Juvenile gingivitis is a severe general inflammation in the gingiva in young cats. Onset of inflammation can be as early as the time of eruption of the permanent teeth. There is a pronounced inflammation of the gingiva, often followed by marked hyperplasia of the tissue. Juvenile gingivitis is typically diagnosed between 6 and 12 months of age.
An exact cause is not known, but the disease complex is believed to be caused by one or more of a number of predisposing factors such as inflammation during shedding of primary teeth, viral infection, immune system hypersensitivity, bacteria, and maybe even genetic predisposition, since some breeds (Maine Coon and Siamese) are more frequently affected. Treatment is targeted towards two goals; keeping the mouth clean and supporting the immune system. Clean mouth is obtained by daily tooth brushing (using mega- or ultra-soft brushes) combined with daily rinse with an appropriate chlorhexidine solution (fluid or gel). Using toothpaste with Aloe vera and Propolis can also help in preventing the formation of dental plaque.
The home prophylaxis should be combined with a professional scale and polish under general anaesthesia every 3–6 months in the period of treatment. When under anaesthesia, hyperplastic gingiva can be resected to avoid having pseudopockets that can shield dental plaque and hence increase the inflammation. Full mouth radiographs also should be obtained to evaluate for the development of Feline Juvenile Periodontitis, that the gingivitis can develop into if not properly controlled.
If attachment loss develops, elective extractions can be necessary to minimize the periodontal inflammation. Patients should also be evaluated for tooth resorptions, since the inflammation triggers an increased risk of TR.
To lower the inflammation NSAIDs can be used. Corticosteroids should be avoided, since there is a tendency to a worsening of the disease (after a short initial improvement). The painkilling effect of NSAIDs will also help in treating possible anorexia due to the pain. In some cases, opioids or gabapentin can also be useful.
I do not recommend the use of long-term systemic antibiotics. The distribution of antibiotics to the periodontal pockets. to prevent plaque bacteria to cause inflammation/infection, is very low. Compared to the side effects and risk of resistant bacteria to develop, I rarely use antibiotics more than 8 days - if I use it at all in these young animals.
Boosting the immune system, can be achieved by oral administration of TetraDecanol-Complex (may be applied locally on to the gums), Beta-Glucan, Aloe vera, lactoferrin, or others - used alone or in combinations. Effect, patient and owner compliance are unpredictable, so the final “package” for use in a cat, must be individually evaluated in every case.
The juvenile gingivitis should be differentiated from the feline lymphocytic-plasmocytic gingivitis/stomatitis, by age at onset and the distribution, that is limited to the gingiva (or periodontium in the juvenile periodontitis). The affection of the distal part of the oral mucosa seems to be pathognomonic for LPGS.
A fair number of the cats with juvenile gingivitis, that are well treated will resolve when they are around two years old. But it takes several depuration procedures and a meticulous home prophylaxis, including administration of medicine and other supportive nutrients. In many cases, treatment will, in the end, include multiple extractions. Full mouth extractions have a good prognosis (like in many of the LPGS cases), but both owners and vets are reluctant to perform too dramatic extraction procedures in cats that are very young.
In my opinion, owners are more motivated for multiple extraction procedures when they have tried by conservative treatment first. The best way of treating these patients will always be in an open and honest dialogue with the owners.