Page 1879 - Cote clinical veterinary advisor dogs and cats 4th

Stomatitis 943

• Glucocorticoids should not be given PROGNOSIS & OUTCOME Technician Tips
concurrently with nonsteroidal antiinflam- • Acute (classical): generally good to excellent Neck pain is the hallmark sign of this disorder.
VetBooks.ir Possible Complications • Chronic: prognosis is fair to guarded due to of pain-associated aggression. Diseases and Disorders
Avoid neck leads. Be aware of the possibility
matory drugs (NSAIDs) or other potentially
ulcerogenic medications.
prognosis if treated early and aggressively
Client Education
frequent relapses.
Glucocorticoid side effects: polyuria, polydipsia, • A recent retrospective analysis of 74 dogs Warn owners of glucocorticoid side effects;
polyphagia, weight gain, GI ulceration, iatro- with SRMA (Biedermann et al., 2016) they should know that if effects are intolerable,
genic hyperadrenocorticism, and others found more than one-half of dogs had no alternative immunosuppressive treatments are
evidence of relapse after initial treatment. available but that treatment should never be
Recommended Monitoring Approximately one-third of dogs had at discontinued abruptly.
• Neurologic exam every 4-6 weeks. Repeat least one relapse, with up to four relapses
CBC, biochemistry profile, and urinalysis as reported. SUGGESTED READING
needed to monitor for adverse drug effects Tipold A, et al: Inflammatory diseases of the spine in
(e.g., hepatopathy due to azathioprine). PEARLS & CONSIDERATIONS small animals. Vet Clin Small Anim 40:871-879,
• Ideally, CSF analysis should be repeated 2010.
every 4-6 weeks before planned reduction Comments AUTHOR: Mark T. Troxel, DVM, DACVIM
in medication dosage. • SRMA has a good to excellent prognosis EDITOR: Karen R. Muñana, DVM, MS, DACVIM
• In lieu of repeat CSF analyses, serial CRP when treated early.
levels have been used to monitor for • CSF analysis should be performed early in
remission. the course of disease.

Stomatitis Bonus Material Client Education
Online
Sheet

BASIC INFORMATION • Cats with stomatitis often show periodontal a role in disease progression, and control of
disease (p. 776) and resorption of multiple oral bacteria can be a critical contributor to
Definition teeth (p. 982). successful management.
In clinical use, stomatitis is inflammation of the Clinical Presentation • The most reliable treatment in both species is
mucous lining of any of the structures in the extraction of teeth in affected areas ± extrac-
mouth. The term should be reserved to describe DISEASE FORMS/SUBTYPES tion of all teeth, eliminating bacteria-laden
widespread oral inflammation (beyond gingivitis Ulcers and inflammation on gingiva, plaque deposits.
and periodontitis) that may also extend into alveolar mucosa, and mucosa of lip, cheek, and • FCV and FHV infection may play a role
submucosal tissues. tongue in the immune system’s aberrant response
to plaque; 88% of stomatitis cats shed
Synonyms HISTORY, CHIEF COMPLAINT both viruses (versus 21% of cats without
Lymphocytic-plasmacytic stomatitis, gingivo- Pain when eating, yawning, palpation of mouth; stomatitis). FCV polymerase chain reaction
stomatitis (cats); ulcerative stomatitis (dogs); decreased grooming; drooling; weight loss (PCR) assay is positive for 97% of cats with
alveolar, labial/buccal, sublingual, and caudal caudal stomatitis.
stomatitis PHYSICAL EXAM FINDINGS
Cats: DIAGNOSIS
Epidemiology • Poor body condition and haircoat if condi-
SPECIES, AGE, SEX tion is chronic Diagnostic Overview
Adult cats and dogs • Symmetrical, bright red, ulcerated lesions The diagnosis is based on clinical presentation
of gingiva, alveolar, sublingual, labial and (bilaterally symmetrical inflammation that
GENETICS, BREED PREDISPOSITION buccal mucosa (rostral stomatitis), and/or extends beyond the gingiva and mucogin-
• Cats: no known predispositions the area of and lateral to the palatoglossal gival junction into other mucosal linings).
• Dogs: ulcerative stomatitis considered a folds (caudal stomatitis) Anesthesia at the time of initial presenta-
familial disorder in Maltese dogs; terrier • Sometimes affecting the lateral margins of tion allows for biopsy, dental radiography,
breeds more frequently affected the tongue and rostromedial aspects of the professional dental cleaning, and extraction
pharyngeal walls (but usually no hard palate of teeth.
RISK FACTORS involvement)
Cats: sometimes seen in group-housed families; Dogs: Differential Diagnosis
may be pathogen-associated; exposure to viral • Halitosis, drooling, and reluctance to chew • Periodontal disease (p. 776)
diseases such as feline calicivirus (FCV), feline on hard food • Squamous cell carcinoma or other less
herpesvirus (FHV), or feline immunodeficiency • Ulcers most commonly on labial and buccal common neoplasia: usually unilateral (pp.
virus (FIV) mucosa facing plaque-laden tooth surfaces, 711 and 714)
lateral margins of tongue, and palatal mucosa • Eosinophilic granuloma (p. 300)
CONTAGION AND ZOONOSIS adjacent to teeth • Erythema multiforme
Cats: FCV, FHV, and FIV • Ulcers occasionally on areas that do not • Epitheliotropic lymphoma (mycosis
contact teeth fungoides)
ASSOCIATED DISORDERS • Necrosis and osteomyelitis in severe cases • In dogs, stomatitis may occasionally be
• Juvenile hyperplastic gingivitis: cats <1 year a manifestation of autoimmune disease
old, presenting with severe gingival inflam- Etiology and Pathophysiology (pemphigus vulgaris, bullous pemphigoid,
mation and enlargement; unknown whether • Immune-mediated disease related to degree discoid/systemic lupus erythematosus); look
progresses to adult stomatitis of plaque accumulation; plaque bacteria play for other signs of autoimmune disease.

www.ExpertConsult.com