Ulceroproliferative Faucitis/Stomatitis
(Plasma cell stomatitis, Lymphocytic-plasmacytic stomatitis) |  |
| Cats with ulceroproliferative faucitis/stomatitis (UPFS) present with progressively worsening gingivitis and stomatitis. More significantly, the glossopalatine arches (fauces) have readily apparent lesions that are often very severely ulcerated, friable, inflamed, and proliferative. When a severe oral inflammation extends to involve this area in the back of the mouth that connects the upper and lower molar regions, UPFS should be suspected. The cause is unproved, but is suspected
to result from an inappropriate inflammatory response in affected individuals to an unidentified antigen on the tooth surfaces, including the root surfaces and periodontal ligament.
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| The most immediate sign is severe pain on opening the mouth. Cats vocalize and jump when they yawn or open their mouth to prehend food. Halitosis, ptyalism, and dysphagia may be seen. Cats often show an “approach-avoidance” behavior as they approach their food in hunger, then hiss and run off in anticipation of discomfort. If the condition is severe and of long duration, weight loss may be evident. The disease is slowly progressive, and if soft, palatable foods are being fed, it
may be fairly severe before signs are recognized. Submandibular lymphadenopathy is sometimes present. Frequently, because of pain, the oral cavity cannot be visualized adequately without sedation or anesthesia. |
| Diagnosis: |
| A complete history, oral examination, and evaluation for systemic disease (eg, renal failure) is the minimum database that should be obtained. Oral biopsy for histopathology and immunodiagnostic testing, virus isolation (eg, calicivirus), and retroviral testing may also be needed to determine a prognosis; affected cats generally require surgery. Histopathologic evaluation is required to exclude oral neoplasia or other specific oral disorders. Most biopsy samples collected from
chronic inflammatory or ulcerated lesions reveal a predominance of lymphocytes and plasma cells, which indicate the chronic inflammatory nature of the lesion without elucidating the primary etiology. |
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| Treatment: |
| Extraction of all the premolars and molars and removal of the associated periodontal ligaments by alveolar curettage is the only treatment that has provided some improvement and aided in overall longterm control. If any teeth are missing, dental radiographs are required to check for retained roots, which must be removed. Antibiotics (eg, amoxicillin-clavulanate, clindamycin, metronidazole) should be administered if primary or secondary bacterial infections are present.
Culturing the lesions and performing susceptibility tests are rarely indicated even in chronic or recurrent infections. Symptomatic treatment for stomatitis includes dietary changes, antibiotics, and topical antiseptics (eg, 0.1% chlorhexidine solution or gel). Animals that are unable or unwilling to eat and drink should be given parenteral or subcutaneous fluids to prevent dehydration. Placement of a nasoesophageal, pharyngostomy, or gastrostomy tube should be considered in
debilitated animals that do not respond to therapy. Frequent feedings of palatable liquids and, later, semisolid foods encourage eating. |
| Many other treatments for UPFS have been reported, including maintaining good oral hygiene, treating periodontal disease, regular dental prophylaxis, gold salts, azathioprine, hypoallergenic diets, CO2 laser, cryotherapy, electrofulguration, and radiosurgery. None of these provide longstanding resolution. Glucocorticoid administration usually results in significant and immediate clinical improvement due to modulation of the excessive inflammatory
response, but is not recommended. Repeated injections (methylprednisolone) or oral maintenance therapy (prednisone) are frequently required, as the treatment becomes progressively less effective and eventually completely ineffective. In addition, animals treated with glucocorticoids have a poorer prognosis once the teeth are extracted. Extraction of all premolars and molars or full-mouth extractions generally result in significant improvement or complete resolution of the
inflammation if performed early in the course of the disease and before multiple glucocorticoid treatments. (See also
feline stomatitis complex,
Feline Gingivitis/Stomatitis Syndrome.) |
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