Enamel Allergy (Stomatitis) in Cats

Cats who develop stomatitis form severe swellings and lesions on the inside of the mouth. Although the actual cause of stomatitis is typically unknown, a prevailing theory is that the symptoms of the disease are caused by an allergic reaction to either the plaque, enamel, or roots of the teeth, and it is sometimes referred to as an enamel or plaque allergy. This disorder is often resistant to attempts at treatment and in many cases, leads to an extraction of all of the teeth in order to return the animal to a manageable quality of life.

Stomatitis is the inflammation of the gums and mucous membranes of the mouth and may be caused by an allergy to the enamel or roots of the teeth, or the plaque that forms on the teeth.

This disorder usually does not occur until the cat has reached adulthood, although juvenile cases are reported. Juvenile onset often corresponds with the eruption of the adult teeth at around three to five months of age. Symptoms of stomatitis can include:

• Bleeding gums
• Difficulty eating
• Excessive drooling
• Foul breath
• Grossly inflamed gums 
• Lesions on gums 
• Loss of appetite
• Pawing at mouth 
• Reluctance to groom
• Unkempt appearance
• Weight loss

In severe cases, the lesions can extend down to the back of the mouth and the throat areas. 

Types

One of the treatments that is often attempted is the use of steroids to reduce the symptoms. This can be accomplished in different ways, each with their own benefits and drawbacks.

• Daily steroids - This can be given orally or be administered by cream, however, high dosage, long-term use as would be required for stomatitis can lead to the development of diabetes
• Long-lasting steroids - Steroids may be administered by intramuscular injection and is frequently used to treat allergic-response skin conditions as well; depending on the formulation and the specific cat’s reaction, these treatments can last from a month to two or three months but often decrease in efficiency over time

The final cause of this disorder is often unknown. Prevailing theories include an autoimmune disease or an allergy that causes the cat’s body to reject the proteins that make up either the plaque found on the teeth or to the teeth themselves or infection by the Feline Immunodeficiency Virus (FIV),  Feline Leukemia Virus (FeLV), or a calicivirus. Environmental stress and genetic differences may also play a role in the development of this disease.

The preliminary diagnosis of this disorder is generally made based on the oral examination, which is typically done under anesthesia. The symptoms of this disease can be very similar to a number of other issues, however, and underlying issues may also require treatment. Tests that are used in the diagnosis of stomatitis can include:

Biopsy

A biopsy of the area with lesions is often taken and evaluated to eliminate the possibility of cancerous growths.

Blood Tests

Tests will be run on the feline’s blood to detect viruses such as Feline Leukemia, caliciviruses, and FIV. Standard blood tests may also detect underlying conditions such as kidney disease or bacterial infections such as bartonellosis. 

X-Ray Imaging

The imaging of the oral cavity by radiograph is of particular importance when dealing with cases of stomatitis. This is typically done at the diagnostic stage to determine the viability of the roots and to determine if any of the teeth have been reabsorbed. If the teeth are extracted, it is crucial that no portion of the tooth is left behind. In some cases, just a few roots of the teeth can lead to the reoccurrence of the symptoms.

Several treatments can be attempted to ease the symptoms of this disease, although in many situations the full extraction of the teeth is required to restore the animal’s quality of life. Treatments that may be attempted to save the teeth include:

• Antibiotics - Antibiotic therapy is known to give some relief to animals with stomatitis, but the relief is generally temporary; antibiotics may also be used after a tooth extraction to reduce the possibility of further infection
• Cleaning - Both daily care and frequent professional cleanings are required for this therapy to work, and it is rarely enough to curb outbreaks adequately to maintain quality of life
• Immunosuppressant drugs - Immunosuppressants have shown to be useful on a small percentage of the feline population with this disorder, however, side effects from the treatment can include severe anorexia and bone marrow suppression
• Steroid treatments - Steroids are only really helpful in these situations if given over the long term; the problem with this is that steroids become less effective in treating stomatitis over time and long-term steroid use in cats is also linked to a higher incidence of feline diabetes

The cat who undergoes the removal of the teeth will require medication to handle the pain and inflammation, and in many cases will also be prescribed an antibiotic to treat or prevent bacterial infections.

When your recuperating patient returns home from a tooth extraction, ensuring that they have a quiet, calm setting to return home to will help speed recovery. Patients that are recovering from anesthesia may have coordination difficulties at first and are often initially confused and disoriented. Isolation from other pets and from children may be advised until the medication has fully cleared your companion’s system. Cats who have lost their teeth are often able to eat even dry foods quite effectively after a time as they build up calluses on their gums. When your cat first returns home, a diet of wet cat food, dry food moistened with broth, or unseasoned human grade food such as chicken is recommended and some cat owners find it easier to simply continue the softer diet throughout the cat’s life.