Feline Lymphocytic Plasmacytic Stomatitis (FLPS): The majority of these cats present with a chronic history of disease and prior attempts at treatment. Prior treatments that have been reported are dental prophylaxis with extraction of non-salvageableteeth and medical management with antibiotics and steroids. Improvement rates of 40-80% have been reported.1 Caudal teeth extraction has reported rates of 20% improvement, with 60% resolution. 2 Dr. David Nielsen, from the Animal Medical Group in Manhattan Beach, CA has pioneered the use of the CO2 laser in the battle against FLPS. Dr. Nielsen reports 10% improvement with 90% resolution. The CO2 laser strives to eliminate the diseased tissue, provide pain relief and save healthy dentition. Laser treatment is NOT a cure for this immune mediated disease, but has proven to be a very important tool in the therapy and control of FLPS. Important points in FLPS therapy: Complete labwork (CBC, Biochemical profile, FeLV, FIV status) should be done pre-treatment. A complete dental evaluation including full mouth radiographs, with extraction of non-salvageable teeth, periodontal therapy and cleaning must be done at the same time as the initial laser treatment. The CO2 laser protocol is 3 treatments, 4-6 weeks apart. Laser settings are 2-6 CW, 0.8-1.4mm tips. The laser is used in a defocused beam to paint the entire inflamed tissue area. Char is wiped off with saline moistened gauze or cotton swabs. Lasering continues till no further bleeding is seen. Care mustbe taken to protect the teeth and the endotracheal tube from the laser beam. Post-operative pain relief is provided by local blocks of 50:50 mix of lidocaine: bupivicaine, and a transdermal Fentanyl patch. Postoperative antibiotic therapy targeted at anaerobes consists of Clindamycin Drops for 10-14 days. After the initial 3 treatments, cats will either resolve completely or require periodic “touch-up” laser treatments 2-4 times per year. Caudal teeth extraction is pursued in those cats that fail to respond well to laser therapy. Best responses to laser therapy are seen in cats with prior caudal or full-mouth extractions.
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