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Tooth extractions and stomatitis in cats

Jennings, MW, Lewis JR, et al. Effect of tooth extraction on stomatitis in cats: 95 cases (2000-2013). J Amer Vet Med Assoc. 2-15 Mar 15; 246(6):654-660.

Dental disease is one of the top medical conditions of cats. Stomatitis is different from gingivitis and periodontitis in that the inflammation in the mouth extends into the nongingival tissues and may further extend into the caudal portions of the oral cavity. This inflammatory condition is also frequently severe and chronic. Cats can experience oral discomfort or pain, loss of appetite, drooling, weight loss, poor haircoat, and bad breath as a result. While certain viruses, i.e. feline calicivirus, seem probable to have a relationship in its development, no direct cause has been established as a single factor and multiple causes are more likely.

This study evaluated a large number of cases over an extended time period to best determine reported response rates to tooth extraction and medical management in cats with stomatitis. They also wanted to verify if there was a difference in outcome when partial mouth extraction (PME) was performed versus full mouth extraction (FME). Ninety-five cases met the inclusion criteria for the study. Cats were categorized according to response to treatment.

The median postoperative follow-up time was 231 days. Six cats (6.3%) of the 95 had no improvement, 25 (26.3%) has little improvement following tooth extraction and extended medical management (EMM). Post tooth extraction, 37 (39%) had substantial clinical improvement and 27 (28.4%) cats had complete resolution of stomatitis; of this group, 44 (68.8%) required EMM for a finite time period to achieve the positive resolution. The extent of tooth extraction in this study, PME versus FME, was not associated with overall response to treatment.

Under EMM, the main categories utilized were primarily antimicrobials, then anti-inflammatories, and finally analgesics. Most of the cases received just one category of therapy, some a combination of two types, and 2 cases received all three medications. In all three categories, no individual antimicrobial, anti-inflammatory, or analgesic had better effectiveness that could be considered clinically relevant. While helping control oral discomfort associated with stomatitis, medical management initiated prior to tooth extraction did not appear to have a significant long term impact on response.

The results of the study emphasized the need for tooth extraction as a definitive treatment for stomatitis. Further, most patients will need extended medical management following tooth extractions to achieve significant or complete resolution of their oral inflammatory disease. If improvement in behavior of the cat was noticed on early follow-up examinations, these cats were also likely to have better resolution of their disease. The extent of tooth extraction was not related to the overall response to treatment. Therefore, extracting teeth in the area of inflammatory lesions alone is most likely a better approach. (VT)

See also:
Lyon KF. Gingivostomatitis. Vet Clin Am Small Anim  Pract. 2005 Jul; 35(4):891-911.