Guided bone regeneration (GBR) in the treatment of cat stomatitis

This treatment alternative completely and permanently reverses the oral inflammation and pain evidenced in feline stomatitis patients.

Animal dentists have been investigating feline stomatitis for over 25 years. The etiology of this very painful pathology has yet to be determined. The classic treatment in general practice has revolved around the usage of corticosteroids and antibiotics to suppress the immune system and treat soft tissue infection-inflammation, and the extraction of some – or often all – of the teeth. Only about half the felines with this type of extraction surgery reach full recovery.

My studies have confirmed that feline stomatitis (FS) is a disease of the bone, probably a
polymicrobial bone pathology. As a treatment alternative, I have developed a procedure called feline stomatitis guided bone regeneration. It completely and permanently reverses the oral inflammation and pain evidenced in feline stomatitis patients.

All FS felines should first be scrutinized for other non-related medical problems. FeLVpositive cats are not good candidates for this surgery.

The procedure uses oral digital radiology to identify areas of sclerosing osteomyelitis, condensing osteitis, sclerotic alveolar crestal bone loss, and hypertrophic bone reaction with resorption.

Once the pathology is identified, radiowave radiosurgery is used to cut all soft tissue and expose all the pathology identified by digital radiology. The pathologic bone is then removed, using surgical length burs and diamond instruments. This is followed by a guided tissue regeneration procedure.

This cat exhibits Class IV stomatitis. Note ulcerations on tongue and in oropharynx. Final diagnosis of stomatitis must include histopathology to rule out oral cancer.

The GBR surgical technique shows that all abnormal soft tissue does not need to be removed at the time of surgery. The inflammation in soft tissue quickly resolves once the osseous surgery is completed.

Antibiotics after surgery are utilized to treat septic soft tissue and bone that cannot be surgically treated because of proximity to vital anatomy. Pain control is paramount both intra-operatory and post-operatory. The pain comes not from the surgery itself, but from the oral inflammation and ulcerations present pre-surgery. Anti-inflammatory therapy is short-term and can be accomplished with traditional Western medicines or alternative Eastern medicine protocols. I do not recommend non-steroidal anti-inflammatory therapy. All medicines cease 30 days post-operatively.

All patients have an esophagostomy tube placed two weeks prior to surgery, and which is removed two weeks after surgery. This tube is for alimentation and administration of medicines.

Personal note

I want to take this opportunity to honor the late Dr. Harold Loe. I was humbled to meet Dr. Loe, known as one of the fathers of human periodontology, at the UCONN Dental School. Without his work in the 1960s, our knowledge of the pathogenesis of periodontal disease in humans would have been significantly delayed. A “ten-minute” meeting with Dr. Loe to discuss cat stomatitis lasted two hours, as he questioned me about the disease. He told me I had reached an important threshold by identifying that cat stomatitis is a bone disease
and not a dental disease. I left that meeting with excitement and have never stopped educating veterinarians about GBR surgery for cat stomatitis. Dr. Loe died at his home in Norway in 2008, at the age of 82.

Why feline stomatitis is a bone disease, not a dental disease 

In all ages of FS patients, digital oral radiology shows characteristic changes in the bone. Soft tissue biopsies describe an inflammatory infiltrate, primarily of plasma cells, neutrophils and lymphocytes. The fact that all patients respond to aggressive osseous surgery sheds light on the bone origin of FS. If FS pathology was of dental origin, all patients – rather than only 50% to 60% – would fully respond to whole mouth exodontia, with a complete and permanent resolution of inflammation.


Dr. Donald Deforge is a Fellow of the Academy of Veterinary Dentistry and President of the Society for Veterinary Medical Ethics. He developed a special interest in oral care after graduating from the University of Pennsylvania School of Veterinary Medicine. Dr. DeForge is co-editor of An Atlas of Veterinary Dental Radiology along with Ben H. Colmery III, DVM, DAVDC. He was an Adjunct at Northwestern Community College’s Veterinary Technology Program, where he established the Department of Oral Radiology and Periodontology for veterinary technology students, in conjunction with Dr. Nancy Marchetti-Program Director. Dr. DeForge is also the Oral Radiology Consultant for E-Vet Diagnostics, a telemedicine reading service for veterinarians.