Lymphocytic/Plasmacytic Gingivitis Stomatitis in Cats
Cats can suffer from lymphocytic/plasmacytic gingivitis stomatitis (LPGS) or feline gingivitis stomatitis (FGS), a condition that is unique to their species. These terms refer to a severe inflammation that can affect the entire mouth as well as the gums. The gums will be very red and bleed easily if chafed. Some cats will have lesions that proliferate along the gums. Affected cats will have bad breath and may drool a great deal. These cats have extremely painful mouths and often will simply lick at their food, making no attempt to pick up pieces or chew.
Although most cats with this problem are middle-aged or older, there is a form that affects kittens just 3 to 5 months old. The kittens may outgrow the problem with extensive care, but most older cats do not. Abyssinians, Siamese, and Persians seem especially prone to the juvenile form of this problem.
The disease itself seems to be an immune reaction against dental plaque and/or the actual dentin of the teeth (the substance just under the enamel). The definitive cause is unknown. It appears to be an allergic or immune-based problem. About 15 percent of cats with LPGS will be positive for feline leukemia virus or feline immunodeficiency virus. An earlier exposure to calicivirus is considered to be a factor as well. The Bartonella species of bacteria are also implicated.
A biopsy may be needed to definitely diagnose this condition and rule out other similar problems that can result from renal failure, diabetes, or cancer. The fact that the lesions tend to be bilateral and symmetrical makes cancer less likely, but it should be considered and definitively ruled out. X-rays should be taken to check for tooth problems, including root resorptions (dissolving roots) and abscesses.
Treatment: Cats with LPGS will need to be treated for the inflammation with oral or injectable steroids. Antibiotics should be added, at least initially, to prevent bacterial overgrowth. Pain medications, such as a fentanyl patch, can be important to keep the cat comfortable. Laser surgery may be done to remove proliferative areas of inflamed tissue. Bovine lactoferrin (an iron-binding protein with immunomodulation capabilities) can be compounded for cats and used to flush the mouth. This product may act against calicivirus, as well, so it may be a double-edged weapon.
Cats with plaque and tartar buildup need to have that problem addressed. This may require cleanings under anesthesia as often as every four to six months. In addition, a diet for tartar control, such as Science Diet Oral Care, Purina D/H, Hill's Prescription Diet Feline t/d, or Royal Canin Feline Dental DD 27, may be helpful. CET Oral Hygiene freeze-dried meat chews for cats may also be useful.
Home care includes keeping the mouth and teeth as clean as possible with daily brushing and mouth washings. Switching from plastic or rubber to stainless-steel or ceramic food and water bowls may help some cats. Also, switching to a hypoallergenic, limited protein source diet, such as Royal Canin's Hypoallergenic HP 23, may be beneficial.
In many cats, LPGS will not clear up despite aggressive treatment and they will remain in discomfort until all of their teeth-or at least all of the teeth except the canines-are removed. Although this may seem a bit drastic, the cats do extremely well, regain lost weight, are clearly more comfortable and have no trouble eating-even dry kibble, in most cases.
This article is excerpted from “ Cat Owner’s Home Veterinary Handbook” with permission from Wiley Publishing, Inc.
Copyright © 2008 by Delbert Carlson, DVM, and James M. Giffin, MD. All rights reserved.
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