what is the treatment protocol for feline chronic gingivostomatitis, including when to proceed to full-mouth extraction?

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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. 6 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. 9 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. 8 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. 1 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. 1 Immunomodulatory agents are the preferred systemic therapy for refractory FCGS. Cyclosporine (CsA) and recombinant feline interferon-ω (IFN-ω) are established immunomodulatory options. 1 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. 1 NSAIDs are used as an alternative to corticosteroids for controlling pain and inflammation. 1 For chronic pain management, gabapentin, amitriptyline, and tramadol (cats only)