Plasmacytic-Lymphocytic Stomatitis in cats is a chronic condition that results in extreme gingivitis and tooth loss. There are several things that cause this disease but the end result is always the same. Cats with stomatitis often have a rancid odor in their mouth, salivate excessively and have difficulty eating. The chronic mouth pain results in a decreased appetite and weight loss. Examination of the teeth and gums reveals extreme gingivitis especially around the upper back molars. The gums will appear raw and bumpy and bleed easily. As the disease progresses the gums will recede from the tooth root and the root will begin to be absorbed resulting in tooth loss. Biopsies of affected gum tissue reveal plasma cells and lymphocytes, thus the name of the disease. These cells are present in cases of chronic inflammation and reveal not a distinct disease but rather an out-of-control immune reaction. With this degree of inflammation occurring, secondary invasion of bacteria is very common. The bacterial infection results in the rancid odor and can lead to bacterial invasion of the blood stream with infection in other organs such as the kidneys, heart and liver.
Researchers have not been able to isolate any one cause of this disease, although calicivirus has been isolated in many of these cases. Calicivirus infections in kittens cause small blisters on the tongue and gums. It is suspected that many cats are chronically infected with this virus with recurrent infections causing extreme gingivitis.
Diseases that cause a suppression of the immune system can result in chronic stomatitis. Many cats with Feline Leukemia Virus infection and Feline Immunodeficiency Virus (FIV) also have extreme gingivitis. There are also many unknown factors that could play a role in this disease such as a severe reaction to bacteria present in plaque. The severe lesions seen in cats with this disease suggest that the underlying cause is most likely a combination of two or more of the above factors.
Lymphocytic-plasmacytic stomatitis tends to occur in young adults and older cats. Kittens develop juvenile gingivitis that causes mouth odor and inflamed gums but with aggressive home care most kittens will outgrow this gingivitis within 2 years. Several cases of juvenile onset periodontitis have been reported. This disease starts before 9 months of age and unlike juvenile gingivitis results in excessive plaque and tartar build up on the teeth.
Various treatment regimens have been used for chronic stomatitis with varied results. Unfortunately, on a long term basis response to treatment is poor. The cornerstone of any treatment approach is a thorough dental cleaning under anesthesia. It is important to get below the gum line and to apply a long acting disinfectant gel. Antibiotic therapy gives temporary relief and will control bacterial invasion of the gum tissue. Antinflammatory therapy with cortisone has been used with mixed results. Immunostimulants such as Immunoregulin also have been used with some success.
Extraction of all the premolars and molars seems to be the only treatment option that provides long term relief to these cats. It is important that all the roots be extracted to eliminate the inflammatory response. This option is utilized after all the above treatments have failed to give these cats some relief. It is important to remember that these cats are in extreme pain and are reluctant to eat; providing adequate nutritional support is essential. There are several high calorie soft foods on the market that will provide this required nutrition.
Since treatment response is poor, it makes sense that chronic gingivitis is better controlled through prevention. Since calicivirus appears to be a possible contributing factor to this disease, it is important to control upper respiratory infections in the household. Kittens should be vaccinated against calicivirus at 6 weeks, 9 weeks and 12 weeks of age, and they should be kept isolated from other kittens and adults until the vaccination series is completed. All adults in the household should also be kept current on their calicivirus vaccinations. In addition, testing should be done for Feline Leukemia and FIV. Any positive cats should be removed or isolated.
Any adults that either have chronic gingivitis or produce kittens that later develop chronic gingivitis should be spayed or neutered. If gingivitis does occur, then early aggressive treatment is important for control. Teeth should be checked weekly for gingivitis beginning at 12 weeks of age. Pay special attention to the premolars and molars. If gingivitis is present, aggressive homecare with topical antiseptic gels should be started. Antibiotics should also be used if there is any odor or pain present in the mouth.
In early 1997, two new products came on the market that are designed to prevent and control tartar and gingivitis. T/D is a dry food produced by Hill's that is designed to reduce the rate of plaque and tartar accumulation. If severe disease is already present then the use of this food is contraindicated. C.E.T. Chews produced by VRx Pharmaceuticals is a freeze-dried fish treat that provides abrasive cleansing action as well as antibacterial enzymes to combat gingivitis. Both products are available through veterinarians and may prove to be important tools in preventing chronic gingivitis and ultimate tooth loss in cats.
Credit : http://www.cfa.org/articles/health/gingivitis.html
