Caring for cats with gingivitis

My mother's cat Tom, who had herpes, also had gingivitis and my mother never really investigated why his mouth smelled bad. By the time he was rehomed to me, he had bad periodontal disease as well as a gum inflammation and we had to remove all of his teeth. This was expensive and scary to contemplate but it was the best thing I ever did for him. Once he recovered sufficiently from his herpes outbreak - this took months - he went for extractions. Today, he has his lower canines, because these are still healthy and the risk of breaking the jaw is high during extractions and still has his incisors but all of his carnassial (chewing) teeth and upper canines are gone. This doesn't stop him from eating kibble, which he prefers to eat. He was already swallowing it whole before tooth extraction because his mouth was too painful to chew anything so I make sure that the kibble isn't too large and he eats his food as normal. It is possible that the herpes was the cause of his gingivitis, some of the respiratory viruses that cats get are suspected to damage the immune system and cause overactive allergic responses.

Tom says that having teeth is overrated

Gingivitis or stomatitis, or to give it its full name: Feline Chronic Gingivostomatitis, is a rather misunderstood disease in cats. Many people think of it in human terms as an oral hygiene problem but in fact, it is more of an autoimmune disease in cats - an allergic response to plaque. While plaque is controlled in humans by brushing, this doesn't help much with cats because firstly, not many cats will actually allow you to brush their teeth after every meal and secondly, it is normal for plaque to form in the mouth and brushing reduces plaque quantities but even a tiny quantity of plaque is going to cause a problem if a cat is allergic to it.

Cats and dogs are different to humans in that they are capable of renewing their dentin throughout their lives so they don't get holes in their teeth the way we do and there is a constant cycle of breaking down and renewal within the tooth. Unfortunately for cats with gingivitis, the inflammation accelerates the breaking-down process and there is no renewal so their teeth don't develop holes, they simply crumble. This is called tooth resorption and it is very painful for cats. It is a common side effect of gingivostomatitis, along with increased bacterial activity in the mouth, which causes periodontal disease and bone loss over time.

Many cats just start with inflammation of the gums, around the teeth, but others develop severe inflammation of the entire mouth and this is so painful that they drool and won't eat. Sometimes, gingivitis can have a bacterial cause and a long course of antibiotics may clear it up if you are lucky but for many cats, the only effective treatments revolve around reducing the inflammatory response in the mouth. Sometimes, a diet change helps reduce allergic responses but for cats that are badly affected, only treatments that suppress the immune system, such as steroids or atopica will help, although these medications have serious side-effects. There have been some experimental studies involving stem cell therapy which look promising but if these are ultimately shown to be an effective intervention, it's still a long way off.
The most common treatment is to remove all the teeth. While this sounds extreme and barbaric, it is still one of the most effective treatments, with no drug side effects. Removing all the teeth is helpful in about 80% of cases. It works because plaque can no longer adhere to teeth and thus there is no source of inflammation for the gums. For the remaining unlucky 20%, even the tiny amounts of plaque that form in the mouth will be a source of inflammation