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.

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.

Oral feedings should be withdrawn in patients with severe stricture or oesophagitis.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.