Practicing “Toothanasia”

Feline stomatitis prevalence estimates range from 0.7% to 12%, but no direct causes have been proven. Medical management provides palliative relief, but long-term control is rare. This case series evaluated outcome of tooth extraction in 95 cats with stomatitis. Extraction of all stomatitis-affected and otherwise diseased teeth resulted in either full-mouth extraction (FME, n = 60) or partial-mouth extraction (PME, n = 35). Median follow-up time was 231 days. Patients were given effectiveness of treatment (EOT) scores based on clinical sign improvement and need for extended medical management (EMM). More than two-thirds of cats (64/95) showed either substantial clinical improvement or complete resolution of stomatitis, although 44 required EMM (antimicrobial, antiinflammatory, or analgesic) for a finite period. There was no significant difference in EOT between cats treated with PME vs FME. Treatment with antimicrobials, antiinflammatories, or analgesics prior to FME or PME was not associated with EOT scores. Likewise, clinical sign duration had no bearing on overall EOT scores. Cats showing a positive response by their first follow-up visit were more likely to have more positive long-term results. Results support PME if not all teeth exhibit stomatitic lesions, but clients must be educated about the disease’s chronic nature and likely need for EMM.

Global Commentary

Extraction is recognized as an effective treatment for caudal stomatitis; however, its irreversibility worries many pet owners. Steve Holmstrom called extraction “toothanasia” and Colin Harvey “a dentist’s admission of defeat.” Reasonable use of extractions should be a goal for veterinarians and veterinary dentists.

This study provides information for reasonable algorithms in caudal stomatitis management. The results highlight extraction as a logical, effective modality of definitive treatment. An important study detail was that the standard of treatment included not only surgery but also criteria for case selection, pain management, and follow-up.

Many of the cats (even edentulous) required further medical treatment. This is because plaque remains an important causative factor of caudal stomatitis and will accumulate on a cat’s tongue and mucosal surfaces. If plaque is not controlled, glossectomy is certainly not a treatment option, but there are still other conservative methods available: cyclosporine, steroids, or recombinant interferon omega.—Jerzy Gawor, DVM, PhD, FAVD, DAVDC