Dental Corner: Feline gingivostomatitis: How to relieve the oral discomfort
Feb 01, 2006
The oral lesions associated with feline gingivostomatitis are often mistaken for an oral infection; however, gingivostomatitis is not an infection but rather an inflammation. The inflammatory lesions associated with feline gingivostomatitis are thought to be the result of a highly reactive immune system. The specific antigen that the immune system is reacting to is not easily identified and is often unknown. The fact that most of these lesions will resolve when the teeth are removed suggests the involvement of an antigen that is intimately associated with the teeth (i.e. bacteria). However, because not all inflammation resolves when the teeth are removed, it must be conceded that multiple antigens may be involved. Other antigens that may have a role in triggering the oral inflammation associated with feline gingivostomatitis include viral, food, or environmental antigens. Autoimmunity may also be a component of the disease.
Differential diagnoses for oral inflammation in a cat include feline gingivostomatitis, periodontal disease, inflammation secondary to feline odontoclastic resorptive lesions (FORLs), certain viral diseases (infection with feline herpesvirus or feline calicivirus) that can cause oral inflammation and ulceration, eosinophilic granuloma, oral ulceration secondary to uremia, and neoplasia. A complete patient evaluation is paramount to making a correct diagnosis and embarking down a specific treatment path.
To begin this evaluation, perform a physical examination, a complete blood count and serum chemistry profile, and serologic testing for feline leukemia virus and feline immunodeficiency virus infections. Perform additional testing and imaging as indicated. The results of these tests in cats with feline gingivostomatitis are usually unremarkable except for oral lesions, mandibular lymphadenopathy, and hyperglobulinemia.
Histologic examination results in cats with feline gingivostomatitis show plasmacytic stomatitis or lymphocytic-plasmacytic stomatitis. There may be concurrent neutrophilic inflammation or even a superficial bacterial component, but the predominant population of cells will be plasmacytes and lymphocytes.