What is feline orofacial pain syndrome?
Disease processes occur more in the mouth than anywhere else in a cat’s body. Dental diseases are very common and, if left untreated, can lead to bad breath, swollen and bleeding gums, eating disorders and mouth pain. Cats are naturally secret and often do not show that they have mouth discomfort. Occasionally cats find that their mouths are injured by drooling and will deliberately turn their heads to one side while eating to avoid chewing the side of the mouth, which is painful and sometimes scratching their mouth. Some may stop eating dry food because the crunch becomes painful and they only eat wet food.
The Burmese cat is one of my favorite breeds. Adorable little faces aside, I loved my Burmese patients for how friendly and cooperative they are in the exam room. Whether it was a routine physical exam, an X-ray, or a blood sample, they made my job easy.
While all breeds of cats are prone to oral / dental disease, there is one puzzling (and luckily not very common) oral condition that Burmese cats are particularly predisposed to: feline orofacial pain syndrome (FOPS).
What FOPS looks like
The main noticeable signs of FOPS are excessive licking and chewing movements with paws on the mouth. Typically (but not always) the discomfort is one-sided or worse on one side. The signs of oral discomfort can be continuous (20% of cases) but often appear in discrete episodes (80% of cases). These uncomfortable episodes are often triggered by mouth movements such as eating, drinking, or grooming. Episodes can last a few minutes or several hours, with some people reporting a brief period of anxious cat behavior just before an episode.
In some cats, it is possible to temporarily distract the cat from the episodes. Severe cases can result in the cat damaging the tongue from repeated chewing movements or injuring its face with aggressive paws. Most cats appear to be pain free between episodes.
What races get it
The exact cause of the disorder is not certain, but FOPS shares some clinical features of two neurological facial pain syndromes in humans: trigeminal neuralgia and glossodynia. Trigeminal neuralgia is characterized by brief episodes of severe pain in the areas of the face that are innervated by the trigeminal nerve, mainly the upper and lower jaws. Glossodynia (also known as “burning mouth syndrome”) is a condition in humans in which patients experience changes in taste, dry mouth, and a burning or tingly feeling in the mouth, especially around the tip of the tongue. In fact, tongue discomfort appears to be the main problem for many affected cats
Although FOPS has been reported in Siamese, British Shorthair, Somali, Tonkinese and Shorthair cats, the Burmese are significantly overrepresented: in a study of 113 cats, 100 of them were Burmese.
Dental problems like periodontal disease can predispose cats to developing the disease. In some cases, signs of FOPS started soon after the milk teeth fell out and the permanent teeth erupted.
Environmental factors can also play a role. One study showed that 20% of the cases, single cats from households with multiple cats who exhibited poor social coping skills were more prone to the condition.
There is no definitive diagnostic test for FOPS. Diagnosis is made based on clinical symptoms (episodic licking, chewing, paws on face), breeding and removal of other causes of clinical symptoms, e.g. B. a foreign object in the mouth or throat, or another neurological condition that could affect the trigeminal nerve like cancer.
Treatment can be difficult. An Elizabethan collar can be used to prevent damage to the face from excessive pawing, or soft plastic nail caps can be placed on the paws. A referral to a veterinary dentist is worth considering as dental problems can make the condition worse. In one study, approximately 50% of cats with FOPS who had dental treatment showed sustained improvement in clinical symptoms.
Since this is a painful condition, analgesics are the mainstay of treatment. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) can be given, but carefully dosed because cats do not metabolize them very well. Pain relievers like gabapentin are often effective and can be given in combination with NSAIDs. In cases that respond poorly, anti-epileptic drugs should be considered, as some of these drugs have analgesic, desensitizing properties. Environmental factors should also be taken into account. Recognizing social incompatibility in a multi-cat household is important and steps should be taken to correct it, if any.
The forecast for FOPS is considered fair to good. Spontaneous remission can occur in a small percentage of cats, but most will require treatment. Many cats (around 50%) respond to short-term medications during the episodes. Some may be completely withdrawn from medication, or at least between recurrent episodes. About a third of cats need long-term treatment. Unfortunately, despite treatment, some cats cannot be made comfortable. In this study of 113 cats with FOPS, 12% of the cats had to be euthanized due to treatment failure.
Fortunately, FOPS is a rare condition. In my 32 year old veterinary practice, I have never seen or treated a case of it. Burmese cat owners should be aware of the condition and ensure that their cat receives regular veterinary exams, with an emphasis on dental care.
Featured photo: Yana Tatevosian | Getty Image
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