Gingivitis and stomatitis in cats

What is it?

Feline chronic gingivostomatitis (FCGS) is a chronic, immune-mediated inflammation of the gums and oral mucous membranes in the cat. The condition is painful and can severely impede eating [1]. Up to 26% of domestic cats may be affected; in households with multiple cats, the risk is increased sevenfold [1][3].

Cause

The exact cause is not fully elucidated. Feline calicivirus (FCV) is found in most affected cats, but a direct causal link has not been proven [1]. Presumably, an abnormal immune response to oral antigens plays a central role.

Proven treatment: tooth extraction

Tooth extraction — partial or full — is the most effective treatment currently available. In approximately two-thirds of cases, substantial improvement or complete remission occurs [2][3]. Full extraction of all premolars and molars shows no demonstrable added value over partial extraction [2]. Early intervention, before irreversible fibrosis occurs, yields a better prognosis [1].

Approximately 33% of cats respond insufficiently to surgery [3]. For these refractory cases, there are promising options:

• Ciclosporin — showed 77.8% response in a controlled study [4]
• Recombinant feline interferon-omega — comparable efficacy in the same cohort [4]
• Mesenchymal stem cell therapy — early results are positive, but large-scale data are still lacking [1]

Steroids and antibiotics

Corticosteroids and antibiotics alleviate symptoms temporarily but are not a durable treatment. They are used at most as a bridge — prior to surgery or during short-term pain crises — and do not resolve the underlying problem [1][3].

Natural and complementary options

There are no well-controlled studies demonstrating that herbal preparations, dietary supplements or homeopathy are effective in FCGS. Oral care based on chlorhexidine may be considered as an adjunct to conventional treatment for hygiene, but does not replace a surgical or immunomodulatory approach [3]. Softer food may somewhat alleviate pain perception during eating, but does not treat the inflammation itself.

Complementary here does not mean: an alternative to extraction or ciclosporin. With a proven effective treatment for a painful chronic condition, delay is risky for the cat's welfare.

Measuring treatment response

The SDAI (Stomatitis Disease Activity Index) is the standardised measurement instrument for severity and treatment response. An SDAI score after extraction below 6.5 predicts long-term remission [4]. Pain management is essential around interventions and in refractory cases [1].

When to see the vet?

At the slightest suspicion of FCGS, a veterinary consultation is necessary. The condition causes chronic pain and deteriorates without treatment. See the red flags below for situations requiring acute care.

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Sources: [1] J Feline Med Surg 2023, [2] JAVMA 2015, [3] Front Vet Sci 2016, [4] BMC Vet Res 2025