There was no question there was something wrong with 2 year old Tabby Cat’s mouth. His family had let him out in the exam room for about two minutes before I came in, and already the entire room smelled like a sewer. His people were sitting on the bench with scrunched faces, trying to tolerate the stench without passing out. Not only had Tabby’s bad breath progressed to the level of room-clearing, he was now drooling and refusing to eat.

When I looked at his teeth they were in surprisingly good condition, with very little tartar and nothing that was obviously abscessed. His gums on the other hand, where a different story. They were fire engine red and swollen. The insides of his lips were also bright red and ulcerated where they touched the edges of his gums--something known as a kissing lesion. His gums were so tender that the simple act of pulling his lips back caused significant pain.

Tabby Cat was suffering from a surprisingly common disease called stomatitis, a word that literally means mouth inflammation. It occurs in both cats and dogs, but is more common in cats. Animals with this problem are often fairly young and appear to have dental disease far beyond what would normally be expected for their age. For these patients the problem is not so much one of building excessive tartar around their teeth like most animals with ordinary dental disease, but that their immune system is wildly over reacting to the normal bacterial inhabitants of their mouth. When their immune system decides that all bacteria need to be treated like virulent foes it launches an endless war that it can never win because the mouth is always filled with bacteria that are supposed to be there, just minding their own business, who should just be ignored. As the immune system lobs toxic balls of inflammatory chemicals into what it perceives as infected tissues those tissues start to suffer collateral damage. The severity of symptoms ranges from mild gum redness to pain so severe the animal is unable to eat. This continual immune assault also degrades and damages the teeth, so over time they tend to become infected and will rot out. Siamese cats seem to have this problem at a somewhat higher rate than the general cat population, and in many severe feline cases the patients are found to be concurrently infected with Feline Immunodeficiency Virus.

There are a range of treatments available depending on the severity of the problem. Milder cases may respond well to a good dental cleaning followed by regular tooth brushing and antiseptic mouth rinses--especially ones that contain chlorhexadine. Check the ingredient list on any mouth rinses you use to make sure they do not contain Xylitol, a sweetener that is very common and even beneficial in human oral products, but is not safe for use with dogs in particular, and likely is not safe for cats either.

More serious cases may require the use of anti-inflammatory steroids and possibly antibiotics. A round of this type of treatment may give relief for a few months before symptoms return, as they almost always do.

Severe cases tend to respond best to surgical extraction of all the teeth. It sounds radical, but in many cases the problem is permanently resolved and the animal can finally move on with life without suffering continual mouth pain. (Although teeth are required to rend flesh from bone, it requires not one single tooth to subdue and ingest a kibble)

In a few cases even the full mouth dental extraction does not bring complete relief, but even for those patients the symptoms often become much more amenable to medical management with steroids and antibiotics