Gingival Hyperplasia

Typical Signalment

• Common condition in dogs but less common in cats
• The following breeds are predisposed:
  • Boxer
  • Border Collie
  • Laborador
  • German Shepherd Dog

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. 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 and extent of the stricture but include:

• Regurgitation shortly after feeding (may then attempt to re-ingest the regurgitant)
• Anorexia
• Weight loss
• Malnutrition
• Ptyalism
• Aspiration pneumonia (with associated pulmonary signs such as wheezing and crackling on lung auscultation)
• Liquid food better tolerated than solid food.

Diagnostic Imaging

Fibrosing strictures must be differentiated from vascular ring anomalies, oesophagitis, intraluminal and extraluminal masses. This can be done with survey and contrast radiography, endoscopy and ultrasonography.

Survey radiographs are usually unremarkable in animals with benign oesophageal strictures. Barium contrast radiography is normally diagnostic of the disorder and may demonstrate:

• Segmental or diffuse narrowing of the oesophagus
• Oesphageal dilatation proximal to the site of the stricture

Ultrasonography is not usually useful in diagnosing small benign strictures but may visualise those caused by mass compression.

Oesophagoscopy is used for a definitive diagnosis. It should be used to confirm the site and severity of the stricture and also to exclude the presence of an intraluminal mass.

Treatment

The suspected cause (ie.Oesphagitis)should be corrected first. Oral feedings should be withdrawn in patients with severe stricture or oesophagitis. An oesophagostomy tube may be placed in these cases to provide nutritional support.

Medical therapies:

• Oral sucralfate
• Gastric acid secretory inhibitors (cimetidine, ranitidine, omeprazole)
• Anti-inflammatory doses of corticosteroids (prednisolone) to prevent fibrosis and re-stricture.

Surgical therapies:

• Dilation/widening of the stricture by ballooning or bougienage.
• Surgical resection is not recommended because iatrogenic strictures at the anastomotic site are possible.

Prognosis

The shorter the length of oesophagus involved and the quicker the corrective procedure is performed the better the prognosis. Animals with large, mature strictures and those with continued oesophagitis have a guarded prognosis. Long term gastrostomy tubes may be required in some cases.

References

• Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition) BSAVA

• Merck & Co (2008) The Merck Veterinary Manual

• Nelson, R.W. and Couto, C.G. (2009) Small Animal Internal Medicine (Fourth Edition) Mosby Elsevier.