Stomatitis in cats: what it looks likesymptoms and treatment of gingivostomatitis

What stomatitis in a cat looks like

If you gently lift your cat's lip, with gingivostomatitis you are likely to see not the thin red line along the teeth typical of gingivitis, but wide areas of deep red, raw-looking tissue. It may be smooth and shiny, covered in ulcers, or lumpy as if overgrown. This tissue bleeds easily when touched.

The most typical location is the back of the mouth: behind the last teeth, on the folds on either side of the base of the tongue (the palatoglossal folds). Inflammation in this area is called caudal stomatitis, and it is the most painful part. You usually cannot see it at home — the cat will not let you open its mouth, and that is normal. Do not try to force it.

What you may notice even without fully opening the mouth:

• the gums around the premolars and molars (cheek teeth) are bright red, swollen and bleed;
• the lining at the back of the mouth is red, ulcerated or lumpy, often on both sides;
• inflammation on the lips, palate or under the tongue — it is not limited to the gum margin;
• the inflammation is disproportionately severe compared with the amount of plaque and tartar: sometimes the teeth look almost clean;
• saliva is thick and stringy, sometimes blood-tinged; the fur on the chin and paws becomes matted.

If you are taking photos for an online consultation, the most useful shot is from the side with the lip gently lifted. Even one such photo helps judge how urgent things are, but the mouth can only be fully assessed under anaesthesia.

Symptoms of stomatitis in cats

Gingivostomatitis hurts all the time, and especially when eating. That is why the first signs are often seen not in the mouth but in the cat's behaviour:

• approaches the bowl with interest but walks away without eating, or suddenly jerks its head back;
• meows or cries out while eating, drops bits of food, licks up only the gravy or pâté;
• drooling, sometimes with blood, a constantly wet chin;
• strong unpleasant breath;
• paws at the face, shakes the head;
• grooms less — the coat becomes unkempt and matted;
• loses weight, hides more, becomes irritable, avoids having its head touched.

Symptoms vary in severity. Some cats keep eating and only change how they eat: they choose wet food or swallow pieces without biting into them. So a preserved appetite does not mean the cat is not in pain. I describe other signs of pain in the article on how to tell if your cat has toothache.

Gingivitis or stomatitis: what is the difference

Both start with red gums, so they are easy to confuse. The difference lies in how far and how severe the inflammation is — and therefore in the treatment.

A cat may have gingivostomatitis, tooth resorption (TR) and periodontal disease at the same time. Affected teeth keep the inflammation going, so each one is assessed separately. More in the article on tooth resorption in cats.

What causes gingivostomatitis in cats

The exact cause of FCGS is still unknown. The most widely accepted explanation is an excessive immune response of the oral lining to plaque bacteria: the cat's body seems to “fight” the plaque on the surface of its own teeth, and the inflammation does not settle.

Chronic viral infections — feline calicivirus (FCV) and feline immunodeficiency virus (FIV) — are discussed as contributing factors. A direct cause-and-effect link has not been proven, but such infections can affect the treatment plan and prognosis.

Gingivostomatitis itself does not spread from cat to cat like a cold. But the viruses associated with it can be transmitted, so where clinically indicated the vet may recommend testing for them.

How it is diagnosed

An initial assessment can be made at the consultation: often it is enough to gently lift the lip to see the typical inflammation. But a painful cat's mouth cannot be fully examined without anaesthesia, and the key answers lie below the gums.

Under anaesthesia I examine the whole mouth, probe every tooth and take full-mouth dental radiographs. The radiographs show what determines the extent of treatment: tooth resorption, periodontal disease, roots left behind after previous extractions. A root left in the bone can keep the inflammation going for a long time, so a plan without radiographs is a plan made blind.

If the changes are one-sided or look atypical, a biopsy is taken: some oral tumours can resemble stomatitis. Viral testing and other investigations are carried out where clinically indicated. Before anaesthesia, as before any planned procedure, a complete blood count, blood biochemistry, echocardiography and abdominal ultrasound are needed — the list may be extended.

Treating stomatitis in cats: why extraction is the core

The best-documented results in chronic gingivostomatitis come from tooth extraction. The logic is simple: the inflammation is driven by plaque on the tooth surfaces, and once there are no teeth in the inflamed area, the immune system has nothing left to “fight”.

The extent is decided individually, based on the clinical picture and radiographs:

• partial-mouth extraction — removing all premolars and molars when the inflammation is concentrated around the cheek teeth and at the back of the mouth;
• full-mouth extraction — removing all teeth if there is also inflammation around the canines and incisors, or if it persists after partial extraction;
• always complete, roots included: radiographs are taken after extraction to make sure no fragments remain in the bone.

According to clinical studies, in most cats inflammation improves substantially or resolves after extractions — but not in all of them: some cats need further medical treatment. That is why I do not promise to “cure it once and for all”; instead, I explain what to expect and plan follow-up.

How cats live and eat without teeth is covered in the article “A cat without teeth”. How dental care for cats works in general is on the cat dentistry page. The stages of treating gingivostomatitis are shown below:

1. 01

   Consultation

   We assess symptoms, weight, diet and previous treatment; pain relief before the procedure is prescribed if needed.

2. 02

   Pre-anaesthetic tests

   Complete blood count and biochemistry, echocardiography, abdominal ultrasound; additional tests where clinically indicated.

3. 03

   Diagnosis under anaesthesia

   Examination of the whole mouth, probing, full-mouth dental radiographs and, if needed, a biopsy.

4. 04

   Tooth extraction

   Partial or full-mouth, guided by radiographs; with local dental nerve blocks and post-extraction radiographs.

5. 05

   Recovery at home

   Pain relief as prescribed, soft food, keeping an eye on appetite and weight.

6. 06

   Follow-up visits

   We assess healing and any remaining inflammation; if it persists, medical therapy is added.

Can stomatitis in cats be treated with medication alone

Anti-inflammatory drugs, including steroids, pain relief and, where clinically indicated, antibiotics can bring quick relief. That matters: the cat eats again, and the procedure can be prepared calmly. But medication does not remove the cause — plaque on the teeth and the affected teeth themselves — so inflammation usually returns once it is stopped.

Long-term or repeated steroid use in cats can have serious side effects, including an increased risk of diabetes. Repeated antibiotic courses without a treatment plan promote bacterial resistance and delay an effective solution. Gels, sprays and rinses do not treat gingivostomatitis — I explain why in the article “Why ointments, gels and sprays don't treat teeth”.

So I see medical treatment as a temporary bridge: before the procedure, when anaesthesia has to be postponed because of other illnesses, or after extractions if inflammation persists. For cats with ongoing inflammation after extraction there are additional therapy options, chosen individually.

What happens after tooth extraction

Many cats adapt well to life without some or all of their teeth: they swallow wet food and pâté easily, and some keep eating kibble without biting into it.

In the first days, pain relief on schedule, soft food and rest are what matter. The oral lining needs time to heal, so the result of treatment is judged at follow-up visits, not in the first week. I set the timing of check-ups individually.

If some teeth (canines, incisors) are kept, they need home care once healed — brushing with a veterinary toothpaste if the cat allows it. More in the article on aftercare following tooth extraction.

How much does treating stomatitis in a cat cost

The cost is made up of several parts: the consultation, pre-anaesthetic tests, anaesthesia, diagnostics and professional cleaning under the COHAT protocol, and the surgical stage. The price of extractions depends on the number of teeth and their complexity, so an exact figure can only be given after dental radiographs.

Frequently asked questions