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Treating chronic gingivostomatitis in cats

Winer JN, Arzi, B, Verstraete FM.  Therapeutic Management of Feline Chronic Gingivostomatitis: A Systematic Review of the Literature.  Front Vet Sci. 2016 Jul 18;3:54.  (Free article)

Feline chronic gingivostomatitis (FCGS) is a not uncommon condition characterized by prolonged, painful and debilitating oral inflammation in cats.  The cause is currently unknown, but it is generally thought to arise from an inappropriate immune response to oral antigenic stimulation (e.g., oral bacteria, viral exposure, etc.) and potentially multifactorial (e.g., genetic predilection, nutrition, stress, environment, etc.) in nature.

Researchers, and experts regarding FCGS, from the University of California, Davis reviewed the published literature on this topic.  The reviewers devised a grading scheme dependent on evidence-based medicine in order to identify high quality scientific published articles pertaining to FCGS.   Based on this grading scheme, 16 research publications were identified.

These 16 publications were either categorized as medical or surgical treatment regimes. Medical therapy depended on immunosuppression [i.e., corticosteroids or cyclosporine] or immunomodulation (i.e., feline interferon-w, local paramunization with PIND-ORF (parapoxvirus ovis), stem cell treatment, etc.), while surgical treatment involves partial or full mouth teeth extraction.   A satisfactorily consistent and successful treatment regime was not identified likely due to the lack of understanding the underlying cause of FCGS.

Nevertheless, the reviewers agreed that full-mouth or near full-mouth dental extractions is the current standard of care, with only ~ 30% complete remission and ~40% partial improvement to treatment.  A subset of cats remains unresponsive to treatments (~ 20-30%).  The “holy grail” of FCGS research is to discover the cause of FCGS and to identify a treatment protocol that attains a near 100% remission rate.

The reviewers also recommended that the field of FCGS research would benefit from standardizing studies by adopting use of the same quantitative or semi-quantitative scoring system and extending follow-up duration to at least 6 months.

In conclusion, veterinarians should be able to recognize and insist on having high quality evidence-based medicine articles and be able to optimize patient care based on these studies.  In addition, they should keep in mind both the strengths and weaknesses of the current literature when drawing conclusions.  Large prospective studies are needed to compare existing treatments and demonstrate the promise of new treatments.  Further investigation of novel and innovative therapeutics is needed in the field of FCGS research. (GO)

See also:
Arzi B, Mills-Ko E, et al. Therapeutic Efficacy of Fresh, Autologous Mesenchymal Stem Cells for Severe Refractory Gingivostomatitis in Cats. Stem Cells Transl Med. 2016 Jan;5(1):75-86.