Stomatitis (Lymphocytic/plasmacytic)

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This disease goes by several names. Some of them 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, drooling, a poor haircoat, halitosis (bad breath), bloody oral discharge, 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. You can see the anesthetic breathing tube at the bottom left of the picture.

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 panelviral teststhyroid levels, and dental radiographs.

The roots in this first radiograph are normal

normalrad

The circle shows the problem with the roots of this tooth. There is loss of bone around the tooth.

badtoothrad1circle

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 called squamous cell carcinoma, can mimic this one.

Cause

  • Kidney failure causing uremia
  • Foreign bodies from plant material
  • Viruses
  • Allergic responses

It is usually caused by a specific reaction in the immune system (called immune-mediated), similar to, but not exactly like, allergies. This abnormal response is secondary to even a small amount of plaque on the teeth. For some reason a cats immune system over reacts to this plaque and the inflammation starts. This emphasizes the need for early and thorough dental care.

Like many diseases, there are numerous factors working together.  These factors  include viruses, bacteria, genetics, stress, nutrition, and hormone diseases.

It is sometimes associated with the Feline Leukemia virus (FeLV), and more commonly associated with the Feline Immunodeficiency virus (FIV). We can easily test for these diseases with our in-hospital laboratory. Fortunately, due to vaccines, we rarely see FeLV any more.

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. The medical therapies eventually do not work well, and removal of the teeth is needed.

1. Laser Surgery

In very select cases 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 remove just the layers of tissue that are inflamed. After 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

Antibiotics can give immediate relief until the best course of action is decided. For most people we choose 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. Cortisone

Prior to our new and more effective treatment modalities, cortisone, in the form of DepoMedrol injections, was used to control the inflammation. It was helpful because it helped decrease the inflammation for up to a month, and when used with antibiotics, helped these cats feel better and start eating again.

It never cured the problem, and eventually required higher doses to achieve its desired effect. In many cases, it no longer worked at all. Even though cats are very tolerant of cortisone compared to people, high and prolonged levels cortisone can cause  problems, so this form of therapy is no longer recommended.

4. Homeopathy

Anecdotal evidence suggests some cats do well with homeopathic remedies, although this is far from being proven or a standard treatment for this disease. 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.

5. Tooth Removal

Even though it seems extreme, in most cases we recommend removing all of the teeth. It might be more effective when used earlier in the course of the disease, which is why we frown upon long term use of oral antibiotics and DepoMedrol. These medications are delaying the inevitable, add to the cost, and increase chances of side effects to the medication. Removing all of the teeth cures the problem in the majority of cases. Those that are not cured show a significant improvement, making the surgery well worth it.  Your cat does not need teeth to eat, even hard food.

 Removing these teeth is a tedious process due to the number of teeth involved, the small size of these teeth, and the inflammation around the teeth.

Long Term Care

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.

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