Vetnews | September 2025 44 « BACK TO CONTENTS In a previous VetNews column, we provided an overview of feline chronic gingivostomatitis (FCGS) and the general therapeutic strategies available. In this article, we turn our focus to the management of refractory cases—patients who fail to respond adequately to standard surgical treatment. These cases often require complex, multimodal, and long-term medical intervention. Surgical Treatment: The Gold Standard Partial-mouth or full-mouth dental extractions remain the gold standard for FCGS management. The decision between the two is based on the anatomical distribution and severity of inflammation. However, despite surgical intervention, some cats do not respond or only show partial improvement. In a 2015 study by Jennings et al., 28% of cats achieved complete resolution post-extraction, 39% showed substantial improvement, and 33% had minimal or no improvement. Typically, clinical improvement occurs within 33 to 49 days post-operatively (Soltero-Rivera et al., 2023). Cats showing little to no improvement within this period are classified as refractory and require ongoing medical management to control inflammation and pain. Medical Management of Refractory Cases When addressing refractory FCGS, treatment must be tailored to the individual patient, taking into account comorbidities, concurrent medications, and drug administration feasibility. A combination of analgesics, immunosuppressants, and in select cases, immunomodulating therapies, may be used. Analgesia: A Cornerstone of Therapy Pain is a significant concern in refractory FCGS patients, often leading to anorexia, weight loss, and reduced grooming behaviour. Effective analgesia is therefore critical. - NSAIDs (e.g., Meloxicam): Widely used in clinical practice. At doses of 0.01–0.05 mg/kg q24h, long-term meloxicam use in IRIS Stage 1–2 chronic kidney disease cats did not show adverse renal effects (Monteiro et al., 2019). Nonetheless, hydration status should be carefully monitored in cats with poor oral intake. - Amantadine: At 3–5 mg/kg q24h, this NMDA antagonist has shown benefits for chronic pain and quality of life in cats with osteoarthritis. Sedation is a possible side effect (Shipley et al., 2021). - Gabapentin: Effective for neuropathic and musculoskeletal pain. Administer at 5–10 mg/kg q8–12h (Siao et al., 2010). Useful as an adjunct. - Buprenorphine: Administered via the buccal mucosa, though bioavailability may be compromised in stomatitis patients. A study by Stathopoulou et al. (2018) found decreased absorption in cats with oral inflammation. Immunosuppressive Therapy - Corticosteroids: Commonly used but should be approached with caution. Longterm use can induce diabetes mellitus, and the clinical remission rate is low (Hennet et al., 2011). - Cyclosporine: An effective option for true refractory cases, administered at 2.5 mg/kg. Its use is best reserved for patients unresponsive to dental extractions. Lommer (2013) reported a 45.5% clinical cure rate after ≥3 months of treatment. Therapeutic monitoring is essential; plasma concentrations >300 ng/mL are associated with better outcomes. Due to the risk of opportunistic infections and systemic toxoplasmosis (Last et al., 2004), treated cats should be kept indoors and not fed raw meat. Regulars I Dental Column Managing Refractory Cases in Feline Chronic Gingivostomatitis By Dr. Mareli van de Wetering Onderstepoort Veterinary Academic Hospital
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