Kelly is a 5 year old, male, neutered, domestic longhair cat. He lives strictly indoors and is fed a good quality dry food. About 3 weeks ago the owners noted that he was eating more slowly than normal. He would always finish his food but would take a long time. This behavior has progressed and he is now not finishing his food, even the canned foods they have been offering. He has also started to drool and have extremely bad breath. On physical exam he has normal vital signs and has a normal body condition. His weight is down 1 lb since his exam about 6 months ago. Aside from his mouth, his physical exam is normal for a cat of his age. There is severe halitosis. The gums are very red around all the teeth. He grudgingly allows a look in his opened mouth and you see very red tissue in the back of his mouth.

What is Kelly's problem and what is the treatment of choice?

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 Feline Caudal Stomatitis

Kelly has severe inflammation of the tissues around his teeth and in the back of his mouth. This condition is known as feline caudal stomatitis (inflammation of the mouth). It is extremely painful and often causes cats to stop eating, drool, have severe halitosis and lose weight. It can be differentiated from periodontal disease because the inflammation due to periodontal disease will not extend to the back of the mouth, it will only be around the teeth. Biopsy is often done to confirm the diagnosis.

Feline caudal stomatitis is poorly understood. There are several theories on what causes it. These include viral infection, altered immune function, and severe inflammatory reactions to the bacteria in the plaque on the teeth. Most likely it has a combination of causes. Feline leukemia virus or feline immunodeficiency virus infections can be associated with this problem and decrease the prognosis.

Medical treatment seldom results in satisfactory resolution of the inflammation. The most consistently successful treatment is extraction of the teeth. If the canine teeth and incisors do not have inflammation around them, many cats will respond to extraction of all teeth behind the canines. If the canines and/or incisors are involved (as Kelly has), all the teeth need to be removed. Care must be taken to make sure all the roots are removed.

Kelly was started on pain medications pending further treatment. This helped him continue to eat. Routine lab work was all normal. FeLV and FIV testing were negative. He was referred to a veterinary dentist for further evaluation and full mouth extractions. All teeth were extracted.

Kelly has steadily improved since the extraction of the teeth. His mouth is visibly less inflamed. He is back to eating well. He no longer has halitosis and is not drooling. However, his family finds it entertaining that his tongue sticks out a little bit occasionally.

Kelly was one of the lucky ones. Treatment seems to have worked quite well for him. This is not true for all cats. Feline caudal stomatitis can be a very frustrating and painful disease and treatment is often only partially successful.  

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