Feline Lymphoplasmacytic Gingivitis Stomatitis Complex
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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. These include hypersensitivity to oral antigens and bacterial infections including those caused by Porphyromonas sp and Haemobartonella henselae. Certain viruses have also been implemented including Feline calicivirus (FCV),Feline herpesvirus (FHV), Feline immunodeficiency virus (FIV),Feline leukaemia virus (FeLV) and Feline coronavirus (FCoV).
Typical Signalment
No sex, age or breed predilection. Pure breed cats seem to develop disease of greater severity. These include:
Burmese
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Persian
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Siamese
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Abyssinian
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The median age of those affected is 7 years (range 4 months - 17 years).
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
Include halitosis, dysphagia, ptyalism, weight loss, cachexia, bilateral erythematous, ulcerative and/or proliferative lesions of the gingiva, submandibular lymphadenopathy and variable amounts of plaque and calculus accumulation. Additionally teeth are often loose or missing.
Laboratory Tests
Tests to eliminate underlying viral causes include virus testing for FIV, FeLV and an oral Swab for FCV. Routine haematology and biochemistry are also useful to screen for underlying disease. High globulin levels may be indicative of a hypersensitive state.
Diagnostic Imaging
Full skull 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: Treating any underlying/existing dental disease, client education of the disease process and client education in dental homecare (diet and daily teeth brushing). Antibiotics may also be necessary and a dental scale and polish is recommended.
More advanced cases that have not responded to initial treatments may require a gingivectomy, repeated scale and polishing and extraction of cheek teeth followed by flushing of the alveolar sockets with saline or chlorhexidine (considered by many to be the most effective treatment) Additionally Corticosteroids are often required to control inflammation when there is a hypersensitive response.
Prognosis
Partly due to the 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(Eighth edition)Merial