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Jessie is sweet domestic short haired cat, who was referred to us by her regular vets for management of Feline Chronic Gingivostomatitis (FCGS), that became refractory to medical treatment.

Jessie was only 2 years of age when she first developed symptoms of bad breath, and was diagnosed with severe gingivitis and suspected FCGS. Her vets performed an FIV and FELV blood test which was negative, and a respiratory PCR swab, which confirmed Calicivirus infection. She was initially managed with an antibiotic injection and dental prophylaxis such as dental food and antiseptic mouth rinse. After 6 months she however developed marked mouth pain and had difficulty eating, with her owners having to change her to a soft food diet. She was treated with pain relief, corticosteroids and antibiotics, and antiseptic mouth rinse, and later antiviral medication. 3 months later she was referred to Perth Cat Hospital for dental x-rays and probable full mouth extractions.

On examination Jessie had severe gingivitis of the upper maxillary teeth, and some inflammation of the back of the throat area (caudal stomatitis). Jessie had pre anaesthetic blood tests performed which thankfully only showed some chronic inflammation likely due to the gingivitis, without any major organ dysfunction.

Jessie was placed on intravenous fluid therapy and premedicated with a sedative and methadone pain relief. She was given a general anaesthetic via her intravenous catheter, intubated and anaesthesia maintained with oxygen and isofluorane gas. Her vitals were monitored with our Surgivet anaesthetic monitor. This machine monitors heart rate, respiratory rate, oxygen saturation, inspired and expired carbon dioxide, and blood pressure. Nurse Colleen monitored the anaesthetic carefully whilst Dr Martine performed the diagnostic and treatment procedures on Jessie.

Whilst anaesthetised Jessie had her mouth thoroughly examined, her teeth were probed and a full set of dental radiographs were taken. She had severe gingivitis with moderate periodontal disease associated with all cheek teeth, and the lower molar teeth had advanced periodontal disease. The canines and incisors only had mild periodontal disease and inflammation. Her mouth was flushed with Hexarinse solution prior to a cleaning procedure performed on all teeth above and below the gum line.  Local anaesthetic nerve blocks were administered to all four quadrants to help with extra pain relief.

All caudal teeth were extracted (14 teeth) whilst preserving all 4 canines and all incisiors. This required the creation of gingival flaps, burring of bone near the roots, division of multi rooted teeth, and very careful elevation of each individual root. All roots were extracted in one piece except for one root tip fracture, which was successfully extracted separately. The bone was then burred to smooth any uneven areas (alveoloplasty), wounds flushed with saline, and gingival flaps sutured in place with very fine absorbable suture material. A biopsy of the inflamed gingiva was also collected and sent to the laboratory for histopathology. This later confirmed severe inflammatory process and ruled out any cancer as a cause.

Jessie received Intravenous antibiotics during the procedure, and was treated with post operative antibiotics and ongoing pain relief. Jessie was transferred to Perth Veterinary Emergency for dedicated ongoing pain relief and supportive care overnight, and transferred back to Perth Cat Hospital the following day.

Jessie had not yet eaten overnight, and developed quite a high temperature overnight. The temperature settled down over the day and Jessie was able to go home the same afternoon.

The following morning Jessie had eaten a whole tin of Dine food! Her temperature still remained slightly elevated which resolved later that day. She continued to improve in herself, and on recheck 7 days post operatively she had even started to try to eat biscuits. Her wounds were healing well, although gingival inflammation still present as expected so soon after her surgery. She was recommenced on anti-inflammatory medication post operatively and antibiotics continued another 2 weeks.

Cats with Feline Chronic Gingivostomatitis like Jessie often have a very sore mouth and suffer long term if their gingival and mouth inflammation is not addressed. Usually treatment with antibiotics and anti-inflammatory medication alone does not help in the long term and indeed the prognosis for response of surgical treatment reduces the longer the inflammation has been present. Full or caudal mouth extractions early in the disease process are often the best course of action. Although this is a major and delicate surgical procedure most cats recover relatively quickly after their procedure. It is common for cats to develop a temporary fever, and it may take a day or two for most cats to eat comfortably.

Jessie bounced back after her big procedure very quickly once she was back at home, and very quickly returned to eating. The inflammation from FCGS can sometimes take a few months to settle down, especially if there is a delay before a surgical approach is taken. Within a few months post-operative, Jessie’s mouth was responding very well and only showing minimal areas for very mild inflammation.

Full and caudal teeth extractions is not a procedure for every veterinarian. It is essential to have dental radiography performed to assess the underlying anatomy of each tooth root, and additionally to obtain after the extraction has been performed to ensure all components of the tooth roots have been removed. It is a delicate procedure that requires patience and skill from the veterinarian and a carefully managed post-operative pain management plan. We routinely accept both referral patients  from vet hospitals around Perth and first opinion cases for this procedure.

We have recently prepared some notes on current thoughts of causes, diagnosis and treatment options for Feline Chronic Gingivostomatitis – a frustrating disease. Please head to our FCGS information page to read more. 

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