CONDITION

Feline Stomatitis

Why this matters now

Feline stomatitis most commonly appears in cats between two and eight years of age, though any age can be affected. The condition often develops gradually, with owners initially noticing subtle changes in eating behaviour or grooming before more obvious signs emerge. While not immediately life-threatening, the pain associated with stomatitis can severely impact quality of life and nutritional status.

Early stages may involve mild gum redness that progresses to widespread oral inflammation affecting the tissues behind the teeth (caudal stomatitis), the gums, and sometimes the tongue. As the condition advances, eating becomes increasingly painful, leading to weight loss and deterioration in coat condition. Some cats develop cycles of flare-ups and partial improvement, while others experience persistent severe inflammation.

Signals & patterns

Early signals

Reluctance to eat hard food

Cats may approach their food bowl with apparent hunger but then hesitate, eat cautiously, or prefer softer options.

Dropping food while eating

Difficulty chewing or pain when food contacts inflamed tissues may cause food to fall from the mouth.

Bad breath

Oral inflammation and secondary infection often produce noticeably unpleasant odour.

Decreased grooming

Cats may groom less frequently or incompletely, leading to coat changes, as mouth discomfort interferes with normal behaviour.

Later signals

Weight loss

Persistent pain limits food intake, leading to progressive weight loss even when appetite appears present.

Drooling or blood-tinged saliva

Severe inflammation may cause excessive salivation, sometimes with visible blood staining the fur around the mouth.

Pawing at the mouth

Some cats paw at their face or mouth, apparently trying to address the source of discomfort.

Visible red, angry tissue when mouth opens

Even brief glimpses may reveal intensely inflamed, sometimes proliferative tissue along the gums and back of the mouth.

Click to read about the biological mechanisms

How this is usually investigated

Diagnosis involves oral examination, often under sedation for thorough assessment, along with investigation into potential underlying viral infections and other contributing factors.

Oral examination under sedation

Purpose: Thorough assessment of the mouth requires sedation or anaesthesia in most cases, allowing visualisation of all oral surfaces and assessment of dental health.
Considerations: Enables grading of inflammation severity and identification of which structures are affected. Often combined with dental assessment and potential treatment.

Dental radiographs

Purpose: X-rays assess tooth root health, identify hidden dental disease, and help plan any dental extractions that may be indicated.
Considerations: Important for understanding the full extent of dental involvement and planning surgical approaches if needed.

Viral testing

Purpose: Testing for feline immunodeficiency virus (FIV), feline leukaemia virus (FeLV), and sometimes calicivirus can identify factors that may influence management.
Considerations: Viral status may affect prognosis and treatment decisions, though stomatitis can occur in cats without positive viral tests.

Biopsy and histopathology

Purpose: Tissue samples can confirm the inflammatory nature of lesions and rule out other conditions such as oral tumours.
Considerations: Generally reserved for cases where diagnosis is uncertain or response to treatment is unexpected.

Blood tests

Purpose: General health assessment and evaluation of parameters that might indicate chronic inflammation or immune dysfunction.
Considerations: Helps assess overall health status and may identify concurrent conditions requiring attention.

Options & trade-offs

Management ranges from medical therapy to surgical intervention, with tooth extraction often providing the best outcomes for many cats despite seeming a dramatic step.

Medical management

Anti-inflammatory medications, pain relief, antibiotics for secondary infection, and immunomodulating drugs may provide temporary improvement.

Trade-offs: Can help manage flare-ups but often does not provide lasting resolution. Long-term medication use has various considerations including potential side effects.

Dental cleaning and treatment

Professional dental scaling, polishing, and treatment of any diseased teeth addresses bacterial accumulation and dental pathology.

Trade-offs: May provide some improvement but typically insufficient alone for true stomatitis cases. Regular repetition often needed.

Partial or full-mouth tooth extraction

Removing teeth eliminates the surfaces against which the immune system appears to react, and provides long-term resolution for many cats.

Trade-offs: A significant surgical procedure, but often the most effective long-term solution. Many cats show dramatic improvement and manage well without teeth. Some cats do not fully respond even to extraction.

Dietary and supportive care

Soft food, pain management, and nutritional support help maintain body condition while managing the condition.

Trade-offs: Essential supportive measures but do not address underlying disease. Important adjunct to other treatments.

Common misconceptions

Misconception:

"Stomatitis is caused by poor dental hygiene"

Reality:

While dental disease can contribute to oral inflammation, true stomatitis reflects immune dysfunction rather than simple hygiene failure. Affected cats often develop severe inflammation despite reasonable dental health.

Misconception:

"Cats cannot survive without teeth"

Reality:

Cats adapt remarkably well to eating without teeth, even consuming dry food by crushing it between their gums. Quality of life often improves dramatically once the painful teeth are removed.

Misconception:

"Tooth extraction is too extreme and should be a last resort"

Reality:

Evidence suggests earlier extraction may actually produce better outcomes than prolonged medical management. The teeth appear to be part of the problem in many cases.

Cats showing signs of oral pain, eating difficulty, or visible oral inflammation may benefit from examination under sedation to assess the extent and nature of the problem. Understanding the diagnosis helps inform discussions about management approaches, which may range from medical therapy to dental surgery depending on severity and response patterns.

Last reviewed: 24 April 2026 · Dr Alastair Greenway MRCVS