Lymphocytic-Plasmacytic Gingivitis Stomatitis (LPGS)

What is LPGS?

feline2.jpg (27122 bytes)
Severe inflammation around the canines
and premolars

LPGS is a severe oral disease which affects some cats. The cat becomes allergic to plaque around its teeth. The allergic response appears as marked inflammation at the area where the tooth meets the gum line.

Signalment - purebred feline breeds (Abyssinian, Persian, Himalayan, Burmese, Siamese, and Somaliís) are predisposed.

Signs - ptyalism, halitosis, dysphasia, anorexia (prefers soft food), dysphasia, weight loss, scruffy hair coat.

Physical Exam - erythematous, ulcerative, proliferative lesions affecting either the gingiva, glossopalatine arches, tongue, lips, buccal mucosa and/or the hard palate. The gingival inflammation completely surrounds the tooth (as compared to gingivitis which usually only occurs on the buccal surfaces. The syndrome may extend to the glossopharyngeal arches (faucitis) as well as the palate.

Causes and Risk Factors - Actual cause unknown, bacterial, viral and immunologic etiologies are suspected. Significant findings of feline coronavirus were found in one study. Immunosupression from FeLV or FIV can also lead to non responsive infections. Most cats affected by LPGS are negative for FeLV and FIV.

faucitis.jpg (6640 bytes)
Ulceration of a cat's pharynx
due to feline stomatitis

Diagnosis

Differental DX - periodontal disease, oral malignancy, eosinophilic granuloma complex.

CBC/CHEM/UA - polyclonal gammopathy secondary to antibody production following bacterial invasion into periodontal tissues. Leukocytosis and eosinophilia may be present.


Resolution of ulcers two weeks
after extraction of cheek teeth
and laser therapy

Imaging - intraoral radiographs are indicated to evaluate periodontal disease and feline oral odontoclastic resorptions.

Diagnostic Procedures - biopsy should be performed especially in unilateral lesions to rule out neoplasia (primarily squamous cell carcinoma).

Pathologic Findings - plasma cells in sheets with some lymphocytes

Treatment

First line therapy involves teeth cleaning above and below the gingiva as well as strict home care and treatment (extraction) for those teeth affected with grades 3 and 4 periodontal disease and/or feline odontoclastic resorptive lesions.

Currently, the only treatment that will deliver consistent results of 70% cure without the use of follow up medications, are extractions of all the teeth distal to the canines. In addition to extraction, all quadrants are flapped and a bur is used to remove a trough of bone where the roots were, thus removing most of the keritinized gingiva, periodontal ligament and periradicular alveolar bone. In those non-responding, all teeth are removed. When extracting the teeth meticulous attention must be paid that, all tooth substance is removed. Intraoral radiographs should be taken before and after surgery. Additionally, the alveolar socket should be "smoothed down" with a high-speed drill bur before resuturing the gingiva. Postoperative application of fluocinonide 0.05% (Lidex Gel) to the gingival margin helps in the healing process.

Drugs - Antibiotics (clindamycin 5mg/kg q12hrs), Metronidazole, amoxicillin, ampicillin, enrofloxacin, tetracycline, Corticosteroids: Prednisone 2mg/kg initially daily followed by every other day. Methylpredinsolone acetate 2mg/kg q 7-30 days may also help control inflammation. Gold Salts (Solganol: Shering 1mg/kg im every week until improvement (up to four months) then every 14-35 days), megestrol acetate 1mg/kg, levamisole, cyclophosphamide, cyclosporin-A, chlorambucil 2mg/m2 orally every other day or 20 mg/m2 every other week, vitamin therapy, asprin, megestrol acetate, Bovine Lactoferin (40mg/kg) applied to the oral mucus membranes, and CO2 laser therapy have been used with inconsistent long term results. Lack of permanent response to conventional oral hygiene, antibiotics, anti-inflammatory drugs, and immunosupressives is typical.

Follow-Up - N/A

Age Related Factors - N/A

Associations with Other Diseases - for cats that are FIV+ AZT (5mg/kg) orally BID for three weeks and evaluate results, Oral interferon (Roferon) may help in the short term.

 



This page last updated on October 31, 2000
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Jan Bellows, DVM
All Pets Dental Clinic
17100 Royal Palm Blvd.
Weston, FL 33326
(954) 349-5800
dentalvet@aol.com