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Full Mouth Extractions for a Cat with Stomatitis, a Frustrating Oral Disease
Biscuit presented to NorthStar VETS due to a chronic decrease in appetite, drooling and weight loss. Awake oral examination showed moderate to severe inflammation of the gingiva, mucosa and caudal oral cavity consistent with feline stomatitis (Figure 1).
Feline stomatitis is a frustrating disease for which there are no guaranteed cures. Among possible treatment options, extraction of teeth (sometimes all teeth, sometimes just the premolars and molars) provides the best chance for a cure. Approximately 20 percent of cases will not be clinically cured by extraction and are categorized as "refractory stomatitis" cases.
The oral lesions associated with feline stomatitis are often mistaken for an oral infection; however, inflammation, rather than infection, is the problem, with infiltrates of plasma cells and lymphocytes. These inflammatory lesions are thought to be the result of a highly reactive immune system. The specific antigen(s) causing the aberrant immune response are unknown. The cause may be multifactorial.
Stomatitis improves when plaque-reduction efforts are made (tooth extraction being the ultimate form of plaque reduction), which suggests involvement of an antigen that is intimately associated with the teeth (i.e., plaque bacterial antigen).
Biscuit underwent full mouth extraction in a single session, and all surgical flaps were closed with 5-0 Monocryl in a simple interrupted pattern (Figure 2A). Six weeks later, the degree of oral inflammation was significantly improved (Figure 2B). Biscuit had gained 1.5 pounds since the procedure, and his owners reported that Biscuit was "like a new cat." All medications were discontinued and Biscuit appears to be a clinical cure after extractions.