Heard from the specialist today. My concerns were around treatment options and prognosis from those options. The biggest concern was about having all of his teeth pulled to stop the infection process.
Basically (and of course she didn't see Stumpy so this is a generality on how the disease goes and how treatments work): It is all about pain control. He will be in pain for the rest of his life if not controlled. She suggested not going the liquid or pill med route, unless we can effectively give it to him thru his food. Dosing his mouth directly only adds to his pain. She suggested going down the Depo injection - they take a while to bring relief but eventually she gets cats on a once a month to once every 3 month regime. The key to pain management is to be able to identify the signs that pain is impending, and get him for a shot before the pain becomes severe.
She also suggested to have his teeth pulled. With this disease, his teeth are what goes against him - almost as if he is allergic to his own teeth - causing bacterial infections, increasing the pain, and becomes a visious circle. The recommendation is to go the 2 week antibiotic route as we are doing right now, and if the infection doesn't clear up, and in her experience it doesn't do that very often, then pull all his teeth but possible leave his canines.
Of course my concern is alpha cat in a 12 cat household without teeth - will he behaviorally change to the point that he loses status and gets attacked by the others (e.g. they sense his illness and go after the sick cat). She has not seen this, and in fact once the teeth are gone and the infections cleared up, while they still have pain, they are otherwise healthier. Actually less conflict in the house than with sick cat with teeth.
Long term prognosis? If we can't get the infection under control, it is probably best to put his down as the pain is much higher during the infection period. If we can get it under control, she has treated cats that got the disease at about 10 years old and lived to be 18, and that without teeth. And these cats are on monthly Depo shots for years.
So she shared a lot of generalities, but helped my doubts at least about the teeth pulling route, and armed me with questions to take back to my vet as we progress thru this crisis. It's just difficult having just changed vets with my recent move and I don't yet have the experience with her to know her style of handling problems. The specialist insights were very helpful right now.
There is hope!