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What is Enamel Allergy (Stomatitis)?

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.

Symptoms of Enamel Allergy (Stomatitis) in Cats

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

Causes of Enamel Allergy (Stomatitis) in Cats

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.

Diagnosis of Enamel Allergy (Stomatitis) in Cats

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.

Treatment of Enamel Allergy (Stomatitis) in Cats

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.

Recovery of Enamel Allergy (Stomatitis) in Cats

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.

Enamel Allergy (Stomatitis) Questions and Advice from Veterinary Professionals

Spirit
Unknown; was a rescue
Approx 10
Moderate condition
0 found helpful
Moderate condition

Has Symptoms

Lethargy Poor appetite lip lesion

Is the write-up current on stomatitis? I have an elderly cat (he’s a rescue but we’re sure he is a Norwegian Forest). He has one purple lesion on his lip diagnosed as “probably stomatitis”. He has no energy at all, doesn’t play, and sleeps 98% of the day. He uses the litter boxes well. Eats maybe 2 cans of wet Fancy Feast per day. He’s a huge cat, not overweight, just long & big; 18 pounds. He isn’t grooming himself well. He normally hangs with me daily, talking to me in his cat voice. Now, he doesn’t move from his floor bed except to use the litter box & to eat. I’ve gone to two different vets; both had to have their own blood work. One vet gave an antibiotic shot & steroid shot once the blood results were in. The latest vet took blood & gave him an antibiotic shot. Nothing for pain. This vet insists a full mouth tooth extraction including the tiny teeth on the bottom jaw, to ensure the stomatitis doesn’t return. My boy is old. I’m concerned that his jaw could be broken if his lower teeth are removed. The vet didn’t think it would be an issue but if so, “cats tolerate a wired jaw just fine”, I’m told. Does this sound reasonable to you? I need to know whether a full mouth tooth extraction is appropriate (or not) & is it reasonable to assume my boy’s jaw won’t be broken from removing the lower jaw teeth? No biopsy has been done. Thank you for reading my novel.

Dr. Callum Turner, DVM
Dr. Callum Turner, DVM
3314 Recommendations
The write up on this page was done in the last two years, but I am not sure about exactly when it was done; stomatitis is usually diagnosed based symptoms and running blood and urinary tests to rule out other contributing factors. The cause of stomatitis in cats is not really understood well but many cases respond well to antibiotics and prednisone; cats which show no improvement may have some teeth removed or in severe cases all teeth removed. I would find a Veterinary Dentist for an opinion, I’ve added a link to the American Veterinary Dental College which lists all their Diplomates. Regards Dr Callum Turner DVM www.avdc-dms.org/dms/list/diplomates-map.cfm http://veterinarynews.dvm360.com/feline-stomatitis-how-treat-diseae-unknown-etiology

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Murphy
Long Hair Red Tabby
7 Years
Moderate condition
0 found helpful
Moderate condition

Has Symptoms

raw puffy lip
draining eye
Excessive scratching
Scabs

Medication Used

Hills ZD
Enalapril

Quick question, I have two adult cats. One 8yr old female and one 7yr old male both have long hair. The male orange tabby was diagnosed with this a few years ago. The vet extracted his teeth. (all but 3) The vet said that he was allergic to his own saliva sort of speak.
At that same time, he had also started scratching excessively to the point of scabs. (neck, sides, back...) His right eye accumulates sleep that dries and it doesn't go away. Like ever, until it becomes so large it falls away.(I don't dare wipe it for fear of infecting it further) Occasionally his left lower lip swells and appears red.
I should assure you that
1. They DO NOT have fleas. This is NOT a flea allergy.
2. They have been on a diet of only Hills Z/D for the past 6 mos.
3. They are indoors only.
4. We have mostly tile & hardwood floors, some carpeting upstairs.
I have been to SEVERAL vets for his sake to inquire the cause. The first thing they say is, fleas, then food allergy, then environmental allergy. He has been injected with steroids & antibiotics at which point it clears up. Then returns once the injections wear off. One vet said he had an enlarged heart and put him on enalapril. Another vet said if he is on enalapril, they wont give him the allergy injection due to being unsafe for him. Here comes my question....
Is it possible that he is allergic to his own saliva and his grooming is causing all this? Does stomatitis cause itching?
Extensive allergy test can be upwards of $300.
I had him shaved a couple times thinking he was aggrivated by his own fur. Our home is very clean and I vacuum & dust regularly. I don't know what else to do. Thank you for your advice.

Dr. Callum Turner, DVM
Dr. Callum Turner, DVM
3314 Recommendations
At this point I would consider allergy testing, although it is expensive it may be cheaper in the long term if an allergen is identified and can be controlled or eliminated. Common causes include fleas, food and environment which is why it is the go to for Veterinarians since the majority of the time these are the causes; but I would recommend allergy testing, saliva can be an irritant for cats which can cause itching in some cases. Regards Dr Callum Turner DVM

My cat has suffered from constant itching for years along with fur mowing, with the exact same progression of vet guessing that you described (fleas, food allergies, environmental allergies, we may never know, etc.) Finally he started showing signs of stomatitis which we are just now diagnosing and treating. I do believe that since he was allergic to his saliva, the act of grooming himself was spreading his saliva onto his skin and then causing his skin to itch which was then causing him to groom himself more, causing a domino effect that made it worse. This is my hypothesis.

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Steve
Cat, DSH
8 Years
Moderate condition
0 found helpful
Moderate condition

Has Symptoms

pain when eating
inflamed gums for several weeks

Medication Used

depo medrol

I am not sure if my question went through, but My cat has stomatitis and was recently diagnosed with it. I was wondering what causes this. My vet has cleaned his teeth, removed a piece of tonsillar tissue (benign) and has given him 3 Covenia shots. Now she gave him a depo medrol shot yesterday. The next step would either be X-rays or going to a specialist she said. Could you possibly let me know what causes stomatitis in cats and what a good plan of action might be? I am really trying to avoid going to a specialist since my vet said they would probably want to do a CT scan. Any advice or recommendations would be most helpful. Thanks

Dr. Callum Turner, DVM
Dr. Callum Turner, DVM
3314 Recommendations
Generally stomatitis is diagnosed in cats with certain viral diseases and reactions from bacterial activity on plaque; treatment is usually centered around controlling the immune reaction and treating any bacterial infection. Your Veterinarian or Specialist will be able to guide you better regarding Steve’s specific case; treatment in some cases may be unrewarding leading to full dental extraction. Regards Dr Callum Turner DVM

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