Gingival Flare Case Reports

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

The following case reports are to indicate to you that a mucous membrane antibody deficiency in the mouth can cause not only bad breath but a definite reason why the patient may lose their teeth.

Teeth cleaning is often recommended, but usually may not make a difference with this imbalance. However ever, it might cause a general anesthetic risk even if the patient is young and not old.

CASE 1

This involves a 3 year old, spayed female cat with severe inflammation of her gums.

She was put under general anesthetic yearly to have her teeth cleaned even if there was little plaque formation.

She obviously, with this immune deficiency, had bad breath which changing her food with this imbalance, never worked.

She had been referred to me for a possible different cause.

An Atypical Cortisol Estrogen Imbalance Syndrome (ACEIS) or as the public refers to it as Plechner’s Syndrome blood test was performed with the following results:

TEST RESULTS

Cortisol = 4.1 ug/dl

1 to 2.5 ug/dl

Total Estrogen = 35.16 pg/ml

20 to 25 pg/ml

T3 = 130 ng/dl

100 to 200 ng/dl

T4 = 2.9 ng/dl

2.0 to 4.5 ng/dl

IgA = 53 ng/dl

70 to 170 ng/dl

IgM = 75 ng/dl

100 to 200 ng/dl

IgG = 690 ng/dl

1000 to 2000 ng/dl

Because of her defective, non-active cortisol, and with the pituitary glands lack of recognition of this defective cortisol, the ongoing pituitary ACTH production over stimulated the inner layer adrenal cortex to produce increased amount of adrenal estrogen that not only caused the immune cells to lose recognition of self-tissue but also binds the receptor sites of thyroid and caused the B cell production of antibody to be reduced and deficient.

The IgA level needs to be at 58 for oral steroid absorption to occur and since her IgA level was only at 53, it was necessary to give her 3 IM injections of a short acting and long acting steroid at 10 day intervals to bypass her gut, and fund the negative feedback to the pituitary gland with an active synthetic cortisol in order to reduce the excess production of ACTH and to reduce the adrenal estrogen and allow the IgA to reach 58.

Once this was accomplished, she went on oral steroid replacement 10 days after her 3^rd injection.

After interim testing and final testing these are the following results for her to remain in order to have healthy gums without the concern of losing her teeth while being anesthetized.

SUPPLEMENTED BLOOD TEST RESULTS

Cortisol = 0.79 ug/dl

1 to 2.5 ug/dl

Total Estrogen = 34.98 pg/ml

20 to 25 pg/ml

T3 = 140 ng/dl

100 to 200 ng/dl

T4 = 3.3 ng/dl

2.0 to 4.5 ng/dl

IgA = 80 ng/dl

70 to 170 ng/dl

IgM = 123 ng/dl

100 to 200 ng/dl

IgG = 1340 ng/dl

1000 to 2000 ng/dl

CASE 2

This involved a 5 year old, 25 lb., neutered male, Cocker Spaniel with inflamed gums that were diagnosed as problems with the teeth and after multiple teeth cleanings an antibiotics, the gingival flare still persisted.

An EI test was performed with the following results;

TEST RESULTS

Cortisol = 2.1 ug/dl

1 to 2.5 ug/dl

Total Estrogen = 25.01 pg/ml

20 to 25 pg/ml

T3 = 174 ng/dl

100 to 200 ng/dl

T4 = 3.6 ng/dl

2.0 to 4.5 ng/dl

IgA = 81 ng/dl

70 to 170 ng/dl

IgM = 170 ng/dl

100 to 200 ng/dl

IgG = 1800 ng/dl

1000 to 2000 ng/dl

The gums became normal and the teeth remained in place.

Please remember with gingival problems existing, they will allow for the gums to recede and when this happens, often the gingival recession will eventually expose the roots of many teeth and then dental extraction will be indicated unless the actual damaged teeth normally exit the mouth.

Please also realize that this IgA immune deficiency can also have different impact areas based upon genetics.

Case 3

This involved a 3 year old, neutered male Collie with chronic gum disease that responded to antibiotics while given but returned once the antibiotics were stopped.

The chronic inflammation also cause an over growth of gingival tissue that did over grow some of the teeth itself.

TEST RESULTS

Cortisol = 3.4 ug/dl

1 to 2.5 ug/dl

Total Estrogen = 25.23 pg/ml

20 to 25 pg/ml

T3 = 1.35 ng/dl

100 to 200 ng/dl

T4 = 2.8 ng/dl

2.0 to 4.5 ng/dl

IgA = 56 ng/dl

70 to 170 ng/dl

IgM = 90 ng/dl

100 to 200 ng/dl

IgG = 920 ng/dl

1000 to 2000 ng/dl

Since his IgA was at 56 even with defective or bound elevated cortisol, one injection of an IM steroid allowed oral steroids to start 10 days after his IM injection.

Thyroid hormone was begun immediately due to the estrogenic block of the T3, T4 receptor sites.

His endocrine immune imbalance returned to normal after 3 weeks but his increase gum tissue needed to be removed so electro surgery was done to remove this excess gum growth called gingival hyperplasia.

Hopefully these few cases that represent thousands of other successfully treated cases of gingival flare, will give you an idea why gingival flare does occur.

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