The goal of treatment is aimed at decreasing the inflammatory response to dental plaque, which is achieved with tooth brushing,
topical antimicrobials, systemic anti-inflammatory and antibiotic therapy, immunomodulators/-stimulators, laser treatment,
and professional scaling and tooth removal.
Owners may not be able to brush the teeth sufficiently, as patients are often in too much pain for brushing to be practical.
Chlorhexidine products are applied to teeth and gums after brushing. To manage the inflammation and maintain appetite initially,
some cats may benefit from subcutaneous or intramuscular injections of methylprednisolone, but owners need to be informed
about possible side effects with corticosteroid therapy.
Oral administration of prednisone is challenging in the painful patient. Alternatively, transdermal application of prednisone
(ointment rubbed into the pinna) can be used. Some cats may respond satisfactorily to intralesional injection of triamcinolone.
Clinical improvement also may be achieved with oral administration of lactoferrin, which has antibacterial and immunomodulatory
characteristics. Interferon and immunostimulatory agents also have been recommended in cats with stomatitis. Repeated CO2 laser treatment of inflamed oral tissues has been reported to result in dramatic improvement of some cats.
Figure 2: Resolution of inflammation in the same patient two months after full-mouth dental extractions.
Systemic administration of antibiotics is generally advocated (amoxicillin/clavulanic acid, clindamycin, metronidazole and
doxycycline). The use of azithromycin also has been suggested, but further research is required to determine a link between
Bartonella and oral inflammation.
Antibiotics often provide only short-term clinical benefit or can be ineffective in the initial management of inflammation.
Extraction of teeth is indicated in cats that have retained roots and teeth with periodontitis or feline odontoclastic resorptive
Removing healthy teeth is an option for cats with stomatitis that do not respond to medication or when side effects of drug
therapy are not acceptable. Tooth extraction removes the surfaces that retain plaque, thus decreasing accumulation of bacteria
and the associated secondary inflammatory response.
Partial- or full-mouth tooth extraction can be performed depending on the extent and severity of the disease. Under general
anesthesia, the oral cavity is flushed with chlorhexidine solution. Intravenous antibiotics are administered until the patient
can be given oral antibiotics. The animal is evaluated for periodontal disease, FORL and other causes of oral inflammation.
Dental radiographs are obtained to evaluate for alveolar bone loss (periodontitis), locate FORL and identify retained root
tips. Sublingual and oropharyngeal tissues often become swollen from intubation and handling; intravenous dexamethasone may
be administered to facilitate breathing after extubation. Regional nerve blocks are performed to assist in intra- and post-operative
Mucoperiosteal flaps with releasing incisions are raised, and teeth are extracted following alveoloplasty. Debridement of
friable inflamed soft tissue and bone prior to wound closure with an absorbable suture material will aid in rapid resolution
of inflammation. Postoperative pain control is achieved with a transdermal fentanyl patch, and/or injectable and oral morphine
The response to tooth extraction varies from complete resolution of inflammation (60 percent), minimal residual inflammation
and no oral pain (20 percent), initial improvement requiring continued medical therapy (13 percent) and no improvement (7
percent). Most cats tolerate extractions very well and can eat moist and dry food without teeth.
Dr. Reiter is an assistant professor of dentistry at the University of Pennsylvania School of Veterinary Medicine. He is director
of the dental residency program and senior clinician in the dental service. He is a graduate of the University of Veterinary
Medicine in Vienna, Austria. He is board certified in dentistry from the American Veterinary Dental College and the European
Veterinary Dental College.