told me any vet can pull teeth but you need someone who is a specialist in feline stomotitis and board certified. It is quite an intricate procedure requiring very expensive high tech equipment that most vets simply don’t have. If all the roots and ligaments are not removed completely it will be for nothing. It will be expensive no matter who does the procedure so why not go to the best. I ended up driving from Akron, Ohio to Columbus just to have this done. Anyway, I encourage anyone who loves their cats to have this done so they can live pain free lives.

  7. Lena McCullough, DVM Says:

    Hi Sally,
    I have found the same thing – make sure you get someone to remove teeth who knows what they are doing. My first cat, Melody, actually had a very skilled tech remove her teeth which is highly unusual to find but I had seen his work and knew he could get the roots, my other cat Raven I took to our veterinary dentist. I am glad your two did so well after full mouth extractions. I am lucky to also have two cats who have done very well. Thanks for sharing your experience.
    best wishes,

  8. Kathy Says:

    We found an abandoned black kitten who had all her permanent teeth. Few weeks later I noticed foul mouth odor and a knot on one side of the lower jaw bone. First vet was not sure what it was but thought she may have bit in to an electrical cord. Placed her on antibiotics, then a refill, then a different antibiotic. Horrible odor and infection continued. Ended up extracting the lower teeth on that side. Knot went away. Infection throughout mouth still and more antibiotics. Took her to my long time vet where I used to live. He said if she had all teeth extracted would end up with rubber jaw. No culture done since she had been on antibiotics. This vet prescribed more med and could not help sent me to a different vet where my solution there was to sedate, xray and then probably just take out the teeth. Still horrible odor and infection oozing. I ended up taking her back to first vet. She extracted all but the canines and cleaned them in hopes they would be ok. Month later after med was gone this kitten had so much infection I almost had her put down. My hubby called me while I was at the vet to tell me to do whatever it took to save her. He knew that dime a dozen little black kitten had me wrapped. I had the remaining canines extracted and she was spayed. She eats hard kitten food because it is small and it is what she prefers. She will not eat any canned or packaged food. I still try to give it to her regularly. She does not have rubber jaw! Just a funny little mouth. Unfortunetly some of the infectious drewel damaged a small part of the gum tissue/lip area. She is now 2 years old and doing great without her teeth. Her name is Angel and I absolutely love and adore her.

  9. Stacia Says:

    I came across your site looking up other solutions for our stomatitis kitty. It was found about 9 months ago, after I found 2 swollen lymph nodes. It was severe around his molars and the dental vet came in as a second opinion. They said and it looked like hamburger. So we had his molars and pre molars removed. About 3 months ago they went on grain free dry food, very small kibble, he will not eat wet food at all. Very picky kitty on wet food, and has got to the point he won’t eat it period. I took him for a regular check up and wanted to discuss on getting a rabies shot, he has always had a weak immune system, he is negitive for FIV and Feline Lukema (sp?) And has been tesr 3 seperate times cause he is chronically ill. The vet we saw said that he looked to be healing good from the surgery and stomatitis. We got the 3yr rabies since he was doing so well and it is a state law. A month later he started having episodes of pain. I took him in and the vet examed him and found the stomatitis is back full on. The vet agreed that the rabies shot probably caused it to return full force. We gave him a steriod and pain shot, he didn’t have anymore pain episodes but after looking at his teeth just to see how he was doing his front teeth now have the stomatitis around them, I plan to get him into the vet as soon as possible, but I wanted to see all his options before removing his front teeth. But I don’t want him in a lot of pain. My poor kitty has been through so much for being only 2 1/2 yrs old.

  10. Lena Says:

    I wish I had a good option that didn’t involve pulling the teeth, but I have found over and over again that getting rid of the teeth is the best and everything else is just prolonging the decision to pull them.

  11. Stacia Says:

    That is what I am coming to see. I am just scared that after remove the rest of his teeth that we will still be battling this. He is a sickly kitty and always has been since we adopted him. He is the most loving cat you can ever meet. I hope that this extraction, when we are able to get it done, it will almost completely cure his of this. He has been on everything antibiotic wise for Upper Respiratory Infections, that he has a resistant to it. And as everyone knows steroids suppress the immune system, which he has also been on with the stomatitis. He has a vet appointment tomorrow so we will get him something for the pain until they have a appointment open for the extraction.

  12. Lena Says:

    My own girl Melody had all her teeth removed at the age of 2 years old because of stomatitis (yes I have two of them, adopted Melody knowing she already had it). She was an extremely sickly kitten which often goes along with this disease, still is chronic upper respiratory and the last year has been battling on again off again sinus infections. She is now 14 and thankfully has been fine as far as the pain and gingitivis, her mouth is perfect. She also is about the sweetest cat I have met. Seems like the chronically sick often are. Good luck with everything:-)