Feline Chronic Gingivostomatitis (FCGS) is a persistent inflammatory disease of unknown origin that affects the gums and oral mucosa. It can affect cats of any age, sex, or breed. Although its exact cause remains unknown, it is widely accepted that it results from an inappropriate immune response to chronic oral antigenic stimulation. The condition is likely multifactorial and may have various underlying triggers.
Some of the implicated factors include systemic pathogens (such as feline calicivirus, herpesvirus, FeLV, FIV, and Bartonella), dental diseases (resorptive lesions and periodontal disease), hypersensitivity to dental plaque, or food allergies. Stress may also play a significant role.
The lesions are typically ulcerative or ulceroproliferative in nature. Gingivitis tends to be diffuse, while stomatitis mainly affects the alveolar, labial, and/or buccal mucosa in contact with dental plaque. In some cats, ulcers may also be observed on the tongue.
What Are the Most Common Characteristics?
One of the hallmark signs of FCGS is inflammation of the caudal oral mucosa. This inflammation often involves the periodontal tissues, causing gingival recession, furcation exposure, increased gingival pocket depth, and both horizontal and vertical bone loss. Dental resorptive lesions are also commonly associated with this disease.
Clinical signs include depression, aggression, reduced social interaction, dysphagia, and anorexia. Cats often appear poorly groomed due to pain while grooming. Additional signs may include halitosis, dehydration, weight loss, and mandibular lymphadenopathy. Affected cats often paw at their mouths or strike at them. They may also show difficulty opening their mouths, with vocalizations during grooming, eating, or yawning. Continuous drooling and the presence of blood in the saliva are other possible symptoms.
How Is FCGS Diagnosed?
Evaluating the cat’s medical history and performing an oral examination under anesthesia are key steps for an accurate diagnosis. Additional tests that help plan effective treatment include intraoral X-rays, blood work (CBC and biochemistry), viral testing, and histopathological analysis of oral lesions.
Cats suffering from FCGS often present with disorexia or anorexia, leading to weight loss. These cats usually prefer soft food. Oral pain is another hallmark, manifesting as vocalizations, refusal to have their mouths handled, apathy, or even aggressive behavior.
A preliminary diagnosis can be attempted while the patient is awake. It’s important to assess the location and extent of lesions to distinguish FCGS from other conditions with similar lesions, such as periodontal disease, pyogenic granulomas, tumors, or systemic diseases. However, because the condition is painful and cats are often uncooperative, an oral examination under anesthesia is typically necessary.
During the anesthetized exam, ulcerative or ulceroproliferative lesions may be observed, which bleed easily on contact. A defining feature of FCGS is that these lesions extend beyond the gingiva and vestibular mucosa, affecting areas such as the caudal oral mucosa, sublingual region, palate, and dorsal tongue. Lesions are usually bilateral, and ulceroproliferative lesions can be large enough to obstruct the view of the caudal areas. Generalized periodontal disease, resorptive lesions, and missing teeth are commonly observed.
It is recommended to record all findings in the medical record and on a dental chart or odontogram. High-quality photographs of all affected areas should be taken and attached to the patient’s file. This helps monitor disease progression and is a useful tool to explain the condition and justify treatment.
What Is the Treatment?
Surgical treatment, along with perioperative medical management, is essential for controlling this disease. It is crucial to understand the core principles of treatment to avoid poor outcomes and caregiver frustration. The main objectives are:
Partial or full-mouth tooth extractions (particularly premolars and molars) are the surgical treatment of choice. The goal is to remove plaque-retaining structures and exposed parts of teeth that should not be in contact with the oral cavity, such as those affected by resorptive lesions or chronic antigenic stimuli like periodontitis.
Early detection and prompt veterinary care are essential to ensure your cat’s oral health. If you notice any signs of dental pain in your cat, do not hesitate to contact us. At IVeM, we’ll be happy to help with proper diagnosis and treatment. Dental health is vital for your pet’s overall well-being!
