Feline Lymphoplasmacytic Gingivitis Stomatitis Complex

Typical Signalment

• No sex, age or breed predilection
• Pure breed cats seem to develop disease of greater severity. These include:
  • Siamese
  • Himalayan
  • Burmese
  • Abyssinian
  • Persian
• Median age of those affected is 7 years (range 4 months - 17 years)

Description

Feline lymphoplasmacytic gingivitis stomatitis Complex is a poorly understood condition. It presents as erythematous, ulcerative lesions of the gingiva, buccal mucosa, lips, palatoglossal folds and the lateral pharyngeal walls. No clear aetiology has yet been discovered but many different causes of the condition have been proposed:

• Hypersensitivity to oral antigens
• Bacteria
  • Porphyromonas sp
  • Haemobartonella henselae
• Viruses
  • Feline calicivirus (FCV)
  • Feline herpesvirus (FHV)
  • Feline Immunodeficency Virus (FIV)
  • Feline Leukaemia Virus (FeLV)
  • Feline coronavirus (FCoV)

Diagnosis

Diagnosis of this condition can usually be made on the clinical appearance of the oral lesions and symptoms, together with a lack of response to professional teeth cleaning and home dental care.

Clinical Signs

• Halitosis
• Dysphagia
• Ptyalism
• Weight loss
• Cachexia
• Bilateral erythematous, ulcerative and/or proliferative lesions of the gingiva
• Submandibular lymphadenopathy
• Variable amounts of plaque and calculus accumulation
• Missing teeth
• Loose teeth

Laboratory Tests

• Virus testing for FIV, FeLV
• Oral Swab for FCV
• Routine haematology and biochemistry to screen for underlying disease. High globulin levels may be indicative of a hypersensitive state.

Diagnostic Imaging

Full mouth radiography should be carried out to assess the teeth, alveolar bone and also to identify any broken roots.

Biopsy

Biopsies should be taken to rule out any malignant neoplasms (ie squamous cell carcinoma) or other pathology ( ie eosinophilic granuloma) and to confirm the diagnosis. Histologically, dense band-like submucosal lymphocytic-plasmacytic infiltrates are reported with this condition.

Treatment

The aim of treatment of this condition is to improve the hygiene of the oral cavity. Initial treatment can include the following:

• Treat any underlying/existing dental disease
• Client education of the disease process
• Client education in dental homecare (diet and daily teeth brushing)
• Antibiotics
• Dental scale and polish

More advanced cases that have not responded to initial treatments may require:

• Gingivectomy
• Repeated scale and polishing
• Extraction of cheek teeth followed by flushing of the alveolar sockets with saline or chlorhexidine (considered by many to be the most effective treatment)
• Other drug therapy

Corticosteroids are often required to control inflammation when there is a hypersensitive response.

Prognosis

Partly due to our lack of understanding of this condition, feline lymphoplasmacytic gingivitis stomatitis complex is frustrating to treat. Many patients fail to respond to treatment, even after full mouth extraction. In these cases it is thought that the oral bacteria that remain are sufficient to maintain inflammation. In cases that undergo prolonged ineffective medical treatment, the disease appears to become more refractory to further treatment.

References

• Tutt, C., Deeprose, J. and Crossley, D. (2007) BSAVA Manual of Canine and Feline Dentistry (3rd Edition) BSAVA

• Merck & Co (2008) The Merck Veterinary Manual