Full-mouth extraction (FME) or partial-mouth extraction (PME) of all premolar and molar teeth is the standard of care for feline chronic gingivostomatitis (FCGS), achieving successful outcomes — defined as complete resolution or substantial improvement with mild-to-moderate inflammation remaining — in 60–80% of treated cats. American Journa…

Tooth extraction is the first-line intervention regardless of disease severity. Dental radiographs should be obtained before extraction to assess alveolar bone loss and detect tooth resorption, and post-extraction radiographs are required to confirm complete root removal, as residual roots are a recognized cause of FCGS recurrence. Journal of Feli… There are no published data from these sources establishing a specific clinical threshold that mandates FME over PME; outcomes do not differ significantly between the two approaches in cats subsequently treated with mesenchymal stromal cell (MSC) therapy. Journal of Feli…

For cats that do not achieve adequate improvement after extraction, extended medical management (EMM) is initiated. EMM includes antibiotics, analgesics, and anti-inflammatory medications, which may need to be continued for weeks to months. BMC Veterinary… Among cats undergoing extraction plus EMM, 46.3% show improvement with medical therapy following extraction, while 21% improve without medication after extraction alone; 32.6% do not respond to extraction and EMM. BMC Veterinary…

Immunomodulatory agents are the preferred systemic therapy for refractory FCGS. Cyclosporine (CsA) and recombinant feline interferon-ω (IFN-ω) are established immunomodulatory options. BMC Veterinary… Corticosteroids such as prednisone are no longer a preferred option due to limited long-term efficacy and adverse effects including polyuria, polydipsia, diabetes mellitus, and skin fragility; they are recommended only for short-term symptomatic relief. BMC Veterinary… NSAIDs are used as an alternative to corticosteroids for controlling pain and inflammation. BMC Veterinary… For chronic pain management, gabapentin, amitriptyline, and tramadol (cats only) are also considered. WSAVA Global Gu… Long-term NSAID therapy is generally required after multiple dental extractions even when opioids and local anesthetic techniques are used perioperatively. WSAVA Global Gu…

MSC therapy is the recommended intervention for cats with refractory FCGS that fail extraction and EMM. Adipose-derived MSCs (adMSCs) have demonstrated improvement and, in some cases, complete cure of clinical signs in refractory FCGS. Journal of Feli… A small percentage of refractory FCGS patients do not respond to adMSC therapy. Journal of Feli…

Uterine-derived MSCs (UMSCs) administered intravenously as two doses of 20 million cells 14 days apart produced the following success rates in refractory FCGS cats: owner-reported quality-of-life improvement (client-specific outcome measures, CSOM) of 61.4% at day 28, 76.3% at day 60, and 78.8% at day 90; owner-reported overall response (ORA) of 65.9% at day 28, 73.7% at day 60, and 75.8% at day 90; and veterinarian-assessed oral lesion healing (global oral lesion score, GOLS) of 31.8% at day 28, 47.5% at day 60, and 45.5% at day 90. Journal of Feli… After a single dose at day 14, CSOM success was 52.3% and GOLS success was 25.0%. Journal of Feli… Cats treated within 6 months of tooth extraction had greater improvement in GOLS. Journal of Feli… Adverse events were generally mild and transient; all six serious adverse events were either unlikely to be attributable to UMSC therapy or inconclusively attributed to it. Journal of Feli…

Placenta-derived MSCs administered as a single intravenous infusion produced notable clinical improvement in all cats in a case series of refractory FCGS patients. Journal of Smal… MSC therapy is not effective when administered prior to full-mouth tooth extraction — adMSCs given before extraction produced no positive clinical response in three of four cats and only a mild response in the remaining one, with no evidence of immune modulation; this approach is not recommended. Journal of Feli…

Coinfection with feline calicivirus (FCV), feline foamy virus (FFV), or feline leukemia virus (FeLV) is associated with poorer treatment outcomes and increased disease severity and should be assessed as part of the diagnostic workup. BMC Veterinary…

Cats that do not respond to extraction, EMM, and immunomodulatory therapy face a severely impaired quality of life, and humane euthanasia is ultimately considered in some cases. BMC Veterinary…

Would you like to go deeper on the cyclosporine and interferon-ω dosing protocols for cats that are not candidates for or have not yet received MSC therapy?