Difference between revisions of "Gingival Hyperplasia"

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==Typical Signalment==
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== Introduction ==  
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*Common condition in dogs but less common in cats
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[[File:Gingival hyperplasia.jpg|250px|right|thumb|Gingival hyperplasia]]
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*The following breeds are predisposed:
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Gingival hyperplasia often appears as pink, hyperaemic and ulcerated lesions that can be either firm or soft. There can be varying amounts of pigmentation reflecting the normal pigmentation of the oral mucosa. [[Tooth - Anatomy & Physiology#Crown|Crowns]] of teeth are often partially or completely covered by the hyperplastic gingiva forming a potential space or pocket between the [[gingiva]] and the [[Tooth - Anatomy & Physiology#Crown|crown]] where plaque is able to accumulate.
 
  
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Gingival hyperplasia can be described as focal lesions, multiple focal lesions or generalised lesions; or a combination of all of these.
 
  
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It is thought to be the result of an imbalance in the plaque/host tissue response. There are many factors that can cause this condition. These include drugs such as ciclosporin, phenytoin and calcium channel blockers. Chronic irritation and dental plaque are also causative. Other causes include odontoplastic resorptive lesions, neoplasia and mechanical irritation.
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<gallery>
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Image:Border_Collie.jpg|''Border Collie'' <p> sannse 2003, WikiMedia Commons
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Image:Boxer.jpg|''Boxer'' <p> Lilly M 2007, WikiMedia Commons
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Image:GermanShep.jpg|''German Shepherd (Alsatian)''<p> Elf 2004, WikiMedia Commons
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Image:labrador.jpg|''Retriever (Labrador)''<p> Elf 2004, WikiMedia Commons
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</gallery>
  
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== Signalment ==
+
==Description==  
−
This is a common condition in dogs but less common in cats. The following breeds are predisposed:
+
Gingival hyperplasia often appears as pink, hyperaemic and ulcerated lesions that can be either firm or soft. There can be varying amounts of pigmentation reflecting the normal pigmentation of the oral mucosa. [[Crown|Crowns]] of teeth are often partially or completely covered by the hyperplastic gingiva forming a potential space or pocket between the gingiva and the [[Crown|crown]] where plaque is able to accumulate.
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Border Collie, Boxer, German Shepherd (Alsatian), Retriever (Labrador).
 
  
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== Clinical Signs ==
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Gingival hyperplasia can be described as:
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Signs depend on the severity of gingival hyperplasia and the degree to which the teeth are covered. They include pain on mastication, drooling +/- blood in saliva, haemorrhage of the gingiva, reluctance to eat and dysphagia. The animal may paw its mouth or rub its mouth along the floor.
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*Focal lesions
 +
*Multiple focal lesions
 +
*Generalised
 +
*Combinations of the above
  
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== Diagnosis ==
+
It is thought to be the result of an imbalance in the plaque/host tissue response. There are many factors that can cause this condition. These include the following:
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Clinical signs are indicative of the condition. A detailed oral examination under sedation will lead to a presumptive diagnosis.
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*Drug-induced
 +
**Ciclosporin
 +
**Phenytoin
 +
**Calcium channel blockers
 +
*Chronic irritation
 +
**Dental plaque
 +
**Odontoclastic resorptive lesions
 +
**Neoplasm
 +
**Mechanical irritation
  
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'''Diagnostic Imaging'''
 
  
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Oral radiographs should be taken to rule out concurrent conditions. One such condition is [[Periodontal Disease|periodontitis]] which is demonstrated radiographically by alveolar bone loss associated with pocket formation between the tooth crown and gingiva.
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==Diagnosis==
  
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'''Biopsy'''
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===Clinical Signs===
 +
Depend on the severity of gingival hyperplasia and the degree to which the teeth are covered but include:
 +
*pain on mastication
 +
*haemorrhage (mild to moderate)
 +
*reluctance to eat
 +
*drooling
 +
*dysphagia
  
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Biopsy samples should include those areas of [[Gingiva|gingiva]] that show signs of inflammation with a softer than normal texture. Any gingiva with radiographic signs of bone involvement should also be sampled.
+
===Diagnostic Imaging===
 +
Oral radiographs should be taken to rule out concurrent conditions. One such condition is periodontitis which is demonstrated radiographically by alveolar bone loss associated with pocket formation between the tooth crown and gingiva.
 +
 
 +
===Biopsy===
 +
Biopsy samples should include those areas of [[Gingiva Introduction|gingiva]] that show signs of inflammation with a softer than normal texture. Any gingiva with radiographic signs of bone involvement should also be sampled.
 +
 
 +
==Treatment==
  
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== Treatment ==
 
 
The suspected cause of the condition should be corrected first. This may include a multimodal treatment plan aimed at controlling plaque formation including teeth brushing and providing the animal with sticks/toys that clean the teeth crowns.
 
The suspected cause of the condition should be corrected first. This may include a multimodal treatment plan aimed at controlling plaque formation including teeth brushing and providing the animal with sticks/toys that clean the teeth crowns.
  
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'''[[Periodontal Surgery - Small Animal#Gingivoplasty|Gingivectomy and gingivoplasty]]''' should be carried out under general anaesthetic if significant pseudo-pockets are present between the gingiva and teeth crowns. The aim should be to eliminate the pseudopockets and re-establish the normal anatomy of the gingival margin.
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*'''Gingivectomy and gingivoplasty''' - should be carried out under general anaesthetic if significant pseudo-pockets are present between the gingiva and teeth crowns. The aim should be to eliminate the pseudopockets and re-establish the normal anatomy of the gingival margin.
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+
**Electrosurgery and Laser surgery - care must be taken with electrosurgery to avoid contact between the teeth crowns and the electrodes to prevent irreversible heat damage to the pulp.
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Electrosurgery and laser surgery can be performed. Care must be taken with electrosurgery to avoid contact between the teeth crowns and the electrodes to prevent irreversible heat damage to the pulp.
 
  
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== Prognosis ==
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==Prognosis==
 
The prognosis following surgical excision and histopathology is good. However, local recurrence is possible but less common if a treatment plan aimed at reducing plaque formation is implemented. A re-examination of the patient should be carried out at least every 6 months to assess for signs of recurrence and the sufficiency of plaque control measures.
 
The prognosis following surgical excision and histopathology is good. However, local recurrence is possible but less common if a treatment plan aimed at reducing plaque formation is implemented. A re-examination of the patient should be carried out at least every 6 months to assess for signs of recurrence and the sufficiency of plaque control measures.
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{{Learning
 
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|Vetstream = [https://www.vetstream.com/canis/Content/Disease/dis00713.asp, Gingival hyperplasia]
 
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}}
 
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==References==
 
==References==
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Tutt, C., Deeprose, J. and Crossley, D. (2007)''' BSAVA Manual of Canine and Feline Dentistry '''(3rd Edition), ''British Small Animal Veterinary Association.''
 
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Merck & Co (2008) '''The Merck Veterinary Manual,''''' Merial.''
 
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{{Lisa Milella reviewed
 
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|date = 13 August 2014}}
 
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{{Waltham}}
 
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{{OpenPages}}
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*Tutt, C., Deeprose, J. and Crossley, D. (2007) '''BSAVA Manual of Canine and Feline Dentistry (3rd Edition)''' ''BSAVA''
  
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[[Category:Oral_Cavity_-_Proliferative_Pathology]][[Category:Teeth_-_Proliferative_Pathology]][[Category:Expert_Review - Small Animal]]
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*Merck & Co (2008) '''The Merck Veterinary Manual'''
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[[Category:Oral Diseases - Dog]][[Category:Oral Diseases - Cat]][[Category:Periodontal Conditions]]
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[[Category:Oral_Cavity_-_Proliferative_Pathology]][[Category:Teeth_-_Proliferative_Pathology]][[Category:To_Do_-_Clinical]]
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[[Category:Lisa Milella reviewed]]
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[[Category:Oral Pathology - Dog]]
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[[Category:Waltham reviewed]]
 

Revision as of 14:48, 15 December 2010

Typical Signalment

  • Common condition in dogs but less common in cats
  • The following breeds are predisposed:


  • Border Collie

    sannse 2003, WikiMedia Commons

  • Boxer

    Lilly M 2007, WikiMedia Commons

  • German Shepherd (Alsatian)

    Elf 2004, WikiMedia Commons

  • Retriever (Labrador)

    Elf 2004, WikiMedia Commons

Description

Gingival hyperplasia often appears as pink, hyperaemic and ulcerated lesions that can be either firm or soft. There can be varying amounts of pigmentation reflecting the normal pigmentation of the oral mucosa. Crowns of teeth are often partially or completely covered by the hyperplastic gingiva forming a potential space or pocket between the gingiva and the crown where plaque is able to accumulate.

Gingival hyperplasia can be described as:

  • Focal lesions
  • Multiple focal lesions
  • Generalised
  • Combinations of the above

It is thought to be the result of an imbalance in the plaque/host tissue response. There are many factors that can cause this condition. These include the following:

  • Drug-induced
    • Ciclosporin
    • Phenytoin
    • Calcium channel blockers
  • Chronic irritation
    • Dental plaque
    • Odontoclastic resorptive lesions
    • Neoplasm
    • Mechanical irritation


Diagnosis

Clinical Signs

Depend on the severity of gingival hyperplasia and the degree to which the teeth are covered but include:

  • pain on mastication
  • haemorrhage (mild to moderate)
  • reluctance to eat
  • drooling
  • dysphagia

Diagnostic Imaging

Oral radiographs should be taken to rule out concurrent conditions. One such condition is periodontitis which is demonstrated radiographically by alveolar bone loss associated with pocket formation between the tooth crown and gingiva.

Biopsy

Biopsy samples should include those areas of gingiva that show signs of inflammation with a softer than normal texture. Any gingiva with radiographic signs of bone involvement should also be sampled.

Treatment

The suspected cause of the condition should be corrected first. This may include a multimodal treatment plan aimed at controlling plaque formation including teeth brushing and providing the animal with sticks/toys that clean the teeth crowns.

  • Gingivectomy and gingivoplasty - should be carried out under general anaesthetic if significant pseudo-pockets are present between the gingiva and teeth crowns. The aim should be to eliminate the pseudopockets and re-establish the normal anatomy of the gingival margin.
    • Electrosurgery and Laser surgery - care must be taken with electrosurgery to avoid contact between the teeth crowns and the electrodes to prevent irreversible heat damage to the pulp.

Prognosis

The prognosis following surgical excision and histopathology is good. However, local recurrence is possible but less common if a treatment plan aimed at reducing plaque formation is implemented. A re-examination of the patient should be carried out at least every 6 months to assess for signs of recurrence and the sufficiency of plaque control measures.

References

  • Tutt, C., Deeprose, J. and Crossley, D. (2007) BSAVA Manual of Canine and Feline Dentistry (3rd Edition) BSAVA
  • Merck & Co (2008) The Merck Veterinary Manual
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