Feline Juvenile Gingivitis, Juvenile-onset Periodontitis, and Gingivostomatitis
Cats have their own unique set of dentistry problems and we are going to discuss a subset of those problems here that can cause severe pain for the patient and also a lot of confusion among the veterinary community.
Each of these diagnoses are different from one another but one can lead to the next if they are not treated early and aggressively which is why it is so important that they are recognized.
Juvenile Gingivitis
The least problematic of these three diagnoses is feline juvenile gingivitis. This is an early onset of gingivitis is a very young cat often as their adult teeth are erupting. The gingiva can even be hyperplastic and can even overgrow the teeth (hyperplastic). The gingivitis or erythema does not extend to the caudal oral cavity and is only associated with the attached gingiva surrounding the teeth.
The treatment for this disease is a thorough cleaning and assessment of the teeth under anesthesia. The only way to know for sure that this is only gingivitis is with full mouth xrays to assess for any tooth resorption or loss of bone around the teeth (periodontitis). If xrays are normal and a thorough oral exam shows no problems other than gingivitis, then the teeth are cleaned and if necessary a gingivectomy is performed to remove excessive gingiva. Secondly, a homecare regimine is very important. Healthy mouth water additive, daily teeth brushing, and other products as recommended by the Veterinary Oral Health Council (VOHC.org) are instituted to try and reduce plaque and tartar build up. Finally, the cat must be scheduled for regular dental cleanings under anesthesia every 3-4 months until around the age of 2 years old when they usually can outgrow the condition.
If treatment is not initiated many of these cats will then progress to the next stages of disease including periodontitis and/or stomatitis which then requires more aggressive treatment including tooth extractions.
Juvenile-onset Periodontitis
Juvenile-onset periodontitis also affects very young cats (usually starting at adult tooth eruption) but besides gingivitis they also have changes to bone surrounding the teeth (periodontitis), attachment loss of the gingiva to the tooth, and often have tooth resorption. This condition is ultimately differentiated from juvenile gingivitis after a full oral exam under anesthesia and dental xrays are taken but sometimes can be visualized on an awake exam. Again, this condition does not involve the caudal oral cavity and gingivitis and erythema is only associated with the gingiva surrounding the teeth.
Treatment for this condition includes extraction of the teeth with periodontal changes and initiation of a regular daily homecare regimine and frequent dental cleanings and assessment under anesthesia. Owners should be prepared that this disease may still progress and future extractions are not unlikely.
Feline Gingivostomatitis
Feline gingivostomatitis is the most serious diagnosis of the three and the two previous conditions mentioned above can lead to gingivostomatitis if not treated early and aggressively as discussed. The differentiating factor of feline gingivostomatitis is that there is gingivitis or erythema of the caudal oral cavity behind the teeth also called caudal mucositis. This condition can become very severe and is a debilitating, painful disease. While steroids and pain medications can help alleviate the symptoms and pain they do not cure the disease and overtime the condition worsens.
Once a patient has caudal mucositis or stomatitis, the preferred treatment is full mouth extractions. A majority of patients get full resolution of the disease with this treatment, if done properly, within a few months. A small subset of patient may require additional treatments or medications as well. It is very important that this procedure is done by an experienced veterinarian with dental radiographs to ensure that no roots or tooth material is left behind to get the best chance of complete resolution. The earlier this procedure is done and the less time the patient is on steroids, the better the chance of full resolution.
While this treatment may seem extreme, cats do quite well without any teeth. An extensive pain management regimine is used before and after the procedure and most of them go home eating within an hour or two of the procedure. They can be maintained on canned food and some may even still eat small kibble once they are healed. The video below is one of our patients one hour after his full mouth extractions.
As you can see, it is very important to accurately diagnosis these three conditions since the treatment options vary widely. It is also important to diagnosis early to prevent pain and suffering for the patient and for the best possible outcome. These cases, especially feline gingivostomatitis, should be treated and managed by an experienced practitioner and definitely one with digital dental xrays. Finally, even if full mouth extractions are necessary, these patients do very well with proper pain management and treatment.
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