CONDITION
Stomatitis in Cats
Why this matters now
Feline chronic gingivostomatitis (FCGS) can develop at any age but is most commonly recognised in cats from young adulthood onward. In some cats, the condition develops during adolescence, while in others it may not become clinically apparent until middle age. The onset may be gradual, with mild gingivitis progressing over months to more widespread oral inflammation, or it may present more acutely with sudden reluctance to eat and obvious oral discomfort. Cats with chronic viral infections — particularly feline calicivirus — may be predisposed, though the condition can occur in cats without identified viral carriage.
Without management, stomatitis typically follows a progressive course, though the rate of progression varies considerably between individual cats. Mild gingivitis may slowly extend to involve the caudal oral mucosa, creating the characteristic inflammation of the fauces (the back of the mouth). As inflammation worsens, eating becomes increasingly painful, leading to progressive weight loss and declining body condition. Some cats develop a cyclical pattern with periods of relative improvement followed by painful flare-ups, while others experience more constant, severe inflammation. The condition rarely resolves spontaneously, and the inflammatory process can cause permanent tissue changes including mucosal proliferation, ulceration, and in some cases, bone involvement.
Signals & patterns
Early signals
Subtle changes in eating behaviour
Cats may begin eating more slowly, showing hesitation before biting into food, or preferring wet food over dry kibble. They may approach the food bowl with apparent interest but then eat cautiously or walk away after only a few bites. These subtle changes in eating mechanics can precede more obvious signs of oral pain by weeks or months.
Mild drooling or lip-licking
Occasional drooling, increased swallowing, or repetitive lip-licking may appear as early signs of oral discomfort. In cats, any visible drooling is notable as they normally produce minimal visible saliva. The drooling may initially be intermittent, occurring mainly around mealtimes.
Slight decline in grooming
As oral pain develops, cats may begin to groom less frequently or less thoroughly, as the act of grooming involves the tongue contacting inflamed oral tissues. This may initially manifest as a subtle change in coat condition — slightly duller or less well-maintained fur — before becoming more obviously reduced.
Mild bad breath
The inflammatory process and bacterial involvement in stomatitis can produce a noticeable change in breath odour that may be among the first signs detected by owners during close contact with their cat. Early halitosis may be mild and intermittent.
Later signals
Significant difficulty eating and weight loss
As stomatitis progresses, cats may dramatically reduce food intake, eating only small amounts of the softest available food or refusing food entirely during flare-ups. The resulting weight loss can become severe, with visible muscle wasting and declining body condition. Some cats develop a characteristic head-shaking or crying out when attempting to eat.
Profuse drooling, sometimes blood-tinged
Advanced stomatitis can produce copious, thick saliva that may be tinged with blood from the severely inflamed and ulcerated oral tissues. The drooling may stain the fur around the mouth and chin, and owners may find wet patches on bedding or furniture.
Complete cessation of grooming
Cats with severe stomatitis may stop grooming entirely due to the pain of moving their tongue against inflamed tissues. The coat may become matted, greasy, or unkempt, particularly along the back and flanks where self-grooming is most active.
Behavioural changes and withdrawal
The chronic pain of advanced stomatitis can produce significant behavioural changes including social withdrawal, increased irritability, reluctance to be touched around the head, and reduced interaction with household members. Some cats develop a hunched posture or spend more time hiding.
Click to read about the biological mechanisms
How this is usually investigated
Investigating stomatitis involves confirming the diagnosis, assessing the severity and distribution of oral inflammation, identifying any contributing factors such as viral infections, and evaluating the cat's overall health status to inform management decisions.
Oral examination under sedation or anaesthesia
Dental radiographs
Tissue biopsy
Viral testing
Blood work
Options & trade-offs
Management of feline stomatitis typically involves a stepwise approach, with the choice of interventions depending on the severity of inflammation, the cat's response to initial treatment, and the individual circumstances of each case. Understanding the range of available approaches helps contextualise the decisions that may be discussed with the veterinary team.
Full-mouth or near-full-mouth tooth extraction
Extraction of all premolar and molar teeth (partial extraction) or all teeth including canines and incisors (full-mouth extraction) removes the major source of plaque-associated antigenic stimulation that drives the inflammatory response. This is widely considered the most effective long-term management approach for FCGS, with studies reporting clinical improvement or cure in approximately 60-80% of cats following full-mouth extraction.
Trade-offs: Tooth extraction is a significant surgical procedure requiring general anaesthesia, and full-mouth extraction may need to be staged over two or more sessions. Recovery involves a period of soft food feeding and pain management. While the concept of removing all teeth concerns many owners, most cats adapt remarkably well and can eat soft food comfortably. Not all cats respond completely, and some may require ongoing medical management even after extraction. The procedure is irreversible.
Medical management with immunosuppressive therapy
Corticosteroids, ciclosporin, and other immunomodulatory medications can reduce the inflammatory response and provide symptomatic relief. These medications may be used as primary management in mild cases, as adjunctive therapy alongside surgical approaches, or in cats where extraction has not produced complete resolution.
Trade-offs: Medical management typically provides temporary improvement rather than cure, with symptoms often recurring when medication is reduced or discontinued. Long-term corticosteroid use carries risks including diabetes mellitus, immunosuppression, and other systemic effects. Ciclosporin may be better tolerated for long-term use but requires regular monitoring and can produce gastrointestinal side effects. The need for ongoing medication represents a sustained commitment.
Pain management
Comprehensive pain management is an essential component of stomatitis care regardless of other interventions. This may include non-steroidal anti-inflammatory drugs (where appropriate), opioid-based pain relief, gabapentin, and other analgesic approaches tailored to the individual cat's needs and the severity of their pain.
Trade-offs: Effective pain management significantly improves quality of life and enables cats to eat more comfortably, supporting nutritional status. However, pain management alone does not address the underlying inflammatory process. Some analgesic medications require careful monitoring, particularly in cats with concurrent kidney disease. Finding the optimal pain management protocol may require adjustment over time.
Dental cleaning and plaque control
Professional dental cleaning under anaesthesia removes plaque and calculus, reducing the bacterial antigenic load. Home dental care, where tolerated, can help slow plaque accumulation between professional cleanings. In mild early cases, thorough dental care may slow progression.
Trade-offs: While dental cleaning provides temporary improvement by reducing the plaque burden, it does not address the underlying immune dysregulation and the benefits are typically short-lived without concurrent extraction of severely affected teeth. Home dental care is extremely challenging in cats with painful mouths. Regular anaesthetics for repeated cleanings carry cumulative risk.
Stem cell therapy and novel approaches
Mesenchymal stem cell therapy has shown promising results in some studies for cats with refractory stomatitis that have not responded adequately to extraction and conventional medical management. Other investigational approaches including interferon therapy and various immunomodulatory protocols are being studied.
Trade-offs: Stem cell therapy is not widely available, involves significant cost, may require multiple treatment sessions, and long-term outcome data remain limited. While early results are encouraging in some study populations, this approach is generally considered for cases that have not responded to conventional management rather than as a first-line approach. Availability varies significantly by geographic region.
Common misconceptions
"Stomatitis is simply bad dental hygiene or tartar build-up"
While dental plaque plays a role as an antigenic trigger, stomatitis is fundamentally an immune-mediated condition where the cat's immune system produces an exaggerated inflammatory response to oral antigens. Many cats with severe dental disease do not develop stomatitis, and many cats with stomatitis have inflammation disproportionate to the degree of plaque present. This distinction is important because standard dental cleaning alone is rarely sufficient to manage stomatitis.
"Cats cannot manage without teeth and tooth extraction is too extreme"
While the prospect of removing all or most teeth understandably concerns owners, the evidence strongly supports extraction as the most effective management approach for stomatitis. Most cats adapt remarkably well to eating without teeth, continuing to eat soft food comfortably and, in many cases, managing dry food as well using their gums. The relief from chronic oral pain following successful extraction typically produces a dramatic improvement in quality of life, appetite, grooming behaviour, and social engagement.
"If the cat is still eating, the stomatitis cannot be that severe"
Cats are remarkably stoic animals that may continue eating despite significant oral pain, particularly if they are hungry. A cat that eats slowly, selectively, or with apparent difficulty may be managing considerable discomfort. Some cats with severe stomatitis maintain some level of food intake by swallowing small pieces whole or eating only the softest foods, masking the true severity of their condition. The intensity of oral pain in stomatitis should not be judged solely by whether the cat is still eating.
Understanding that stomatitis is an immune-mediated condition rather than simply a dental problem helps contextualise why management approaches focus on reducing antigenic stimulation (through tooth extraction) and modulating the immune response (through medication). Each cat's response to treatment is individual, and the management plan may need to be adjusted based on how the cat responds. Monitoring appetite, body weight, grooming behaviour, and overall comfort provides valuable information about how effectively the condition is being managed.
Last reviewed: 24 April 2026 · Dr Alastair Greenway MRCVS