Gingival Flare or Gingival Hyperplasia (Stomatitis)

By Alfred J. Plechner, D.V.M.

What is a gingival flare or gingival hyperplasia (stomatitis)? A gingival inflammation is a syndrome that I have found that relates to a thin red line in the gum tissue as it joins the enamel or an overall inflammation of the gums that is not related to a dental problem.

What does a gingival flare indicate? It indicates that the patient has Atypical Cortisol Estrogen Imbalance Syndrome (ACEIS), that the general public refers to as Plechner’s Syndrome.

Why does it happen? This occurs because there is a hormonal imbalance that has caused a deficiency in the antibody production of IgA, which is referred to as the mucous membrane antibody produced by the B lymphocyte in the mucous membranes of the inner body, and many times it is more easily visible in the mouth. This red line [gingival flare], indicates a deficiency in the mucous membranes of the body, is referred to as IgA deficiency. It may be present in as high as 70% of the cat population and 30% of the dog population.

It seems to be mainly genetic and can be acquired and can be caused by monthly chemical insect repellents which you can read about on Dr. Plechner’s Corner on this website.

If this deficiency occurs throughout the body, then where also may this deficiency affect the body of the patient? If you consider all the areas in the body, where the IgA antibody if not present in adequate amounts to protect the patient?

Hopefully, you can understand that this disease may occur in many different areas. The following list happens to be just a few areas where chronic disease may occur when an IgA deficiency is present like dental problems, asthma and other respiratory disorders, chronic runny eyes, irritable bowel syndrome, chronic kidney and bladder disease, chronic dermatitis and other skin lesions, food sensitivities, joint disease, auto-immunity and cancer.

The chronicity of many diseases is the hall mark of ACEIS or Plechner’s Syndrome.

Please remember, if the tested IgA level is low enough in animals and in people, proper hormone reinstatement cannot occur through oral supplementation due to malabsorption in the gut, and Plechner’s Syndrome will continue.

Hopefully some of my thoughts will help.

The following 3 clinical cases relate to 2 cats and a dog.

Clinical Case #1

This is a 10 lb. 1 years old male, neutered cat with very bad breath that had had his teeth cleaned by his veterinarian and still had bad breath based upon his inflamed gums.

Upon referral, an endocrine immune test was performed with the following results:

 Cortisol = 0.57 ug/dl

 1 to 2.5 ug/dl

 Total Estrogen = 25.21 pg/ml

 20 to 25 pg/ml

 T3 = 0.84 ng/dl

 100 to 200 ng/dl

 T4 = 1.7 ng/dl

 2 to 4.5 ng/dl

 IgA = 53 ng/dl

 70 to 170 ng/dl

 IgM = 79 ng/dl

 100 to 200 ng/dl

 IgG = 879 ng/dl

 1000 to 2000 ng/dl

Because his IgA was at 53, he needed 2 intramuscular injection of a combination of Vetalog and Depomedrol to re control the pituitary ACTH and 10 days after his last injection, 10 mgs of Prednisolone or Prednisone was given orally.

The following were his last supplemented tests results:

 Cortisol = 2.0 ug/dl

 1 to 2.5 ug/dl

 Total Estrogen = 24.98 pg/ml

 20 to 25 pg/ml

 T3 = 137 ng/dl

 100 to 200 ng/dl

 T4 = 3.3 ng/dl

 2 to 4.5 ng/dl

 IgA = 76 ng/dl

 70 to 170 ng/dl

 IgM = 170 ng/dl

 100 to 200 ng/dl

 IgG = 1561 ng/dl

 1000 to 2000 ng/dl

Most cats unless they are truly hypothyroid or have FIP do not need thyroid hormone.

Clinical Case #2

A 3 year old 20 lb. spayed female Bichon, with a horrible gingival flare.

The owner was told the only way to solve the problem was with a total mouth extraction.

A client recommended this pet owner who was willing to check my syndrome.

 Cortisol = 3.1 ug/dl

 1 to 2.5 ug/dl

 Total Estrogen = 35.23 pg/ml

 20 to 25 pg/ml

 T3 = 78 ng/dl

 100 to 200 ng/dl

 T4 = 1.24 ng/dl

 2 to 4.5 ng/dl

 IgA = 49 ng/dl

 70 to 170 ng/dl

 IgM = 67 ng/dl

 100 to 200 ng/dl

 IgG = 719 ng/dl

 1000 to 2000 ng/dl

Three intramuscular injections of a combination steroid were given at a 10 day interval, followed up by 2mgs of oral Medrol 10 days later. 0.2 mgs of a T4 supplement twice daily was started immediately.

Supplemental test results:

 Cortisol = 1.8 ug/dl

 1 to 2.5 ug/dl

 Total Estrogen = 35.01 pg/ml

 20 to 25 pg/ml

 T3 = 147 ng/dl

 100 to 200 ng/dl

 T4 = 3 ng/dl

 2 to 4.5 ng/dl

 IgA = 71 ng/dl

 70 to 170 ng/dl

 IgM = 130 ng/dl

 100 to 200 ng/dl

 IgG = 1240 ng/dl

 1000 to 2000 ng/dl

Clinical Case #3

A 9 year old, 15 lb., female spayed cat.

She had had most of her teeth extracted due to this gingival flare and even after having many teeth removed, she still had the gingival flare and bad breath.

 Cortisol = 0.42 ug/dl

 1 to 2.5 ug/dl

 Total Estrogen = 35.16 pg/ml

 20 to 25 pg/ml

 T3 = 157.8 ng/dl

 100 to 200 ng/dl

 T4 = 2.75 ng/dl

 2 to 4.5 ng/dl

 IgA = 58 ng/dl

 70 to 170 ng/dl

 IgM = 95 ng/dl

 100 to 200 ng/dl

 IgG = 975 ng/dl

 1000 to 2000 ng/dl

Since her IgA was at 58, she should be able to absorb oral steroids, so she began 10 mgs of Prednisolone once daily. A number of weeks after beginning the hormone supplement, her gingival flare was gone.

Supplemental test results:

 Cortisol = 0.6 ug/dl

 1 to 2.5 ug/dl

 Total Estrogen = 34.98 pg/ml

 20 to 25 pg/ml

 T3 = 176 ng/dl

 100 to 200 ng/dl

 T4 = 3.4 ng/dl

 2 to 4.5 ng/dl

 IgA = 81 ng/dl

 70 to 170 ng/dl

 IgM = 185 ng/dl

 100 to 200 ng/dl

 IgG = 1759 ng/dl

 1000 to 2000 ng/dl

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