Gingivitis stomatitis complex in cats

Oral pain can go unnoticed in our pets as the symptoms may be too subtle for us to detect until disease is severe and debilitating. There are many causes of oral pain, but in cats, gingivitis stomatitis complex is one of the more common and can cause a great deal of pain and discomfort.

Gingivitis stomatitis complex (GSC) is a complicated disease and the cause is not fully understood. It is believed to be an inappropriate immune response to normal plaque and viruses found in the oral cavity. White blood cells are recruited to react to the perceived threat and in doing so they release enzymes that cause inflammation and damage to the gums and tissue surrounding the teeth. This causes severe redness, ulceration and pain of the oral tissues, often at the back of the mouth and around the molars. It can occur in cats of any breed and any age, some as young as 12 months, with symptoms including loss of appetite, bad breath, reluctance to groom and excessive salivation, although often the disease is in advanced stages until symptoms are noticeable. It is important to understand the potential severity of the disease, even when your pet is not exhibiting extensive symptoms, as GSC causes chronic pain and will progress leading to extensive damage of the oral tissues.

Any of us who have had experience of GSC in our beloved pet will know how involved it can be to manage and treat. Plaque control is at the heart of effective management, but for the majority of cat owners, this is not a viable option. Often the mouth is too painful for any manual plaque control such as tooth brushing, and plaque is such a stable biofilm that the bacteria within it are protected from antibiotics. Hence, any improvement of the disease process with antibiotic therapy is likely to be short-lived and may even be counter-productive with the development of resistant bacteria. Anti-inflammatory medication or steroids can reduce inflammation and manage the discomfort, but won’t reduce plaque levels or stop the progression of the disease. Removing some or all of the teeth is currently the management treatment of choice, with some patients showing complete resolution of symptoms. Unfortunately, however, some may continue to need additional long term medical management. This may include oral or injectable anti-viral treatment, anti-inflammatories and chronic/neuropathic pain management.

We all know how difficult it can be to administer medication to cats, and sometimes we are unable to give medication because our pets have other medical problems or can’t tolerate the side effects. Thankfully, there is a new safe and well-tolerated treatment, which provides effective pain relief and anti-inflammatory effects to targeted areas of the body. Used by many dentists, laser therapy involves directing infra-red light into inflamed, damaged or painful tissues. This infra-red light provides energy to the cells within the tissue allowing them to repair more quickly and reduces the transmission of pain signals from the tissue to the central nervous system; having a combined effect on tissue healing and pain. Laser therapy can therefore be used in the management of chronic GSC, to reduce inflammation and pain, as well as post-dental extraction where it provides effective analgesia and improves gingival healing. The treatment takes less than one minute to administer so it can be performed with minimal stress to the patient, and the analgesics effects can be instantaneous. Often several treatments are administered initially to get the maximal benefit, then treatment can continue lifelong on a monthly basis or as required.

A recent study has investigated laser therapy in the management of feline stomatitis. The aim was to assess how effective laser therapy is at treating  GSC and to optimise the treatment protocol. 10 cats with GSC were divided into 2 groups. Both groups were treated with laser therapy twice per week for five weeks, group I had a higher dose (longer treatment) than group II. The cats were given a pain score, and biopsies of the affected tissue were taken before and at the end of laser treatment. Most of the cats showed improvement in their clinical symptoms in the weeks following laser therapy with all having significant improvement 5-6 months after the end of treatment. Interestingly those treated with a lower dose had significant improvement in their symptoms within 2 weeks and even demonstrated major reduction in the number of white blood cells their tissue biopsy samples. Although small, this preliminary study shows that laser therapy can be effective in the management of stomatitis. Although there were different response times in the two groups, laser therapy caused an improvement in the symptoms of all cats including a better appetite, less pain on yawning and less reluctance to groom. You can read the full article here.