Difference between revisions of "Gingival Hyperplasia"

Revision as of 16:10, 11 August 2009

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.

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

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 This may include a multimodal treatment plan aimed at controlling plaque formation Oral feedings should be withdrawn in patients with severe stricture or oesophagitis.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.

@@ Line 1: / Line 1: @@
-{{OpenPagesTop}}
+{{review}}
-== Introduction ==
+==Typical Signalment==
-[[File:Gingival hyperplasia.jpg|250px|right|thumb|Gingival hyperplasia]]
+*Common condition in dogs but less common in cats
-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.
+*The following breeds are predisposed:
+**Boxer
+**Border Collie
+**Laborador
+**German Shepherd Dog
-Gingival hyperplasia can be described as focal lesions, multiple focal lesions or generalised lesions; or a combination of all of these.
-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.
-== 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. 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.
-Border Collie, Boxer, German Shepherd (Alsatian), Retriever (Labrador).
-== Clinical Signs ==
+Gingival hyperplasia can be described as:
-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.
+*Focal lesions
+*Multiple focal lesions
+*Generalised
+*Combinations of the above
-== 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:
-Clinical signs are indicative of the condition. A detailed oral examination under sedation will lead to a presumptive diagnosis.
+*Drug-induced
+**Ciclosporin
+**Phenytoin
+**Calcium channel blockers
+*Chronic irritation
+**Dental plaque
+**Odontoclastic resorptive lesions
+**Neoplasm
+**Mechanical irritation
-'''Diagnostic Imaging'''
-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.
+==Diagnosis==
-'''Biopsy'''
+===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
-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.
-== Treatment ==
+===Biopsy===
-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.
+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.
-'''[[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.
+==Treatment==
-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.
-== 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.
-{{Learning
+The suspected cause of the condition should be corrected first. This may include a multimodal treatment plan aimed at controlling plaque formation
-|Vetstream = [https://www.vetstream.com/canis/Content/Disease/dis00713.asp, Gingival hyperplasia]
+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.
-==References==
+Surgical therapies:
-Tutt, C., Deeprose, J. and Crossley, D. (2007)''' BSAVA Manual of Canine and Feline Dentistry '''(3rd Edition), ''British Small Animal Veterinary Association.''
+*Dilation/widening of the stricture by ballooning or bougienage.
+*Surgical resection is not recommended because iatrogenic strictures at the anastomotic site are possible.
-Merck & Co (2008) '''The Merck Veterinary Manual,''''' Merial.''
+==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==
-{{Lisa Milella reviewed
+*Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) '''BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition)''' ''BSAVA''
-|date = 13 August 2014}}
-{{Waltham}}
-{{OpenPages}}
+*Merck & Co (2008) '''The Merck Veterinary Manual'''
-[[Category:Oral_Cavity_-_Proliferative_Pathology]][[Category:Teeth_-_Proliferative_Pathology]][[Category:Expert_Review - Small Animal]]
+*Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine (Fourth Edition)''' ''Mosby Elsevier''.
-[[Category:Oral Diseases - Dog]][[Category:Oral Diseases - Cat]][[Category:Periodontal Conditions]]
-[[Category:Lisa Milella reviewed]]
-[[Category:Waltham reviewed]]