Page 1881 - Cote clinical veterinary advisor dogs and cats 4th

944 Stomatitis

10 mg/kg PO q 48h provides good control
in animals that relapse.
VetBooks.ir treatment, extract all remaining teeth, and
• If there is no improvement with initial
start prednisone treatment 0.5-1 mg/kg PO
q 12-24h, tapering down to the lowest dose/
frequency that controls clinical signs.
Nutrition/Diet
• Soft food during healing
• Esophagostomy tube placement if severe
oral discomfort precludes prehension and
chewing of food
Drug Interactions
Do not combine glucocorticoids and NSAIDs.
Possible Complications
STOMATITIS In a cat with inflammation of gingiva, alveolar mucosa, and labial and buccal mucosa, the
palatal mucosa immediately adjacent to the cheek teeth also is inflamed. There is severe plaque and calculus • Outcome is unpredictable. Some patients
accumulation and loss of attachment on cheek teeth (gingival recession, periodontitis). (Copyright Dr. Alexander have poor quality of life regardless of
M. Reiter, University of Pennsylvania.) treatments.
• Exacerbation of pre-existing infections
comfort together with pain medications; (toxoplasmosis, FIV) due to immunosup-
Initial Database if possible, avoid depot formulations pressive drug use; other adverse effects of
• CBC, serum chemistry profile, urinalysis to (methylprednisolone 1-2 mg/kg SQ) due to glucocorticoids
rule out distant organ disease or systemic long-term side effects (e.g., diabetes mellitus,
disease; hypergammaglobulinemia due to congestive heart failure). Recommended Monitoring
polyclonal gammopathy is most common. • Daily home oral hygiene with topical anti- • Glucocorticoids: monitor for adverse drug
• FIV and FeLV tests for cats septics (chlorhexidine gel or zinc ascorbate effects.
gel PO q 12h) and/or antimicrobials (e.g., • Cyclosporine: assess blood levels after 4-6
Advanced or Confirmatory Testing amoxicillin-clavulanate 13.75 mg/kg PO weeks and every 6-12 months thereafter
Biopsy of representative lesions; mixture of acute q 12h); nursing care (nutritional support, (target levels at 12 hours post blood sample
and chronic inflammatory cells (particularly grooming) are > 300 ng/mL)
lymphocytes and plasma cells); rule out • Re-exam 1- 2 weeks after initial treatment; if
autoimmune disease or neoplasia significant improvement, continue home oral PROGNOSIS & OUTCOME
hygiene regimen (including toothbrushing
TREATMENT if tolerated) and re-examine the patient in Variable; response to full-mouth or almost
3, 6, and 12 months. full-mouth extraction: 28%-60% fully cured,
Treatment Overview 20%-38% clinically cured (some inflamma-
Extraction of selected (partial-mouth extraction) Chronic Treatment tion, no need for further medical therapy,
or all teeth (full-mouth extraction) to remove Cats: but continued home oral hygiene), 13%-26%
the plaque-retentive surfaces; up to 80% of cases • Extraction of otherwise healthy teeth (partial- slightly improved (but needing further medical
improve after tooth extraction. If extraction mouth or full-mouth extraction) therapy), and 7% unimproved (nonresponsive)
is not an option or is ineffective, treat with • CO 2 laser: effective in selected cases of
strict plaque control, immunomodulators, ± severely proliferative disease but requires PEARLS & CONSIDERATIONS
antimicrobials. multiple anesthesia sessions ± placement
of an esophagostomy tube (p. 1106) Comments
Acute General Treatment • Recombinant feline interferon (Virbagen • Tooth extraction provides the most reliable
• Initial approach with anesthetized oral Omega, Virbac): vial of 10 MU is injected results without long-term side effects; partial-
exam, dental radiographs, biopsy (if not in a 100-mL bag of sodium chloride and mouth or full-mouth extraction should be
already performed), extraction of diseased frozen in ten 10-mL aliquots; client gives 1 considered as an early option.
teeth (e.g., those with periodontal disease, mL orally every 24 hours for 100 days; the • Affected dogs and cats usually show decreased
tooth resorption), and scaling/polishing of 10-mL fraction in use is refrigerated, and appetite or abnormal oral behavior but
remaining teeth the other aliquots are kept frozen until usually do not stop eating; rule out other
• Pain management with opioids (e.g., trans- needed causes of anorexia/hyporexia (e.g., chronic
mucosal buprenorphine 0.01 mg/kg q 6-8h • Cyclosporine (Neoral 2.5 mg/kg PO q 12h kidney disease, neoplasia) before surgery.
[cats], 0.02 mg/kg q 6-8h [dogs]; codeine as a starting dose) resulted in improvement
2 mg/kg PO q 8h), gabapentin 5-20 mg/kg in 85% of cats with refractory stomatitis. Prevention
PO q 8-12h • Bovine lactoferrin spray 6 mg/CAT PO q • Good home oral hygiene program may
• Glucocorticoids (prednisolone 0.5-1 mg/kg 12h and piroxicam 0.3 mg/kg PO q 48h decrease the inflammatory response in at-risk
PO q 12-24h; taper dose slowly over months in combination resulted in improvement in animals.
to determine the lowest dose that controls 77% of cats. • Exercise caution when introducing new cats
clinical signs). Alternative is nonsteroidal Dogs: into the household with unknown oral health
antiinflammatory drugs (NSAIDs) (e.g., • Some dogs may start to develop lesions (and or FeLV/FIV status.
meloxicam 0.1 mg/kg SQ or PO on first oral pain) soon after initial treatment; in
day, followed by 0.05 mg/kg PO q 24h), such cases, metronidazole 20 mg/kg PO q Technician Tips
but NSAIDs should not be combined with 24h for 1-2 weeks may help, then gradually • Home oral hygiene is challenging for cats
steroids. Either may temporarily provide reducing the dose. Continuous treatment at and dogs with painful, inflamed mouths.

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