Plasma Cell Stomatitis, also known as Lymphoplasmacytic Stomatitis (LPS), feline caudal stomatitis, chronic oral inflammatory disease, feline chronic gingivostomatitis, or caudal mucositis, is a challenging and painful oral condition that affects cats. It primarily involves inflammation of the oral tissues, specifically the area at the back of the mouth where the upper and lower jaws meet, known as the palatoglossal arch or fauce.
Causes and Factors Associated with Plasma Cell Stomatitis
The exact cause of plasma cell stomatitis is not fully understood, making it difficult to prevent. Several factors and associations have been identified:
- Immune Reaction: Plasma cell stomatitis appears to result from an inappropriate immune reaction, potentially triggered by plaque on the teeth or other oral antigens.
- Calicivirus: Many affected cats are chronic carriers of calicivirus, a common upper respiratory virus in cats. While the relationship between calicivirus and plasma cell stomatitis is unclear, it may be a contributing factor.
- Feline Immunodeficiency Virus (FIV): Cats with FIV may be predisposed to developing plasma cell stomatitis.
- Metabolic Diseases: Some metabolic conditions can contribute to oral inflammation. Blood tests can help identify and address underlying metabolic issues.
Diagnosing Plasma Cell Stomatitis
Diagnosing plasma cell stomatitis often involves a combination of clinical signs and diagnostic tests:
- Clinical Signs: Cats with this condition typically exhibit bright red and inflamed gums, especially in the palatoglossal arch area. Severe pain can lead to difficulty eating, grooming, and unpleasant breath.
- Biopsy: A definitive diagnosis is usually confirmed through a biopsy of the inflamed oral tissues.
Treatment Approaches for Plasma Cell Stomatitis
Effective management of plasma cell stomatitis focuses on several key components:
- Full Mouth Extractions: While it may seem drastic, one of the most effective treatments for plasma cell stomatitis is the extraction of all molars and premolars, often referred to as full mouth extractions. This approach has yielded excellent long-term results in many cases. In one study, up to 90% of cats experienced a cure or significant improvement after full mouth extractions, with a higher success rate when canine teeth (fangs) were also extracted. It is crucial to perform dental radiography to ensure complete removal of root tips and to ensure the periodontal ligament is fully obliterated to prevent ongoing inflammation. Pain medication is typically prescribed post-extraction.
- Inflammation and Pain Control: Medical management focuses on suppressing excessive immune activity and relieving inflammation and pain. Cortisone-derived medications like prednisone or triamcinolone are often used initially. Long-acting injectable steroids like methylprednisolone acetate may be beneficial in severe cases. Cyclosporine, an oral medication with fewer side effects than steroids, may also be considered.
- Antibiotics: Antibiotics such as Clavamox or clindamycin are prescribed, often for extended periods (at least four weeks), to address bacterial infections in the mouth. These antibiotics target anaerobic bacteria residing in plaque on the teeth.
- Miscellaneous Medications/Treatments: Other medications, including pentoxifylline, maropitant citrate (Cerenia®), interferon omega, bovine lactoferrin, and hypoallergenic diets, may be used as adjunctive treatments to help manage inflammation and alleviate pain.
Pain relief options such as fentanyl patches or buprenorphine may be necessary during painful flare-ups.
It is essential to consider full-mouth extraction early in the disease's course for the best results. Medical management is typically reserved for specific situations, such as severe flare-ups or patients requiring additional treatment after extractions.
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