Canine chronic gingivostomatitis

16 Canine chronic gingivostomatitis




INITIAL PRESENTATION


Halitosis and selective feeding.



PATIENT DETAILS


A 6-year-old, neutered male, greyhound.



CASE HISTORY


The dog was a retired racing greyhound. He had been with the owners for 3 months at the time of presentation to the referring veterinarian. The owners were concerned about halitosis and his eating habits. He was on a mixed dry kibble and moist canned food diet, but would only eat the moist food and would not eat every day, and never any large amounts. He had lost 2 kg in 3 months. The referring veterinarian diagnosed ‘severe periodontal disease’ and the dog received periodontal therapy (scaling and polishing), followed by a short course of antibiotics. This resulted in a reduction of the oral inflammation and increased appetite for a few weeks, after which both the halitosis and eating problems returned. The dog was then referred to us for investigation and treatment. Haematology and biochemistry screens were normal.



ORAL EXAMINATION – CONSCIOUS


Conscious oral examination was allowed, which revealed intense halitosis and gingivostomatitis (Fig. 16.1a). The mandibular lymph nodes were enlarged and seemed painful on palpation.


image

Figure 16.1 Lateral photograph of the right mandibular premolar region (a) and oblique lateral photograph of the right rostral upper jaw (b). The free and attached gingivae are intensely inflamed. Note the clear demarcation of gingiva from oral mucosa.



ORAL EXAMINATION – UNDER GENERAL ANAESTHETIC


A thorough oral examination, including investigating periodontal parameters, was performed and all findings were noted on the dental record.


In summary, examination under general anaesthesia identified the following:


1. Severe inflammation of free and attached gingivae (Fig. 16.1a, b)

2. Inflammation of the buccal mucosa (Fig. 16.2)

3. Inflammation of the lingual mucosa

4. Moderate amounts of plaque and calculus were present on the buccal aspects of the upper premolars and molars (Fig. 16.2)

5. No evidence of periodontitis (loss of periodontal attachment), i.e. no increased PPD or GR.

image

Figure 16.2 Oblique lateral photograph of the right maxilla. There is only a moderate amount of calculus and plaque present. Note the inflammation of the buccal mucosa as well as the gingivae.



FURTHER INVESTIGATIONS


All teeth were present and there were no clinical signs of periodontitis, so radiographs were not indicated at this stage.



ORAL PROBLEM LIST


Chronic gingivostomatitis.



THEORY REFRESHER


Chronic gingivostomatitis (CGS) describes a clinical syndrome characterized by focal or diffuse inflammation of the gingivae and oral mucosa. While it is more common in cats, it also occurs in dogs.


It is thought to be an inappropriate response to oral antigens, namely bacterial plaque present on the tooth surfaces. While underlying vesiculo-bullous disease, e.g. pemphigus and pemphigoid or discoid lupus erythematosus (DLE), cannot be excluded, it is essential to have plaque control before these can be investigated.


In the dog, I approach CGS as follows:


1. Haematology and biochemistry screens to exclude systemic diseases, e.g. endocrine or renal disorders, which may predispose to the development of severe gingival inflammation in the presence of plaque

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Sep 3, 2016 | Posted by in SMALL ANIMAL | Comments Off on Canine chronic gingivostomatitis
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