and pharyngeal problems can be disconcerting from the viewpoint
of the cat owner and that of the veterinary surgeon. These
conditions of the mouth and throat are a common occurrence
and many of them are unresponsive to treatment. For a large
proportion of these conditions no rational therapy is available
because, at the moment, we do not completely understand their
the causes of oropharyngeal disease in the cat are poorly
recorded, it is clear that a number of these conditions may
be a consequence of underlying generalised disease, particularly
chronic kidney failure, leucopenia (depressed white blood
cell count), immunosuppression secondary to FeLV or FIV infections
and, rarely, diabetes mellitus. In such cases the oral problem
cannot be expected to resolve unless the underlying problem
is diagnosed and, where amenable to treatment, treated.
are a number of signs which will suggest that a cat has some
disorder of the mouth or pharynx. The cat may show no interest
in food, or may come to the food bowl and then be reluctant
to eat. It may chew with obvious caution and discomfort, may
drop food from its mouth, or may swallow with great difficulty
or discomfort. Excessive saliva may overflow from the mouth,
there may be a marked unpleasant odour to the breath and,
in some cases, bleeding. Clawing at the mouth and head shaking
may also occur, particularly with foreign bodies or very painful
disorders. The reluctance to eat may lead to weight loss which
can become quite marked.
number of conditions may affect the lips and surrounding skin.
granuloma (rodent ulcer, labial ulcer)
is a chronic ulcerative area occurring on the lips, usually
where the skin joins the lining membrane of the mouth. The
affected part is relatively localised but the area gradually
becomes larger. It is usually found in the region between
the mid-line cleft of the lip (philtrum) and the canine tooth
on the upper lip. The problem may occur on one side or both
and occasionally may be seen elsewhere. The edges of the ulcer
are hard and raised and the broken skin irregular. The base
of the ulcer is salmon-pink. In most cases the problem is
a cosmetic one rather than presenting any real disability
for the cat, but sometimes very deep ulcers may cause pain
and reluctance or inability to eat, and the animal may be
unable to groom itself. A number of causes have been suggested
for this problem, including continual irritation by the rough
tongue, infection or food allergy; there is little to support
wide variation of treatments have been applied in cases of
eosinophilic granuloma, reflecting the lack of any one uniformly
successful treatment, and the unsatisfactory outcome of treatment
in many patients. It would seem that the most successful approach
is a four to six week course of the steroid prednisolone.
This may resolve the lesion, but, if not, it may be followed
by cryosurgery - a double cycle of controlled freezing and
thawing. Although this inevitably leads to some scarring,
recurrence seems less frequent than with other methods of
treatment. In some cases Ovarid has also been used successfully.
Whatever treatment is used, recurrence is common and the treatment
may have to be repeated.
cell carcinoma (see below)
cancerous growth can occur on the lips, as may fibratoma.
This must be distinguished from eosinophilic granuloma and
in cases of doubt, a biopsy may be taken from pathological
examination to establish the diagnosis. Cryosurgery is the
treatment of choice in those lesions which have not reached
an advanced stage. Advanced lesions may require euthanasia.
are very prolific masses in which mycobacteria may be identified
on biopsy. The masses may ulcerate. Surgical removal or cryosurgery
are the treatments of choice but fortunately the condition
is a congenital anatomical defect. It will be apparent when
the affected kitten is born, and may occur with a cleft palate.
The degree of hare lip varies and a mild deficit may not interfere
with normal life too much or may be repairable. However, for
a severe deficit, especially if there is also a cleft palate,
surgery is impractical and euthanasia is the only humane course
since sucking is interfered with.
are commonly encountered as a result of road traffic accidents
and as a consequence of fighting, particularly among entire
males. Abscess formation may follow. If possible, wounds should
be presented immediately to a veterinary surgeon so that they
can be stitched if necessary, since scarring of the lips may
hinder feeding. Animals with abscesses which do not burst
with one or two days of regular bathing with warm water should
be taken to a veterinary surgeon for lancing, as should those
which make the cat generally unwell.
inflammation of the mouth (stomatitis) and ulceration of the
can be caused by a variety of micro-organisms, but commonly
one of the 'flu viruses is responsible. Both feline calcivirus
and feline rhinotracheitis virus will produce stomatitis but
feline calcivirus does so more commonly.
calcivirus (FCV) is divisible into a number of strains
which vary in capacity to produce disease. Some strains will
produce mouth ulceration only, the ulcers appearing typically
on the upper surface and margin of the tongue, although they
may also occur on the gums, palate and nose. Other strains
of calcivirus may produce ulceration together with relatively
mild signs of upper respiratory tract disease.
viral rhinotracheitis (FVR) is a more severe disease
with typical signs of upper respiratory tract disease, often
involving inflammation of the pharynx and tonsils. The presence
of tongue ulcers is rare.
both cases the viral infection may predispose to superimposed
bacterial infection. Since there are no usable antiviral drugs,
treatment must consist of the use of broad spectrum antibiotics
to control secondary infection. Palatable antibiotic syrups
formulated for children can be of particular value because
of their ease of administration and their local action in
the mouth and throat.
nursing of the patient with frequent removal of secretions
is important. The cat should be offered liquidised or pureed
aromatic foods such as strongly flavoured fish. If the cat
refuses to eat for long periods, or becomes collapsed, specialised
intensive nursing treatment may be needed.
household materials, such as cleaners, paint strippers and
bleach are irritants, and curiosity may lead cats (and children)
to swallow these, causing irritation of the mouth and gut
which may be very severe in some cases. Prevention is better
than cure, and all such agents should be kept away from curious
creatures, be they man or beast. Should such an accident occur,
the cat should be taken to the veterinary surgeon (with the
container of irritant).
problems and gingivitis
problems will be considered together since they may be closely
dental caries, the process of decay to which human teeth are
so susceptible, is very rare in the cat, though occasionally,
true caries of the tooth table is encountered, particularly
involving molar teeth. Affected teeth should be extracted,
as should teeth in which injury has led to the tooth shattering,
cracking or breaking off so as to expose its central sensitive
more common problem than caries is erosion of the junction
of the crown and the root which may lead to the crown shearing
off from the root, either under normal wear or when an attempt
is made to extract the tooth. The root is very likely to be
infected and should be extracted.
may form at the root tip of any tooth and may produce marked
pain. After the diagnosis has been established by radiography,
the tooth should be removed to allow the abscess to drain.
One of the upper cheek teeth has roots which terminate in
the bone just below the eye; occasionally abscessation around
these roots may reveal itself as a distinctly fluid-feeling
swelling below the eye or as a small hole in the skin from
which pus discharges. If there is any doubt, radiography will
confirm this diagnosis and extraction of the tooth is necessary.
calculus, periodontitis and gingivitis
calculus, also known as tartar, consists of mineral-impregnated
bacterial plaque. Tartar may build up on any tooth, but is
commonest on the outer faces of the molars and premolars,
and on the inside surface of the incisors. Calculus accumulates
with age and is more likely to occur in animals fed soft diets.
tends to accumulate around the junction of the gum with the
tooth and, as this occurs, a niche is produced in which bacteria
can flourish. As a consequence of this bacterial infection,
the gum becomes inflamed (gingivitis) and retracts from the
base of the tooth. It may also become ulcerated and the infection
may spread to the gum. The retraction of the gum allows infection
to track down the outside of the tooth root (periodontitis)
and a discharge of pus (pyorrhoea) from around the teeth results.
The tooth root may also become infected and eroded (see above).
early cases, all that is needed is for the cat to have the
tartar removed by 'scaling' under general anaesthesia. In
severe, established cases, it will be necessary to take swabs
to identify the organisms involved in the infection and to
give long-term antibiotic therapy. After antibiotics have
been given for three of four days, all the involved teeth
should be taken out. This sequence avoids the risk of septicaemia
usually reforms after scaling and, once it has been initiated,
dental attention is likely to be required increasingly often.
It is suggested that the feeding of dry cat food may help
to limit the problem. If dry food is fed, free access to water
should be allowed to avoid the risk or urinary tract disease.
of the gum margin
kittens a narrow band of reddening of the gum margin just
below the teeth is a common finding. This appears to present
no problem to the cat and resolves without any treatment.
Owners need not be particularly concerned therefore unless
other signs of disease are associated with it. A specific
and rather more extensive and dramatic gingivitis (gum inflammation)
has been reported in kittens three and a half to seven months
of age. The cause of this condition is not known and it often
fails to respond to treatment. The condition may disappear
spontaneously when the cat cuts its permanent adult teeth.
inflammation of the mouth and gums
from the conditions mentioned above, there remains a large
group of oral inflammatory conditions in the adult cat which
are unrelated to dental disease and which are extremely unresponsive
to treatment. These conditions present with long-term inflammation
of the lining of the mouth, little vesicles and ulcers being
present in most cases. The problem most frequently affects
the angles where the jaws meet at the back of the mouth although,
less commonly, any other part of the mouth can be affected.
cause of this condition is not fully understood; a number
of bacteria have been isolated but their significance remains
uncertain. FCV and FVR occasionally cause a short-lived inflammation
of the mouth (see above) lasting two to three weeks. It is
suspected, however, the feline calcivirus may have a significant
causal role in the chronic condition. In a survey undertaken
at Bristol , it was found that gingivitis is very much more
common in pedigree cats than in cats of mixed breeding. All
the cases in pedigree cats were of the non-specific form,
whilst most cases in cats of mixed breeding were associated
with dental disease. The difference in the incidence of non-specific
gingivitis was reflected in the frequency with which FCV could
be isolated from the two groups of cats. Furthermore, in both
groups there was a strong correlation between the presence
of FCV and non-specific gingivitis. there is also a significant
association between gingivitis/stomatitis and FIV infection.
In fact, oral inflammation is one of the most common clinical
signs in FIV-infected cats. It is not clear whether FIV plays
a direct role or whether, like FeLV, it may precipitate gingivitis
by its deleterious effect on the immune system. However, there
is evidence that there is a link between FIV infection, FCV
infection and gingivitis, and that cats infected with both
viruses will have more severe oral lesions.
of these cases needs long-term antibiotic therapy and, in
carefully selected cases, steroids may be used with caution.
Cats infected with FIV are likely to respond favourable to
corticosteroid therapy. Careful supportive nursing by the
owner is again of great importance. Despite the lack of apparent
involvement of dental disease in this condition, unresponsive
cases may be improved by the removal of any involved teeth
or even all the teeth. Provided they are fed moderately divided
soft food, cats do well without their teeth.
is proliferation of the tissues of the gum to produce florid
irregular masses. These are very friable and are easily damaged,
causing ulceration and haemorrhage. Removal of the teeth may
again be helpful since the teeth damage the mass during chewing.
Attempts to cut off the masses are usually unsuccessful; bleeding
is a problem and the masses recur. Burning them off by electrocautery,
or the use of cryosurgery are more successful initially, but
may provoke an increased response. The cause of this condition
is unknown and its relation to the ulcerative condition is
proliferating masses of non-specific gingivitis must be distinguished
from the several types of cancerous growth which can affect
the mouth. In cases of doubt, biopsy may be needed to obtain
a diagnosis. Malignant tumours of the mouth, particularly
squamous cell carcinomas, are unfortunately relatively common.
Occasional benign tumours may be seen.
are encountered mainly in older cats, they commonly occur
under the tongue, but may also be seen on the gums, tonsils
and palate. Early in their growth they are firm white or pink
nodules or lobed masses. Often, however, they are not noticed
until they are advanced in growth and are large ulcerated
bleeding masses, difficult to distinguish from gingival hyperplasia.
Radiology, as well as biopsy, can then be helpful in diagnosis. Tumours
of the mouth rarely spread to other parts of the body but,
if removed, they commonly recur locally. The exception to
this rule is squamous cell carcinoma of the tonsil, which
frequently spreads elsewhere. In all cases of malignant tumours,
treatment is palliative and euthanasia will be necessary sooner
fibrous tumours occasionally occur on the lips and cause no
problem: they need not be removed unless so large as to be
a hindrance to the cat. Polyps arising from the palate and
growing up into the back of the nasal cavities and the pharynx
can be very successfully removed surgically.
gland disease is rare in the cat. Very occasionally, blockage
of a salivary duct can give rise to a swelling under the tongue
or on the neck; these are amenable to surgical treatment.
Very rarely, cats exposed to human cases of mumps may develop
a similar disease; there is no specific treatment, but supportive
nursing is helpful.
palate - foreign bodies
uncommonly, foreign bodies such as small sticks or bones may
become wedged across the palate between the teeth, or may
impale it. A general anaesthetic may be required for the removal
palate occurs in kittens as a developmental abnormality; some,
but not all cases are of genetic origin. It may occur alone,
or with hare lip. The condition becomes apparent soon after
birth when there is difficulty in suckling and regurgitation
of milk down the nose, accompanied by sneezing, noisy breathing
and distress. The kittens do not thrive and can develop pneumonia
due to inhalation of milk. Sometimes a kitten may die suddenly
without warning signs. Treatment is not practical and euthanasia
is the most appropriate course. Cleft palate also occurs in
cats of all ages as a result of trauma, most commonly in road
traffic accidents. The practicality of repair will depend
on the severity of any other injuries sustained in the accident.
shortening of the soft palate occurs in kittens and is very
similar in its effects to cleft palate. Treatment is not practicable.
of the throat and tonsils have similar signs to disease of
the mouth but retching may also occur.
of the pharynx commonly occurs as part of upper respiratory
tract viral infection and the measures described above are
are usually malignant and euthanasia is indicated.
any cat with signs of pharyngeal disease, the possibility
of the presence of a foreign body must be considered. Foreign
bodies, when present, are usually small bones, fish scales,
fish hooks or fibrous or filamentous material. Anaesthesia
may be required for radiology and is necessary for direct
inspection of the pharynx and for the removal of offending
is very rare except as a component of 'cat 'flu'.
squamous cell carcinoma
is discussed above.