Symptoms
This disease goes by several names. Some
of the are faucitis and infectious stomatits. The primary symptom
noticed by most people is a cat that is no longer eating well
(anorexia). In some cases, there will be weight loss, a poor haircoat,
halitosis (bad breath), or a pet that seems ill in general.
Some cats are also painful around the
mouth, and resist being petted there, and might even cry out in pain.
We have even seen cats with severely inflamed mouths that have no
symptoms at all. The problem was discovered during a routine exam. This
is rare, and this cat will probably show symptoms in the near future.
Symptoms of this disease might come and
go, but as time goes on the symptoms become more apparent and
consistent. This again stresses the need for routine physical exams on
all pets to catch problems while they are still treatable or curable.
Diagnosis
A diagnosis is made by one of our
veterinarians when you bring in your pet for an exam. During the oral
part of the exam our doctor will notice inflammation of the gums and
tissue in the oral cavity.
This is an example of the seriously
inflamed mouth that occurs in this disease. This cat is under
anesthesia and we are preparing to biopsy the roof of the mouth prior
to treatment. This cat is so painful we can only do this exam under
anesthesia.
There are a multitude of other diseases the mimic
lymphocytic/plasamcytic gingivitis:
After our oral exam we do a basic diagnostic
workup. This includes a blood panel, viral tests, thyroid levels, and dental
radiographs.
A definitive (positive) diagnosis is made by taking a
biopsy of the tissue and sending it to a veterinary pathologist. This
step is important because other diseases, especially cancer, can mimic
this one.
Cause
It is caused by a specific reaction in
the immune system, similar to, but not exactly like, allergies. The
exact cause is not know, and like many diseases, there are numerous
factors. These factors include viruses, bacteria, genetics,
stress, nutrition, and hormone
diseases.
It is associated with the Feline
Leukemia virus (FeLV) and the Feline
Immunodeficiency virus (FIV). We can
easily test for these diseases with our in-hospital laboratory.
More specifically, it is the
inflammation in the gums, not an infection, that causes this problem.
The inflammation is caused by plasma cells and lymphoctyes (hence the
name in the title of this page) that infiltrate the gums. It is the
immune system that gets this whole process going. Why, we do not know.
It is at this point, called
a neck lesion in the cat, that gets the process started. The slight
redness and inflammation does not seem like much at this point in
time, which is why most people ignore the problem at this stage.
This problem rapidly
progresses unless the teeth are professionally
cleaned and routine dental hygiene is instituted at home. Now the
stage is set for the severe inflammation seen in the first picture on
this page.
Treatment
This problem is one of the most
frustrating diseases for veterinarians and owners, not to mention the
poor cats that have this problem. Some cats respond to treatment,
others do not. Some cats are effectively treated with a specific
modaltily, while other cats treated with that same type of treament
might not respond at all. Prevention is particularly important in this
disease due to the difficulty in controlling it once it occurs.
Plaque control is paramount in
treatment. This means your cat's teeth need to be professionally
cleaned as the plaque builds up. In our hospital we perform
non-anesthetic dentals (also called NAD) to
start the process of dental hygiene long before the gums become
significantly inflamed like the two prior pictures. For most cats
cleaning the teeth this way every 6 months can prevent the problem.
In between these cleanings the teeth
need to be brushed. This is difficult to near impossible to accomplish
once the gums become inflamed. It emphasizes the importance of
preventing this problem with good dental hygiene before any symptoms
appear.
Our dental page
has comprehensive information on how we professional clean pets' teeth.
You will read about and hear of numerous
treatments for this problem. In most cases they only give temporary
relief, if that, and cats continue to suffer. The most consistent and
effective treatment for this problem is removal of the teeth.
Unfortunately people commonly wait too long thinking medical therapy
will cure the problem.
There are several different therapies,
that have been used by themselves or in combination, to treat this
disease.
1. Laser Surgery
Our laser machine has been used to help
cats with this serious problem. The results are not always beneficial.
It removes the inflamed tissue and makes the mouth much less painful.
Sometimes several treatments are performed in order to gently removed
just the layers of tissue that are inflamed. If your cat is a
candidate for tooth removal the laser can sometimes be beneficial to
help with the gums that are still inflamed.
Click here to
learn more about our laser in general and to see how it is used in many
surgeries.
2. Antibiotics
For most people we chose liquid
antibiotics due to their ease of administration in cats, not to mention
cats whose mouths are in pain. To help ease administration only a small
amount of antibiotic is needed. One of our technicians will demonstrate
the proper method of administration.
We chose antibiotics that are safe and
specific for the type of bacteria that are adding to the problem. They
are given for one to two weeks initially, and are refilled as needed.
They will be used periodically during the course of this disease as the
problem flares up in the future. We will sometimes vary them for
greater effectiveness. Unfortunately, they do not effect a cure, and
only help us bide time. Their long term use can also cause resistance.
3. Interferon
Interferon is used for its ability to
help stimulate the immune system. This works well in some cats,
although it is a relatively new therapy and has not proven itself in
the long run. For a cat that is not responding to other medications it
is well worth trying this drug. It is inexpensive and given in small
amounts.
4. Cortisone
Prior to our new and more effective
treatment modalities, cortisone, in the form of DepoMedrol, was used to
control the inflammation. It never cured the problem, and eventually
required higher doses to achieve its desired effect. In many cases, it
no longer worked at all. At high and prolonged levels cortisone can
cause significant problems, so this
form of therapy is no longer recommended.
5. Homeopathy
Some cats do well with homeopathic
remedies. This treatment modality is used in select cases by one of our
doctors. You can learn more about it by following this link on homeopathy.
6. Tooth Removal
In most cases we recommend removing the
teeth that are associated with the inflamed gums. If nothing else
works, or your pet is showing side effects to the medication that is
routinely used (particularly cortisone), this procedure makes sense. It
works well in 60% of the cases. It might be more effective when used
earlier in the course of the disease.
In some cases we only remove the molars
or premolars, leaving the incisors and canines. Most cats feel
significantly better when these teeth are removed. Your doctor will let
you know if it is an appropriate therapy to use for your pet.
Some cats still have inflamed gums even
after tooth removal. Laser can be an beneficial treatment in these
cases. Some of these cats respond to pain or anti-inflammatory
medication, and medications to decrease the immune response
(cyclosporine). If these cats eat well and maintain their weight then
we have helped them.
Every ill pet benefits from proper
nutrition and husbandry. There are some specific Prescription Diet
foods that are fed to keep your pets weight up and give it the strength
to fight this problem. We also use Standard Process vitamin
supplementation successfully. Ask your doctor if one of them is
appropriate for your situation.
Compliance
In a chronic disease like
Lymphoplasmocytic gingivitis it can be frustrating to give proper
medication and care on a long term basis. It is important to understand
that this disease is not cured with medical therapy alone, it is only
controlled. It is important that you make your pet's care a high
priority and give medication as prescribed. It is also important to
bring your cat in for an exam at least every 6 months, and even more
often in some situations.
Always let us know if you are having
difficulty giving medication or following our recommendations. We have
extensive experience in diseases of animals, and can help you with your
unique situation. Never hesitate to call us with questions, or bring
your pet in for an exam if you think it is having a problem or are
unsure of what to do because we are all part of your pet's health care
team
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